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This article presents a brief overview of theory as background for a more detailed discussion of midrange theory-its origins, the critical role for midrange theory in the development of nursing practice knowledge, and the criteria for evaluating midrange theory. We then chronicle Cheryl Tatano Beck's program of research on postpartum depression (PPD) and advance the thesis that her theory of PPD, titled Teetering on the Edge, is an exemplar of a substantive midrange nursing theory. We demonstrate Beck's progression from identification of a clinical problem to exploratory-descriptive research, to concept analysis and midrange theory development, and finally to the application and testing of the theory in the clinical setting. Through ongoing refinement and testing of her theory, Beck has increased its generalizability across various practice settings and continually identifies new issues for investigation. Beck's program of research on PPD exemplifies using nursing outcomes to build and test nursing practice knowledge. [ABSTRACT FROM AUTHOR]

This project evaluates the acceptability and utilityof a storybook, entitled Unexpected: Parents' Experience of Preterm Birth , as an educational resource for parents in the neonatal intensive care unit (NICU). Forty-nine parents were recruited from Level II and Level III NICUs and completed several questionnaires; a subset of 11 parents also participated in focused qualitative interviews. Almost all parents experienced the characters as believable and agreed/strongly agreed that the stories accurately portray what it is like to be a parent in the NICU. The multiple narrators offer different perspectives of the NICU experience, which helped to normalize their experience and reminded them that they were not alone. Participants reported learning something new from the storybook and would recommend it to others.

Rationale and Aims: Meaning is an integral aspect of life that drives behaviours, actions and emotions. Perception of pain is believed to be affected by the meaning of pain. Our primary aim was to investigate and discuss the determinants of meaning in acute pain following a traumatic injury., Methodological Design: Using the Interpretive Description approach, a method of qualitative inquiry, 13 adults hospitalised due to their accidental injuries were recruited. Semi-structured interviews that were digitally recorded were used to collect the data. Ethical approval was received by our local Health Research Ethics Board, and all relevant ethical standards were followed as outlined in the approved ethics proposal., Findings: The three primary determinants of meaning during an acute pain event, or the experience of acute pain include permanence of injuries, incongruence of care quality, and personal responses to the injury and care received. Although the permanence of an injury is lasting, we did not find any emotional response to this fact while the participants were hospitalised. The emotion characterising the personal response to the perceived poor quality of hospital care received was anxiety., Conclusion: Both the technical and personal components of healthcare quality have the potential to increase the perception of pain. Meanings in an acute pain event are primarily related to the determinants of incongruent care and the personal response to that determinant: anxiety., (© 2017 Nordic College of Caring Science.)

Objective: To synthesize and summarize evidence regarding the mental health of parents of infants in the NICU., Data Sources: Thirteen electronic databases were searched in October 2014 using the following terms individually and in combination: postpartum woman, mother, NICU, preterm birth, depression, anxiety, acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and parental stress., Study Selection: We examined the published research regarding the experiences of parents who have infants admitted to the NICU, the mental health problems that parents may develop, the tools that have been used to identify such problems, and factors related to parental mental health., Data Extraction: After the exclusion of articles according to preset criteria, we included 66 articles in the full review., Data Synthesis: Mental health issues are common in parents of infants in the NICU across diverse ethnocultural groups and countries. Parents report feelings of guilt and shame, high levels of stress, mood and anxiety symptoms, and the positive influence of specific coping strategies and social support. The ethnocultural meanings of these experience and thus nursing interventions may differ widely., Conclusion: Ongoing assessments of the mental health of parents should be part of routine NICU care. Identification of mood and anxiety symptoms and testing innovative interventions to address at-risk or affected parents is imperative to ensure that there are culturally appropriate policies and services in place to respond to the mental health needs of NICU families., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Purpose: Lesbians, gay men, and bisexuals have been shown to have different risks for mood and anxiety disorders than heterosexuals in population studies, but there is a paucity of research in this area in military populations. This study examined the relationship between sexual orientation and depression in the Canadian Armed Forces (CAF)., Methods: Data were drawn from the Canadian Forces Mental Health Survey 2013 (n = 8165), a representative sample of Regular and Reserve members of the Canadian military. Binomial logistic regression was used to predict 12-month and lifetime odds ratios for major depressive episode (MDE) stratified by sexual orientation and sex., Results: Gay male members had higher risk (AOR = 3.80, 95% CI 1.60-9.05) for lifetime MDE, but not for past 12-month MDE compared to heterosexual males. There was no significant difference in risk for lesbians or bisexuals compared to heterosexuals., Conclusions: The results suggest that gay male members of the CAF are at higher risk for a history of MDE, but not current MDE. This may be a result of ongoing discrimination and stigma faced by gay men in the military or may reflect MDE that occurred before military service. The lack of difference in MDE risk for lesbian and bisexual members compared to heterosexual members is an important positive finding.

Background: While women and healthcare providers have generally viewed perinatal mental health screening favorably, some qualitative studies suggest that some women intentionally decide not to reveal their symptoms during screening., Purpose: The purpose of this study was to describe women's reported willingness to disclose mental health concerns during screening and factors associated with this., Methods: This cross-sectional study included pregnant women who were >16 years of age and could speak/read English. Women were recruited from five maternity clinics and two community hospitals in Alberta, Canada (May-December, 2013). Eligible women completed the online Barriers and Facilitators of Mental Health Screening Questionnaire on recruitment. The primary outcome for this analysis was women's level of honesty about mental health concerns (completely vs somewhat/not at all honest) during screening. Analyses included descriptive statistics and multivariable logistic regressions to identify factors associated with honesty., Results: Participation rate was 92% (460/500). Seventy-nine percent of women indicated that they could be 'completely honest' during screening. Women who feared their provider would view them as bad mothers were less likely to be honest. We found a significant association between 'less anonymous' modes of screening and honesty., Limitations: Over eighty percent of women in this study were well-educated, partnered, Caucasian women. As such, generalizability of the study findings may be limited., Conclusions: Most women indicated they could be honest during screening. Stigma-related factors and screening mode influenced women's willingness to disclose. Strategies to reduce stigma during screening are warranted to enhance early detection of prenatal mental illness., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Introduction: The process of mental health screening can influence disclosure, uptake of referral, and treatment; however, no studies have explored pregnant women's views of methods of mental health screening. The objectives of this study are to determine pregnant women's comfort and preferences regarding mental health screening., Methods: Pregnant women were recruited (May-December 2013) for this cross-sectional descriptive survey from prenatal classes and maternity clinics in Alberta, Canada, if they were aged >16 years and spoke/read English. Descriptive statistics summarized acceptability of screening, and multivariable logistic regression identified factors associated with women's comfort with screening methods. Analysis was conducted in January-December 2014., Results: The participation rate was 92% (N=460/500). Overall, 97.6% of women reported that they were very (74.8%) or somewhat (22.8%) comfortable with mental health screening in pregnancy. Women were most comfortable with completing paper- (>90%) and computer-based (>82%) screening in a clinic or at home, with fewest reporting comfort with telephone-based screening (62%). The majority of women were very/somewhat comfortable with provider-initiated (97.4%) versus self-initiated (68.7%) approaches. Women's ability to be honest with their provider about emotional health was most strongly associated with comfort with each method of screening., Conclusions: The majority of pregnant women viewed prenatal mental health screening favorably and were comfortable with a variety of screening methods. These findings provide evidence of high acceptability of screening--a key criterion for implementation of universal screening--and suggest that providers can select from a variety of screening methods best suited for their clinical setting., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Over the past two decades, Brazil has made progress in bringing political and community attention to issues related to violence. The recognition of links between violence and health has intensified calls to accelerate the development of a forensic nursing specialty in Brazil., Aim: The aim of this study was to systematically examine and synthesize the literature on the development of the forensic nursing specialty around the globe and to extract important lessons for the establishment of a forensic nursing specialty in Brazil., Method: An integrative review was conducted according to the method described by Whittmore and Knafl (2005). Electronic searches of the following databases were conducted between December 2012 and March 2013: CINAHL Plus with Full Text, Criminal Justice, Index to Legal periodicals, MEDLINE, Soc Index with Full Text, Social Work Abstracts, SCOPUS, and PsycINFO. The search terms used were: [(TI nurs* or SU nurs*) and [TI (forensic* or penal or prison*) or SU (forensic* or penal or prison*)] and (sexual assault nurse examiner*). Preestablished inclusion/exclusion criteria were used to select published articles for review., Results: Twenty-three articles met inclusion criteria and were included in the full review. Important lessons for Brazil are discussed in terms of education and curricular issues and forensic psychiatric nursing., Conclusions: In Brazil, there is a window of opportunity to contribute the theoretical foundations of forensic nursing science and to advance nursing specialty practice in the areas of Sexual Assault Nurse Examiners and forensic psychiatric nurses.

Background: Nurses have a key role in teaching cardiovascular (CV) surgical patients to manage their post-surgical care after discharge. There is evidence that effective patient teaching contributes to improved quality of life, decreased anxiety and depression and fewer post-CV surgery emergency department visits and hospital readmissions. Despite this, there are no guidelines or standards for how best to educate CV surgical patients for discharge., Aim: To conduct a literature review of published research on discharge education for CV surgical patients to inform guidelines for educating CV surgical patients., Method: An exhaustive search of CINAHL, Medline, Web of Science, Cochrane Database of Systematic Reviews, and ERIC was executed using the following search terms: cardiovascular, cardiac, cardio*, heart, surg*, transplant, discharge, self-manage*, teach*, educat*, preop*, patient, care. In addition, an ancestry search of all reference lists was completed. Studies were included if they were published between 2007 and 2012 and focused on preoperative CV surgery adult patient education., Results: The search yielded 20 studies, 12 were excluded because they did not meet the inclusion/exclusion criteria. Eight studies were included in the final review. Three studies reported statistically significant decreases in reported anxiety and depression and increased subjective health. Four studies had mixed results with both positive and neutral findings. No studies reported negative findings in relation to preoperative education., Conclusion: Patients and staff identified that patient education is essential. Standardized educational tools are appropriate as they can spare resources, but are only effective if used in conjunction with individualized education.

Background: Preterm birth (PTB) places a considerable emotional, psychological, and financial burden on parents, families, health care resources, and society as a whole. Efforts to estimate these costs have typically considered the direct medical costs of the initial hospital and outpatient follow-up care but have not considered non-financial costs associated with PTB such as adverse psychosocial and emotional effects, family disruption, strain on relationships, alterations in self-esteem, and deterioration in physical and mental health. The aim of this inquiry is to understand parents' experience of PTB to inform the design of subsequent studies of the direct and indirect cost of PTB. The study highlights the traumatic nature of having a child born preterm and discusses implications for clinical care and further research., Method: Through interviews and focus groups, this interpretive descriptive study explored parents' experiences of PTB. The interviews were audiotaped, transcribed, and analyzed for themes. Analysis was ongoing throughout the study and in subsequent interviews, parents were asked to reflect and elaborate on the emerging themes as they were identified., Results: PTB is a traumatic event that shattered parents' taken-for-granted expectations of parenthood. For parents in our study, the trauma they experienced was not related to infant characteristics (e.g., gestational age, birth weight, Apgar scores, or length of stay in the NICU), but rather to prolonged uncertainty, lack of agency, disruptions in meaning systems, and alterations in parental role expectations. Our findings help to explain why things like breast feeding, kangaroo care, and family centered practices are so meaningful to parents in the NICU. As well as helping to (re)construct their role as parents, these activities afford parents a sense of agency, thereby moderating their own helplessness., Conclusion: These findings underscore the traumatic nature and resultant psychological distress related to PTB. Obstetrical and neonatal healthcare providers need to be educated about the symptoms of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) to better understand and support parents' efforts to adapt and to make appropriate referrals if problems develop. Longitudinal economic studies must consider the psychosocial implications of PTB to in order to determine the total related costs.

Lifetime prevalence rates of depression are higher in women than men. Because this gender disparity appears after the onset of puberty and declines after menopause, gonadal hormones may play a role in women's increased vulnerability to dysphoric states. Estrogens have powerful effects beyond their role in reproduction. Fluctuations in estrogen occur naturally throughout the reproductive years and can be associated with disruptions in mood. Treatment for depression with exogenous estrogen has produced equivocal results. To shed light on the complex interactions among estrogens, serotonin, and mood, we briefly examine (a) central serotonin systems and their relationship to mood and mood disorders, (b) nonreproductive effects of estrogens on those systems, (c) potential points of intersection between serotonin systems and estrogens, and (d) research into the use of exogenous estrogen in depression in women. In conclusion, we reiterate the call for carefully controlled research into the etiology and treatment of depression in women.

Topic: The aim of this three-part series is to examine the sufficiency of the posttraumatic stress (PTSD) diagnostic construct to capture the full spectrum of human responses to psychological trauma. Part I (Lasiuk & Hegadoren, 2006a) reviewed the conceptual history of PTSD from the nineteenth century to its inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), while Part II (Lasiuk & Hegadoren, 2006b) described subsequent refinements to the original PTSD diagnostic criteria and highlighted subsequent controversies., Purpose: This paper focuses on interpersonal violence (sexual, physical, and emotional abuse/assault) and its sequelae in women. We argue in support of Judith Herman's (1992) conceptualization of the human trauma response as a spectrum, anchored at one end by an acute stress reaction that resolves on its own without treatment, and on the other by "complex" PTSD, with "classic" or "simple" PTSD somewhere between the two., Sources of Information: he existing theoretical, clinical and research literatures related to humans responses to trauma., Conclusion: The paper concludes with a call for the need to increase a gendered perspective in all aspects of trauma research and clinical service delivery.

Topic: The impairment associated with posttraumatic stress disorder (PTSD) carries with it staggering costs to the individual, to the family, and to society as a whole. Although there is strong evidence that gender plays a significant role in responses to stress and trauma, gender specificity is still not well incorporated into clinical or research work in the area of PTSD., Purpose: This is the second of three articles examining the sufficiency of the current PTSD construct to articulate the full spectrum of human responses to trauma. This article chronicles ongoing refinements to the original PTSD criteria and the subsequent controversies., Source of Information: Existing bodies of theoretical and research literature related to the effects of trauma., Conclusion: In a third article we will review evidence supporting the existence of a more complex posttraumatic stress reaction associated with interpersonal trauma (physical/sexual abuse/assault).

Topic: Posttraumatic Stress Disorder (PTSD) is a significant health problem, characterized by high rates of chronicity and comorbidity., Purpose: This is the first of three articles examining the sufficiency of the current PTSD construct to articulate the spectrum of human responses to trauma, in particular as it relates to women and interpersonal trauma. This paper reviews the conceptual history of PTSD from the nineteenth century up to its inclusion in the DSM-III (American Psychiatric Association, 1980)., Sources of Information: Existing bodies of theoretical and research literature related to the effects of trauma., Conclusion: Although there is strong evidence that gender plays a role in responses to stress and trauma, gender specificity is not well-incorporated into clinical services or research in the area of PTSD.