Publications

Publications

Advancing Long-Term Care Science Through Using Common Data Elements: Candidate Measures for Care Outcomes of Personhood, Well-Being, and Quality of Life

Edvardsson, D., Rebecca, B., Corneliusson, L., Anderson, R. A., Anna, B., Boas, P. V., Corazzini, K., Gordon, A. L., Hanratty, B., Jacinto, A., Lepore, M. J., Leung, A. Y., McGilton, K. S., Meyer, J. E., Schols, J. M., Schwartz, L., Shepherd, V., Skoldunger, A., Thompson, R., Toles, M., Wachholz, P., Wang, J., Wu, B., & Zuniga, F. (2019). Gerontology and Geriatric Medicine. 10.1177/2333721419842672

Association between dying experience and place of death: Urban-rural differences among older Chinese adults

Dong, T., Zhu, Z., Guo, M., Du, P., & Wu, B. (2019). Journal of Palliative Medicine. 10.1089/jpm.2018.0583

Cardiovascular Risk in Middle-Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage

Sadarangani, T., Trinh-Shevrin, C., Chyun, D., Yu, G., & Kovner, C. (2019). Journal of Nursing Scholarship. 10.1111/jnu.12465
Abstract
Purpose: It is reported that while immigrants are, initially, healthier than the native-born upon resettlement, this advantage erodes over time. In the United States, uninsured aging immigrants are increasingly experiencing severe complications of cardiovascular disease (CVD). The purpose of this study was to compare overall CVD risk and explore the importance of health insurance coverage on CVD risk relative to other health access barriers, from 2007 to 2012, in recent and long-term immigrants >50 years of age. Methods: This study was based on secondary cross-sectional analysis of the National Health and Nutrition Examination Survey (N = 1,920). The primary outcome, CVD risk category (high or low), was determined using the American College of Cardiology and American Heart Association Pooled Cohort equation. Differences between immigrant groups were examined using independent-samples t tests and chi-square analysis. The association between insurance and CVD risk was explored using a hierarchical block logistic regression model, in which variables were entered in a predetermined order. Changes in pseudo R 2 measured whether health insurance explained variance in cardiac risk beyond other variables. Results: Recent immigrants had lower overall CVD risk than long-term immigrants but were twice as likely to be uninsured and had higher serum glucose and lipid levels. Based on regression models, being uninsured contributed to CVD risk beyond other health access determinants, and CVD risk was pronounced among recent immigrants who were uninsured. Conclusions: Health insurance coverage plays an essential part in a comprehensive approach to mitigating CVD risk for aging immigrants, particularly recent immigrants whose cardiovascular health is susceptible to deterioration. Clinical Relevance: Nurses are tasked with recognizing the unique social and physical vulnerabilities of aging immigrants and accounting for these in care plans. In addition to helping them access healthcare coverage and affordable medication, nurses and clinicians should prioritize low-cost lifestyle interventions that reduce CVD risk, especially diet and exercise programs.

Caregiver Contribution to Self-care in Patients With Heart Failure: A Qualitative Descriptive Study

Durante, A., Paturzo, M., Mottola, A., Alvaro, R., Vaughan Dickson, V., & Vellone, E. (2019). The Journal of Cardiovascular Nursing, 34(2), E28-E35. 10.1097/JCN.0000000000000560
Abstract
BACKGROUND: Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe. OBJECTIVE: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur). METHODS: Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis. RESULTS: Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic). CONCLUSIONS: Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.

Chinese Dementia Caregiver Intervention Research and its Future Development

Wu, B., Zhu, Z., Wang, J., & Xu, H. (2019). Chinese Nursing Management, 172-177.

Cognitive Function and Oral Health Among Ageing Adults

Kang, J., Wu, B., Bunce, D., Ide, M., Pavitt, S., & Wu, J. (2019). Community Dentistry and Oral Epidemiology. 10.1111/cdoe.12452
Abstract
ObjectivesThere is inconclusive evidence that cognitive function is associated with oral health in older adults. This study investigated the association between cognitive function and oral health among older adults in England.MethodsThis longitudinal cohort study included 4416 dentate participants aged 50 years or older in the English Longitudinal Study of Ageing during 2002‐2014. Cognitive function was assessed at baseline in 2002/2003 using a battery of cognitive function tests. The self‐reported number of teeth remaining and self‐rated general oral health status was reported in 2014/2015. Ordinal logistic regression was applied to model the association between cognitive function at baseline and tooth loss or self‐rated oral health.ResultsCognitive function at baseline was negatively associated with the risk of tooth loss (per each 1 standard deviation lower in cognitive function score, OR: 1.13, 95% CI: 1.05‐1.21). When cognitive function score was categorized into quintiles, there was a clear gradient association between cognitive function and tooth loss (P‐trend = 0.003); people in the lowest quintile of cognitive function had higher risk of tooth loss than those in the highest quintile (OR: 1.39, 95% CI: 1.12‐1.74). A similar magnitude and direction of association were evident between cognitive function and self‐rated oral health.ConclusionThis longitudinal study in an English ageing population has demonstrated that poor cognitive function at early stage was associated with poorer oral health and higher risk of tooth loss in later life. The gradient relationship suggests that an improvement in cognitive function could potentially improve oral health and reduce the risk of tooth loss in the ageing population.

A comparison of scheduling, work hours, overtime, and work preferences across four cohorts of newly licensed Registered Nurses

Stimpfel, A., Fletcher, J., & Kovner, C. (2019). Journal of Advanced Nursing. 10.1111/jan.13972
Abstract
Aims: To conduct a comparative analysis of four cohorts of newly licensed Registered Nurses and their work schedule, daily shift length, weekly work hours, second job, and weekly overtime hours. Nurses also reported their preferences regarding work schedule and daily shift length. Design: We used a retrospective, comparative design analysing four cross-sectional surveys from new nurses first licensed between 2004–2015. Methods: Using state licensure lists, nurses who were first licensed between 1 August 2004 and 31 July 2005 were randomly sampled using a nested design in 23 geographical areas in 13 states and Washington, DC. The same sampling strategy was conducted for subsequent cohorts in January 2009, 2012, and 2016. We sent a mailed survey measuring demographics, education, work attributes, and attitudes to participants with a $5 incentive, following methods by Dillman. Results: There were no statistically significant differences in average weekly work hours (39.4 hrs) or holding more than one job for pay (11.6–14.6% across all cohorts). There were statistically significant differences in overtime across cohorts and shift length by unit type. The preferred shift length was 12 hrs and day shift was the preferred work schedule. Conclusion: New nurses are predominantly scheduled for 12-hrs shifts and nearly half work weekly overtime, trends that have remained relatively stable over the past 10 years. Nurse managers, policy-makers, and researchers should pay attention to new nurses’ schedule and shift preferences and guard against mandatory overtime hours.

Complementary low-level laser therapy for breast cancer-related lymphedema: a pilot, double-blind, randomized, placebo-controlled study

Kilmartin, L., Denham, T., Fu, M., Yu, G., Kuo, T. T., Axelrod, D., & Guth, A. A. (2019). Lasers in Medical Science. 10.1007/s10103-019-02798-1
Abstract
This pilot, double-blind, randomized, placebo-controlled study is aimed at evaluating the effectiveness of low-level laser therapy (LLLT) as a complementary treatment to complete decongestive therapy (CDT) treating lymphedema among breast cancer patients for 12 months post-intervention. Study population was breast cancer patients who were diagnosed and referred to lymphedema clinic for CDT. Participants (n = 22) were randomized and assigned into either an active laser intervention group or an inactive laser placebo-control group. Active LLLT was administered to participants twice a week at the beginning of each CDT session. Outcome measures included lymphedema symptoms, symptom distress, and limb volume by an infrared perometer. Participants in the active and placebo laser groups were comparable in demographic and clinical predictors of lymphedema. In comparison with the placebo group (83.3%), significantly fewer participants in the active laser group (55.6%) reported more than one lymphedema symptom (p = 0.012) at 12 months post-intervention. Significantly, more patients in the active laser group (44.4%) reported less than two impaired limb mobility symptoms in comparison with the placebo group (33.3%) at 12 months post-intervention (p = 0.017). The active laser group had statistically significant improvements in symptom distress of sadness (p = 0.005) from 73 to 11% and self-perception (p = 0.030) from 36 to 0% over time from baseline to 12-months post-intervention. There was no significant reduction in limb volume. Findings of the trial demonstrated significant benefits of complementary LLLT for relieving symptoms and improvement of emotional distress in breast cancer patients with lymphedema.

Debriefing approaches for high-fidelity simulations and outcomes related to clinical judgment in baccalaureate nursing students

Lavoie, P., Pepin, J., Cossette, S., & Clarke, S. (2019). Collegian. 10.1016/j.colegn.2019.01.001
Abstract
Simulation followed by debriefing is increasingly common in clinical nursing education. Yet, limited studies have compared approaches to debriefing—the portion of simulations where participants re-examine and make sense of their experience. In this study, 120 baccalaureate nursing students in Quebec were randomized to receive one of two types of debriefing (self-assessment with Plus-Delta vs. guided reflection using a structured tool with REsPoND) after each of four simulations (a hemorrhage scenario, two sepsis scenarios, and a trauma simulation) during which their situation awareness was measured as a proxy for their clinical judgment. Unexpectedly, situation awareness scores showed little to no consistency across students or simulations and no clear improvements over time were noted, which rendered the comparison of the debriefing approaches across scenarios problematic. However, when comparing the two iterations of the sepsis scenario, students who participated in a reflective debriefing showed greater improvement in their recognition of abnormalities in patient vital signs and level of consciousness than students whose debriefing involved self-assessment.

Edentulism, Dental Care Service Use, and Trajectories of Cognitive Functioning Among Older Adults

Han, S. H., Wu, B., & Burr, J. (2019). Journal of Aging and Health. 10.1177/0898264319851654

The Experience of Being Aware of Disease Status in Women with Recurrent Ovarian Cancer: A Phenomenological Study

Finlayson, C. S., Fu, M., Squires, A., Applebaum, A., Van Cleave, J., O’Cearbhaill, R., & DeRosa, A. P. (2019). Journal of Palliative Medicine, 22(4), 377-384. 10.1089/jpm.2018.0127
Abstract
BACKGROUND: Awareness of disease status has been identified as a factor in the treatment decision-making process. Women with recurrent ovarian cancer are facing the challenge of making treatment decisions throughout the disease trajectory. It is not understood how women with ovarian cancer perceive their disease and subsequently make treatment decisions. PURPOSE: The purpose of this phenomenological study was to understand the lived experience of women with recurrent ovarian cancer, how they understood their disease and made their treatment decisions. METHODS: A qualitative design with a descriptive phenomenological method was used to conduct 2 in-depth interviews with 12 women (n = 24 interviews). Each interview was ∼60 minutes and was digitally recorded and professionally transcribed. Data collection focused on patients' understanding of their disease and how patients participated in treatment decisions. A modified version of Colaizzi's method of phenomenological reduction guided data analysis. RESULTS: Three themes emerged to describe the phenomenon of being aware of disease status: (1) perceiving recurrent ovarian cancer as a chronic illness, (2) perceived inability to make treatment decisions, and (3) enduring emotional distress. CONCLUSIONS AND IMPLICATIONS: This study revealed how 12 women conceptualized recurrent ovarian cancer as a chronic disease and their perceived inability to make treatment decisions because of lack of information and professional qualifications, resulting in enduring emotional distress. Future research should replicate the study to confirm the persistence of the themes for racially, ethnically, and religiously diverse patient samples and to improve understanding of awareness of disease status and decision-making processes of patients.

Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer

Merriman, J., Sereika, S. M., Conley, Y. P., Koleck, T. A., Zhu, Y., Phillips, M. L., Bertocci, M. A., Brufsky, A. M., & Bender, C. M. (2019). Biological Research for Nursing, 21(1), 50-60. 10.1177/1099800418799964
Abstract
Purpose: Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. Methods: We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer (N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways (n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. Results: We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. Conclusions: Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.

Factors Predicting Adoption of the Nurses Improving Care of Healthsystem Elders Program

Stimpfel, A., & Gilmartin, M. (2019). Nursing Research, 68(1), 13-21. 10.1097/NNR.0000000000000327
Abstract
Background Registered nurses are often underprepared with the knowledge and skills to care for hospitalized older adult patients. One strategy to bridge this gap is for hospitals to adopt the Nurses Improving Care for Healthsystem Elders (NICHE) program: A nurse-led interdisciplinary organizational intervention to improve care of hospitalized older adults. Objectives This study aimed to identify the market, organizational and managerial, and sociotechnical factors associated with the adoption of NICHE among U.S. hospitals in order to understand factors that promote and inhibit the adoption of models to improve care for elders and to provide a basis for future studies that evaluate the effects of NICHE participation on patient outcomes. Methods We used an observational, retrospective design, linking three national administrative data sources, in a secondary analysis. Data included the 2012-2013 American Hospital Association Annual Survey, NICHE database, and the American Nurses Credentialing Center Magnet database. Multivariate logistic regression models were completed at the hospital level (n = 3,506). Results Statistically significant variables associated with hospital adoption of the NICHE program include using a medical home model, being in a network, having a pain services program, being in an urban location, and having over 100 beds. Discussion Understanding factors that promote the adoption of organizational interventions like NICHE holds promise for accelerating the use of evidence-based clinical practices to promote health, function, and well-being for older hospitalized adults. Our results provide a foundation for assessing the effects of NICHE participation on patient outcomes by identifying factors that account for membership in NICHE.

False alarms and overmonitoring: Major factors in alarm fatigue among labor nurses

Simpson, K. R., & Lyndon, A. (2019). Journal of Nursing Care Quality, 34(1), 66-72. 10.1097/NCQ.0000000000000335
Abstract
Background: Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. Purpose: The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Methods: Nurses were asked via focus groups about the utility of clinical alarms from medical devices. Results: There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Conclusions: Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

Father-son communication about consistent and correct condom use

Guilamo, V., Thimm-Kaiser, M., Benzekri, A., Rodriguez, C., Fuller, T. R., Warner, L., & Koumans, E. H. (2019). Pediatrics, 143(1). 10.1542/peds.2018-1609
Abstract
OBJECTIVES: With this study, we explore communication about consistent and correct condom use among African American and Latino male adolescents ages 15 to 19 and their fathers. METHODS: Twenty-five father-son dyads completed semistructured interviews designed to elicit specific preferences for teaching and learning about consistent and correct condom use and strategies for addressing common condom use errors and problems. For analysis, we used in vivo coding and vertical and horizontal analysis techniques. RESULTS: Fathers and sons agreed that communication about condom use is feasible and acceptable. However, fathers tended to convey vague messages regarding protecting oneself from the negative consequences of sexual activity. Furthermore, both fathers and sons reported barriers hindering conversations. Secondly, the style and frequency of condom use conversations can help overcome barriers and support father-son relationship management. Talking frequently in 1-on-1 settings and using strategies to reduce discomfort made communication easier. Lastly, fathers and sons reported distinct preferences for teaching and learning about condom use. Sons wanted fathers to give specific guidance on the use and management of condoms. Fathers expressed interest in opportunities for improving their own condom knowledge and skills. Fathers identified gaps in their own condom use knowledge as a limitation to effective instruction of their sons. CONCLUSIONS: A father-focused communication intervention about condom use is feasible and acceptable. Enhancing the intergenerational benefits of father-son communication by addressing specific father-son preferences and learning needs for condom use instruction, as well as communication barriers, represents a novel mechanism for reducing male sexual reproductive health disparities.

Feasibility of Assessing Sodium-Associated Body Fluid Composition in End-Stage Renal Disease

Clark-Cutaia, M., Reisinger, N., Anache, M. R., Ramos, K., Sommers, M. S., Townsend, R. R., Yu, G., & Fargo, J. (2019). Nursing Research, 68(3), 246-252. 10.1097/NNR.0000000000000320
Abstract
Background: Cardiovascular disease accounts for more than half of all deaths in the hemodialysis (HD) population. Although much of this mortality is associated with fluid overload (FO), FO is difficult to measure, and many HD patients have significant pulmonary congestion despite the absence of clinical presentation. Cohort studies have observed that FO, as measured by bioimpedance spectroscopy (BIS), correlates with mortality. Other studies have observed that lower sodium intake is associated with less fluid-related weight gain, improved hypertension, and survival. Whether sodium intake influences FO in HD patients as measured by BIS is not known. Objective: The aims of the study were to determine the feasibility of assessing the impact of sodium restriction on body fluid composition as measured by BIS among patients with three levels of sodium intake and to determine if there are statistical and/or clinical differences in BIS measures across sodium intake groups. Methods: We used a double-blinded randomized controlled trial design with three levels of sodium restriction, 2,400 mg per day, 1,500 mg per day, and unrestricted (control group), to test our aims. Forty-two HD patients from a tertiary acute care academic institution associated with three urban DaVita dialysis centers were enrolled. Participants remained in the inpatient center for 5 days and 4 nights and were randomly assigned to sodium intake groups. Body fluid composition was measured with BIS. Results: Recruitment, enrollment, and retention statistics supported the feasibility of the study design. Regression analyses showed that there were no statistically significant differences among sodium intake groups on any of the outcomes. Discussion: Our data suggest the need for additional research into the effects of sodium restriction on body fluid composition.

Genomics of reproductive traits and cardiometabolic disease risk in African American Women

Hardy, T. M., De Mendoza, V. B., Sun, Y. V., & Taylor, J. (2019). Nursing Research, 68(2), 135-144. 10.1097/NNR.0000000000000337
Abstract
Background Age at menarche and age at natural menopause occur significantly earlier in African American women than in other ethnic groups. African American women also have twice the prevalence of cardiometabolic disorders related to the timing of these reproductive traits. Objectives The objectives of this integrative review were to (a) summarize the genome-wide association studies of reproductive traits in African American women, (b) identify genes that overlap with reproductive traits and cardiometabolic risk factors in African American women, and (c) propose biological mechanisms explaining the link between reproductive traits and cardiometabolic risk factors. Methods PubMed was searched for genome-wide association studies of genes associated with reproductive traits in African American women. After extracting and summarizing the primary genes, we examined whether any of the associations with reproductive traits had also been identified with cardiometabolic risk factors in African American women. Results Seven studies met the inclusion criteria. Associations with both reproductive and cardiometabolic traits were reported in or near the following genes: FTO, SEC16B, TMEM18, APOE, PHACTR1, KCNQ1, LDLR, PIK3R1, and RORA. Biological pathways implicated include body weight regulation, vascular homeostasis, and lipid metabolism. Discussion A better understanding of the genetic basis of reproductive traits in African American women may provide insight into the biological mechanisms linking variation in these traits with increased risk for cardiometabolic disorders in this population.

Hospital readmission in persons with dementia: A systematic review

Ma, C., Bao, S., Dull, P., Wu, B., & Yu, F. (2019). International Journal of Geriatric Psychiatry. 10.1002/gps.5140

The Impact of Living Alone and Intergenerational Support on Depressive Symptoms Among Older Mexican Americans: Does Gender Matter?

Pei, Y., Cong, Z., & Wu, B. (2019). International Journal of Aging and Human Development. doi.org/10.1177/0091415019836099
Abstract
The study examined gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. The sample included 335 parent–adult child pairs which are nested within 92 Mexican American respondents, because each respondent reported their specific relationships with each child. Clustered regression analysis showed gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. In general, older men provided and received less intergenerational support than older women, but their depressive symptoms were more susceptible to living alone and different types of intergenerational support. Factors such as living alone, receiving instrumental support were associated with more depressive symptoms in older men than inolder women, whereas older men benefited more from the emotional closeness with children than older women. The findings highlight the need for a gender-specific approach to future research on this topic.

Integrating Health Care Interpreters Into Simulation Education

Latimer, B., Robertiello, G., & Squires, A. (2019). Clinical Simulation in Nursing, 32, 20-26. 10.1016/j.ecns.2019.04.001
Abstract
Patients with limited English proficiency skills are accessing health care services more frequently around the world. Language barriers increase patient vulnerability for adverse events, and health care interpreters may mitigate this risk. Nursing education regarding the effective and appropriate use of health care interpreters has been limited. Interpreters are natural partners for nurses as a strategy to bridge language barriers with patients and could be integrated more regularly into nursing education using clinical simulation strategies. This article offers an overview of the different types of interpreters in health care, proposes recommendations for integrating them into simulation education, and provides a case example to illustrate implementation.

Integrating Oral Health Curricula into Midwifery Graduate Programs: Results of a US Survey

Haber, J., Dolce, M. C., Hartnett, E., Savageau, J. A., Altman, S., Lange-Kessler, J., & Silk, H. (2019). Journal of Midwifery and Women’s Health. 10.1111/jmwh.12974
Abstract
Introduction: Midwives are a significant segment of the US maternal and primary health care workforce and play a pivotal role in addressing women's oral health care needs during pregnancy and throughout their life span. The purpose of this research was to assess oral health curricular integration in midwifery programs and examine factors that influence integration and satisfaction with graduates’ level of oral health competence. Methods: A cross-sectional, national survey of midwifery programs was conducted using an electronically distributed 19-item, self-administered questionnaire completed by the Directors of Midwifery Education. Data analysis included univariate and bivariate statistics. Results: All of the responding midwifery programs (N = 33) were educating their graduates about oral health; however, less than a quarter (22.6%) of program directors were satisfied with their graduates’ competency. Significant factors promoting integration were routine teaching by a dental professional and a formal relationship with a dental school, dental residency, or dental hygiene program. Programs with 4 or more hours of oral health curriculum were more likely to have a faculty oral health champion, use simulation in evaluation of their learners, and include interprofessional oral health education. Discussion: With adequate oral health education, midwives are ideally positioned to integrate oral health in pregnancy care as well as well woman care throughout the life span, thereby expanding access to oral health care.

Interprofessional Development of a Livestream Simulation Activity to Enhance an Undergraduate Nursing Research Course

Lanier, Y., Bryant, K., Budin, W. C., Marsaglia, M., Resto, D., Genee, J., Birk, K., Sultana, N., Carumba, R., & Jaravata, J. A. (2019). Nursing Education Perspectives, 40(1), 50-52. 10.1097/01.NEP.0000000000000432
Abstract
The article describes the development, implementation, and evaluation of an interactive simulation activity to enhance student engagement and comprehension of evidence-based practice principles. An interprofessional team of nurse educators, simulation experts, information technology specialists, and nursing informatics graduate students collaborated on the simulation design. The results of this project support the need to develop innovative learning strategies to facilitate nursing students' understanding of the relevance of evidence-based practice research to improve patient outcomes.

Lifestyle modifications in adults and older adults with chronic gastroesophageal reflux disease (gerd)

Commisso, A., & Lim, F. (2019). Critical Care Nursing Quarterly, 42(1), 64-74. 10.1097/CNQ.0000000000000239
Abstract
Gastroesophageal reflux disease (GERD) is a chronic disorder that causes the unwanted backflow of gastric contents into the esophagus, throat, and mouth.1 Gastroesophageal reflux disease affects roughly 20% of the US population. It is estimated that older adults experience GERD symptoms more commonly and with greater severity because of age-related physiologic changes. Comorbidities and polypharmacy, common in older adults, can also exacerbate GERD symptoms, which can allow the disease to progress. This integrative review aims to identify key lifestyle-associated risk factors and interventions appropriate for older adults with GERD. Findings can drive evidence-based collaborative best practices to care for patients in both acute and community settings with GERD. Recommendations for nursing education material that aims to address the gap of multilingual and culturally relevant GERD content will be discussed. It is likely that the prevalence of GERD will increase as the prevalence of obesity increases. It is here that registered nurses can play an instrumental role in the prevention and management of GERD in older adults by providing education, promoting health behaviors, and serving as patient advocates.

Mental Health and Substance Use Disorders in Patients Diagnosed With Cancer: An Integrative Review of Healthcare Utilization

Woersching, J., Van Cleave, J., Haber, J., & Chyun, D. (2019). Oncology Nursing Forum, 46(3), 365-383. 10.1188/19.ONF.365-383
Abstract
PROBLEM IDENTIFICATION: The impact of mental health disorders (MHDs) and substance use disorders (SUDs) on healthcare utilization (HCU) in patients with cancer is an understudied phenomenon. LITERATURE SEARCH: A literature search of studies published prior to January 2018 that examined HCU in patients with preexisting MHDs or SUDs diagnosed with cancer was conducted. DATA EVALUATION: The research team evaluated 22 studies for scientific rigor and examined significant trends in HCU, as well as types of the MHD, SUD, and cancer studied. SYNTHESIS: The heterogeneity of HCU outcome measures, MHD, SUD, sample sizes, and study settings contributed to inconsistent study findings. However, study trends indicated higher rates of HCU by patients with depression and lower rates of HCU by patients with schizophrenia. In addition, the concept of HCU measures is evolving, addressing not only volume of health services, but also quality and efficacy. IMPLICATIONS FOR RESEARCH: Oncology nurses are essential to improving HCU in patients with MHDs and SUDs because of their close connections with patients throughout the stages of cancer care. Additional prospective studies are needed to examine specific MHDs and different types of SUDs beyond alcohol use, improving cancer care and the effectiveness of HCU in this vulnerable population.

Network Analysis of the Multidimensional Symptom Experience of Oncology

Papachristou, N., Barnaghi, P., Cooper, B., Kober, K. M., Maguire, R., Paul, S. M., Hammer, M., Wright, F., Armes, J., Furlong, E. P., McCann, L., Conley, Y. P., Patiraki, E., Katsaragakis, S., Levine, J. D., & Miaskowski, C. (2019). Scientific Reports, 9(1). 10.1038/s41598-018-36973-1
Abstract
Oncology patients undergoing cancer treatment experience an average of fifteen unrelieved symptoms that are highly variable in both their severity and distress. Recent advances in Network Analysis (NA) provide a novel approach to gain insights into the complex nature of co-occurring symptoms and symptom clusters and identify core symptoms. We present findings from the first study that used NA to examine the relationships among 38 common symptoms in a large sample of oncology patients undergoing chemotherapy. Using two different models of Pairwise Markov Random Fields (PMRF), we examined the nature and structure of interactions for three different dimensions of patients’ symptom experience (i.e., occurrence, severity, distress). Findings from this study provide the first direct evidence that the connections between and among symptoms differ depending on the symptom dimension used to create the network. Based on an evaluation of the centrality indices, nausea appears to be a structurally important node in all three networks. Our findings can be used to guide the development of symptom management interventions based on the identification of core symptoms and symptom clusters within a network.