Intense Distress Research Articles

Exploring Mortality and Prognostic Factors of Heart Failure with In-Hospital and Emergency Patients by Electronic Medical Records: A Machine Learning Approach.

As HF progresses into advanced HF, patients experience a poor quality of life, distressing symptoms, intensive care use, social distress, and eventual hospital death. We aimed to investigate the relationship between morality and potential prognostic factors among in-patient and emergency patients with HF. A case series study: Data are collected from in-hospital and emergency care patients from 2014 to 2021, including their international classification of disease at admission, and laboratory data such as blood count, liver and renal functions, lipid profile, and other biochemistry from the hospital's electrical medical records. After a series of data pre-processing in the electronic medical record system, several machine learning models were used to evaluate predictions of HF mortality. The outcomes of those potential risk factors were visualized by different statistical analyses. In total, 3871hF patients were enrolled. Logistic regression showed that intensive care unit (ICU) history within 1week (OR: 9.765, 95% CI: 6.65, 14.34; p-value < 0.001) and prothrombin time (OR: 1.193, 95% CI: 1.098, 1.296; <0.001) were associated with mortality. Similar results were obtained when we analyzed the data using Cox regression instead of logistic regression. Random forest, support vector machine (SVM), Adaboost, and logistic regression had better overall performances with areas under the receiver operating characteristic curve (AUROCs) of >0.87. Naïve Bayes was the best in terms of both specificity and precision. With ensemble learning, age, ICU history within 1week, and respiratory rate (BF) were the top three compelling risk factors affecting mortality due to HF. To improve the explainability of the AI models, Shapley Additive Explanations methods were also conducted. Exploring HF mortality and its patterns related to clinical risk factors by machine learning models can help physicians make appropriate decisions when monitoring HF patients' health quality in the hospital.

Efficacy and Safety of Virtual Reality-Based Versus Traditional Emotion-to-Emotion Therapy for Treatment of Hwa-Byung: A Protocol for a Single-Center, Randomized, Assessor-Blind, Parallel-Group Clinical Trial.

Hwa-Byung is a culturally bound syndrome prevalent in Korea, characterized by intense emotional distress and physical symptoms related to suppressed anger. Patients frequently report experiencing chest tightness, heat sensations, and globus pharyngeus (the sensation of a lump in the throat). These physical symptoms often accompany psychological distress and can exacerbate the sense of frustration and helplessness associated with the condition. The distinctive presentation of these symptoms highlights the necessity for therapeutic interventions that address both the emotional and physical aspects of Hwa-Byung. Conventional therapeutic methods, such as Emotion-to-Emotion Therapy (ETE), have shown efficacy in treating this condition. This study aims to assess the efficacy of Virtual Reality-based Emotion-to-Emotion Therapy (VR-based ETE) compared to conventional ETE, utilizing immersive digital platforms to enhance therapeutic engagement. This single-center, randomized, assessor-blind, parallel-group clinical trial will enroll 96 participants, evenly divided into two experimental groups and one control group. Over eight weeks, each participant will undergo 12 intervention sessions. Experimental group 1 will receive conventional ETE, experimental group 2 will receive VR-based ETE, and the control group will receive Hwa-Byung management training materials. The primary outcome will be the change in symptoms, measured by the Likert Scale for Major Symptoms of Hwa-Byung from baseline to 8 weeks. Secondary outcomes will include psychometric scales and physiological measures such as the core seven-emotions inventory short form, physical health questionnaire, stress response index, Beck depression inventory, state-trait anger expression inventory, state-trait anxiety inventory, functional near-infrared spectroscopy, and heart rate variability. For economic efficiency assessment, quality-adjusted life-years will be the primary outcome using the EuroQol-5 dimension, and the secondary outcome will be using the EuroQol visual analog scale. ETE is a recognized oriental psychotherapy that enhances symptom management, self-regulation, and stress coping. VR is expected to deepen treatment immersion. By combining these strengths, VR-ETE may further improve emotion regulation and alleviate psychosomatic symptoms. If successful, this study will not only advance the treatment of Hwa-Byung but also contribute to the modernization of traditional Korean medicine through the integration of digital therapies.

Neighborhood disadvantage and pain-related experiences in a pain psychology clinic: The mediating roles of pain catastrophizing and pain-related fear

This study investigated the relationship between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and pain-related variables in a pain psychology clinic. We also examined the sequential mediating roles of pain catastrophizing and pain-related fear on these relationships. Participants (N = 509) completed questionnaires assessing usual pain intensity, fatigue, emotional distress, and interference with daily activities. The mean ADI score was 32.57 (SD = 22.65), with scores ranging from 1 to 100. Linear regression analysis, adjusting for age and gender, revealed that higher ADI (i.e., less advantage) was significantly associated with higher scores on pain-related variables (pain intensity: B = 0.026, p < .001; fatigue: B = 0.018, p < .001; emotional distress: B = 0.020, p < .001; interference with daily activities: B = 0.014, p = .006). Sequential mediation analysis revealed pain catastrophizing and pain-related fear mediated these relationships, with significant indirect effects for fatigue (B = 0.001, 95% CI [0.000, 0.002]) and interference with daily activities (B = 0.001, 95% CI [0.001, 0.003]) — but not pain intensity or emotional distress. Pain catastrophizing alone mediated neighborhood disadvantage-pain relationship for all variables. The results suggest that neighborhood disadvantage is associated with higher scores on pain-related experiences and that consistent with the fear avoidance model, pain catastrophizing and pain-related fear may play a role in these relationships for fatigue and interference with daily activities. These findings underscore that neighborhood disadvantage is associated with worse pain-related experiences and highlight the importance of considering neighborhood factors in chronic pain management. PerspectiveThis study identifies potential pathways linking neighborhood disadvantage to chronic pain variables, highlighting the roles of pain catastrophizing and pain-related fear. The findings underscore the need for a holistic approach to pain management that recognizes both individual cognitive-emotional factors and the broader social context in which pain occurs.

PENGARUH INTENSITAS MODAL, KEPEMILIKAN MANAJERIAL, LEVERAGE, FINANCIAL DISTRESS TERHADAP KONSERVATISME AKUNTANSI PADA PERUSAHAAN MANUFAKTUR YANG TERDAFTAR DI BEI TAHUN 2020-2022

The aim of this research is to examine the impact of capital intensity, managerial ownership, leveragee and financial distress on the level of application of conservatism used in manufacturing companies listed on the BEI from 2020 to 2022. The population of this research is manufactur companies listed on the BEI. The method of this research used a purposivee sampling method, totaling 66 companies were used as samples. The panel regression model was used in data analysis, to assess the feasibility of the model using the F test and coefficient of determination. The research results of the hypothesis show that capital intensity has a significant positive impact on the application of accounting conservatism. in contrast, managerial ownership, leverage, and financial distress have no impact on accounting conservatism

Perinatal loss: attachment, grief symptoms and women’s quality of life

ABSTRACT Aims/Background Perinatal loss may cause intense distress even psychiatric issues, affecting the woman’s quality of life. Attachment may provide a useful perspective in understanding the outcomes of the mourning process. Thus, the objectives of the present study were to evaluate perinatal grief symptoms and the psychological and general quality of life among 137 Italian women (mean age 36,9. ± 6,88 years old) in relation to attachment, specifically measured through parental care and control. Design/Methods About 79.6% of the participants had miscarriages and 20.4% had stillbirths. About 45.3% were childless. The women completed the Parental Bonding Instrument, the Perinatal Grief Scale and the Psychosocial General Well-Being Index online most frequently between 3 and 6 months (56.2%) after the perinatal loss. Results All the study participants showed intense grief and severe grief reactions to loss. Moreover, women experiencing optimal bonding towards their own mothers had a more positive effect on perinatal grief and psychological and general quality of life. Conclusions Attachment-based, tailored interventions for women who have experienced perinatal loss should improve their psychological and overall quality of life.

ASD or OCD? An evidence‐based differentiation of repetitive behaviors

While distinct diagnoses, the behavioral presentation of ritualistic/repetitive behaviors seen in obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) can present similarly. This results in difficulty with accurate diagnosis and implementation of evidence‐based treatments. OCD is characterized by prolonged and recurrent unwanted thoughts, known as obsessions, which cause a feeling of intense anxiety or distress. As a result, people with OCD perform repetitive behaviors known as compulsions to help alleviate distress. ASD is characterized as a developmental disorder causing persistent challenges associated with social communication, restricted and repetitive behaviors (RRB), and impairment in functioning. While the definitions are distinct, accurate conceptualization is not always clear. The picture can become even more complex with comorbidities. To parse these behaviors apart, we can consider the course of the behavior and assess the function. With better ability to differentiate, we can have a clearer picture of how to support the youth and family.

The Relationship Between Perceived Comfort Level with Moral Sensitivity and Moral Distress Among Oncology Nurses: A Descriptive Correlational Study

ObjectiveThis study aimed to investigate the relationship between perceived comfort level with moral distress and moral sensitivity among oncology nurses MethodsThis is a descriptive-correlational study on 210 oncology nurses. The samples were selected through the convenience method from September 2020 to February 2022 in the oncology centers of Ahvaz, Iran. Data were collected via a demographic form, Lutzen's Modified Moral Sensitivity Questionnaire, Corley's Moral Distress Scale, and Kolcaba's Nurses Comfort Questionnaire (NCQ). Data were analyzed using SPSS V24, descriptive statistics, Independent t, Mann-Whitney-U, Kruskal-Wallis, Pearson's correlation coefficient, ANOVA, and linear regression tests. ResultsNurses experienced a moderate level of perceived comfort (67.91 ± 8.75), moral sensitivity (58.4 ± 13.3), and moral distress (57.54.8 ± 8.9). Moral sensitivity was significantly inversely related to the intensity of moral distress (P < .001). A statistically significant relationship was found between nurses' perceived comfort level with frequency of distress (P < .001) and moral sensitivity (P = .046). Moral distress explained 13.8% of changes in perceived comfort level (R2 = 0.138, F = 6.51, sig < 0.001, R = 0.371). ConclusionNurses’ perceived comfort level, moral sensitivity, and moral distress were at a moderate level and intercorrelated. It is suggested that factors contributing to moral distress should be eliminated. Also, moral sensitivity should be refined as a decisive factor. Implication for Nursing PracticeOncology nurses are exposed to morally distressing situations that may be a source of discomfort. This study guides nurses, managers, planners, and policymakers to identify the contributing factors and use strategies and solutions to enhance nurses' perceived comfort level.

The relationship between moral distress and clinical care quality among nurses: an analytical cross-sectional study

BackgroundNurses constitute the largest group of service providers in the healthcare system and significantly influence the quality of healthcare services. Factors such as ethical considerations may be related to the quality of care. This study aimed to determine the relationship between moral distress and the quality of clinical care among nurses working in Gonabad, Iran.MethodsAn analytical cross-sectional study was conducted on 252 nurses working in emergency, internal medicine, surgery, psychiatry, critical care and maternity wards at Allameh Bohlool Hospital from May to July 2023. This research used demographic information questionnaire, the revised Moral Distress Scale (MDS-R), and the Quality Patient Care Scale (QUALPAC). The significance level for the study was set at p < 0.05.ResultsThere was a significant relationship between the frequency of moral distress and the quality of clinical care (p = 0.032), as well as between the intensity of moral distress and the quality of clinical care (p = 0.043). Nurses who experienced moral distress more frequently and intensely provided better quality care. However, there was no significant relationship between the effect of moral distress and the quality of clinical care (r = 0.032, p = 0.619). Additionally, a significant statistical relationship was found between the intensity of moral distress and the physical dimension of clinical care quality (r = 0.171, p = 0.007), indicating that increased moral distress intensity was associated with higher quality of physical care.ConclusionsNurses who experience higher levels of moral distress, both in terms of frequency and intensity, perform better in the care they provide and deliver it in the best possible manner, particularly in the physical dimension of care.

Meaning-Centred Coping Predicted Lower Depressive Symptoms among Caregivers with Complicated Grief.

Complicated grief is characterised by persistent low mood, intense distress and cognitive impairment. This study aimed to explore coping strategies (i.e. emotion-, problem- and meaning-centred) used by bereaved individuals facing complicated grief and how these strategies may predict psychological and cognitive outcomes. In a cross-sectional study, 20 bereaved individuals (5 males, 15 females) that aged 27 years old-65 years old (mean = 42.25, standard deviation [SD] = 9.30) were recruited following the loss of a loved one due to physical illness. Participants were screened for complicated grief and subsequently completed self-report assessments of coping strategies and depressive symptoms using Brief Grief Questionnaire (BGQ), Brief Coping Orientation to Problems Experienced (COPE) Questionnaire, Meaning-Centered Coping Scale (MCCS) and Patient Health Questionnaire-9 Items (PHQ-9). Following that, participants underwent a neurocognitive assessment of working memory using the 2-Back task. Caregivers with complicated grief suffered from moderate severity of depressive symptoms (mean = 17.45, SD = 4.43) as they were coping with the losses. Furthermore, the findings showed that MCC significantly predicted lower levels of depressive symptoms (b = -0.50, t (16) = -2.25, P = 0.04). However, coping strategies did not significantly predict working memory performance. These findings highlight the potential benefits of MCC in alleviating depressive symptoms in bereaved individuals and underscore its contribution to the development of grief interventions. Grief therapists can emphasise this coping strategy to promote healing and resilience in patients in the grief work.

'I'm ruined': Young people's and their mothers' experiences of living with, and receiving a diagnosis of, borderline personality disorder: An interpretative phenomenological analysis.

The adolescent borderline personality disorder (BPD) diagnosis has been widely debated for many years. Strikingly, young people's experiences of both receiving a diagnosis of BPD, and of living with BPD, are largely under-explored. The current study seeks to address these gaps in the literature in a multi-perspectival design utilising young people-parent dyads. Young people (aged 16-18 years) with a diagnosis of BPD (n = 5) and their mothers (n = 5) were recruited from two NHS Community Mental Health Services in the West Midlands and participated in semi-structured interviews. Data were analysed using interpretative phenomenological analysis [IPA]. Analysis identified two superordinate themes with five subthemes: (1) The "ugly" reality of living with BPD (providing a stark insight into what it is like to live with the unpredictable nature of experiences labelled as BPD), and (2) The diagnosis that dare not speak its name (highlighting the complexities of how the diagnosis itself is experienced by participants as a symbol of personal and permanent defectiveness and danger). Findings highlight a clear commonality of experience centred around the intensity of the young people's emotional distress and the accompanying pressure on parents to keep young people safe, both of which services must strive to do more to contain. Ultimately, the costs of receiving a BPD diagnosis appear to outweigh the benefits, and this paper adds support to calls for change in respect to how we conceptualise difficulties labelled as BPD and how we communicate about these difficulties, in order to avoid causing harm.

Moral distress and protective work environment for healthcare workers during public health emergencies

BackgroundPublic health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors.ObjectivesThe current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic.MethodsWe employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic.ResultsAbout half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress.ConclusionsOur findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment.

Comparison between Topical Minoxidil 5% Alone versus Combined with Dutasteride (Topical 0.02% through Microneedling or Oral 0.5 mg) in Treatment of Androgenetic Alopecia

Abstract Background Androgenetic alopecia (AGA) in both males and females is considered as the most common hair loss disorder. The importance of this disease comes from intense psychological and emotional distress and disrupted self-image caused by hair loss where there is progressive nonscarring replacement of terminal hair follicles over the frontal and vertex regions by miniaturized follicles, which leads progressively to a visible reduction in hair density. Aim of the Work To assess and compare between the clinical efficacy and safety of topical Minoxidil 5% alone or either with Dutasteride topical 0.02% (through Microneedling) or oral Dutasteride (0.5 mg) in treatment of AGA. Patients and Methods This study was done on 30 patients (24 males and 6 females) with AGA, which were distributed randomly, equally, and blindly into 3 treatment groups (A, B, and C). All were subjected to detailed history taking, examination, and grading. Each patient was instructed to use topical Minoxidil 5% lotion twice daily for 16 weeks in all groups (A, B and C). In addition, group B patients were instructed to use oral Dutasteride 0.5 mg once daily for 16 weeks. Also, Patients in group C were subjected to once per month, of microneedling with topical Dutasteride 0.02% for 4 successive sessions. Furthermore, digital scalp photographs and trichoscope assessment before treatment and at weeks 4,8,12,16 week was done to assess treatment response, as well as 24 week to assess durability of treatment. Also, assessment of patient’s satisfaction, clinical assessment by the physicians through comparing patients' digital photographs, and possible side effects were recorded at the end of treatment (week 16). Results The obtained data from objective parameter regarding hair density, and hair width caliber (through tricoscan) along with subjective parameter regarding patient’s satisfaction including side effects, and physician assessment were tabulated and statistically analyzed. Our study showed clinically significant improvement results in all groups (group C, showed the highest improvement, but group A had the lowest adverse effect profile). This suggests that the novel use of topical Dutasteride (0.02%) through microneedling sessions along with daily use of topical Minoxidil 5% has better result with less systemic side effects than oral Dutasteride (0.5 mg) along with daily use of topical Minoxidil 5%. Moreover, groups B and C showed better results in median hair density and hair width caliber after 16 weeks of treatment. Thus, proofing more efficacy of combined treatment than monotherapy. Although, probably more side effects. In addition, our study showed better results regarding treatment durability in groups B &amp; C more than group A in preserving hair density, while same durability results found in all groups regarding hair width caliber 8 weeks after end of treatment. Conclusion Topical Minoxidil 5% either as montherapy or combined with oral 0.5 mg or topical 0.02% Dutasteride is effective and safe in treating AGA in both males and females. Topical Dutasteride through microneedling is a promising therapy in treatment of AGA of both sexes that may offer same or better results than systemic Dutasteride with negligible side effects.

Pengaruh Komisaris Independen, Capital Intensity Dan Financial Distress Terhadap Konservatisme Akuntansi

This research aims to test and prove the influence of independent commissioners, capital intensity and financial distress on accounting conservatism” (Empirical Study on LQ 45 index companies listed on the BEI for the 2018-2023 period).The type of research used is a quantitative method. The type of data used is secondary data in the form of financial reports of LQ 45 companies listed on the Indonesia Stock Exchange for the period 2018-2023. Samples were collected using the purposive sampling method. The number of companies that met the research sample criteria was 15 companies out of 45 companies with a research period of 6 years of observation, so that a total of 90 research samples were obtained. Data processing using the Eviews 10 Statistical Program. Next, carrying out various tests including descriptive statistical tests, panel data model tests, model selection tests, classical assumption tests and hypothesis tests. So the research results prove that independent commissioners, capital intensity and financial distress simultaneously influence accounting conservatism. Independent commissioners partially influence accounting conservatism. capital intensity influences accounting conservatism. Financial distress has no effect on accounting conservatism.

Assessing the Severity of Earthquake Trauma on Syrian Refugee Survivors in Southern Turkey and Displaced Individuals in Northwest Syria

The study sought to investigate the extent and intensity of earthquake-related psychological distress experienced by Syrian refugee survivors residing in southern Turkey and displaced individuals in northwest Syria. A technique focused on providing detailed descriptions and conducting thorough analysis was employed. Three scales of post-traumatic stress disorder (PTSD), Trauma History Screen (THS), and Brief Trauma Questionnaire (BTQ) were used. The study included 600 participants, with 300 participants from each region. The prevalence rate of PTSD among survivors one year after the 2023 Turkey earthquake was high, around 68%. while the prevalence rate of THS and BTQ was low. The results for PTSD indicated that there were statistically significant differences only between age and marital status in southern Turkey. As for northwest Syria, there were statistically significant differences only in gender. The results for THS and BTQ indicated statistically significant differences only between gender, age, and working status in southern Turkey. As for northwest Syria, there were statistically significant differences between gender, education level, and working status. There was a positive direct correlation between PTSD on the one hand and THS and BTQ on the other hand. This indicates that the level of PTSD increases as THS and BTQ increase. In regression analysis, the results showed that THS and BTQ contribute to interpreting the variance in PTSD. When THS and BTQ increase, they contribute to increased symptoms of PTSD. The beta value for THS in southern Turkey and northwestern Syria was (β = 1.127, β = 0.793), respectively. While the beta value for BTQ in southern Turkey was (β = 0.70) .Conclusions: Both THS and BTQ make a statistically significant contribution to explaining the variations in PTSD among survivors in the research of the two locations. The incidence of Post-Traumatic Stress Disorder (PTSD) among survivors was 68%. PTSD was found to be linked with older age, female gender, widowhood, and divorce.

Autolesiones en jóvenes universitarios sobrevivientes del suicidio

Self-injurious behaviors often arise as an attempt to regulate emotions and temporarily alleviate emotional and social pain, potentially leading to suicidal attempts over time—a complex phenomenon that demands a profound and diverse understanding of intense emotional distress and an urgent need for help and support. Thus, this article aimed to explore self-injurious experiences in survivors of suicide attempts during university years through a systematic review methodology using the PRISMA protocol, identifying and critically evaluating the quality of 24 studies spanning a period from 2003 to 2024, using keywords such as self-injury, non-suicidal self-injury, university students, adolescents, young adults, and others in databases like Web of Science, Redalyc, and Dialnet. It was found that self-injurious experiences in university students include cuts, burns, blows, pinches, falls, bites, scratches, and more, resulting from depression, anxiety, stress, impulsivity, emotional dysregulation, avoidant coping styles, psychoactive substance use, bullying, academic pressure, history of violence, existential void, fatalistic attitudes, low self-esteem, cognitive rumination, family dysfunction, negative sexual experiences, and more. The above reveals that these experiences require specialized management that includes institutional and family care and support protocols, encompassing emotional, social, and personal factors, which implies the creation of early intervention programs, continuous psychological support, and awareness campaigns to reduce the stigma associated with self-injury and suicide.

The inner struggle of nurses, exploring moral distress among hospital nurses: A cross-sectional study

BackgroundAs frontline caregivers, nurses often find themselves at the crossroads of complex ethical decisions that can significantly impact patient outcomes and their own well-being. Identifying the areas of experienced moral dilemmas in the workplace and gaining insight into the prevalence of moral distress can lead to a healthier workplace environment. ObjectiveThis study aims to examine the frequency, intensity and level of moral distress among nurses who work in a hospital, and to identify the variables associated with the level of moral distress. DesignCross-sectional study. SettingOne university hospital and six general hospitals. Participants654 of the 1095 nurses working on inpatient units filled out the questionnaire (response rate 60 %). MethodsThe intensity and frequency of moral distress was assessed using the Moral Distress Scale-Revised (MDS-R). We also asked two additional questions about considering leaving their job, and if they could describe a distressing case and how moral distress was discussed. Multivariable regression analysis was conducted to identify the variables associated with the level of moral distress. ResultsThe overall mean MDS-R score of the 654 included nurses was low at 36.4 (SD 26). Nurses reported to have frequent dilemmas regarding organizational aspects and aspects of end-of-life care. The multivariable analyses showed that higher levels of moral distress were experienced by registered nurses, nurses working on a medical ward, and nurses who had ever left or considered leaving their job, or considering leaving their job at the moment. ConclusionsAlthough nurses in our study experiences low levels of moral distress, they do experience moral dilemmas related to organizational topics and end of life care. We all need to pay attention to these dilemmas and how to discuss them in order to achieve a resilient nursing profession at a time of major nursing shortages. Tweetable abstractCaring for increasingly complex patients in a dynamic healthcare system is likely to continue to produce morally challenging scenarios.

State-of-the-Art Review: Evaluation and Management of Delusional Infestation.

Delusional infestation is a condition encountered frequently by healthcare professionals across a variety of specialties in which patients have a fixed, false belief that they are infested with living creatures, such as bugs, parasites, worms, or mites, or nonliving objects, such as fibers. Delusional infestation can be debilitating for patients, who not only present with intense psychological distress and physical discomfort but are also at risk of developing numerous dermatological and psychiatric complications. This condition poses unique diagnostic challenges, as these symptoms can occur secondary to many metabolic or infectious causes, as well as unique treatment challenges, with patients frequently refusing psychiatric care and consequently seeking evaluation by other healthcare professionals. In this review, we aim to use existing literature to provide clinicians in infectious diseases or other specialties with sufficient clinical context and treatment guidance for the appropriate management of delusional infestation.

A mixed-method study to develop and evaluate a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients in Critical Care Units

Aims and objectivesTo develop and evaluate the effectiveness of a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients. BackgroundCaregivers of critically ill patients experience intense psychological distress, and their needs often go unexpressed or unidentified. Structured therapeutic communication enables nurses to explore and fulfill these needs. MethodA mixed-method study was conducted among 30 caregivers of critically ill patients. During phase one, a qualitative interview was conducted, and a structured therapeutic communication module was developed based on Hildegard Peplau's Interpersonal Relations Theory. In the second phase, one group pre-test and post-test design was adopted. The Hospital Anxiety and Depression Scale (HADS) and a Semi-structured interview schedule were used to assess psychological distress and perceived needs, respectively. ResultsHalf of (50 %) the caregivers reported a high level of anxiety before intervention, with a mean of 11.30 (SD: 4.0), and 66.7 % of them had a high level of depression, with a mean of 12.03 (SD: 0.08). There was a statistically significant difference in anxiety (CI: 0.451–2.016) and depression (CI: 0.261–1.538) before and after the intervention. The qualitative analysis revealed unmet needs perceived by caregivers. ConclusionUsing a structured therapeutic communication module helps nurses to alleviate the psychological distress experienced by caregivers of CCU patients. Relevance to clinical practiceNurses need to be sensitive to the unexpressed needs of caregivers of critically ill patients. The structured therapeutic communication modules can be integrated into routine nursing care practice to ensure family-centered care.

Can the Phoenix still rise? Traumatic effect of Beirut port explosion on Lebanese people's experiences.

Mental distress and decreased functionality are highly prevalent after collective traumas. Survivors' ability to function is worsened by untreated distress and unmet needs related to job security and a sense of belonging. We aim to identify groups of people using a latent class analysis based on multiple dimensions of subjective experiences after a massive urban violent event. This cross-sectional internet-based study included 1,305 Lebanese adults 4 months after the Beirut Port explosion. Emotions, attitudes, and needs were assessed using the iCode software, a novel approach measuring explicit subjective answers and implicit reaction time to various statements. Responses revealed alarming levels of distress with 75%-80% of participants feeling anxious. Latent class analysis differentiated three groups on initial dimensions derived from the principal component analysis. The first group included those with the most intense emotional distress and intrusive thoughts. They were younger, had higher job worries, and wanted to leave the country. The second group was equally distressed, with marked intrusion and avoidance yet with faith and community resilience buffering negative emotionality. The last group was less distressed with a marked sense of community. Clustering people based on emotional experiences, needs, and resources might offer additional benefits to traditional assessments that fail to detect the variability of vulnerability to mass violence within seemingly homogeneous samples. Integrating implicit and explicit responses also helps with a rapid classification, providing insight to subjective attitudes postcollective trauma. The study mostly provides suggestions for targeted outreach to at-risk subpopulations to better foster resilience in unstable environments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The psychological impact of wrongful convictions: Exploring retrospective trajectories of distress in exonerees.

Although an emerging body of research has examined the legal causes of wrongful convictions, there is little research that examines the psychological impact of wrongful convictions. This study aims to understand the psychological experiences of exonerees, with a focus on the role of meaning-making in individuals' reactions to trauma. The study also aims to examine exonerees' self-reported trajectories of distress throughout their experience of being wrongfully convicted and subsequently exonerated. A total of 46 exonerees completed an online survey. Measures included: Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Posttraumatic Growth Inventory, World Assumptions Questionnaire, Meaning in Life Questionnaire, Satisfaction with Life Scale, and a self-reported retrospective trajectory measure. Cluster analysis suggested a four-factor solution: Chronic Distress, Relief and Readjustment, Recovery, and Intense Distress with Minimal Recovery. The Recovery cluster (n = 17; 37.0%) had significantly lower levels of PTSD and anxiety symptoms than the other three groups. The Recovery cluster had higher levels of positive world assumptions and lower levels of searching for meaning than the other three clusters, but there were no differences among clusters in level of meaning made, presence of meaning, depression symptoms, and satisfaction with life. The results revealed that exonerees with more positive world beliefs (conceptualized as an outcome of meaning-making) have lower rates of PTSD and anxiety. Consistent with the literature, results also suggest that the search for meaning may be indicative of increased distress and less recovery. Clinical and policy implications are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).