Are Expectations for Community Mental Health Increasing Among Older Adults in China?
In recent years, the Chinese government began expanding access to social services to older adults. This study examined whether older adults have increasing expectations that psychological consulting services will be provided by their communities. We analyzed the responses of participants in a prospective cohort study at 2 time points: 2005 and 2008. We utilized logistic regression with survey weights to determine whether there were any changes in attitudes toward community mental health services during the study period, and to determine the correlates of this change. The study participants had a higher expectation that their government would provide psychological consulting services in 2008 than 2005. The multiple logistic regressions conducted indicated that there was a statistically significant relationship between expectations for community-provided psychological consulting services and being a rural resident (odds ratio [OR] = 0.553, 95% confidence interval [CI] [0.353, 0.865]), change in gross regional product per capita (OR = 0.967, 95% CI [0.937, 0.997]), the interaction of those 2 variables (OR = 1.07, 95% CI [1.03, 1.11]), and increase in psychological well-being (OR = 0.971, 95% CI [0.954, 0.988]). Our study highlights the role that economic development can play in changing attitudes toward community-provided psychological consulting services. It suggests that as economic development occurs, expectations for local communities to provide mental health services will increase. (PsycINFO Database Record
Chronic Illness and Older Adults
Risk for Falls
General Surgical Care of the Older Adult.
Making QSEN visible in the classroom: Innovative use of in-class care mapping activity.
Perioperative Care of the Older Adult.
The will to live and living well.
301 Careers in Nursing
A nurse practitioner-led heart failure education program for certified nursing assistants in a long term care facility
A Research Agenda for Gero-Oncology Nursing.
The global challenge of accessible, affordable cancer care for all older adults requires a new research agenda for gero-oncology nursing to guide investigator skill development, identify priority areas for investigation, and direct resource distribution.
A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Randomized Clinical Trial Rationale and Protocol.
Despite current advances in cancer treatment, many breast cancer survivors still face long-term post-operative challenges as a result of suffering from daily pain and other distressing symptoms related to lymphedema, ie, abnormal accumulation of lymph fluid in the ipsilateral upper limb or body. Grounded in research-driven behavioral strategies, The-Optimal-Lymph-Flow is a unique Web- and mobile-based system focusing on self-care strategies to empower, rather than inhibit, how breast cancer survivors manage daily pain and symptoms. It features a set of safe, feasible, and easily-integrated-into-daily-routine exercises to promote lymph flow and drainage, as well as guidance to maintain an optimal body mass index (BMI).
Acculturation and Dental Service Use Among Asian Immigrants in the U.S.
The objective of this study was to assess dental service utilization across different Asian immigrant groups and to examine the relationship between acculturation and dental service utilization among Asian immigrants in the U.S.
Achieving a High-Quality Cancer Care Delivery System for Older Adults: Innovative Models of Care.
To examine innovative models and other research-based interventions that hold potential to assure high-quality care for the growing older adult population living with cancer as one of multiple chronic conditions. Evidence from these care delivery approaches provides a roadmap for the development of future care models.
Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management
Cancer-related lymphedema: an overview of current evidence-based treatment
Challenges in Recruiting People Who Use Drugs for HIV-Related Biomedical Research: Perspectives from the Field.
Recruitment of people who use drugs (PWUD) for HIV-related research has been undertaken since early in the epidemic. In early studies, recruitment was often performed by outreach workers with familiarity with the target population, who distributed risk reduction materials, and administered the surveys being conducted on drug use and risk behaviors. The evolution of effective treatments for HIV has provided opportunities for PWUD to participate in biobehavioral studies testing the efficacy of medical treatment advances and exploring the underlying biomedical basis for prevention and treatment efforts. Recruitment for these studies has led to new challenges for outreach workers and institutions conducting this research. PWUD, particularly those from race/ethnic minority populations, have had lower rates of engagement in HIV care and have been underrepresented in HIV/AIDS medical studies. To address these health disparities, enhanced efforts are needed to increase their participation in biomedical studies. This article examines the challenges identified by experienced outreach workers in recruiting PWUD for HIV-related biomedical studies, including individual (participant)-, institutional-, and recruiter-level challenges, and provides recommendations for addressing them.
Cognitive Impairment-Adults-Down’s Syndrome
Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers.
Home health care agencies are increasingly taking care of sicker, older patients with greater comorbidities. However, they are unequipped to appropriately manage these older adults, particular persons living with dementia (PLWD). We therefore developed the Dementia Symptom Management at Home (DSM-H) Program, a bundled interprofessional intervention, to improve the care confidence of providers, and quality of care delivered to PLWD and their caregivers. We implemented the DSM-H with 83 registered nurses, physical therapists, and occupational therapists. Overall, there was significant improvement in pain knowledge (5.9%) and confidence (26.5%), depression knowledge (14.8%) and confidence (36.1%), and neuropsychiatric symptom general knowledge (16.8%), intervention knowledge (20.9%), attitudes (3.4%) and confidence (27.1%) at a statistical significance of (P < .0001). We also found significant differences between disciplines. Overall, this disseminable program proved to be implementable and improve clinician's knowledge and confidence in caring for PLWD, with the potential to improve quality of care and quality of life, and decrease costs.
Development of a Barbershop-Based HIV/STI Risk Reduction Intervention for Young Heterosexual African American Men.
Young, heterosexual African American men ages 18 to 24 years continue to be at high risk for HIV and other sexually transmitted infections. However, few interventions have been designed to meet the needs of this "forgotten" population. The article describes the systematic development of a theory-based, culturally-tailored, gender-specific, barbershop-based HIV risk reduction intervention for heterosexual African American men ages 18 to 24. The process included developing a community advisory board, selecting a guiding theoretical framework, incorporating community-based participatory research principles, and conducting formative research with African American males, barbers, and barbershop owners. The result was Shape Up: Barbers Building Better Brothers, a 2-day, HIV risk reduction intervention focused on increasing HIV knowledge and condom use and reducing the number of sexual partners. Intervention sessions were facilitated by barbers who used iPads to deliver the content. As a high-risk population, this intervention has great public health significance for the health of African American men and their sexual partners.
Evaluating the need for organ donation and transplant related education in nursing curricula
Evaluation of a peer mentoring program for early career gerontological nursing faculty and its potential for application to other fields in nursing and health sciences.
As the retirement rate of senior nursing faculty increases, the need to implement new models for providing mentorship to early career academics will become key to developing and maintaining an experienced faculty.
Evaluation of an Electronic Module for Reconciling Medications in Home Health Plans of Care.
Transitions in patient care pose an increased risk to patient safety. One way to reduce this risk is to ensure accurate medication reconciliation during the transition. Here we present an evaluation of an electronic medication reconciliation module we developed to reduce the transition risk in patients referred for home healthcare.
Examining Racial Discrimination Frequency, Racial Discrimination Stress, and Psychological Well-Being Among Black Early Adolescents
Examining the influence of country-level and health system factors on nursing and physician personnel production.
A key component to achieving good patient outcomes is having the right type and number of healthcare professionals with the right resources. Lack of investment in infrastructure required for producing and retaining adequate numbers of health professionals is one reason, and contextual factors related to socioeconomic development may further explain the trend. Therefore, this study sought to explore the relationships between country-level contextual factors and healthcare human resource production (defined as worker-to-population ratio) across 184 countries.
Exploring longitudinal shifts in international nurse migration to the United States between 2003 and 2013 through a random effects panel data analysis.
No study has examined the longitudinal trends in National Council Licensure Exam for Registered Nurse (NCLEX-RN) applicants and pass rates among internationally-educated nurses (IENs) seeking to work in the United States, nor has any analysis explored the impact of specific events on these trends, including changes to the NCLEX-RN exam, the role of the economic crisis, or the passing of the WHO Code on the International Recruitment of Health Personnel. This study seeks to understand the impact of the three aforementioned factors that may be influencing current and future IEN recruitment patterns in the United States.
High Prevalence of Medication Discrepancies Between Home Health Referrals and Centers for Medicare and Medicaid Services Home Health Certification and Plan of Care and Their Potential to Affect Safety of Vulnerable Elderly Adults.
To describe the prevalence of discrepancies between medication lists that referring providers and home healthcare (HH) nurses create.
Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial.
Human immunodeficiency virus (HIV) disease in the United States disproportionately affects minorities, including Latinos. Barriers including language are associated with lower antiretroviral therapy (ART) adherence seen among Latinos, yet ART and interventions for clinic visit adherence are rarely developed or delivered in Spanish.
Measuring fear of falling among high-risk, urban, community-dwelling older adults.
Fear of falling (FOF) creates a psychological barrier to performing activities for many older adults. The negative impact of fear of falling increases risk of curtailment of activities, future falls, and injury. The specific aim for this study was to investigate the relationship between two fear of falling measures used in clinical research, the FOF Likert scale and Falls Self Efficacy Scale-International (FES-I). The study included a convenience sample of 107 high-risk, community-dwelling, mostly Black (94%) members from one Program for All-Inclusive Care for the Elderly program. The FOF scale is one-item asking to rate overall concern about falling, while the FES-I is 16-items rating concern about falling during physical and social activities. One-way ANOVA and Kruskal-Wallis were highly significant (F-value = 22.25, R-squared = 0.39, p < 0.0001). The Graded Response Model statistics demonstrated one underlying latent factor, fear of falling. This study supports the use of both tools for thorough FOF measurement.
mHealth self-care interventions: managing symptoms following breast cancer treatment.
Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system.
Multiple chronic conditions and hospitalizations among recipients of long-term services and supports
Pharmacological Approaches for the Management of Persistent Pain in Older Adults: What Nurses Need to Know.
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Pharmacological Approaches for the Management of Persistent Pain in Older Adults: What Nurses Need to Know" found on pages 49-57, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until November 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe age-related barriers to pain assessment and key aspects of the assessment process. 2. Identify benefits and risks associated with commonly prescribed analgesic medications for the treatment of later life pain. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The current article addresses pharmacological treatment issues regarding the management of persistent pain in later life, which is a worldwide problem associated with substantial disability. Recommendations from guidelines were reviewed and data are presented regarding the benefits and risks of commonly prescribed analgesic medications. The evidence base supports a stepwise approach with acetaminophen as first-line therapy for mild-to-moderate pain. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. In properly selected older patients, opioid drugs should be considered if pain is not adequately controlled. Careful surveillance to monitor for benefits and harms of therapy is critical, given that advancing age increases risk for adverse effects. Key aspects of the pain care process that nurses routinely engage in are covered, including conducting pain assessments prior to initiating therapy, addressing barriers to effective pain care, educating patients and family members about the importance of reducing pain, discussing treatment-related risks and benefits, and formulating strategies to monitor for treatment outcomes. Finally, a case is presented to illustrate issues that arise in the care of affected patients. [Journal of Gerontological Nursing, 42(12), 49-57.].
Precision assessment of heterogeneity of lymphedema phenotype, genotypes and risk prediction.
Lymphedema following breast cancer surgery is considered to be mainly due to the mechanical injury from surgery. Recent research identified that inflammation-infection and obesity may be the important predictors for lymphedema. The purpose of this exploratory research was to prospectively examine phenotype of arm lymphedema defined by limb volume and lymphedema symptoms in relation to inflammatory genes in women treated for breast cancer. A prospective, descriptive and repeated-measure design using candidate gene association method was used to enroll 140 women at pre-surgery and followed at 4-8 weeks and 12 months post-surgery. Arm lymphedema was determined by a perometer measurement of ≥5% limb volume increase from baseline of pre-surgery. Lymphedema symptom phenotype was evaluated using a reliable and valid instrument. Saliva samples were collected for DNA extraction. Genes known for inflammation were evaluated, including lymphatic specific growth factors (VEGF-C & VEGF-D), cytokines (IL1-a, IL-4, IL6, IL8, IL10, & IL13), and tumor necrosis factor-a (TNF-a). No significant associations were found between arm lymphedema phenotype and any inflammatory genetic variations. IL1-a rs17561 was marginally associated with symptom count phenotype of ≥8 symptoms. IL-4 rs2070874 was significantly associated with phenotype of impaired limb mobility and fluid accumulation. Phenotype of fluid accumulation was significantly associated with IL6 rs1800795, IL4 rs2243250 and IL4 rs2070874. Phenotype of discomfort was significantly associated with VEGF-C rs3775203 and IL13 rs1800925. Precision assessment of heterogeneity of lymphedema phenotype and understanding the biological mechanism of each phenotype through the exploration of inherited genetic susceptibility is essential for finding a cure. Further exploration of investigative intervention in the context of genotype and gene expressions would advance our understanding of heterogeneity of lymphedema phenotype.
Precision health and precision phenotype assessment of breast cancer-related lymphedema
Psychometric properties of the Breast Cancer and Lymphedema Symptom Experience Index: The Chinese version.
To translate the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI) into Chinese language and evaluate its psychometric properties among breast cancer survivors with and without lymphedema in China.
Symptom reporting as a useful tool to detect lymphedema for breast cancer survivors and health care providers
Synthetic cannabinoid poisoning: A growing health concern.
The 2015 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
The Impact of Reported Hospice Preferred Practices on Hospital Utilization at the End of Life.
The Affordable Care Act requires hospices to report quality measures across a range of processes and practices. Yet uncertainties exist regarding the impact of hospice preferred practices on patient outcomes.
The relationship of lymphedema status and lymphedema symptoms in breast cancer survivors
Translation and evaluation of Chinese version of the symptom experience index.
Symptom assessment is crucial for patient care through the entire disease trajectory. Patients often experience multiple symptoms concurrently. The symptom experience index is reliable and valid as an instrument developed in the USA for assessing multiple symptoms and distress. The aim of the study was to translate and evaluate the Chinese version of the instrument in healthy adults and oncology patients. This is a psychometric study with a cross-sectional design. To ensure the semantic equivalence and content validity, an integrative translation method was employed to translate the English version into Chinese language. The participants were recruited during 2014 from a large university, two university-affiliated hospitals and a community in Changchun, China. The Chinese version demonstrated high internal consistency, test-retest reliability and content validity. Construct validity was supported by factor analysis and significant differences of symptom experience scores between healthy and oncology groups. Participants' acceptance of the Chinese version and its ability to collect adequate data among Chinese population provided evidence for using this version among Chinese population. This study provided initial evidence to support the psychometric properties of the Chinese version. The Chinese version demonstrated adequate reliability and validity to assess multiple symptom experience by Chinese populations.
Usability and feasibility of health IT interventions to enhance Self-Care for Lymphedema Symptom Management in breast cancer survivors
A pilot study examining health literacy promotion practices among healthcare professionals
A structural equation model of turnover for a longitudinal survey among early career registered nurses.
Key predictors of early career nurses' turnover are job satisfaction, organizational commitment, job search, intent to stay, and shock (back injuries) based on the literature review and our previous research. Existing research has often omitted one of these key predictors.
Accuracy of body weight perception and obesity among Chinese Americans.
Accuracy of body weight perception is an individual's perception of their body weight in comparison with actual body weight and is associated with weight-related behaviors. Chinese Americans have increased risk for obesity but no studies have examined accuracy of body weight perception.
Advanced practice nursing: shaping health through policy.
To highlight the importance of advanced practice nurses (APNs) becoming politically engaged as key to promoting the healthcare interests of patients, communities and the profession and to offer specific strategies on how to become politically competent.
Breast cancer-related lymphedema and sexual experiences: a mixed-method comparison study.
Up to 40% of breast cancer survivors develop lymphedema, a chronic and sometimes disabling condition that manifests as abnormal swelling of the effected arm or hand or upper chest areas. Although the effects of lymphedema on quality of life have been well established, less well documented are the sexual experiences of breast cancer survivors with lymphedema. This study is the first to compare the sexual experiences of women with (n = 243) and without breast cancer-related lymphedema (n = 109).
Comorbidities and Quality of Life among Breast Cancer Survivors: A Prospective Study.
Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis. The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors' quality of life. A prospective design was used to recruit 140 women before cancer surgery, 134 women completed the study. Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index (CCI) before and 12-month after cancer surgery. Quality of life was evaluated using Short-Form Health Survey (SF-36 v2). Descriptive statistics, chi-square tests, t-tests, Fisher's exact test, and correlations were performed for data analysis. A total of 28 comorbidities were identified. Among the 134 patients, 73.8% had at least one of the comorbidities, 54.7% had 2-4, and only 7.4% had 5-8. Comorbidities did not change at 12 months after surgery. Numbers of comorbidities by patients' self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health, physical functioning, bodily pain, and vitality. Comorbidities, specifically hypertension, arthritis, and diabetes, were associated with poorer quality of life in multiple domains among breast cancer survivors. Future research should consider the combined influence of comorbidity and cancer on patients' quality of life.
Dementia Palliative Care
Development and implementation of a peer mentoring program for early career gerontological faculty.
The Hartford Gerontological Nursing Leaders (HGNL) formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), in conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), developed and executed a peer mentoring program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of HGNL members. The purpose of this article is to describe key strategies used to develop and execute the peer mentoring program and to present formative program evaluation.
Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.
To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals.
Implementing interprofessional, graduate level geriatric primary care education: Reflections on year 1 of a new program.
Improvements in Educational Preparedness for Quality and Safety
Lived experiences of reducing environmental risks in an environmental justice community
Maintaining pre-surgery weight in the first year of breast cancer treatment: A prospective study
Mapping the Air-Bridge Locations: The Application of Ethnographic Mapping Techniques to a Study of HIV Risk Behavior Determinant in East Harlem, New York, and Bayamón, Puerto Rico
Nurse work environment and quality of care by unit types: A cross-sectional study.
Nursing unit is the micro-organization in the hospital health care system in which integrated patient care is provided. Nursing units of different types serve patients with distinct care goals, clinical tasks, and social structures and norms. However, empirical evidence is sparse on unit type differences in quality of care and its relation with nurse work environment. Nurse work environment has been found as an important nursing factor predicting nurse and patient outcomes.
Obesity Indicators and Chronic Illness among Chinese Americans: A Pilot Study
Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City.
Available evidence suggests that young former Soviet Union immigrants in New York City have high rates of non-medical prescription opioid and heroin use, drug injection and injection-related risk behavior, making them vulnerable to hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infection, overdose and associated harms. This group has been the focus of little research, however. This paper presents quantitative and qualitative data from 80 former Soviet immigrants (ages 18-29) to characterize their opioid use trajectories, injection risk behavior, HCV/HIV testing histories and self-reported HCV/HIV serostatus, and provides clinically meaningful data to inform tailored education, prevention and harm reduction interventions.
Oral sex is not sex
Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery.
Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing—a critical organizational component of hospital service system—in relation to readmissions.
Patterns of Obesity and Lymph Fluid Level during the First Year of Breast Cancer Treatment: A Prospective Study.
Obesity is one of the risk factors for developing lymphedema following breast cancer treatment. We prospectively enrolled 140 women and followed the participants for 12 months after surgery to investigate patterns of obesity and lymph fluid level in the first year of cancer treatment. Electrical bioimpedance devices were used to measure weight, BMI, and percent of body fat as well as lymph fluid level. General instructions were given to the participants on maintaining pre-surgery weight. Among the 140 participants, 136 completed the study with 2.9% attrition. More than 60% of the participants were obese (30.8%) or overweight (32.4%), while only two participants were underweight and about 35% had normal weight. This pattern of obesity and overweight was consistent at 4-8 weeks and 12 months post-surgery. At 12 months post-surgery, the majority of the women (72.1%) maintained pre-surgery weight and 15.4% had >5% weight loss; 12.5% of the women increase >5% of their weight. Significantly more patients in the obesity group had lymphedema defined by L-Dex ratio >7.1 than those in the normal/underweight and overweight group at pre-surgery and 4-8 weeks post-surgery. There was a trend of more patients in the obesity group had L-Dex ratio >7.1 at 12 months post-surgery. Obesity and overweight remain among women at the time of cancer diagnosis and the patterns of obesity and overweight continue during the first year of treatment. General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight.
Predictors of Practice Patterns for Lymphedema Care Among Oncology Advanced Practice Nurses
Research lessons from implementing a national nursing workforce study.
National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies.
Scheduling and shift work characteristics associated with risk for occupational injury in newly licensed registered nurses: An observational study.
Registered nurses across the globe bear a heavy injury burden. Every shift, nurses are exposed to a variety of hazards that can jeopardize their health, which negatively impacts their ability to provide high-quality patient care. Previous research suggests that inexperienced, or newly licensed nurses, may have an increased risk for certain occupational injuries. However, the current knowledge base is insufficient to fully understand how work hours influence newly licensed nurses' occupational injury, given the significant variation in hospital organization and work characteristics.
Self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema.
The purposes of this study were (a) to evaluate self-care, symptom burden, and reported infections among individuals with lower-extremity primary lymphedema; (b) to examine the differences in self-care, symptom burden, and reported infections between individuals with unilateral and those with bilateral lower-extremity primary lymphedema; and (c) to examine the associations among self-care status, symptom burden, and reported infections in individuals with lower-extremity primary lymphedema.
Symptom report in detecting breast cancer-related lymphedema.
Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors' limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.
The Economics of Health Professional Education and Careers: Insights from a Literature Review
The impact of patients' awareness of disease status on treatment preferences and quality of life among patients with metastatic cancer: a systematic review from 1997-2014.
Advances in cancer treatment present challenges to patients with metastatic cancer who have to make treatment decisions in the face of newer and more effective treatments. Patients' awareness of disease status has been an important factor in making treatment choices. We conducted a systematic review of the published literature from 1997-2014 to evaluate the evidence of the impact of patients' awareness of disease status on treatment preferences and quality of life among patients with metastatic cancer.
The Influence of Clinical Decision Support on Diagnostic Accuracy in Nurse Practitioners.
Clinical decision support systems (CDSSs) at the point of care are evidence-based interventions that have demonstrated incremental positive impact on quality of healthcare delivery over the past two decades. Existing best practices inform strategies to promote adoption and achievement of targeted outcomes. The purpose of this improvement project was to conduct a pilot implementation to understand the contextual factors and readiness for dissemination of a newly acquired electronic CDSS by evaluating its influence on diagnostic accuracy in nurse practitioners (NPs) functioning in a community health setting.
The use of large healthcare data sets in pursuit of a clinical question.
The use of large healthcare databases may be of interest to nurse practitioners who wish to answer clinical questions. This column will provide information about access to selected large healthcare databases, requirements for statistical software, and the skills required to utilize these databases.
A clinical update: Non-Celiac gluten sensitivity—Is it really the gluten?
A multisite geriatric education program for rural providers in the Veteran Health Care System (GRECC-Connect).
Older patients who live in rural areas often have limited access to specialty geriatric care, which can help in identifying and managing geriatric conditions associated with functional decline. Implementation of geriatric-focused practices among rural primary care providers has been limited, because rural providers often lack access to training in geriatrics and to geriatricians for consultation. To bridge this gap, four Geriatric Research, Education, and Clinical Centers, which are centers of excellence across the nation for geriatric care within the Veteran health system, have developed a program utilizing telemedicine to connect with rural providers to improve access to specialized geriatric interdisciplinary care. In addition, case-based education via teleconferencing using cases brought by rural providers was developed to complement the clinical implementation efforts. In this article, the authors review these educational approaches in the implementation of the clinical interventions and discuss the potential advantages in improving implementation efforts.
A synopsis: understanding genetic predisposition to lymphedema following breast cancer treatment
Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.
Barriers and facilitators to engagement in lifestyle interventions among individuals with HIV
Bayesian Multilevel MIMIC Modeling for Studying Measurement Invariance in Cross-group Comparisons.
Recent methodological advancements should catalyze the evaluation of measurement invariance across groups, which is required for conducting meaningful cross-group comparisons.
Breast cancer-related lymphedema in genomic era
Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management.
The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.
Brief sexual histories and routine HIV/STD testing by medical providers.
Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief, gender-neutral sexual history tool for clinical use. This pilot evaluation demonstrates that providers were willing to utilize a sexual history tool in clinical practice in support of HIV/STD prevention efforts.
Challenges of nurses' deployment to other New York City hospitals in the aftermath of Hurricane Sandy.
On October 29, 2012, a 12-ft storm surge generated by Hurricane Sandy necessitated evacuation and temporary closure of three New York City hospitals including NYU Langone Medical Center (NYULMC). NYULMC nurses participated in the evacuation, and 71 % were subsequently deployed to area hospitals to address patient surge for periods from a few days up to 2 months when NYULMC reopened. This mixed methods study explored nurses' experience in the immediate disaster and the subsequent deployment. More than 50 % of deployed nurse participants reported the experience to be extremely or very stressful. Deployed nurses encountered practice challenges related to working in an unfamiliar environment, limited orientation, legal concerns about clinical assignments. They experienced psychosocial challenges associated with the intense experience of the evacuation, uncertainty about future employment, and the increased demands of managing the deployment. Findings provide data to inform national and regional policies to support nurses in future deployments.
Church attendance in men who have sex with men diagnosed with HIV is associated with later presentation for HIV care.
We demonstrate an interdependent relationship between sexual behavior and church attendance on timing of human immunodeficiency virus (HIV) diagnosis and presentation for care. Men who have sex with men (MSM) and who attend church are more likely to present with lower CD4(+) T-lymphocyte counts than MSM who do not attend church.
Early career nurses’ experiences of verbal abuse from other nurses
Effect of primary care intervention on breastfeeding duration and intensity.
We determined the effectiveness of primary care-based, and pre- and postnatal interventions to increase breastfeeding.
Evaluation of a meta-tutor for constructing models of dynamic systems
Exploring direct and indirect influences of physical work environment on job satisfaction for early-career registered nurses employed in hospitals.
We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p < .05) on job satisfaction through ten variables: negative affectivity, variety, workgroup cohesion, nurse-physician relations, quantitative workload, organizational constraints, distributive justice, promotional opportunity, local and non-local job opportunities. The findings make important contributions to the understanding of the relationship between physical work environment and job satisfaction. The results can inform health care leaders' insight about how physical work environment influences nurses' job satisfaction.
HIV Peripheral Neuropathy and Foot Care Management
Humanistic-existential and solution focused approaches for psychiatric advanced practice nurses
Impact of parent-child communication interventions on sex behaviors and cognitive outcomes for black/African-American and Hispanic/Latino youth: a systematic review, 1988-2012.
We reviewed human immunodeficiency virus (HIV) and sexually transmitted infection (STI)- behavioral interventions implemented with disproportionately affected black/African-American and Hispanic/Latino youth and designed to improve parent-child communications about sex. We compared their effectiveness in improving sex-related behavior or cognitive outcomes.
In our country tortilla doesn't make us fat: cultural factors influencing lifestyle goal-setting for overweight and obese Urban, Latina patients.
Obesity disproportionately affects Latina adults, and goal-setting is a technique often used to promote lifestyle behavior change and weight loss. To explore the meanings and dimensions of goal-setting in immigrant Latinas, we conducted four focus groups arranged by language ability and country of origin in an urban, public, primary care clinic. We used a narrative analytic approach to identify the following themes: the immigrant experience, family dynamics, and health care. Support was a common sub-theme that threaded throughout, with participants relying on the immigrant community, family, and the health care system to support their goals. Participants derived satisfaction from setting and achieving goals and emphasized personal willpower as crucial for success. These findings should inform future research on how goal-setting can be used to foster lifestyle behavior change and illustrate the importance of exploring the needs of Latino sub-groups in order to improve lifestyle behaviors in diverse Latino populations.
Is bioelectrical impedance analysis reliable and sensitive for detecting breast cancer-related lymphedema
Latina food patterns in the United States: a qualitative metasynthesis.
Obesity disproportionately affects Latinas living in the United States, and cultural food patterns contribute to this health concern.
Lower limb lymphedema after gynecological cancer surgery: An overview
Methodological considerations when translating "burnout"
No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout.
No Turning Back
Nurse employment contracts in Chinese hospitals: impact of inequitable benefit structures on nurse and patient satisfaction.
Ongoing economic and health system reforms in China have transformed nurse employment in Chinese hospitals. Employment of 'bianzhi' nurses, a type of position with state-guaranteed lifetime employment that has been customary since 1949, is decreasing while there is an increase in the contract-based nurse employment with limited job security and reduced benefits. The consequences of inequities between the two types of nurses in terms of wages and job-related benefits are unknown. This study examined current rates of contract-based nurse employment and the effects of the new nurse contract employment strategy on nurse and patient outcomes in Chinese hospitals.
Nursing care of patients with cancer
Palliative Care for Uncommon Disorders
Palliative Care for Uncommon Disorders
Proactive approach to lymphedema risk reduction: a prospective study.
Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term postoperative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The Optimal Lymph Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index (BMI).
Psychosocial Impact of Lymphedema
Putting evidence into practice: cancer-related lymphedema.
Cancer-related lymphedema is a progressive and chronic syndrome of abnormal swelling and multiple symptoms resulting from cancer treatment. Even with modern medical advances, lymphedema remains a major health problem affecting thousands of cancer survivors. To provide healthcare professionals with evidence-based clinical practice guidelines for lymphedema treatment and management, a systematic review was conducted to evaluate 75 selected articles from 2009-2014 by the Oncology Nursing Society Putting Evidence Into Practice lymphedema team. Findings of the systematic review support complete decongestive therapy, compression bandages, and compression garments with highest evidence for best clinical practice. Weight management, full-body exercise, information provision, prevention, and early intervention protocols are likely to be effective for clinical practice. Historic recommendations for activity restriction and avoidance of aerobic and resistive exercises that limit cancer survivors' daily lives have been challenged with more evidence. Cancer survivors may not need to restrict activities such as resistive or aerobic exercises and weightlifting with gradual exercise progression. Future research should focus on providing high-level evidence using randomized clinical trials with larger samples and studying lymphedema beyond breast cancer.
The prevalence of infections and patient risk factors in home health care: a systematic review.
Home health care (HHC) has been the fastest growing health care sector for the past 3 decades. The uncontrolled home environment, increased use of indwelling devices, and the complexity of illnesses among HHC patients lead to increased risk for infections.
Tongue inspection in TCM: Observations in a study sample of patients living with HIV
Transcranial Direct Current Stimulation to Enhance Cognition and Functioning in Schizophrenia
Understanding the role of the professional practice environment on quality of care in Magnet® and non-Magnet hospitals.
The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care.
Validation of the Spanish verison of the practice environment scale of the Nursing Work Index in the Colombian context.
A multi-state assessment of employer-sponsored quality improvement education for early-career registered nurses.
Increasing participation of registered nurses (RNs) in quality improvement (QI) is a promising strategy to close the health care quality chasm. For RNs to participate effectively in hospital QI, they must have adequate QI knowledge and skills.
A narrative of the attending nurse model implementation
A review of interprofessional dissemination and education interventions for recognizing and managing dementia.
The number of individuals with dementia is expected to increase dramatically over the next 20 years. Given the complicated clinical, sociobehavioral, and caregiving skills that are needed to comprehensively assess and manage individuals with dementia, the gold standard of care requires involvement of interprofessional teams. This systematic review examined 4,023 abstracts, finding 18 articles from 16 studies where an interprofessional dissemination program was performed. Most studies found some improvement in clinician knowledge or confidence, or patient outcomes, though methods and patient and clinician populations were disparate. Although a significant evidence base for assessing and managing individuals with dementia has been developed, few studies have examined how to disseminate this research, and even fewer in an interprofessional manner. These findings suggest that greater emphasis needs to be placed on disseminating existing evidence-based care and ensuring that programs are interprofessional in nature so that excellent, patient-centered care is provided.
A systematic survey instrument translation process for multi-country, comparative health workforce studies.
As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems.
Acu/Moxa for distal sensory peripheral neuropathy in HIV: A randomized control pilot study
Advancing the future of nursing: a report by the Building Academic Geriatric Nursing Capacity (BAGNC) Alumni Policy and Leadership Committee
African American women: Living with sickle cell disease
An Experimental Deployment of a Portable Inflatable Habitat in Open Water to Augment Lengthy In-Water Decompression by Scientific Divers
Assessment and management of low limb lymphedema after gynecological malignancy surgery
Breast cancer related lymphedema: risk factors, assessment and management
Caring for Lesbian, Gay, Bisexual and Transgender Older Adults
Content validity of the Spanish version of the Practice Environment Scale of the Nursing Work Index.
The objective of this study is to evaluate the content validity of the Iberian Spanish version of the questionnaire The Practice Environment Scale of the Nursing Work Index (PES-NWI) by using the Content Validity Indexing (CVI).
Cotransplantation of glial restricted precursor cells and Schwann cells promotes functional recovery after spinal cord injury.
Oligodendrocyte (OL) replacement can be a promising strategy for spinal cord injury (SCI) repair. However, the poor posttransplantation survival and inhibitory properties to axonal regeneration are two major challenges that limit their use as donor cells for repair of CNS injuries. Therefore, strategies aimed at enhancing the survival of grafted oligodendrocytes as well as reducing their inhibitory properties, such as the use of more permissive oligodendrocyte progenitor cells (OPCs), also called glial restricted precursor cells (GRPs), should be highly prioritized. Schwann cell (SC) transplantation is a promising translational strategy to promote axonal regeneration after CNS injuries, partly due to their expression and secretion of multiple growth-promoting factors. Whether grafted SCs have any effect on the biological properties of grafted GRPs remains unclear. Here we report that either SCs or SC-conditioned medium (SCM) promoted the survival, proliferation, and migration of GRPs in vitro. When GRPs and SCs were cografted into the normal or injured spinal cord, robust survival, proliferation, and migration of grafted GRPs were observed. Importantly, grafted GRPs differentiated into mature oligodendrocytes and formed new myelin on axons caudal to the injury. Finally, cografts of GRPs and SCs promoted recovery of function following SCI. We conclude that cotransplantation of GRPs and SCs, the only two kinds of myelin-forming cells in the nervous system, act complementarily and synergistically to promote greater anatomical and functional recovery after SCI than when either cell type is used alone.
Defining the Behavior of an Affective Learning Companion in the Affective Meta-tutor Project
Effects of initiating palliative care consultation in the emergency department on inpatient length of stay.
Increased attention has been directed at the intersection of emergency and palliative medicine, since decisions made in the emergency department (ED) often determine the trajectory of subsequent medical treatments. Specifically, we examined whether inpatient admissions after palliative care (PC) consultation initiated in the ED were associated with decreased length of stay (LOS), compared with those in which consultations were initiated after hospital admission.
Exploratory Study: Evaluating the Effects of Fish Oil and Controlled Diet to Reduce Triglyceride Levels in HIV
Feasibility of Implementing a Web-Based Education Program in Geriatric Pain and Depression for Home Health Care Nurses
Florence Nightingale: a pioneer of self-reflection.
Gender differences in the use and benefit of advanced learning technologies for mathematics.
History lesson: how a little girl and her family moved mountains to change care and policy to help children with special health care needs go home.
How differing shift lengths relate to quality outcomes in pediatrics.
The aims of this study were to describe the shift lengths of pediatric nurses and to measure the association of shift length with nurse job outcomes, nurse-reported patient outcomes, and nurse-assessed safety and quality of care in hospitals.
How do depressive symptoms influence self-care among an ethnic minority population with heart failure?
Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF.
HSV-2 Infection as a Cause of Female/Male and Racial/Ethnic Disparities in HIV Infection.
To examine the potential contribution of herpes simplex virus 2 (HSV-2) infection to female/male and racial/ethnic disparities in HIV among non-injecting heroin and cocaine drug users. HSV-2 infection increases susceptibility to HIV infection by a factor of two to three.
Job satisfaction among immigrant nurses in Israel and the United States of America.
The aim of this study is to examine perceptions of job satisfaction among immigrant registered nurses (RNs) in Israel and the USA.
L-Dex Ratio in Detecting Breast Cancer-Related Lymphedema: Reliability, Sensitivity, and Specificity
Lesbian, gay, bisexual, and transgender health: fundamentals for nursing education.
As the health care needs of the lesbian, gay, bisexual, and transgender (LGBT) population become increasingly important, health care professionals require appropriate academic and clinical training in preparation for the increased demand for culturally competent care. Nurses are of particular interest, as they are the core direct caregivers in many health care settings. This article explores the national climate around LGBT individuals and their related health needs. Educators and administrators who work with future nurses should strive to ensure they foster the development of knowledgeable practitioners who will be able to implement best practices in LGBT patient care. Attention should be paid to providing students with diverse clinical placements, access to LGBT interest groups, and clear expectations for LGBT-sensitive nursing care plans and course outcomes selection that promote cultural competence. Recommendations for nursing education and curricular reform are discussed.
Managing of irritable bowel syndrome
Physical and mental health needs of LGBT older adults
Psychosocial impact of living with cancer-related lymphedema.
To summarize the evidence of and identify factors influencing the psychosocial impact of lymphedema, as well as to discuss nursing strategies.
Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011.
This systematic review aimed to evaluate the level of evidence of contemporary peer-reviewed literature published from 2004 to 2011 on the psychosocial impact of lymphedema.
Reframing the context of preventive health care services and prevention of HIV and other sexually transmitted infections for young men: new opportunities to reduce racial/ethnic sexual health disparities.
Young Black males, aged 13 to 29 years, have the highest annual rates of HIV infections in the United States. Young Black men who have sex with men (MSM) are the only subgroup with significant increases in HIV incident infections in recent years. Black men, particularly MSM, are also disproportionately affected by other sexually transmitted infections (STIs). Therefore, we must strengthen HIV and STI prevention opportunities during routine, preventive health care visits and at other, nontraditional venues accessed by young men of color, with inclusive, nonjudgmental approaches. The Affordable Care Act and National HIV/AIDS Strategy present new opportunities to reframe and strengthen sexual health promotion and HIV and STI prevention efforts with young men of color.
Self-reported information sources and perceived knowledge in individuals with lymphedema
Sociostructural Correlates of AIDS Progression for African American Women Living with Diagnoses of HIV Infection in the District of Columbia
Strengthening health systems in North and Central America: What role for migration
Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities.
We reviewed data for the Minority HIV/AIDS Research Initiative (MARI), which was established in 2003 to support underrepresented minority scientists performing HIV prevention research in highly affected communities.
The Korean version of the Symptom Experience Index: a psychometric study.
Symptom assessment and management are vital aspects of patient care through the entire illness trajectory. Patients often experience two or more symptoms concurrently. Building global assessment capacity on symptoms holds significant promise for advancing the science of nursing. The Symptom Experience Index is a reliable and valid patient-centered health outcome measure developed in the United States to assess multiple symptoms and distress. No Korean version is available for Korean healthcare professionals and patients to promote an accurate assessment of multiple symptoms.
The nurse in the man: lifting up nursing or lifting himself?
The role of neuroplasticity and cognitive reserve in aging with HIV: recommendations for cognitive protection and rehabilitation.
By and large, the immune systems of people infected with HIV are being protected and maintained by advances in highly active antiretroviral therapy; as such, this is extending the lives of people into old age. Unfortunately, for many living with this disease, HIV is associated with neuroinflammation, co-morbidities, and accelerated aging which can compromise brain function, resulting in cognitive deficits. The purpose of this article is to highlight how to interpret these deficits within the framework of neuroplasticity and cognitive reserve for this clinical population. We suggest several recommendations for cognitive rehabilitation and mitigation such as addressing lifestyle factors, psychostimulants, cognitive remediation therapy, and treatment of depression and anxiety. Implications for nursing research and practice are posited.
The role of practical wisdom in nurse manager practice: why experience matters.
To illustrate through the interpretation of one representative nurse manager's narrative how the methodology of practice articulation gives language to the ways practical wisdom develops in leadership practice and facilitates learning.
Verbal abuse from nurse colleagues and work environment of early career registered nurses.
This study examined relationships between verbal abuse from nurse colleagues and demographic characteristics, work attributes, and work attitudes of early career registered nurses (RNs).
Why Florence Nightingale still matters
Attaining Baccalaureate Competencies for Nursing Care of Older Adults Through Curriculum Innovation
A new window into nurse manager development: teaching for the practice.
An important domain that emerged from the interpretation of 91 nurse manager (NM) narratives was achieving the right relationship between a NM and a recalcitrant staff member. This article depicts the qualitative distinctions in 2 stages of NM practice to show the importance of reflection on experiential learning in the development of expertise. This work confirms that NM development is more complex than teaching a curriculum of business and management theory and should include teaching for mastery of the skilled know-how of clinical leadership practice and formation of the person as manager.
A novel intraoral diabetes screening approach in periodontal patients: results of a pilot study.
This pilot study examines whether a novel diabetes screening approach using gingival crevicular blood (GCB) could be used to test for hemoglobin A1c (HbA1c) during periodontal visits.
A Qualitative Study of Patients' Attitudes toward HIV Testing in the Dental Setting.
An estimated 1.1 million people in the USA are living with HIV/AIDS. Nearly 200,000 of these individuals do not know that they are infected. In 2006, the CDC recommended that all healthcare providers routinely offer HIV screening to adolescent and adult patients. Nurse-dentist collaborations present unique opportunities to provide rapid oral HIV screening to patients in dental clinic settings and reach the many adults who lack primary medical providers. However, little is known about the feasibility and acceptability of this type of innovative practice. Thus, elicitation research was undertaken with dental providers, students, and patients. This paper reports the results of qualitative interviews with 19 adults attending a university-based dental clinic in New York City. Overall, patients held very positive attitudes and beliefs toward HIV screening in dental sites and identified important factors that should be incorporated into the design of nurse-dentist collaborative HIV screening programs.
A qualitative study of the work environments of Mexican nurses.
Studies of the nursing work environment are increasingly common in developed countries, but few exist in developing countries. Because of resource differences between the two contexts, researchers need to clarify what aspects of the work environments are similar and different.
An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender patients.
A growing body of literature suggests that lesbian, gay, bisexual, and transgender (LGBT) persons have significant health disparities as compared to heterosexuals. Although the reasons for this are complex and multifactorial, one area of research has examined the real or perceived negative attitudes of health-care providers. This integrative review critically appraises and synthesizes data from 17 articles regarding nurses' attitudes towards LGBT patients. Every study analyzed showed some evidence of negative attitudes. However, the literature revealed major limitations, including a paucity of well-designed studies; a dearth of qualitative studies; inconsistent use of validated, reliable instruments; and a lack of measures examining attitudes towards lesbian, bisexual, and transgender persons. Increased knowledge in this area could lead to interventions to improve nurses' cultural competency; resource allocation to nursing research, education, and services related to LGBT health; and inclusion of more LGBT content in nursing curricula.
Analysis of measurement tools of fear of falling for high-risk, community-dwelling older adults.
Fear of falling has many health consequences among older adults and may lead to curtailment of activities, immobility, functional dependence, falls, and serious injury. The lack of clarity as to how to best measure fear of falling among high-risk, community-dwelling older adults defined as those who are nursing home eligible, functionally dependent, and vulnerable is further complicated by the multiple definitions used throughout the science. Fear of falling is important to measure effectively if we are to develop and test interventions to promote safe aging in place and prevent injury and institutionalization. This integrative review, 1982 to the present, leads to the conclusion that the Falls Efficacy Scale-International (FES-I) long form stands out as the most appropriate measurement tool to best assess fear of falling in this unique, understudied, and underserved population.
Autologous lymph node transfer: update on a clinical trial
Barriers to self-management of cancer-related lymphedema
Becoming a Promotora
Child and adolescent behavioral health: A resource for advanced practice psychiatric and primary care practitioners in nursing
Clinicians’ training and interests in lymphedema research: Synopsis
Collaborative treatment with primary care
Conducting peer outreach to migrants: outcomes for drug treatment patients.
Peer outreach models have been successful in addressing HIV risk behaviors of drug users. Patients in methadone maintenance treatment programs who were migrants from Puerto Rico and/or familiar with drug use there were trained to conduct HIV-related peer outreach. A group randomized design was implemented; patients in the Experimental (E) condition (n = 80) received training and conducted 12 weeks of outreach. Half of the patients completed the training and outreach. At follow-up, patients in the E condition who conducted outreach felt they were more helpful to their community, showed a trend for engaging in more vocational activities, and were more likely to talk with others about HIV, compared to those who did not conduct outreach and those in the Control condition (n = 78). Drug treatment patients who are migrants can be trained as peer outreach workers and short-term benefits were found. Longer term maintenance of benefits should be assessed.
Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries.
To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts.
Diet, inflammation, and glycemic control in type 2 diabetes: an integrative review of the literature.
Type 2 diabetes (T2D) is a growing national health problem affecting 35% of adults ≥20 years of age in the United States. Recently, diabetes has been categorized as an inflammatory disease, sharing many of the adverse outcomes as those reported from cardiovascular disease. Medical nutrition therapy is recommended for the treatment of diabetes; however, these recommendations have not been updated to target the inflammatory component, which can be affected by diet and lifestyle. To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D, we conducted an integrative review of the literature. A comprehensive search of the PubMed, CINAHL, Scopus, and Web of Science databases from January 2000 to May 2012 yielded 786 articles. The final 16 studies met the selection criteria including randomized control trials, quasiexperimental, or cross-sectional studies that compared varying diets and measured inflammatory markers. The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers. The Mediterranean diet demonstrated the most clinically significant reduction in glycosylated hemoglobin (HbA(1c)). Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking. Continued research is warranted.
Educating diabetes camp counselors with a human patient simulator: a pilot study.
The purpose of this study was to pilot test the feasibility and efficacy of a novel method of teaching camp counselors hypoglycemia management.
Evaluation of Community–Academic Partnership Functioning: Center for the Elimination of Hepatitis B Health Disparities
Evaluation of the clinical hour requirement and attainment of core clinical competencies by nurse practitioner students.
The purpose of this study was to analyze the national practice of fulfilling 500 clinical hours as a requirement for graduation from nurse practitioner (NP) programs at the master's level and to compare this standard to a comprehensive approach of evaluating attainment of clinical competencies.
Eye of the beholder: grand rounds at the museum
Feasibility of implementing rapid oral fluid HIV testing in an urban University Dental Clinic: a qualitative study.
More than 1 million individuals in the U.S. are infected with HIV; approximately 20% of whom do not know they are infected. Early diagnosis of HIV infection results in earlier access to treatment and reductions in HIV transmission. In 2006, the CDC recommended that health care providers offer routine HIV screening to all adolescent and adult patients, regardless of community seroprevalence or patient lifestyle. Dental providers are uniquely positioned to implement these recommendations using rapid oral fluid HIV screening technology. However, thus far, uptake into dental practice has been very limited.
Health care research in Ghana and Worcester: Lessons learned from Ghana natives and immigrants
HIV Risk Behaviors, Knowledge, and Prevention Service Experiences Among African American and Other Offenders
Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008.
We assessed the proportion and characteristics of patients who do not regularly visit general health care providers but do visit dentists and whose unaddressed systemic health conditions could therefore be identified by their dentist. Of the 26.0% of children and 24.1% of adults that did not access general outpatient health care in 2008, 34.7% and 23.1%, respectively, visited a dentist. They varied by census region, family income, and sociodemographics. Dental practices can serve as alternate sites of opportunity to identify health concerns among diverse groups of US patients.
Immunizations for Older Adults
Integration of physical and psychiatric assessment
Lymphedema knowledge and practice patterns among oncology nurse navigators
Malglycemia and cancer: introduction to a conceptual model.
To introduce a conceptual model detailing the physiologic contributions of malglycemia to cancer formation and increased morbidity and mortality.
Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment.
We conducted a systematic review of studies reporting seroincidence of hepatitis C infection (HCV) in relation to shared syringes and drug preparation equipment among injection drug users (IDUs). We identified published and unpublished studies that met inclusion criteria.
Nurse reported quality of care: a measure of hospital quality.
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses' reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses' responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance.
Nursing diagnosis in education: Significance for nursing education
NYU3T: teaching, technology, teamwork: a model for interprofessional education scalability and sustainability.
Interprofessional education is a critical precursor to effective teamwork and the collaboration of health care professionals in clinical settings. Numerous barriers have been identified that preclude scalable and sustainable interprofessional education (IPE) efforts. This article describes NYU3T: Teaching, Technology, Teamwork, a model that uses novel technologies such as Web-based learning, virtual patients, and high-fidelity simulation to overcome some of the common barriers and drive implementation of evidence-based teamwork curricula. It outlines the program's curricular components, implementation strategy, evaluation methods, and lessons learned from the first year of delivery and describes implications for future large-scale IPE initiatives.
Oral health care and smoking cessation practices of interprofessional home care providers for their patients with HIV.
The need for oral health services among patients with HIV, especially those in advanced stages of disease and those who smoke, has been well documented. Patients receiving HIV-related home care services provide an opportunity for assessment of oral health and smoking cessation needs; however, the majority of home care providers lack formal training to provide these services, thus interprofessional collaborations may be of value. This study assessed the oral health and smoking cessation practices of a random sample of 81 HIV home care providers. Results showed very favorable attitudes toward providing these services with some differences across disciplines. More than 70% of nurses would like to receive additional training in comprehensive oral health assessment by dental professionals. The study provides evidence for the potential of expanding these services for patients with HIV through interprofessional collaboration, in particular with nurses and dentists.
Original research: New nurses: has the recession increased their commitment to their jobs?
Current evidence suggests that the economic recession has induced retired RNs to reenter nursing and working nurses to work more hours and delay retirement, thus easing the projected RN shortage. We wondered whether the economic downturn had affected new nurses' work attitudes and behaviors, including those related to turnover.
Partners Advancing Clinical Excellence: Building Professional Councils for Quality Improvement at Six Community Hospitals
Patterns and predictors of HIV/STI risk among Latino migrant men in a new receiving community.
The purpose of this study was to examine patterns and predictors of HIV/STI risk over time among Latino migrant men in a new receiving community. Latino men (N = 125) were interviewed quarterly for 18 months and HIV/STI tested annually. Selected individual, environmental and cultural factors by partner type and condom use were explored longitudinally and in a cross-section. Sex with female sex workers (FSWs) and multiple partners decreased, sex with main partners and abstinence increased, while the number of casual partners remained stable. Consistent condom use was highest with FSWs, lowest with main partners and midrange with casual partners with no trends over time. STI morbidity was low; no HIV was detected. Drug use and high mobility were associated with inconsistent condom use with FSW, whereas having family in the household was protective. HIV/STI prevention efforts should focus on drug using Latino migrants who are highly mobile and should foster healthy social connections.
Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals.
This paper is a report of a study of factors that affect turnover of newly licensed registered nurses in United States hospitals.
Preparing for and Coping with breast cancer-related lymphedema
Quick tips for nurse educators.
Reframing the influence of the Health Insurance Portability and Accountability Act on research.
The purpose of this article is to review the Health Insurance Portability and Accountability Act (HIPAA), the Privacy Rule, the Security Rule, and common issues encountered by researchers related to these federal privacy and security requirements. This article discusses the misconceptions that researchers may hold about HIPAA, including the process for reviewing protected health information when preparing to conduct a study, potential constraint on participant recruitment, and application of HIPAA to a researcher's clinical population. We also present ways to reframe the negative connotations associated with this regulation and provide tips for researchers about how to work with HIPAA when planning and conducting a study and reporting on study findings. Finally, we suggest that the principles of HIPAA be considered when conducting studies in international settings.
Role of self-care in the patient with heart failure.
Optimal outcomes and quality of life for patients with heart failure depend on engagement in effective self-care activities. Self-care is a complex set of activities and most clinicians are not adequately prepared to assist their patients to engage in effective self-care. In this paper, we provide an overview of self-care that includes definitions, the importance of self-care to outcomes, the physiologic basis for better outcomes with good self-care, cultural perspectives of self-care, and recommendations for the improvement of self-care. Promotion of effective self-care by all clinicians could substantially reduce the economic and personal burden of repeated rehospitalizations among patients with heart failure.
Seroma: A predictor for breast cancer-related lymphedema
Short- vs Long-Course Antibiotics for Acute Exacerbations of Chronic Bronchitis
Simulation scenario for nursing educators making it real (2nd ed.).
Stress, coping, and adaptation
Substance misuse and alcohol use disorders
Symptom burden and infection occurrence among individuals with extremity lymphedema.
Currently, there is a lack of data related to differences in symptoms and infection across different types and anatomical sites of lymphedema. The objective of this study was to examine differences in symptoms and infection status among individuals with lymphedema of the upper or lower extremities. The National Lymphedema Network initiated an online survey of self-report lymphedema data from March 2006 through January 2010. Descriptive statistics, Mann-Whitney tests, and Chi-square tests were used to analyze data. 723 individuals with upper extremity lymphedema and 1114 individuals with lower extremity lymphedema completed the survey. Individuals with extremity lymphedema experienced high symptom burden and infectious complications. Compared with individuals with upper extremity lymphedema, individuals with lower extremity lymphedema experienced more frequent and more severe symptoms (p<.001), infection episodes (p<.001), and infection-related hospitalizations (p<.001). No statistically significant differences of symptom burden and infection status were identified between individuals with lower extremity primary and secondary lymphedema. Individuals with extremity lymphedema experience substantial symptom burden and infectious complications; however, those with lower extremity lymphedema have more severe symptoms and more infections than those with upper extremity lymphedema.
Teaching evidence-based practice in nursing: A guide for academic and clinical settings (2nd. Ed.)
The Effects of providing lymphedema information on patients’ cognitive, behavioral, and symptom outcomes
The Geriatric Depression Scale (GDS)
The impact of inflammation on cognitive function in older adults: implications for healthcare practice and research.
Accumulating evidence suggests that levels of inflammation, an immune response, increase with age throughout the body and the brain. The effects of inflammation on the brain, both acute and chronic, have been associated with cognitive decline and risk of dementia in older adults. Factors believed to increase inflammation include certain health-related behaviors, such as smoking, poor diet, and inactivity as well as health conditions like diabetes, hypertension, and chronic obstructive pulmonary disease, most of which require medical intervention and monitoring. As such, nurses and healthcare professionals are likely to encounter patients who are at a high risk for future development of inflammation-related cognitive decline. A review of inflammatory processes and their relation to cognitive function in older adults is provided, along with factors that may increase or reduce inflammation. Implications for practice and research are discussed.
The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction.
Extended work shifts of twelve hours or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the well-being of nurses. Survey data from nurses in four states showed that more than 80 percent of the nurses were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients' dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses' well-being, may result in expensive job turnover, and can negatively affect patient care. Policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted. Nursing leaders should also encourage workplace cultures that respect nurses' days off and vacation time, promote nurses' prompt departure at the end of a shift, and allow nurses to refuse to work overtime without retribution.
The patient protection and affordable care act: implications for geriatric nurses and patients.
The treatment of Constipation-Predominant Irritable Bowel Syndrome with Acupuncture and Moxibustion: A Case Report
Translation+ pendaphonics = movement modulated media
Use of Complementary /Alternative Medicines and Supplements by Mexican-Origin Patients in a US-Mexico Border HIV Clinic
Wake up to better PowerPoint presentations.
Work environment factors other than staffing associated with nurses' ratings of patient care quality.
The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions' ability to rely on RN staffing alone to ensure high-quality care.
201 Careers in Nursing
A competency-based approach to educating and training the eldercare workforce
A continuous glucose monitoring and problem-solving intervention to change physical activity behavior in women with type 2 diabetes: a pilot study.
Diabetes technology has the potential to provide useful data for theory-based behavioral counseling. The aims of this study are to evaluate the feasibility, acceptability, and preliminary efficacy of a continuous glucose monitoring and problem-solving counseling intervention to change physical activity (PA) behavior in women with type 2 diabetes.
A pilot study of a systematic method for translating patient satisfaction questionnaires.
This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica-Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems.
A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions.
Most heart failure (HF) patients have other comorbid conditions. HF self-care requires medication and diet adherence, daily weight monitoring, and a thoughtful response to symptoms when they occur. Self-care is complicated when other chronic conditions have additional self-care requirements. The purpose of this study is to explore how comorbidity influences HF self-care.
A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs.
High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types.
Age differences in heroin and prescription opioid abuse among enrolees into opioid treatment programs.
In the United States, among those entering opioid treatment programs (OTPs), prescription opioid (PO) abusers tend to be younger than heroin users. Admissions of older persons to OTPs have been increasing, and it is important to understand typical patterns of use among those older enrolees.
Agent, host, and environment: hepatitis C virus in people who inject drugs.
An analysis of students’ gaming behaviors in an intelligent tutoring system: predictors and impacts
An evidence-based response to "electroshock, a discerning review of the nursing literature".
Assessment of fear of falling in older adults: The Falls Efficacy Scale-International (FES-I)
Attitudes of methadone program staff toward provision of harm-reduction and other services.
The need for expansion of health services provided in drug treatment programs has been widely discussed since the beginning of the HIV epidemic among drug users. Service expansion has focused on various types of services including medical services (eg, primary care) and harm-reduction services (eg, provision of sterile syringes).
Best Practices in Inter-Professional Communication: The Right Words
Clinicians’ training and interests in lymphedema research
Background: It is essential to understand clinicians’ research training to advance the field of lymphoedema through continuous research and implementation of evidence-based practice. Aims: To investigate clinicians’ training, interests, and opinions regarding lymphoedema research. Methods: A survey was conducted by the National Lymphedema Network (NLN) Research Committee from 2007–2009. A sample of NLN professional members was recruited. Descriptive and comparative data analyses were performed. Results: Among 317 clinicians who completed the survey, 52.4% had received some formal research training. The clinicians rated the most important obstacles for research were lack of funds, followed by lack of time and lack of knowledge. Clinicians rated that the most beneficial education programme should focus on performing clinical research in a busy clinic setting with limited resources. Over 80% of the clinicians expressed interests in research training on critical evaluation of current lymphoedema research, development of research ideas and clinical protocols, and writing fundable grants. Conclusions: This survey identified clinicians’ research training needs and obstacles. Professional organisations may use this information to strategically plan educational opportunities and venues. Declaration of interest: None.
Combining extant datasets with differing outcome measures across studies of older adults after cancer surgery.
Combining extant datasets with differing outcome measures, an economical method to generate evidence guiding older adults' cancer care, may introduce heterogeneity leading to invalid study results. We recently conducted a study combining extant datasets from five oncology nurse-directed clinical trials (parent studies) using norm-based scoring to standardize the differing outcome measures. The purpose of this article is to describe and analyze our methods in the recently completed study. Despite addressing and controlling for heterogeneity, our analysis found statistically significant heterogeneity (p < 0.0001) in temporal trends among the five parent studies. We concluded that assessing heterogeneity in combined extant datasets with differing outcome measures is important to ensure similar magnitude and direction of findings across parent studies. Future research should include investigating reasons for heterogeneity to generate hypotheses about subgroup differences or differing measurement domains that may have an impact on outcomes.
Continuation of prescribed compared with over-the-counter oral contraceptives.
To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S. resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies.
Coping as a Mediator in the Relationships of Spiritual Well-Being to Mental Health in Black Women with Type 2 Diabetes
Creating a culture of care for older adults
Distance traveled and cross-state commuting to opioid treatment programs in the United States.
This study examined commuting patterns among 23,141 methadone patients enrolling in 84 opioid treatment programs (OTPs) in the United States. Patients completed an anonymous one-page survey. A linear mixed model analysis was used to predict distance traveled to the OTP. More than half (60%) the patients traveled < 10 miles and 6% travelled between 50 and 200 miles to attend an OTP; 8% travelled across a state border to attend an OTP. In the multivariate model (n = 17,792), factors significantly (P < .05) associated with distance were, residing in the Southeast or Midwest, low urbanicity, area of the patient's ZIP code, younger age, non-Hispanic white race/ethnicity, prescription opioid abuse, and no heroin use. A significant number of OTP patients travel considerable distances to access treatment. To reduce obstacles to OTP access, policy makers and treatment providers should be alert to patients' commuting patterns and to factors associated with them.
Doctor of nursing practice and nursing education: Highlights, potential and promise.
Drug arrests and injection drug deterrence.
We tested the hypothesis that higher rates of previous hard drug-related arrests predict lower rates of injection drug use.
Early career RNs' perceptions of quality care in the hospital setting.
The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.
Essential tips for first-year nurses
Exploring the links between macro-level contextual factors and their influence on nursing workforce composition.
Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.
Factors affecting recovery of functional status in older adults after cancer surgery.
To explore factors influencing functional status over time after cancer surgery in adults aged 65 and older.
Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews
Herbal Supplements: Talking with your Patients
HIV risk and prevention among Hispanic immigrants in New York: the salience of diversity.
The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.
How Do Cognitive Function and Knowledge Affect Heart Failure Self-Care?
Inflammation-infection: A complication or trigger of lymphedema
Innovation Cooperation: Energy Biosciences and Law
Is Nursing Education Considered an Advanced Practice Role?
Mental health concerns among African immigrants.
African immigrants represent a rapidly expanding group of immigrants in the United States. In New York City, Africans constitute the fastest growing segment of immigrants but the needs and practices of African immigrants in the U.S. remain poorly understood. A community based organization (CBO) serving African immigrants in Staten Island, NY began a health screening program in 2008 with the goal of promoting access to primary care. Over 18 months, 296 visits were recorded at African Refuge health screenings, representing a total of 87 people who averaged just over 3 visits per person. The screenings identified mental health among the top three medical problems of clients but referral to mental health services was rare. Dedicated services are required to better screen for mental health concerns and refer African immigrants to mental health care.
Newly Licensed RNs Describe What They Like Best about Being a Nurse.
About 25% of newly licensed registered nurses (NLRNs) leave their first job within two years, but only 2% leave the nursing profession in this same timeframe. Therefore, the researchers sought to discover what new nurses like best about being a nurse, in hopes of gaining information that might help facilities to reduce turnover rates. Data were collected between January and March 2009 from 1,152 NLRNs licensed in 15 US states. Krippendorff's method was used to analyze survey responses. Five themes emerged: "providing holistic patient care," "having an autonomous and collaborative practice," "using diverse knowledge and skills to impact patient outcomes," "receiving recognition," and "having a job that is secure and stimulating." Strategies are discussed that organizations might employ in helping NLRNs to realize what they best like about their work, which might lead to improved retention rates.
NPs and PAs: A Comfortable Alliance
Nurse, what are you in it for? Reflections of a nurse-teacher
Nursing strategies to reduce the incidence of early childhood caries in culturally diverse populations.
In the United States, early childhood caries (ECC) is a major unmet health care need adversely affecting the overall health of young children from diverse ethnic populations. Nurses who work in the newborn nursery, pediatrics, public, and community health centers have a unique opportunity to positively influence a change in this epidemic of ECC. Guided by Leininger's theory of cultural care, these authors describe ways to implement a comprehensive culturally sensitive oral health education program for parents of newborns and infants. Interventions based on the best available evidence for oral health education, a culturally sensitive caries risk assessment, recommendations for fluoride varnish treatments, and ways for parents to establish a dental home for the infant by 12 months old are presented.
Physiological and behavioral factors related to physical activity in black women with type 2 diabetes mellitus.
To describe relationships among physical activity (PA), physiological factors, and psychological factors in Black women with type 2 diabetes mellitus (T2DM).
Predictors of Cognition in Adults With HIV
Recruitment and retention strategies among older African American women enrolled in an exercise study at a PACE program.
This study examined employment of specific recruitment and retention strategies in a study evaluating outcomes of a moderate activity exercise program for older African American women with functional impairments attending a Program for All-Inclusive Care of Elders (PACE).
Research participant recruitment in Hispanic communities: lessons learned.
Hidden/special populations such as new immigrants are hard-to-reach due to issues such as stigma, discrimination, fear of immigration authorities, and cultural norms. Such factors can affect the recruitment of participants for behavioral research, especially research which addresses stigmatizing conditions such as HIV/AIDS. This research involved a qualitative approach and methods. The study identified contextual factors as well as attitudes, experiences and beliefs affecting HIV risk among recent Hispanic immigrants in New York. During the course of this research, challenges to participant recruitment were identified which were related to the environments, characteristics of the populations, and the sensitive nature of the topic to be studied. Strategies including exploratory fieldwork and sensitivity to participants' fear of "the system" were effective in recruiting individuals from this population. The authors discuss the strategies which facilitated recruitment of research subjects from these new Hispanic immigrant communities and the importance of behavioral research among these vulnerable communities.
Self care in patients with chronic heart failure.
'Heart failure self care' refers to the practices in which patients engage to maintain their own health, and to the decisions that they make about managing signs or symptoms. In this article, we base our discussion of self care in chronic heart failure on the classification of patients as being 'expert', inconsistent', or 'novice' in heart failure self-care behaviors. The available literature on factors predicting heart failure self care and its outcomes are reviewed within this context. Factors known to influence heart failure self care include experience with the illness, physical functioning, depression and anxiety, social support, daytime sleepiness, and attitudes such as confidence. Further research is needed to understand the contributions of comorbidities, patient sex, and health disparities on heart failure self care. The evidence to support a link between heart failure self care and health outcomes is limited, but early evidence suggests that adequate self care is associated with an improvement in health status, a decrease in the number and duration of hospitalizations, and a decline in levels of biomarkers of stress and inflammation, and in intrathoracic impedance. Implications of heart failure self care for clinical practice, policy, and public health are also described.
Simulation laboratory director
Strengthening the practice of nursing
Structuring the nursing home experience: A web-based resource for clinical faculty.
Substance abuse and addiction in registered professional nurses
The attending nurse: an evolving model for integrating nursing education and practice.
The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic "bedsides" where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.
The effect of peer-driven intervention on rates of screening for AIDS clinical trials among African Americans and Hispanics.
We examined the efficacy of a peer-driven intervention to increase rates of screening for AIDS clinical trials among African Americans and Hispanics living with HIV/AIDS.
The Effects of symptomatic seroma on lymphedema symptoms following breast cancer treatment
The Evolution of Palliative Care Nursing Education
The influence of substance use, social sexual environment, psychosocial factors, and partner characteristics on high-risk sexual behavior among young Black and Latino men who have sex with men living with HIV: A qualitative study.
Understanding the sexual risk behaviors of youths living with HIV/AIDS is critical to secondary prevention of HIV. As part of a larger qualitative study of youths living with HIV, in-depth interviews were conducted with 27 African American and Latino, HIV-infected young men who have sex with men, aged 16-24 years, living in New York City. The study explored the role of substance use, the social-sexual-environmental, and psychological contexts in which sexual risk behaviors occurred. Since learning of their HIV infection, the majority of participants had reduced their risky sexual behaviors; however, a subset (26%) of participants continued to have unprotected sex, in most cases with multiple partners. Substance use, the social environmental context of the sexual encounter, the psychological impact of HIV on sexual behavior, and partner characteristics were associated with high-risk sexual behaviors in this group. Among high-risk participants, factors associated with risky sexual behaviors clustered, with 57% reporting two or more factors. More intensive interventions are needed for this subset of youths living with HIV, including assessment and treatment for substance use and mental health issues, strategies for stress reduction, and partner interventions.
The North American Free Trade Agreement (NAFTA) and Mexican nursing.
In the context of nurse migration, experts view trade agreements as either vehicles for facilitating migration or as contributing to brain-drain phenomena. Using a case study design, this study explored the effects of the North American Free Trade Agreement (NAFTA) on the development of Mexican nursing. Drawing results from a general thematic analysis of 48 interviews with Mexican nurses and 410 primary and secondary sources, findings show that NAFTA changed the relationship between the State and Mexican nursing. The changed relationship improved the infrastructure capable of producing and monitoring nursing human resources in Mexico. It did not lead to the mass migration of Mexican nurses to the United States and Canada. At the same time, the economic instability provoked by the peso crisis of 1995 slowed the implementation of planned advances. Subsequent neoliberal reforms decreased nurses' security as workers by minimizing access to full-time positions with benefits, and decreased wages. This article discusses the linkages of these events and the effects on Mexican nurses and the development of the profession. The findings have implications for nursing human resources policy-making and trade in services.
The nurse manager narrative project
Traditional Chinese Medicine and Human Immunodeficiency Virus Related Neuropathy: A Case Report
Traditional Chinese medicine and human immunodeficiency virus-associated neuropathy
Peripheral neuropathy is one of the most common neurological complications of human immunodeficiency virus (HIV) infection and continues to impact people living with HIV/AIDS. The pain associated with peripheral neuropathy can be severe and debilitating. Most pharmacological agents are inadequate in symptom management and are accompanied by adverse side-effects. Acupuncture and moxibustion offer treatment approaches that can reduce HIV symptoms and/or the side-effects of anti-retroviral therapy and improve patients' quality of life.
Treatment of HIV Associated Neuropathy with Acupuncture and Moxibustion
What Impact Do Setting and Transitions Have on the Quality of Life at the End of Life and the Quality of the Dying Process?
Whose job is it? Gender differences in perceived role in heart failure self-care
A clinical translation of the research article titled, "alcohol and violence-related injuries among emergency room patients in an international perspective".
A survey of lymphoedema practitioners across the U.S.
Abusive head trauma.
Acculturation among immigrant nurses in Israel and the United States of America.
Former Soviet Union (FSU) nurses in Israel and Filipino registered nurses (RNs) in the United States of America (USA) play significant roles in the delivery of health-care services in their host countries. However, little is known about how they acculturate in a different culture.
Acupuncture and Moxibustion RCT for Distal Symmetric Peripheral Neuropathy in HIV/AIDS: Rationale, Design, Methods, Procedures and Feasibility
Acupuncture/moxibustion RCT for distal sensory peripheral neuropathy in HIV/AIDS: Rationale, design, methods, procedures and logistics
Distal sensory peripheral neuropathy is a common neurological complication experienced by people living with the human immunodeficiency virus (HIV). Traditional Chinese medicine (TCM) may offer effective interventions in the management of its symptoms. To improve the quality and transparency of reporting acupuncture clinical trials, the Consolidated Standards of Reporting Trials (CONSORT) guidelines were developed in 1996 and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) recommendations were introduced in 2001. Incorporating international guidelines, this paper describes the development of a RCT including rationale, design, methods, procedures and logistics for a pilot study aimed at evaluating acupuncture and moxibustion for neuropathy associated with HIV. Using STRICTA guidelines as a template, aspects of clinical research design are explored to further optimise future studies of TCM.
Adverse event reporting in acupuncture clinical trials focusing on pain.
To review the quality of adverse event reporting for published randomized controlled trials (RCTs) focusing on acupuncture for pain reduction. With the release of the Consolidated Standards of Reporting Trials (CONSORT) in 2001, the quality of published RCTs has improved. To improve reporting on adverse events, CONSORT expanded the section on harms (adverse events) in 2004. This paper evaluates whether the updated harms guidelines have been implemented in RCTs evaluating acupuncture for pain relief.
Alcohol Education Provided to Opioid Treatment Program Patients: Results of a Nationwide Survey
An Evidence-based Protocol for Smoking Cessation for Persons with Psychotic Disorders
Analysis & commentary. Unleashing nurse practitioners' potential to deliver primary care and lead teams.
Highly skilled primary care is a hallmark of high-performing health care systems. We examine nurse practitioners' role in delivering primary care and the effects of current restrictions on their ability to practice. By resolving differences between states' individual scope-of-practice regulations, we can fully benefit from the skills of advanced-practice nurses in all fifty states. We recommend substantive changes in the way health care professionals in all disciplines are trained, and in their roles, so that patients can receive appropriate and cost-effective care from skilled and fully functional health care teams.
Anorexia and cachexia
Assessing weight perception accuracy to promote weight loss among U.S. female adolescents: a secondary analysis.
Overweight and obesity have become a global epidemic. The prevalence of overweight and obesity among U.S. adolescents has almost tripled in the last 30 years. Results from recent systematic reviews demonstrate that no single, particular intervention or strategy successfully assists overweight or obese adolescents in losing weight. An understanding of factors that influence healthy weight-loss behaviors among overweight and obese female adolescents promotes effective, multi-component weight-loss interventions. There is limited evidence demonstrating associations between demographic variables, body-mass index, and weight perception among female adolescents trying to lose weight. There is also a lack of previous studies examining the association of the accuracy of female adolescents' weight perception with their efforts to lose weight. This study, therefore, examined the associations of body-mass index, weight perception, and weight-perception accuracy with trying to lose weight and engaging in exercise as a weight-loss method among a representative sample of U.S. female adolescents.
Attribution of hepatitis C virus seroconversion risk in young injection drug users in 5 US cities.
BACKGROUND. In studies of hepatitis C virus (HCV) seroconversion in injection drug users (IDUs), some have questioned whether underreporting of syringe sharing, a stigmatized behavior, has led to misattribution of HCV risk to other injection-related behaviors. METHODS. IDUs aged 15-30 years who were seronegative for human immunodeficiency virus and HCV antibodies were recruited into a prospective study in 5 US cities. Behavioral data were collected via computer-assisted self-interviewing to reduce socially desirable reporting. Hazard ratios (HRs) were estimated to assess associations between behavior and HCV seroconversion. Because the shared use of cookers, cottons, and rinse water was highly correlated, a summary variable was created to represent drug preparation equipment sharing. RESULTS. Among 483 IDUs who injected during the period covered by the follow-up assessments, the incidence of HCV infection was 17.2 cases per 100 person years; no HIV seroconversions occurred. Adjusting for confounders, the shared use of drug preparation equipment was significantly associated with HCV seroconversion (adjusted HR, 2.66; 95% confidence interval, 1.03-23.92), but syringe sharing was not (adjusted HR, 0.91). We estimated that 37% of HCV seroconversions in IDUs were due to the sharing of drug preparation equipment. CONCLUSIONS. Associations between sharing drug preparation equipment and HCV seroconversion are not attributable to underascertainment of syringe sharing. Avoiding HCV infection will require substantial reductions in exposure to all sources of contaminated blood.
Behavioral and Educational Approaches to Diabetes Self-Management
Cancer Survivors’ views of lymphoedema management
CDC HIV testing guidelines and the rapid and conventional testing practices of homeless youth.
The study's aims were to describe rapid and conventional HIV testing practices and referrals/linkages to services posttest among homeless youth in New York City. We also examined variation among service-involved youth, street youth, and "nomads." Respondent-driven sampling was used to recruit 217 homeless youth who participated in structured interviews. Almost all youth were tested in the past year (82%). Most received pretest/posttest counseling (> 77%). Rapid testing was common and conducted in diverse settings. However, youth reported that rates of referral/linkage to services posttest were low (< 44.4%). Service-involved youth were significantly more likely to receive rapid testing, be tested in the past year, and be tested at a high frequency. Street youth and nomads, those at highest risk for poor health outcomes, had less access to testing and may require creative, low-threshold services. Further, a better understanding of barriers to the use of referrals/linkages to services posttest is needed.
Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors.
To describe women's unexpected and distressing symptom experiences after breast cancer treatment.
Developing a financial framework for academic service partnerships: models of the United States and Europe.
Academic service partnerships (ASPs) are structured linkages between academe and service which have demonstrated higher levels of innovation. In the absence of descriptions in the literature on financial frameworks to support ASPs, the purpose of this paper is to present the supporting financial frameworks of a Swiss and a U.S. ASP.
Diagnosis and management of endometriosis: the role of the advanced practice nurse in primary care.
To discuss the etiology, clinical presentation, diagnosis, and management of endometriosis for the advanced practice nurse (APN) in primary care.
Endometriosis diagnosis and management of endometriosis: The role of the advanced practice nurse in primary care
Ethnographic fieldwork on sexual behavior: Developing ethical guidelines for native researchers
Florence Nightingale: Bring her back to the syllabus
Gathering and appraising the literature
Gender, sexual orientation, and adolescent HIV testing: a qualitative analysis.
Using qualitative data, this article explored the circumstances leading to HIV testing among 59 HIV-infected adolescents recruited from New York City HIV clinics. Results showed differences between the heterosexual women and the gay and bisexual men. Most of the young women were tested during routine health care or self-initiated tests, and most were asymptomatic when they tested positive. Their testing decisions were sometimes based on assessments of their boyfriends' risk behaviors rather than their own. Many young men were experiencing symptoms of illness when they tested positive, and about half of them recognized their symptoms as related to HIV and sought tests. Some young men expressed fear of learning about positive test results, which delayed their testing, and some providers did not initially recommend HIV testing for young men who presented with symptoms. The article concludes that consideration of these gender and sexual orientation-related concerns can facilitate HIV testing among adolescents.
Glycemic control among older adult hematopoietic cell transplant recipients.
Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process. Patients with preexisting diabetes may be at further risk for malglycemic states. The growing number of older adults receiving HCT will substantially increase the likelihood nurses will have to provide care to HCT survivors. Therefore, it is important nurses in all practice settings have an understanding of the short-and long-term effects of glycemic status on immune function.
Health system reconstruction: Perspectives of Iraqi physicians.
In conflict or post-conflict situations, health system reconstruction becomes a critical component of ensuring stability. The purpose of this study was to determine the priorities for health system reconstruction among Iraqi physicians residing in the northern region of the country. A convenience sample of practicing male and female physicians residing in the Kurdish region completed a 13-item survey about health system reconstruction. A total of 1001 practitioners completed the survey with gender breakdown of 29% female and 71% male, all working in different specialty areas. Significant differences between the providers based on gender (p=0.001), specialty (p=0.001) and geographic location (p=0.004) were found to affect the responses of the participants. This study demonstrates that input from healthcare professionals is important for health system reconstruction, but that gender, geography and medical specialty make the process complex.
Herpes simplex virus type 2 associated with HIV infection among New York heterosexuals living in high-risk areas.
Herpes simplex virus type 2 (HSV-2) has been shown to increase the risk of sexual human immunodeficiency virus (HIV) transmission. A matched case-control design was used to examine the association between HSV-2 and HIV infection among heterosexuals in 'high-risk areas' (HRAs) in New York City (NYC). We identified NYC HRAs using HIV surveillance data on heterosexual-related adult HIV diagnoses and USA census data on household poverty. Heterosexuals who were socially or geographically linked to an HRA were recruited using respondent-driven sampling. HIV prevalence was 8.6% and HSV-2 prevalence was 80.1%. Only 6% of HIV-positives knew they were infected. HIV-positive cases were matched to HIV-negative controls on gender, race/ethnicity and age, and tested for antibody to HSV-2. In a multivariate model, HIV infection was associated with HSV-2 infection (adjusted odds ratio [AOR] = 3.5, 95% confidence interval 1.1-11.7) and non-HSV-related sexually transmitted infection diagnosis in the previous year (AOR = 2.6, 1.1-6.2). Effective approaches to HIV risk reduction for individuals with HSV-2 remain uncertain, and these are urgently needed in high-risk communities where multiple social, behavioural and biological factors that facilitate HIV infection coexist.
Hospital staff nurses' work hours, meal periods, and rest breaks. A review from an occupational health nurse perspective.
Registered nurses are the largest group of health care providers in the United States. To provide 24-hour care, hospital staff nurses often work long hours and consecutive shifts, without adequate meal or rest breaks. Serious declines in functioning related to provider fatigue can lead to safety issues for patients and nurses alike. The occupational health nurse can assess the effects of nurses' work hours and break periods on employee health, educate staff on the importance of sleep and deleterious effects of fatigue, and implement programs to improve the work environment. This article examines nurses' work hours, break and meal period laws and regulations, and the role of the occupational health nurse in caring for this group of employees. Overall findings suggest that the expertise of an occupational health nurse in the hospital setting could significantly improve the health and safety of staff nurses.
How persons with chronic hepatitis C in residential substance abuse treatment programs think about depression and interferon therapy.
This secondary analysis of existing qualitative descriptive data is the first to specifically report on how persons undergoing residential treatment for substance abuse think about depression and the risks of neuropsychiatric side effects associated with interferon (IFN) treatment for hepatitis C virus (HCV) infection.
I simulate, therefore I am nursed.
If pelvic inflammatory disease is suspected empiric treatment should be initiated.
To assist the nurse practitioner (NP) to make a rapid diagnosis and develop a treatment plan for pelvic inflammatory disease (PID) in order to assist women to promote their health and reduce their risk of the unnecessary sequelae of infertility, tubal damage, and the possibility of a subsequent ectopic pregnancy.
Innovative collaborations: a case study for academic owned nursing practice.
Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice.
Lymphedema-related symptom distress among breast cancer survivors
Making the diagnosis: idiopathic rapid eye movement sleep behavior disorder.
To present a clinical case of idiopathic rapid eye movement sleep behavior disorder (RBD), differential diagnoses, selected treatments, and the pathology involved.
Migrant drug users: predictors of HIV-related sexual and injection risk behaviors.
Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term "migrant" was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey).
Migrant/seasonal farm workers and day laborers
New nurses' views of quality improvement education.
Quality improvement (QI) is a focus of hospital managers and policymakers. The role of registered nurses (RNs) in QI in hospitals is vital because most hospital-based RNs provide direct care to patients. QI skills are necessary to identify gaps between current care and best practice and to design, implement, test, and evaluate changes and are essential for R.N.s to participate effectively in QI. Newly licensed registered nurses' (new nurses') positions as direct caregivers could have an impact on QI if nurses lack sufficient knowledge, concepts, and tools required for QI.
Nurse practitioners as primary care providers: History, context, and opportunities
Nursing care of patients with cancer
Nursing research: Methods and critical appraisal for evidence-based practice
Overlap of registered nurse and physician practice: implications for U.S. health care reform.
This review offers an analysis of practice overlap between physicians and registered nurses (RNs) who are not advanced practice nurses. Additionally, it spotlights opportunities for expanding traditional professional boundaries to establish novel care delivery models. The examples of RN role expansion offer a beginning for discussion regarding how the health professionals' knowledge and skills can be best used in designing an effective and efficient health care system. Although limited data exist on cost effectiveness and workload implications of the novel care delivery models, policy makers can use the findings of this review to begin to inform U.S. health care reform.
Partner selection among Latino immigrant men who have sex with men.
This qualitative study explored partner selection in a sample of immigrant Latino men who have sex with men (MSM). In-depth interviews were conducted with men living in the greater New York metropolitan area who had been born in Brazil (n = 10), Colombia (n = 14), or the Dominican Republic (n = 9). One focus group was conducted with MSM from each of the three countries (9 Brazilian, 11 Colombian, and 5 Dominican participants). A grounded theory approach revealed three main themes relating to partner selection. The first concerned stereotypes of how Latino and Anglo-American men tend to behave in their sexual encounters and relationships. The participants perceived Latinos to be more affectionate and passionate, whereas they saw Anglo-American men as more independent and practical. These cultural discrepancies sometimes resulted in a preference for Latino partners. A second theme concerned stereotypes of the national groups, including expectations that Brazilians would be sexy and sensual and that Dominicans would have large penises. As found in other research on MSM of color, ethnic and national stereotypes were associated with experiences of sexual objectification. The third theme addressed the importance of masculine characteristics in sexual attraction and partner selection. Negative feelings towards effeminate men who did not conform to normative male physical or behavioral presentation reflect a stigma found inside and outside of the gay community. These findings suggest that gender and ethnic stereotypes play an important role in shaping partner choice and have implications for sexual risk and relationship formation.
Perceived Burdens to Others: A Perspective from breast cancer survivors with lymphedema
Persistence of low drug treatment coverage for injection drug users in large US metropolitan areas.
Injection drug users (IDUs) are at high risk for HIV, hepatitis, overdose and other harms. Greater drug treatment availability has been shown to reduce these harms among IDUs. Yet, little is known about changes in drug treatment availability for IDUs in the U.S. This paper investigates change in drug treatment coverage for IDUs in 90 metropolitan statistical areas (MSAs) during 1993-2002.
Preventing skin breakdown in lymphoedema
Should nursing education be considered advanced practice? Point/Counterpoint
Syphilis in drug users in low and middle income countries.
Genital ulcer disease (GUD), including syphilis, is an important cause of morbidity in low and middle income (LMI) countries and syphilis transmission is associated with HIV transmission.
Tax code reform should keep health in mind
The dental office visit as a potential opportunity for diabetes screening: an analysis using NHANES 2003-2004 data.
The bidirectional relationship between periodontitis and diabetes suggests that the dental visit may offer a largely untapped opportunity to screen for undiagnosed diabetes. To better examine this potential opportunity, data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 were used to determine if a larger proportion of patients with periodontal disease as compared with those without periodontitis would be recommended for screening according to American Diabetes Association (ADA) guidelines. The data were also used to determine whether at-risk individuals with periodontitis visited a dental professional recently, so that they could avail themselves of this opportunity for screening, if offered.
The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes.
An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 +/- 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p < .0001). Systolic blood pressure (p =.01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group x time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.
The effect of language preference on prenatal weight gain and postpartum weight retention in urban Hispanic women.
To describe prenatal weight gain and postpartum loss patterns among Hispanic women receiving prenatal care at an urban community health center by language preference.
The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors.
Despite recent advances in breast cancer treatment, breast cancer related lymphedema (BCRL) continues to be a significant problem for many survivors. Some BCRL risk factors may be largely unavoidable, such as mastectomy, axillary lymph node dissection (ALND), or radiation therapy. Potentially avoidable risk factors unrelated to breast cancer treatment include minor upper extremity infections, injury or trauma to the arm, overuse of the limb, and air travel. This study investigates how providing information about BCRL affects the cognitive and symptomatic outcome of breast cancer survivors.
The effects of an inpatient palliative care team on discharge disposition.
Inpatient palliative care teams' (PCT) contribution to improved quality of life and patient satisfaction as well as decreased utilization and costs has been well established. Yet few studies have examined the specific effect of an inpatient PCT on discharge disposition, despite evidence of an association between hospice enrollment, decreased rehospitalization, and improved resource utilization.
The Evolution and Future of Advanced Practice
The making of a nurse manager: the role of experiential learning in leadership development.
To articulate the experientially acquired knowledge, skill and ethics embedded in nurse manager practice and describe the ways in which they were developed.
The transitional care model for older adults
Treating tobacco dependence in persons with mental illness: Identifying challenges and opportunities
Updating the best practice document (Part I): The charge of the American Lymphedema Framework Project (ALFP)
What nurses need to know about antibiotic resistance
Affect-aware tutors: recognising and responding to student affect
Attracting health professional students to substance abuse research.
Breast cancer survivors' experiences of lymphedema-related symptoms.
As a serious chronic condition from breast cancer treatment, lymphedema or a syndrome of persistent swelling and symptoms is caused by chronic accumulation of lymph fluid in the interstitial spaces of the affected limb or surrounding areas. Although significant prevalence of ongoing multiple symptoms has been reported, little is known about how survivors with lymphedema perceive and respond to lymphedema-related symptoms in their daily lives.
Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial.
Coronary artery disease (CAD) is the major cause of mortality and morbidity in patients with type 2 diabetes. But the utility of screening patients with type 2 diabetes for asymptomatic CAD is controversial.
Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression.
Potential pathways from childhood sexual abuse (CSA) to subsequent romantic intimacy problems were examined in a prospective longitudinal study of 160 ethnically diverse youth with confirmed CSA histories. Participants were interviewed at the time of abuse discovery, when they were 8-15 years of age, and again 1-6 years later. Stigmatization (abuse-specific shame and self-blame) and internalizing symptoms (posttraumatic stress and depressive symptoms), more than abuse severity, explained which youth with CSA histories experienced more sexual difficulties and dating aggression. Stigmatization was found to operate as a predictive mechanism for subsequent sexual difficulties. Internalizing symptoms were not predictive of romantic intimacy problems, although they did show correlational relations with sexual difficulties and dating aggression. Early interventions such as trauma-focused cognitive-behavioral therapy that target stigmatization may be important for preventing the development of sexual difficulties in CSA youth.
Chronic lung disease
Contraceptive use and attitudes among female college students.
Unintended pregnancy is a social issue that severely jeopardizes the quality of life for parents and their children. College age women between the ages of 20-24 have one of the highest rates of unintended pregnancies due to lack of contraceptive use and unsafe sexual practices. Since 80% of college females are sexually active and not seeking to become pregnant, it is important to provide these women with effective contraceptive options. Among this population, Black and Hispanic woman have a disproportionate rate of unintended pregnancies. The purpose of this study was to examine contraceptive attitudes and demographic characteristics among female college students. Participants were grouped into those who use contraceptives consistently, intermittently, or not at all. The sample consisted of 120 racially diverse female college students who were sexually active within the past 3 months. Participants completed the Contraceptive Attitude Scale, contraceptive use tool, and demographic tool. The results showed that there was no significant difference in demographic characteristics and contraceptive attitudes for race, age, marital status, years of college education and income between the contraceptive groups. A majority of participants had a positive attitude regarding contraceptives. Women with higher contraceptive attitude scores were significantly more likely to be consistent contraceptive users. Uninterrupted contraceptive users had significantly higher mean contraceptive attitude scores than intermittent users and nonusers. The results of this study may enable healthcare providers to develop more effective methods of increasing contraceptive use and simultaneously decrease unintended pregnancy rates. Nurses play an integral role by providing women with contraceptive counseling that will assist these women in making an informed decision about contraception use.
Designing and implementing an integrative therapies in primary care subspecialty program
Differences in physical, emotional, and social adjustment of intimate, family, and nonfamily patient-partner dyads based on a breast cancer intervention study.
To assess the degree to which postsurgical adjustment in patients with breast cancer and their partners depends on the nature of the patient-partner dyad relationship.
Distal Sensory Peripheral Neuropathy in HIV: A Case Study
Evidence-based practice challenge: teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students.
The TREAD Evidence-Based Practice Model is a framework for faculty to use in graduate research courses so students can become excellent consumers of the best available evidence to use in their clinical decision making in the practice setting. This model is based on competency in information literacy as the basis for developing evidence-based search strategies to find, appraise, and synthesize Level I evidence, including systematic reviews, meta-analyses, and evidence-based practice guidelines. This model emphasizes the use of standardized critical appraisal tools, such as the Critical Appraisal Skills Programme (CASP) or Appraisal of Guidelines for Research and Evaluation (AGREE), to facilitate user-friendly rapid appraisal of Level I evidence. Faculty are challenged to embrace this paradigm shift, to unlearn how they learned, and to teach their graduate research course focusing on the importance of Level I evidence to enable their graduates to make informed advanced practice decisions and improve patient outcomes.
Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association.
Familias Apoyadas: Latino families supporting each other for diabetes care.
This study was undertaken to improve the cultural and linguistic sensitivity of an established parent-mentor training curriculum for Latino parents of young children newly diagnosed with type 1 diabetes. The cultural sensitivity of curriculum components was determined by interviewing four Latino mothers raising five children (aged 7 to 12 years) with type 1 diabetes. The mothers recommended offering resources in English and Spanish, including access to bilingual taxi service, providing access to family diabetes education on child development and preparation of healthy traditional cultural foods, and training for babysitting children with diabetes. They also suggested offering after-school and weekend diabetes clinics to decrease interference with work and school activities.
HIV care providers' implementation of routine alcohol reduction support for their patients.
Screening and brief intervention (SBI) for alcohol reduction is an important health promoting strategy for patients with HIV, and HIV care providers are optimally situated to support their patients' reduction efforts. We report results from analyses that use data collected from providers (n = 115) in 7 hospital-based HIV care centers in the New York City metropolitan area in 2007 concerning their routine use of 11 alcohol SBI components with their patients. Providers routinely implemented 5 or more of these alcohol SBI components if they (1) had a specific caseload (and were therefore responsible for a smaller number of patients), (2) had greater exposure to information about alcohol's effect on HIV, (3) had been in their present positions for at least 1 year, and (4) had greater self efficacy to support patients' alcohol reduction efforts. Findings suggest the importance of educating all HIV care providers about both the negative impact of excessive alcohol use on patients with HIV and the importance and value of alcohol SBIs. Findings also suggest the value of promoting increased self efficacy for at least some providers in implementing alcohol SBI components, especially through targeted alcohol SBI training.
HIV peripheral neuropathy: Case report & clinical evaluation
HPV vaccination for adolescents. An ethics case study.
Methodological challenges in cross-language qualitative research: a research review.
Cross-language qualitative research occurs when a language barrier is present between researchers and participants. The language barrier is frequently mediated through the use of a translator or interpreter. The purpose of this analysis of cross-language qualitative research was threefold: (1) review the methods literature addressing cross-language research; (2) synthesize the methodological recommendations from the literature into a list of criteria that could evaluate how researchers methodologically managed translators and interpreters in their qualitative studies; (3) test these criteria on published cross-language qualitative studies.
Next-of-Kin's Perspectives of End-of-Life Care
Nursing education in the prevention and treatment of SUD
Pathophysiology of post-breast cancer lymphedema
Point/Counter-Point: Should the DNP Take the NBMLE for Certification?
Post-breast cancer lymphedema: part 2.
As breast cancer survivors often say, lymphedema is more than just a swollen arm. A result of surgical or radiologic breast cancer treatment, it's an abnormal accumulation of lymph in the arm, shoulder, breast, or thoracic area that usually develops within three years of a breast cancer diagnosis but can occur much later. In Part 1 (July) the authors described the pathophysiology and diagnosis of lymphedema. In Part 2 they discuss current approaches to risk reduction, treatment and management of the condition, and implications for nurses.
Post-breast cancer. Lymphedema: part 1.
Lymphedema, which can be a debilitating sequela to breast cancer treatment, is characterized by an abnormal accumulation of lymph in the arm, shoulder, breast, or thoracic area. It may appear gradually or suddenly, and although it usually develops within three years of a breast cancer diagnosis, it can arise much later; survivors remain at lifetime risk. The condition can cause physical discomfort and pain, impaired function, and emotional distress. It's imperative that survivors' risk of lymphedema be reduced and that those who develop it receive help to manage it. Part 1 of this two-part article describes post-breast cancer lymphedema and discusses its diagnosis and measurement. Part 2 (next month) will discuss risk reduction, treatment, and implications for nurses.
Predicting nursing human resources: an exploratory study.
The nurse-to-population ratio (NPOP) is a standard indicator used to indicate a country's health care human resources capacity for responding to its disease burden. This study sought to explore if socioeconomic development indicators could predict the NPOP in a country. Mexico served as the case example for this exploratory study, with the final five variables selected based on findings from a qualitative study analyzing the development of nursing human resources in the country. Multiple linear regression showed that two variables proved significant predictors of the NPOP and the model itself explained 70% of the variance (r( 2) = .7; p = .0000). The findings have multiple implications for nursing human resources policy in Mexico and at a global level as governments attempt to build human capital to respond to population health needs.
Question Corner: Risk reduction practice. National Lymphedema Network
Research news you can use: Base your practice on evidence: Can falls be prevented?
Role development of community health workers: an examination of selection and training processes in the intervention literature.
Research evaluating community health worker (CHW) programs inherently involves these natural community leaders in the research process, and often represents community-based participatory research (CBPR). Interpreting the results of CHW intervention studies and replicating their findings requires knowledge of how CHWs are selected and trained.
The 2009-2013 research agenda for oncology nursing.
The American Lymphedema Framework Project (ALFP) – Identifying issues in the field of lymphedema in the United States: Report of the stakeholder’s meeting
The contribution of malglycemia to mortality among allogeneic hematopoietic cell transplant recipients.
Allogeneic hematopoietic cell transplantation (HCT) continues to be associated with substantial rates of nonrelapse mortality (NRM). Numerous factors influence glucose metabolism among HCT recipients. We hypothesized that "malglycemia," defined as hyperglycemia, hypoglycemia or increased glycemic variability, is associated with increased mortality in HCT patients. In a retrospective cohort study Cox regression was used to assess the association of malglycemia after transplant with day 200 NRM. A total of 66,062 blood glucose (BG) measurements from 1175 adult allogeneic HCT recipients between 2000 and 2005 at the Fred Hutchinson Cancer Research Center were evaluated (median 0.55 values per patient-day, range: 0.09-3.62). Overall, there were 215 cases of NRM by day 200 post-HCT and 601 deaths from any cause throughout observation. After adjustment for previously identified factors associated with NRM, all 3 components of malglycemia were associated with increased NRM when individually modeled as time-dependent covariates. Specifically, the hazard ratio for death was 1.93 for BG >200 mg/dL (P = .0009) and 2.78 for BG >300 (P = .0004) compared with BG 101-150 mg/dL. A minimum BG </=89 was associated with a risk of day 200 NRM 2.17 times that of a minimum BG >89 (P < .0001). The upper quartile of glucose variability was associated with a 14.57-fold increase in risk of NRM by day 200 relative to the first quartile (P < .0001). These retrospective data indicate that malglycemia is associated with mortality following HCT. The applicability of these findings to other situations and whether correcting malglycemia in HCT can lead to reductions in mortality remain to be determined.
The inextricable nature of mental and physical health: implications for integrative care.
There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.
The little things we do
The oral-systemic connection in primary care.
The potential use of gingival crevicular blood for measuring glucose to screen for diabetes: an examination based on characteristics of the blood collection site.
This study examined conditions under which gingival crevicular blood (GCB) could be used to obtain a useful glucose reading to screen for undiagnosed diabetes during routine dental visits.
The Structure of the Lived Experience for Persons Having Undergone rTMS for Depression Treatment.
This phenomenological research study reports preliminary findings about experiences of persons undergoing repeated transcranial magnetic stimulation (rTMS) for depression treatment.
Transcranial Magnetic Stimulation (TMS): An Entirely Novel Form of Treatment in Psychiatry and a Groundbreaking Opportunity for Psychiatric Mental Health Nursing.
'Making the best of it': Chinese women's experiences of adjusting to breast cancer diagnosis and treatment.
This paper is a report of a study to describe Chinese women's experiences of adjusting to breast cancer diagnosis and treatment.
A typology of heart failure self-care management in non-elders.
Heart failure (HF) self-care is extremely challenging and few people master it. Self-care was defined as an active, cognitive process in which persons engage for the purpose of maintaining their health (maintenance) and managing symptoms (management).
Adherence to antiretroviral therapy among older children and adolescents with HIV: a qualitative study of psychosocial contexts.
Abstract Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.
Behavioral interventions for HIV infected and uninfected mothers with problem drinking
Body mass index and nutritional intake in patients with HIV and chronic diarrhea: a secondary analysis.
The purpose of this study was to examine the differences in nutritional intake and body mass index (BMI) in HIV patients with chronic diarrhea via secondary analysis of patients' nutritional diaries. A secondary purpose was to evaluate the quality of diets against national dietary guidelines.
Breast-cancer-related lymphedema: information, symptoms, and risk-reduction behaviors.
To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk-reduction behaviors.
Computer Access and Internet Use Among Urban Youths
Denial and compliance in adults with asthma.
A descriptive study examining the relationship of denial of illness and compliance with inhaled controller asthma medications is conducted with 51 adults taking inhaled asthma controller medications. Affective and cognitive denial are assessed with the Levine Denial of Illness Scale. Severity is determined by portable spirometry; compliance is measured for 2 weeks with DOSER, a microelectronic monitor. The mean percent compliance rate for inhaled controller medications is 36%, with only 10.4% of the participants demonstrating optimal compliance (>80%). Although cognitive denial is not significantly associated with compliance, those in the suboptimal compliance group do have significantly higher information avoidance subscale scores (M = 1.88; p = .02). Affective denial is inversely correlated with compliance (r = -.31; p = .05) and is significantly higher in the suboptimal compliance group (M = 11.51; p =.05). These study findings suggest that affective denial may be a contributor to suboptimal compliance.
Ethical behaviours in clinical practice among Mexican health care workers.
The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as ;dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional-patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.
Exercise among urban-dwelling older adults at risk for health disparities.
This study assessed factors that contribute to exercise in older adults at risk for health disparities living in a predominantly African American urban community. A local health database was used to gain an understanding of these factors, which then could be used to develop programs to improve health within a specific urban community. The sample included 112 participants (mean age = 81); the majority were women and African American. Participants were more likely to exercise if not insured by Medicaid, compared with those who did receive Medicaid. Adults with two or more limitations in instrumental activities of daily living (IADLs) were less likely to exercise. Among those who exercised, those with two or more limitations in IADLs were more likely to exercise less than adults with no such limitations, and adults with high blood pressure were more likely to exercise less than those without high blood pressure. The findings of this study will help generate discussion in both the community and outreach programs to invigorate exercise among older adults at risk for health disparities.
Factors Influencing Drug Use and HIV Risk in Two Nicaraguan Cities
Factors influencing independence in adolescents with sickle cell disease.
Factors that predict successful transition from pediatric to adult care for adolescents with sickle cell disease are not fully understood, making transfer decisions difficult.
Grandparenthood status and health outcomes in midlife African American women with type 2 diabetes.
To describe grandparenthood status and determine the relationship between grandparenthood status, metabolic control, and psychosocial factors in African American women with type 2 diabetes.
Improving the quality of nurse practitioner education: the case of Botswana.
Job satisfaction and acculturation among Filipino registered nurses.
To determine the (a) levels of acculturation and job satisfaction, (b) relationship between acculturation and job satisfaction, and (c) effects of select sociodemographic variables in predicting job satisfaction among Filipino RNs educated in the Philippines who are working in the US.
Language barriers and qualitative nursing research: methodological considerations.
This review of the literature synthesizes methodological recommendations for the use of translators and interpreters in cross-language qualitative research.
Lessons learned from advanced practice nursing payment.
For more than 25 years, advanced practice nurses have been incrementally included as a part of the health care financing structure. Following physician payment revisions at the federal level, advanced practice nurses were overtly recognized as Medicare providers and have participated in the establishment of current procedural terminology codes and the subsequent relative work values associated with payment. Success in this regard has been the result of business, political, and policy savvy that has important lessons for moving forward in any health care restructuring for both nurses and advanced practice nurses. Principles of valuing nurse work, time, and intensity in the Resource-Based Relative Value Scale are discussed with implications for future opportunities of measuring nursing work and any potential relationship to quality outcomes of care.
Lymphedema education among breast cancer survivors undergoing radiotherapy
Making the connections: community capacity for tobacco control in an urban African American community.
Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.
Measuring cultural awareness of nursing students: a first step toward cultural competency.
This pilot study was designed to measure nursing students' level of cultural awareness. It replicated phase II of Rew, Becker, Cookston, Khosropour, & Martinez's (2003) methodological study that developed and tested a Cultural Awareness Scale (CAS). Using a cross-sectional design, the CAS was distributed to nursing students in three nursing programs' (bachelor's, master's, doctoral) beginning and end courses. Cronbach's alpha for the CAS Total instrument was 0.869, with subscale scores ranging from 0.687 to 0.902, comparable to the findings of Rew et al. Given the limitations of this study, results must be viewed with a degree of caution. Recommendations include further educational research in the form of psychometric testing of the CAS among nursing students, including refinement of both the CAS instrument and the demographic tool. The authors also recommend that studies be conducted to determine the validity and reliability of the CAS with nurses in the health care arena.
Meta-regression of hepatitis C virus infection in relation to time since onset of illicit drug injection: the influence of time and place.
The authors examined the relation between time since onset of illicit drug injection (time at risk) and rates of hepatitis C virus (HCV) infection by using meta-regression. In 72 prevalence studies, median time since onset of injection was 7.24 years and median prevalence was 66.02%. The model showed statistically significant linear and quadratic effects of time at risk on HCV prevalence and significantly higher prevalence in developing and transitional countries and in earlier samples (1985-1995). In developed countries post-1995, mean fitted prevalence was 32.02% (95% confidence interval: 25.31, 39.58) at 1 year of injection and 53.01% (95% confidence interval: 40.69, 65.09) at 5 years. In developing/transitional countries post-1995, mean fitted HCV prevalence was 59.13% (95% confidence interval: 30.39, 82.74) at 1 year of injection. In 10 incidence studies, median time at risk was 5.29 years and median cumulative HCV incidence was 20.69%. Mean fitted cumulative incidence was 27.63% (95% confidence interval: 16.92, 41.70) at 1 year of drug injection. The authors concluded that time to HCV infection in developed countries has lengthened. More rapid onset of HCV infection in drug injectors in developing/transitional countries resembles an earlier era of the HCV epidemic in other regions.
New definition and natural history of patients with diffuse pulmonary arteriovenous malformations: twenty-seven-year experience.
Patients with diffuse pulmonary arteriovenous malformations (PAVM), a small but important subset of the PAVM population, have significant morbidity and mortality rates.
Nutritional Intake Related to Lipid Health in HIV: A Secondary Analysis
Screening and assessment of coronary heart disease in HIV-infected patients.
Screening for alcohol use and misuse in older adults: using the Short Michigan Alcoholism Screening Test--Geriatric Version.
The Short Michigan Alcoholism Screening Test--Geriatric Version (SMAST-G) is often used in outpatient settings to detect "at-risk" alcohol use, alcohol abuse, or alcoholism in older adults. As the number of older adults in the United States grows, those who develop problems of abuse and a dependence on alcohol will grow as well. The availability of accurate, easy-to-use screening tools to detect people in need of counseling can increase the number of older adults whose lives can be improved and even lengthened. To watch a free online video of a nurse administering the SMAST-G, go to http://links.lww.com/A271.
Shareholder value and the performance of a large nursing home chain.
To analyze corporate governance arrangements and quality and financial performance outcomes among large multi-facility nursing home corporations (chains) that pursue stakeholder value (profit maximization) strategies.
Sleep disorders, glucose regulation, and type 2 diabetes.
Recent epidemiological, biological, and behavioral evidence suggests that sleep disorders may contribute to the development of diabetes; conversely, diabetes itself may contribute to sleep disorders. Sleep appears to moderate the neurohormones that regulate blood glucose. Sleep deprivation and sleep disorders contribute to pathophysiological changes associated with the development of type 2 diabetes. In people who already have diabetes, sleep deprivation contributes to elevations of hemoglobin A1c. Symptoms that occur as a result of diabetes, such as nocturia and neuropathic pain, may in turn contribute to sleep disturbance and exacerbate sleep deprivation. The purposes of this article are to examine the scientific basis for the associations between diabetes and sleep, identify gaps in the understanding of the empirical underpinnings of these relationships, and propose directions for future research.
The Doctor of Nursing Practice: Looking Back, Moving Forward
Women at work with breast cancer-related lympheodema
A case study of an older adult with severe anemia refusing blood transfusion.
To discuss the diagnosis and treatment of severe anemia in an older adult who presents the challenge of declining blood transfusion in a real-world scenario where critical thinking, evidence-based care, and collaboration with other providers must come together to serve this patient's unique needs.
A Policy Analysis of Access to Health Care Inclusive of Cost, Quality, and Scope of Services
Automatic prediction of frustration
Barriers and strategies for recruiting study participants in clinical settings.
Recruiting participants for research studies is often a challenging task. Recruitment requires careful planning, collaboration, and flexibility on the part of researchers and health care providers at the recruitment sites. This article describes six major barriers to recruiting study participants as identified from a review of the literature and from the coauthors' research experiences. These barriers include challenges related to regulations of the Health Insurance Portabililty and Accountability Act (HIPAA), health care providers' work burden, providers' financial disincentives, competition, health care provider concerns regarding research, and provider protection of patients. Each barrier is described, and specific strategies are suggested based on the empirical literature. In some instances, the coauthors' experiences are also shared.
Cognitive influences on self-care decision making in persons with heart failure.
Despite advances in management, heart failure is associated with high rates of hospitalization, poor quality of life, and early death. Education intended to improve patients' abilities to care for themselves is an integral component of disease management programs. True self-care requires that patients make decisions about symptoms, but the cognitive deficits documented in 30% to 50% of the heart failure population may make daily decision making challenging. After describing heart failure self-care as a naturalistic decision making process, we explore cognitive deficits known to exist in persons with heart failure. Problems in heart failure self-care are analyzed in relation to neural alterations associated with heart failure. As a neural process, decision making has been traced to regions of the prefrontal cortex, the same areas that are affected by ischemia, infarction, and hypoxemia in heart failure. Resulting deficits in memory, attention, and executive function may impair the perception and interpretation of early symptoms and reasoning and, thereby, delay early treatment implementation.
Delirium and Physical Restraint in the Hospitalized Elderly
Functional Status Outcomes of a Nursing Intervention in Hospitalized Elderly
Gender-Specific Approaches to Developing Emotionally Intelligent Learning Companions
HIV risk behaviors among female IDUs in developing and transitional countries.
A number of studies suggest females may be more likely to engage in injection and sex risk behavior than males. Most data on gender differences come from industrialized countries, so data are needed in developing countries to determine how well gender differences generalize to these understudied regions.
Measuring symptom occurrence and symptom distress: development of the symptom experience index.
This paper is a report of a study to assess reliability and construct validity of revised and refined version of the Adapted Symptom Distress Scale: the Symptom Experience Index (SEI).
Mentoring: The essential ingredient in developing the next generation of nursing leaders
Newly licensed RNs' characteristics, work attitudes, and intentions to work.
In an effort to better understand turnover rates in hospitals and the effect of new nurses on them, this study sought to describe the characteristics and attitudes toward work of newly licensed RNs, a population important to both the nursing profession and the health care system.
Nonaneurysmal subarachnoid hemorrhage: a review of clinical course and outcome in two hemorrhage patterns.
Patients who experience a nonaneurysmal subarachnoid hemorrhage differ from patients who suffer an aneurysmal subarachnoid hemorrhage in initial presentation (including neurological examination and computed tomography [CT] scans), clinical course, and outcome. A perimesencephalic distribution of nonaneurysmal subarachnoid blood on CT imaging has been described as a distinct clinical entity with a benign course and an excellent prognosis; research suggests that the majority of these patients have excellent outcomes. In most cases, these patients return to their previous level of functioning. Surviving a subarachnoid hemorrhage can be emotionally devastating to patients and their families and can threaten employment and health insurance eligibility. Using evidence-based practice, neuroscience nurses can reassure and educate patients, staff members, and the public and facilitate their understanding of the clinical course and outcome.
Nursing care of clients with cancer
Potential pathways from stigmatization and internalizing symptoms to delinquency in sexually abused youth.
Although childhood sexual abuse (CSA) has been linked to risk for delinquency, research is limited on the potential pathways from CSA to subsequent delinquent outcomes. A total of 160 youth with confirmed CSA histories were interviewed at the time of abuse discovery, when they were 8 to 15 years of age, and again 1 and 6 years later. The findings supported the proposed relations from stigmatization following the abuse (abuse-specific shame and self-blame attributions) and internalizing symptoms to subsequent delinquency through anger and affiliation with deviant peers. This longitudinal research suggests that clinical interventions for victims of CSA must be sensitive to these affective and cognitive processes and how they affect delinquent activity.
Prescription opioid abuse among enrollees into methadone maintenance treatment.
A multi-state survey of 5663 opioid dependent persons enrolling in 72 methadone maintenance treatment programs (MMTPs) was conducted to determine the prevalence of prescription opioid (PO) abuse, factors associated with PO abuse and sources for POs. Regions where PO abuse was believed to be prevalent were oversampled; primary opioid was defined as the drug used the most before coming to the MMTP. Among primary heroin abusers, 69% reported abusing POs. Opioid abuse frequencies among primary PO abusers were oxycodone (79%), hydrocodone (67%), methadone (40%), morphine (29%), heroin (13%), hydromorphone (16%), fentanyl (9%) and buprenorphine (1%). Correlates (p < or = .01) of PO abuse, using general estimating equations, were: low urbanicity (MMTPs located in comparatively low population density counties), white ethnicity, no history of injecting primary drug, no previous methadone treatment, younger age, chronic pain, and pain as a reason for enrollment. The most frequent sources of POs were dealer, friend or relative, and doctor's prescription; least frequent were Internet and forged prescription. One-third of PO abusers reported a history of injecting their primary drug. PO abuse is highly prevalent among MMTP patients. Future studies should describe HIV/HCV needle injection practices, characteristics that predict treatment outcomes, and factors that contribute to higher prevalence of persistent pain among PO abusers.
Resolution of asymptomatic myocardial ischemia in patients with type 2 diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study.
The purpose of this study was to assess whether the prevalence of inducible myocardial ischemia increases over time in patients with type 2 diabetes.
Syringe disposal among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.
Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.
The $5 man: the underground economic response to a large cigarette tax increase in New York City.
We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase.
The advanced practice nurse in palliative care
The critical role of a pediatric nurse practitioner in an early intervention program for children with prenatal drug exposure.
Validation of dietary intake data in black women with type 2 diabetes.
The validity of baseline dietary intake data in women participating in a culturally competent intervention study for black women with type 2 diabetes was assessed. The relationship of sociodemographic and physiologic factors with underreporting of dietary intake was determined. Criterion validity of dietary intake, which had been assessed using the Nutritionist Five Collection Form, a combination of a standard 2-day dietary recall and a modified, culturally appropriate food frequency questionnaire, was determined. Data were analyzed using First Data Bank Nutritionist Five (version 2.3, 2000, First Data Bank, San Bruno, CA) software. Validation of baseline dietary data in 109 women was performed by calculating the ratio of energy intake to resting metabolic rate. Chi(2) and t tests were used to assess relationships between underreporting and sociodemographic and physiologic factors. Mean ratio of energy intake to resting metabolic rate was 1.46 (+/-0.4). Using a lower limit of 1.35, the prevalence of underreporting was 46.8%. Underreporting was significantly associated with body mass index (P< or =0.001) and waist circumference (P<0.001). Use of this combined dietary recall and modified food frequency questionnaire might, therefore, provide more accurate dietary assessment in this population. Additional modification and validity testing is warranted in this and other populations.
Cancer care in nursing homes.
To review the available scientific literature on cancer care in nursing homes and recommendations for clinical practice and further research are offered.
Caring for clients with cancer
Cavernous malformation within a schwannoma: review of the literature and hypothesis of a common genetic etiology.
The finding of cavernous malformations within tumors of the central or peripheral nervous system is a rare occurrence. We report a case of a histologically proven cavernous malformation found within an eighth cranial nerve schwannoma in a 76-year-old man. The patient presented with progressive loss of hearing on the left, facial pain and dysesthesia. Symptoms improved significantly after the tumor was subtotally resected through a left retrosigmoid craniotomy. Including the present report, 34 cases of cavernous malformations associated with tumors of nervous system origin, 24 cases (71%) involving tumors of Schwann cell origin, and 9 cases (26%) involving gliomas have been published. The cases were classified into two forms based on the type of association. Conjoined association, in which the cavernous malformation is located within the tissue of the nervous system tumor, and discrete association, in which the cavernous malformation and nervous system tumor are in separate locations. We explore the etiology of this association and hypothesize that a common genetic pathway may be involved in a majority of these cases.
Competencies for nursing care of patients with substance related disorders
Concordance of provider recommendations with American Diabetes Association's Guidelines.
To determine if selected client characteristics were factors influencing the provision of provider advice for diet, exercise, smoking cessation, alcohol cessation, eye and foot care, and influenza and pneumonia vaccine for those told by a provider that they had diabetes.
Correlates of spiritual well-being in terminally ill persons with AIDS and terminally ill persons with cancer
Diagnosis: Benign paroxysmal homesickness: Reflections of a former registered alien nurse
Disorders of glucose metabolism in the context of human immunodeficiency virus infection.
To discuss the pathophysiology and the current treatment approaches for the dysregulation of glucose metabolism in the context of human immunodeficiency virus (HIV) infection.
Eligibility for treatment of hepatitis C virus infection among young injection drug users in 3 US cities.
Among 404 injection drug users aged 18-35 who tested positive for hepatitis C virus (HCV) RNA, 96% had conditions that are potentially unwarranted contraindications for HCV treatment (e.g., problem drinking, moderate-to-severe depression, and recent drug injection). Restrictive eligibility criteria may deny treatment to a large proportion of patients who could benefit from it.
Factors Associated With Adherence to Antiretroviral Therapy
HIV and hyperlipidemia: current recommendations and treatment.
In recent years, CVD risk factors have been recognized among individuals living with HIV/AIDS (Dube et al., 2003) and have been associated with the medication regimen (HAART) used to manage the diseases. A specific class of HIV medication, protease inhibitors, has been implicated in elevating serum levels of triglyceride and cholesterol in treated individuals (Green, 2002; Penzak & Chuck, 2000). However, current treatments for hyperlipidemia in HIV are not always effective and can be dose-limited due to interactions with HAART regimens (Currier, 2002). Dietary guidelines by the NCEP have been recommended as the first-line approach to managing this condition. Well-controlled studies are needed to test the effectiveness of the NCEP diet on HIV-positive individuals. Published studies have focused primarily on dietary counseling and have lacked randomization, control groups, and adequate description of the counseling intervention. Because the mechanism associated with dyslipidemia and HAART is not fully understood, rigorously controlled dietary studies may provide the opportunity to investigate how diet metabolically affects lipid levels during HAART treatment.
Immigration and HIV/AIDS in the New York Metropolitan Area.
Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders. The impact of cross-cultural migrations and the importance of studying that impact in terms of demographic characteristics as well as cultural and environmental factors has not received adequate attention in public health research. This collaborative analysis utilizes data from three studies of immigrant groups in New York to describe and compare these factors that provide the context for risk and prevention of HIVAIDS and other health challenges. Data discussed were obtained utilizing multi-method approaches to identify and describe HIV risks among both new and more established immigrant populations within the urban settings of North America, with NYC as a central focus. Demographic and epidemiological data situate the analysis within the larger contexts of US migration and the HIV/AIDS epidemic in NYC. The authors identify risk and protective factors embedded to varying degrees in immigrants' multiple cultures and sub-cultures. The three populations studied include: 1) new Hispanic immigrants from the Dominican Republic, Mexico and Central America; 2) West Indian (Caribbean) immigrants from Jamaica, Trinidad/Tobago and other anglophone Caribbean nations; and 3) South Asian immigrants from India (Indian Americans). The paper seeks differences and commonalities, focusing on the social, attitudinal and behavioral factors that contribute to increased HIV/AIDS vulnerability among these populations. The data presented also identify some of the attitudes and behaviors of individuals and groups, as well as other facilitators and obstacles to transmission for immigrants as they adapt to new environments. Topics addressed include factors affecting HIV/AIDS vulnerability of immigrant groups, goals and expectations, health and mental heath issues, gender role change, sexual risk, alcohol and other drug use, perception of HIV/AIDS risk and implications for prevention.
New Hispanic Migration and HIV Risk in New York
Recruitment of black women with type 2 diabetes into a self-management intervention trial.
The purpose of this study was to evaluate the relationship of recruitment methods to enrollment status in Black women with type 2 diabetes screened for entry into a randomized clinical trial (RCT). Using a cross-sectional study design with convenience sampling procedures, data were collected on recruitment methods to which the women responded (N=236). Results demonstrated that the RCT had a moderate overall recruitment rate of 46% and achieved only 84% of its projected accrual goal (N=109). Chi-square analysis demonstrated that enrollment outcomes varied significantly according to recruitment methods (P=.05). Recruitment methods such as community health fairs (77.8%), private practice referrals (75.0%), participant referrals (61.5%), community clinic referrals (44.6%), community advertising and marketing (40.9%), and chart review (40.4%) demonstrated variable enrollment yields. Results confirm previous findings that indicate that Black Americans may be successfully recruited into research studies at moderate rates when traditional recruitment methods are enhanced and integrated with more culturally sensitive methods. Lessons learned are considered.
Symptom Management of HIV-Related Diarrhea by Using Normal Foods: A Randomized Controlled Clinical Trial
The association of psychological factors, physical activity, neuropathy, and quality of life in type 2 diabetes.
The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p = .0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.
The impact of syringe deregulation on sources of syringes for injection drug users: preliminary findings.
In 2001, New York State enacted legislation to allow the provision of syringes by pharmacies and healthcare providers without prescription (ESAP, the Expanded Syringe Access Demonstration Program). A longitudinal study of IDUs (n=130) found that pre-ESAP, about half used only the safest source (needle exchange programs [NEPs]). Post-ESAP implementation, ESAP sources were initiated by 14%. Frequency of injection was related to ESAP use and those who used unsafe (or possibly unsafe) sources were as likely to use ESAP as those who had previously used only NEPs. The findings indicate that providing multiple sources of safe syringes for IDUs is necessary.
The research process: Integrating evidence-based practice
The research process: Integrating evidence-based practice
The SATOL Project
The value of reminiscence in hospice care
Transforming a graduate nursing curriculum to incorporate evidence-based practice: The New York University experience
Understanding sickle cell disease in African American women
Using latent class analysis to identify patterns of hepatitis C service provision in drug-free treatment programs in the U.S.
Hepatitis C virus (HCV) infection is a global health problem, and in many countries (including the U.S.), illicit drug users constitute the group at greatest risk for contracting and transmitting HCV. Drug treatment programs are therefore unique sites of opportunity for providing medical care and support for many HCV infected individuals. This paper determines subtypes of a large sample of U.S. drug-free treatment programs (N=333) according to services they provide to patients with HCV infection, and examines the organizational and aggregate patient characteristics of programs in these subtypes. A latent class analysis identified four subtypes of HCV service provision: a "Most Comprehensive Services" class (13% of the sample), a "Comprehensive Off-Site Medical Services" class (54%), a "Medical Monitoring Services" class (8%) and a "Minimal Services" class (25%). "Comprehensive" services class programs were less likely to be outpatient and private for profit than those in the other two classes. It is of concern that so many programs belong to the "Minimal Services" class, especially because some of these programs serve many injection drug users. "Minimal Services" class programs in the U.S. need to innovate services so that their HCV infected patients can get the medical and support care they need. Similar analyses in other countries can inform their policy makers about the capacity of their drug treatment programs to provide support to their HCV infected patients.
A community-based intervention designed to increase preventive health care seeking among adolescents: the Gonorrhea Community Action Project.
We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents.
Cultural factors in oral contraceptive compliance
Developing creativity, motivation, and self-actualization with learning systems
Fathers??? Reflections on Parenting Young Children With Type 1 Diabetes
Improving Diagnostic Accuracy Using an Evidence-Based Nursing Model
Metabolic control, self-management and psychosocial adjustment in women with type 2 diabetes.
To examine factors associated with metabolic control, self-management (diet and exercise behaviour), and psychosocial adjustment (diabetes-related distress) in women with type 2 diabetes.
Necessary Leaps for Addictions Nursing Education and Practice
Practice patterns and potential solutions to the shortage of providers of older adult mental health services.
Little is known about the contribution of advanced practice nurses (APNs) to the mental health care of older adults. This study describes mental health services to older adults by APNs compared with primary care physicians, psychiatrists, psychologists, and social workers. The study uses a retrospective, cross-sectional design with a 5% national sample of 1999 Medicare outpatient claims. Bivariate statistics and multinomial logit models were used to determine differences among these mental health providers. A small proportion of the nationally available providers (10.4%) submitted claims for mental health services rendered to older adults. APNs, psychiatrists, and primary care physicians care for a disproportionate number of rural and poor older adults with complex medical/psychiatric needs compared with psychiatrists, psychologists, and social workers. APNs seem to be an untapped resource for providing mental health services to older adults. Health policy reform is needed to remove barriers to meet mental health care needs.
Promoting Children's Health Through Understanding of Genetics and Genomics
Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.
Research challenges to the study of HIV/AIDS among migrant and immigrant Hispanic populations in the United States.
Migrant populations have been found to be at risk of HIV/AIDS. The growth in immigrant and migrant Hispanic populations in the United States increases the need to enhance understanding of influences on their HIV-risk behaviors. Four challenges to conducting research among these populations were identified: (1) the need to use multilevel theoretical frameworks; (2) the need to differentiate between Hispanic subgroups; (3) challenges to recruitment and data collection; and (4) ethical issues. This article describes how two studies of Hispanic immigrants and migrants in the New York area addressed these challenges. One study focused on new immigrants from Mexico, the Dominican Republic, El Salvador, Honduras and Guatemala, and a second study focused on Puerto Rican drug users. Both studies incorporated qualitative and quantitative methods to study these hard-to-reach populations. Continued study of the sociocultural and contextual factors affecting HIV risk for mobile populations, and addressing the research challenges, is crucial to developing effective intervention programs.
Research vs. support: Focus group participants living with HIV/AIDS
Residential Substance User Treatment Programs as Venues for HCV Pharmacological Treatment: Client and Staff Perspectives
Tandem practice model: a model for physician-nurse practitioner collaboration in a specialty practice, neurosurgery.
To describe the benefits of a physician-nurse practitioner (NP) collaborative practice model, specifically that of a tandem practice model, using a neurosurgeon and a primary care NP in the clinic and inpatient setting.
A comparison of HCV antibody testing in drug-free and methadone maintenance treatment programs in the United States.
Drug treatment programs are uniquely situated to screen patients for antibodies for hepatitis C virus (HCV), an infectious disease that has reached epidemic proportions among drug users. This paper compares the accessibility and patients' use of opportunities for HCV antibody testing in a large sample of methadone and drug-free treatment programs (N=256) in the US, and reports programs' recent changes and future plans concerning it. Results indicate that almost all methadone and about two-thirds of drug-free programs in the sample provided HCV antibody screening to at least some patients in 2001. While about two-thirds of the methadone and close to one-third of the drug-free programs offered this service to all patients, these programs report that only about 3/5 of their patients actually provided specimens for testing for HCV antibodies. Some drug treatment programs were planning to increase the availability and accessibility of HCV antibody screening, but others were planning to cut back on these services, primarily due to limited resources. These results can inform policymakers who advocate for increased HCV antibody screening in drug treatment programs about the current level and future plans for implementing these services, illuminating where resources and motivational efforts need to be targeted.
A Culturally competent intervention of education and care for black women with type 2 diabetes
Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities.
Care transitions are commonplace for ill older adults, but no studies to our knowledge have examined the occurrence of iatrogenic harm from medication changes during patient transfer.
Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits.
To examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits.
Comparison of Nurse Practitioner and Family Physician Relative Work Values
Delirium in the Medically Ill Elderly: Operationalizing the DSM-III Criteria
Developing Passion and Excellence in Critical Care Nursing: Proposed Solutions to Current Challenges in Critical Care
Factors Influencing Participation in Weekly Support Groups Among Women Completing an HIV/STD Intervention Program
Frail Older Patient Care by Interdisciplinary Teams
HIV incidence among high-risk Puerto Rican drug users: a comparison of East Harlem, New York, and Bayamón, Puerto Rico.
Lymphedema following breast cancer treatment, including sentinel lymph node biopsy.
To compare the occurrence, signs, and symptoms of lymphedema (LE) the arms of women after axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), combined SLNB and ALND (Both), or neither as part of breast cancer diagnosis and treatment, a concurrent descriptive-comparative cross-sectional four-group design with retrospective chart review was carried out. In a convenience sample of 102 women treated for breast cancer and receiving follow-up care at a midwestern United States cancer center, sequential circumferential measurements at five selected anatomical sites along both arms and hands were used to determine the presence of LE (> or = 2 cm differences between sites). Participants self-reported LE-related signs and symptoms by interview and completion of the Lymphedema and Breast Cancer Questionnaire (LBCQ). Retrospective chart review was carried out to verify lymph node-related diagnostic and treatment procedures. Based on node group, LE occurred as follows: 43.3% (29 of 67) of women who underwent ALND alone; 22.2% (2 of 9) of those who underwent SLNB alone; 25.0% (3 of 12) of those with combined SLNB and ALND; and 22.2% (2 of 9) with neither SLNB nor ALND. LE-related symptoms were reported by women who underwent ALND alone, SLND alone, combined SLNB and ALND, and neither. Among the node groups, three symptoms were more common: larger arm size, firmness/tightness in past year, and numbness in past year. We conclude that circumferential measurements of the upper arm and forearm may be critical for distinguishing LE from no LE. Overall, the proportion of women who experienced LE-related signs and symptoms was higher among women who underwent ALND versus SLNB. However, numbness and tenderness frequently were reported by those undergoing ALND, SLNB or both; and by women without LE. It is possible that some frequently occurring symptoms, such as numbness and tenderness, may be related to breast cancer surgery and not LE. Findings from this study can assist health professionals in educating women with breast cancer about LE risk factors, as well as early detection and management of LE by using the LBCQ and sequential circumferential arm measurements to evaluate limb changes subjectively and objectively concurrent with each breast cancer survivor's follow-up care.
Post-breast cancer lymphedema and management
Primary health care associates: An innovative model of clinical practice. National Organizations of Nurse Practitioner Faculties
Qualitative needs assessment of HIV services among Dominican, Mexican and Central American immigrant populations living in the New York City area.
This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PLWAs (persons living with AIDS) and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experiences and knowledge of HIV care issues. A total of 57 men and women participated, ranging in age from 19-61. Results included detailed information on cultural meanings of HIV/AIDS; experience of stigma and rejection; gendered health-seeking behaviour; testing issues; and satisfaction with services. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty, repressive governments, lack of education/literacy, ethnicity, class, colour-based stigma and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behaviour. AIDS agencies were seen to play a crucial role in connecting PLWAs to services and resources. The key elements for the provision of services to this population appear to be those that build on cultural norms and network human and institutional resources.
Rehab instead of prison: drug courts provide opportunities for nurse practitioners.
The content and comprehensiveness of hepatitis C education in methadone maintenance and drug-free treatment units.
Although drug users are at elevated risk for hepatitis C virus (HCV) infection, many are uniformed or misinformed about the virus. Drug treatment programs are uniquely situated to provide comprehensive risk-modifying educational programs for decreasing HCV transmission, a strategy advocated in the most recent National Institutes of Health Consensus Development Conference Statement on the Management of Hepatitis C. Given the large proportion of patients that inject drugs in methadone maintenance treatment programs and the high prevalence of HCV among drug injectors, we compared a nationwide sample (N = 246) of methadone maintenance treatment programs and drug-free programs regarding the content and comprehensiveness of HCV education. All of these programs provide HCV education to at least some of their patients. Results indicated that, compared to drug-free programs, methadone maintenance treatment programs cover a significantly greater number of HCV-related topics, and that a significantly greater proportion of the methadone programs cover specific topics (e.g., how to avoid transmitting HCV, the importance of testing for HCV, treatment options if HCV positive). Of special concern is that fewer than three quarters of the drug-free programs address what to do if co-infected with human immunodeficiency virus (HIV) and HCV and how to maintain health if HCV positive, and only about half of the drug-free and methadone maintenance treatment programs educate HCV-positive patients about the importance of obtaining vaccinations for hepatitis A and B. Drug treatment programs need to educate patients about the proactive steps these individuals can take to deal with HCV, provide critically needed HCV services, and encourage patients to make full use of these services.
The transition of elderly patients between hospitals and nursing homes. Improving nurse-to-nurse communication.
Lack of patient information is a particular problem when a patient is transferred from one health care facility to another. The lack of information needed to develop a timely and effective plan of care for an older adult transferred to the nursing home facility may exacerbate disruptions in the older adult's care. Also, adjustment or readjustment to the nursing home or hospital environment may be prolonged. Persistence of problems or difficulty in adjustment may then lead to exacerbation of the disease processes and, ultimately, hospital readmissions. Evidence suggests that elderly patients discharged from the hospital have high readmission rates. Although the patient is most affected by a breakdown in communication, everyone in the nursing home involved in the resident's care is also affected. All staff who provide care to the resident, including nursing, medicine, nutrition, pharmacy, social work, and physical therapy staff members, must be cognizant of issues related to communication for patients being transferred. In this article, the authors discuss the development, implementation, and results of a model designed to increase the communication surrounding the transition of elderly patients from an inpatient unit to and from nursing homes.
Therapeutic effects of exercise on fatigue
Using focus groups to identify asthma care and education issues for elderly urban-dwelling minority individuals
Clinical leadership in action: Lionel’s story
Cultural Factors Influencing HIV Risk Behavior Among Dominicans in New York City
End of life care planning
End of life care planning
Faculty practice: facilitation of clinical integrations into the academic triad model
Integrating qualitative and quantitative methods: comparing HIV-related risk behaviors among Puerto Rican drug users in Puerto Rico and New York.
Multidisciplinary Care of Hepatocellular Carcinoma
Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities.
Little is known about the prevalence and characteristics of chronic pain among patients with different types of chemical dependency.
SHAPING THE ADVANCED PRACTICE PSYCHIATRIC-MENTAL HEALTH NURSING ROLE: A FUTURISTIC MODEL
The role of social and behavioral science in public health practice: a study of the New York City Department of Health.
Studies over the last decade have demonstrated the effectiveness of public health interventions based on social and behavioral science theory for many health problems. Little is known about the extent to which health departments are currently utilizing these theories. This study assesses the application of social and behavioral science to programs in the New York City Department of Health (NYCDOH). Structured open-ended interviews were conducted with executive and program management staff of the health department. Respondents were asked about the application of social and behavioral sciences within their programs, and about the benefits and barriers to increasing the use of such approaches. Themes related to the aims of the study were identified, a detailed coding manual developed, narrative data were coded independently by two investigators (kappa.85), and data analyzed. Interviews were conducted with 61 eligible individuals (response rate 88%). The most common applications of social and behavioral science were individual-level behavior change to prevent HIV transmission and community-level interventions utilizing community organizing models and/or media interventions for health promotion and disease prevention. There are generally positive attitudes about the benefits of utilizing these sciences; however, there are also reservations about expanded use because of resource constraints. While NYCDOH has successfully applied social and behavioral sciences in some areas of practice, many areas use them minimally or not at all. Increasing use will require additional resources. Partnerships with academic institutions can bring additional social and behavioral science resources to health departments and benefit researchers understanding of the health department environment.
Treat DVT with low molecular weight heparin.
Warfarin toxicity. A case study.
A model for successful foster child–foster parent relationships
A nationwide survey of hepatitis C services provided by drug treatment programs
Acute myocardial infarction in the elderly with diabetes
Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus.
To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non-insulin- or insulin-treated diabetes.
Critical reading strategies: Overview of the research process
Developing a collaborative community, academic, health department partnership for STD prevention: the Gonorrhea Community Action Project in Harlem.
Community interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.
Elder Abuse and Neglect
Gerontologic nurse practitioner preceptor guide
Methodologic Issues in Conducting Research on Hospitalized Older People
Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: a preliminary study.
To explore patients' perceptions of fatigue in response to biochemotherapy treatment for metastatic melanoma.
The Chinese translation of the Index of Nausea, Vomiting, and Retching.
The purpose of this study was to determine reliability and validity of the Chinese version of the Index of Nausea, Vomiting, and Retching (INVR) and the Index of Nausea and Vomiting Form 2 (INV-2) to provide a reliable and valid measure of nausea, vomiting, and retching for Chinese nurses and other healthcare providers. An integrative translation method was used in the study. The reliability and validity of the Chinese versions of the INVR and the INV-2 was evaluated using test-retest, parallel forms, and crossover design. A convenience sample of 177 Chinese-speaking participants was accrued from a large teaching cancer institute and a teaching obstetric hospital in Beijing, Peoples Republic of China. The integrative translation method was proven to be an effective method for translating instruments from the source to the target language. The Chinese versions of both the INV-2 and INVR were found to have high Cronbach's alpha scores and high agreement rates. The responses to the Chinese version of INVR were more frequently consistent than the responses to the INV-2. The majority of the patients voiced preference for the INVR. The findings suggest the significance of the Chinese versions of INVR and INV-2 in terms of nursing practice. The findings also support the cross-cultural method for future study at international level.
A multivariate validation of the defining characteristics of fatigue
Concurrence of drug users' self-report of current HIV status and serotest results.
This study examines the concurrence of drug users' self-reports of current HIV status with serotest results. The analyses are based on data obtained from face-to-face interviews with 7,256 out-of-treatment injection drug and/or crack users in 10 sites that participated in the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program (funded by the U.S. National Institute on Drug Abuse ). Although the degree of concurrence between HIV-negative individuals' self-reports of their current HIV status and their serotest results was high (specificity, 99%), this was not the situation for individuals who tested positive for HIV (sensitivity, 44%).
Modeling Relationships Between Two Categorical Variables When Data Are Missing: Examining Consequences of the Missing Data Mechanism in an HIV Data Set.
Analysts evaluating the strengths of relationships between variables in behavioral science research must often contend with the problem of missing data. Analyses are typically performed using data for cases that are either complete in all the variables, or assume that the data are missing at random. Often, these approaches yield biased results. Using empirical data, the current work explores the implications and consequences of using various statistical models to describe the association of two variables, one ordinal and one dichotomous, in which data are incomplete for the dichotomous variable. These models explicitly reflect the missing data mechanism; models that hypothesize nonignorable nonresponse are given particular attention. Both the statistical fit and substantive consequences of these models are examined. This new methodological approach to examining nonignorable nonresponse can be applied to many behavioral science data sets containing an ordinal variable.
Naturally occurring retirement communities (NORCs)
Providing optimal hands-on experience: A guide for clinical preceptors
Behavioral health home care
Community-based and long-term care
Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts.
To examine predictors of continued restraint use in nursing home residents following efforts aimed at restraint reduction.
Fluid-gas transport: Oxygenation
The HIV/AIDS patient and home infusion therapy
The patient with an impaired immune system: HIV/AIDS
The strength of many voices: A review of John Hopkins guide to diabetes
Guía para el cuido personal con VIH/SIDA
Outsourcing for hospital services
The "VANAC team": establishing a cancer prevention team. VA Nurses Against Cancer.
Nurses recognize the increasing need to focus on primary and secondary prevention of cancer, yet the demands of current staffing prohibit many nurses from organizing and/or participating in cancer prevention and detection activities. This article describes an innovative program established at the Bronx Veterans Affairs Medical Center (VA). Funded by an American Cancer Society professional education grant, nurses at the Bronx VA formed the "VANAC" Team (VA Nurses Against Cancer). The camaraderie of a team approach invited generalist nurses to become involved with the program. The formation and activities of the team are described. After an intensive orientation, nurses participated in a wide range of educational activities, including patient education, staff seminars, and community presentations. The logistics of arranging such a program are discussed and recommendations for future direction are offered. It is hoped that nurses in other institutions can adapt the VANAC approach to their individual settings, thereby increasing the number of nurses involved in cancer prevention.
Home health in rural Kenya
Despite the many environmental and cultural differences, many similarities exist between home health nursing in Kenya and the United States. Family-focused care is the goal, with emphasis on education and prevention.
Arithmetic versus harmonic mean values for cyclosporin-A pharmacokinetic parameters.
The harmonic and arithmetic mean values for volume of distribution at steady state, half-life, and clearance of intravenous cyclosporin-A were calculated using an index set of 22 renal transplant candidates to determine if harmonic mean values provide a less biased estimate of central tendency than arithmetic mean values. Cyclosporin-A was measured using a nonspecific radioimmune assay method. The arithmetic mean value for volume of distribution was 16% larger than calculations by the harmonic mean method. Similarly, the arithmetic mean half-life and clearance values were larger than harmonic mean values by 10% and 15%, respectively. However, 95% confidence intervals for these pharmacokinetic parameters overlapped. When these mean pharmacokinetic parameter values were used to predict actual values in a test group of 22 renal transplant candidates receiving cyclosporin-A, similar levels of precision were demonstrated by either method. Both methods produced positively biased predictions for volume of distribution and clearance. However, these differences were not significant. These findings suggest there is little practical value for the use of harmonic mean calculations to describe the central tendency of pharmacokinetic parameters of cyclosporin-A under the conditions studied. The value of harmonic mean values for pharmacokinetic parameters in other patient populations or with other assay methods for cyclosporin remain to be studied.
Extracorporeal circulation as an alternative to open-chest cardiac compression for cardiac resuscitation.
Open-chest direct cardiac compression represents a more potent but highly invasive option for cardiac resuscitation when conventional techniques of closed-chest cardiac resuscitation fail after prolonged cardiac arrest. We postulated that venoarterial extracorporeal circulation might be a more effective intervention with less trauma. In the setting of human cardiac resuscitation, however, controlled studies would be limited by strategic constraints. Accordingly, the effectiveness of open-chest cardiac compression was compared with that of extracorporeal circulation after a 15-min interval of untreated ventricular fibrillation in a porcine model of cardiac arrest. Sixteen domestic pigs were randomized to resuscitation by either peripheral venoarterial extracorporeal circulation or open-chest direct cardiac compression. During resuscitation, epinephrine was continuously infused into the right atrium, and defibrillation was attempted by transthoracic countershock at 2-min intervals. Systemic blood flows averaged 198 ml.kg-1.min-1 with extracorporeal circulation. This contrasted with direct cardiac compression, in which flows averaged only 40 ml.kg-1.min-1. Coronary perfusion pressure, the major determinant of resuscitability on the basis of earlier studies, was correspondingly lower (94 vs 29 mm Hg). Extracorporeal circulation, in conjunction with transthoracic DC countershock and epinephrine, successfully reestablished spontaneous circulation in each of eight animals after 15 min of untreated ventricular fibrillation. This contrasted with the outcome after open-chest cardiac compression, in which spontaneous circulation was reestablished in only four of eight animals (p = .038). We conclude that extracorporeal circulation is a more effective alternative to direct cardiac compression for cardiac resuscitation after protracted cardiac arrest.
[The osteoprotective effect of ovarian hormones].
Osteoporosis is regarded as a disease of the systems controlling bone evolution. Estrogen modulates such a control system; without estrogen 50% of bone is not formed to the peak bone mass or may be lost lateron. Substitution with estrogen can be interpreted as a natural right of the women in our society. Estrogen modulates by dynamic hormonal system the genexpression in bone and determines its three-dimensional architecture. Substitution with estrogen has to consider the individual genetic situation of each women and its biographic and health situation. Individual estrogen substitution is not fully realized yet but estrogen substitution prevents osteoporosis effectively. We question if senile osteoporosis exists at all if there were no estrogen deficiency.
Incorporating cancer prevention interventions into the home health visit
[Fracture of the styloid process].
The fracture of the styloid process is relatively rare. Most times the fracture is not obvious due to the lack of severe injuries, and remains without diagnosis and symptoms. It may be the result of other causes than that of injury in the head and neck region. The presenting case is of interest because of the referred symptoms.
Priapism in child with chronic granulocytic leukemia.
Digitoxin metabolism by rat liver microsomes.
The beige mouse is an animal model for the human Chediak-Higashi syndrome, a disease characterized by giant lysosomes in most cell types. In mice, treatment with androgenic hormones causes a 20-50-fold elevation in at least one kidney lysosomal enzyme, beta-glucuronidase. Beige mice treated with androgen had significantly higher kidney beta-glucuronidase, beta-galactosidase, and N-acetyl-beta-D-glucosaminidase (hexosaminidase) levels than normal mice. Other androgen-inducible enzymes and enzyme markers for the cytosol, mitochondria, and peroxisomes were not increased in kidney of beige mice. No significant lysosomal enzyme elevation was observed in five other organs of beige mice with or without androgen treatment, nor in kidneys of beige females not treated with androgen. Histochemical staining for glucuronidase together with subcellular fractionation showed that the higher glucuronidase content of beige mouse kidney is caused by a striking accumulation of giant glucuronidase-containing lysosomes in tubule cells near the corticomedullary boundary. In normal mice lysosomal enzymes are coordinately released into the lumen of the kidney tubules and appreciable amounts of lysosomal enzymes are present in the urine. Levels of urinary lysosomal enzymes are much lower in beige mice than in normal mice. It appears that lysosomes may accumulate in beige mice because of defective exocytosis resulting either from decreased intracellular motility of lysosomes or from their improper fusion with the plasma membrane. A similar defect could account for characteristics of the Chediak-Higashi syndrome.
The psychological reactions of children to burn traumata: a review. Part II.
1. Diethyl ether, which is known to be partly metabolized in vivo, has been found to show an O2 uptake with the rat liver microsomal membranes; a similar reaction is given with other short chain aliphatic ethers, isoproply and n-butyl ether. 2. The "etherase" reaction is optimal at pH 7.2-7.4 and is not accompanied by an increased formation of malondialdehyde. 3. When CoA is added to the microsomes together with a source of oxaloacetate and the consensing enzyme synthase, the etherase present forms citrate from diethyl ether, indicating an acetylation of CoA, which then enters the citric acid cycle. 4. Similarly to 3, fluorocitrate is formed from methyl fluoroethyl ether. 5. Differing from plasmalogens, a tetrahydropteridine does not have to be added as a co-factor.
Riding as a joy (and aid) to handicapped children.
A comparison of second-degree baccalaureate and traditional-baccalaureate new graduate RNs: implications for the workforce.
The purpose of this study was to describe the differences between traditional-baccalaureate graduates (TBGs) who had a baccalaureate degree in nursing and no other academic degree or diploma and second-degree baccalaureate graduates (SDGs) who had both a baccalaureate degree in nursing and a baccalaureate or higher degree in a field other than nursing. Using a sample of 953 newly licensed registered nurses (NLRNs), we compared SDGs and TBGs on demographic and work characteristics, including attitudes toward work, intent to stay in their current job, and whether they are searching for a job. TBGs worked slightly more hours per week and were more likely to provide direct care. SDGs were more likely to plan to stay indefinitely in their first job and were less uncertain of plans to stay. SDGs experienced higher family-work conflict and lower workgroup cohesion. Full-time SDGs earn over $2,700 more income per year. Potential explanations for the salary difference are the greater human capital that SDGs bring to the job and their older age. Understanding the workforce productivity of these two groups is important for both organizational planning and policy for recruitment and retention.
A guide to scholarly writing in nursing.
A patient-education tool for patient-controlled analgesia.
To develop a pamphlet for educating patients about patient-controlled analgesia (PCA).
A single-item approach to screening elders for oral health assessment.
Oral health contributes significantly to overall health. Finding a single item that can be used by primary care providers to screen elders who are in need of oral care is important.
A situation-specific theory of heart failure self-care.
Heart failure, a common syndrome in developed countries worldwide, is associated with poor quality of life, frequent rehospitalizations, and early death. Self-care is essential to improving outcomes in this patient population. The purpose of this article is to describe a situation-specific theory of heart failure self-care in which self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Self-care maintenance is further defined to encompass routine symptom monitoring and treatment adherence. Self-care management is characterized as a process initiated by symptom recognition and evaluation, which stimulates the use of self-care treatments and treatment evaluation. Confidence in self-care is thought to moderate and/or mediate the effect of self-care on various outcomes. Four propositions were derived from the self-care of heart failure conceptual model: (1) symptom recognition is the key to successful self-care management; (2) self-care is better in patients with more knowledge, skill, experience, and compatible values; (3) confidence moderates the relationship between self-care and outcomes; and (4) confidence mediates the relationship between self-care and outcomes. These propositions were tested and supported using data obtained in previous research. Support of these propositions provides early evidence for this situation-specific theory of heart failure self-care.
Abusive head trauma: a case study.
Abusive head trauma (AHT) has greater mortality and morbidity than any other form of physical abuse. Therefore, early recognition and accurate diagnosis are essential for comprehensive investigation and appropriate treatment of infants who present with this devastating traumatic injury. Advanced practice nurses need to have a thorough understanding of AHT in order to promptly and accurately assess and manage these infants. Using a case-based approach, the epidemiology, pathophysiology, mechanisms of injury, clinical presentation, diagnosis, and treatment of AHT are described. This article also discusses AHT prevention and implications for advanced practice nurses caring for these patients.
Advanced nursing practice and research contributions to precision medicine.
Genomic discoveries in the era of precision medicine hold the promise for tailoring healthcare, symptom management, and research efforts including targeting rare and common diseases through the identification and implementation of genomic-based risk assessment, treatment, and management. However, the translation of these discoveries into tangible benefits for the health of individuals, families, and the public is evolving.
Age differences in post-breast cancer lymphedema signs and symptoms.
This secondary data analysis was designed to explore the age differences in lymphedema (LE) occurrence and self-reported symptoms in post-breast cancer LE. A descriptive-exploratory cross-sectional design was used with a convenience sample composed of 102 women treated and followed for breast cancer at a midwestern cancer center. Sequential circumferential arm measurement was used to estimate limb volume differences. Self-reported symptoms were assessed by the Lymphedema and Breast Cancer Questionnaire (LBCQ) designed and tested by the research team. Lymphedema occurrence was relatively higher (41.2%) in breast cancer survivors younger than 60 than in those older than 60 (30.6%). Six subjectively reported symptoms were found to occur more often (P </= .05) in the younger women with LE: numbness now and in the past year, tenderness in the past year, aching now and in the past year, increased temperature in arm now. Numbness, tenderness, and aching were the most prevalent symptoms among women in both age groups regardless of LE presence. Our findings suggest that younger breast cancer survivors may have increased LE risk and report LE-related symptoms more often. Future research should focus on age differences in LE risk, occurrence, and perceptions of LE-related symptoms in women treated for breast cancer.
An integrated approach to an analysis of symptom management in patients with cancer.
To provide a definition, describe uses, and identify essential attributes of symptom management by emphasizing the philosophical base for the concept.
An update on the self-care of heart failure index.
The Self-care of Heart Failure Index (SCHFI) is a measure of self-care defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiological stability (maintenance) and the response to symptoms when they occur (management). In the 5 years since the SCHFI was published, we have added items, refined the response format of the maintenance scale and the SCHFI scoring procedure, and modified our advice about how to use the scores.
Are we teaching what patients need to know? Building skills in heart failure self-care.
Heart failure (HF) self-care requires both knowledge and skill, but little attention has been given to identify how to improve skill in HF self-care. The objective was to assess what self-care skills patients with HF perceive that they need and how they developed the skills needed to perform self-care.
Attitudes and beliefs for effective pediatric nurse practitioner and physician collaboration.
The purpose of this study was to explore the attitudes and beliefs of pediatric nurse practitioners (PNPs) and pediatricians concerning collaborative practice relationships and to explore the themes that emerged to establish a definition of collaborative practice between PNPs and pediatricians as it applies to current practice trends.
Barriers and facilitators in implementing "prevention for positives" alcohol-reduction support: the perspectives of directors and providers in hospital-based HIV care centers.
HIV-infected patients have considerable need for alcohol reduction support, and HIV care providers are strategically placed to implement a "prevention for positives" alcohol-reduction approach through alcohol screening and brief interventions (SBIs). To facilitate this approach, we provided alcohol SBI education and training to HIV care providers in four hospital-based, New York City HIV Care Centers in 2007. Interviews with the medical directors and 14 of the HIV care providers who attended the training identified barriers to implementing alcohol SBIs. These included limited time for alcohol screening, patients' incomplete disclosure of alcohol use, providers' perceptions that alcohol use is not a major problem for their patients, and provider specialization that assigns patients with problematic alcohol use to specifically designated providers. Identified facilitators for alcohol SBI implementation included adequate time to conduct the SBI; availability of information, tools, and key points to emphasize with HIV-infected patients; and use of a brief alcohol screening tool.
Barriers to volunteer enrollment in HIV preventive vaccine clinical research trials: a review of the literature.
Behavioural, Mucosal and Systemic Immune Parameters in HIV-infected and Uninfected Injection Drug Users.
Injection drug use (IDU) remains a major risk factor for HIV-1 acquisition. The complex interplay between drug use, non-sterile injection, and Hepatitis C remains poorly understood. We conducted a pilot study to determine the effect of IDU on immune parameters among HIV-uninfected and -infected individuals. We hypothesized that IDU could further augment immunological changes associated with HIV-1 infection, which could in turn affect HIV pathogenesis.
Breast cancer survivors' intentions of managing lymphedema.
The purpose of this study was to describe the experience of managing lymphedema in breast cancer survivors. A descriptive phenomenological method was used as a guide for developing a bracket, gathering data, and analyzing data. A cross-sectional design with a purposive sampling technique was employed. During the 3 private, semi-structured, audio-recorded interviews with each woman, 12 breast cancer survivors described how they managed lymphedema in their daily lives. A taxonomy of 3 levels was created to describe the essential structures of the experience from general, to mediating, to specific: revelatory intention, cluster intention, and unit intention. The study revealed that the women's major intentions of managing lymphedema were to keep in mind the consequences, prevent lymphedema from getting worse, get ready to live with lymphedema, and integrate the care of lymphedema into daily life. Findings of the study provided an insightful alternative to the compliance approach to lymphedema management. Instead of merely evaluating breast cancer survivors' degree of compliance with treatment, it is suggested that researchers and practitioners should also assess the impact of the presence or absence of the women's intentions on lymphedema management.
Breast cancer: education, counseling, and adjustment among patients and partners: a randomized clinical trial.
Although various forms of psychoeducation and counseling interventions have been examined among patients with a variety of diagnoses, the unique contribution of phase-specific psychoeducation and telephone counseling (TC) to the ongoing process of adjustment has not been explored among patients with breast cancer and their partners.
Building bridges in academic nursing and health care practice settings.
The purpose of this article is to describe the development and implementation of a shared position with a focus on evidence-based practice (EBP) between the Visiting Nurse Service of New York and the Lienhard School of Nursing, Pace University. A preexisting relationship between the two institutions in providing student experiences in a community setting paved the way for the evolution a new collaborative effort. The shared position was initially conceived by two of the authors as an outcome of research they were conducting in the home care setting, which tested a model of mentoring frontline nurses in the EBP process on health care professional and patient outcomes. An initial conception of the new role provided a working document for discussions between the two institutions and the creation of a workable contract. The implementation of several initiatives has already provided support for the position, and each partner has benefited from building this bridge between nursing education and service. Benefits include advancing knowledge of and implementing EBP in both settings and promoting collaborative, clinically related scholarship.
Cardiac biomarkers in persons with HIV infection: a review of the literature.
Charting the course for nurses' achievement of higher education levels.
To improve patient outcomes and meet the challenges of the U.S. health care system, the Institute of Medicine recommends higher educational attainment for the nursing workforce. Characteristics of registered nurses (RNs) who pursue additional education are poorly understood, and this information is critical to planning long-term strategies for U.S. nursing education. To identify factors predicting enrollment and completion of an additional degree among those with an associate or bachelor's as their pre-RN licensure degree, we performed logistic regression analysis on data from an ongoing nationally representative panel study following the career trajectories of newly licensed RNs. For associate degree RNs, predictors of obtaining a bachelor's degree are the following: being Black, living in a rural area, nonnursing work experience, higher positive affectivity, higher work motivation, working in the intensive care unit, and working the day shift. For bachelor's RNs, predictors of completing a master's degree are the following: being Black, nonnursing work experience, holding more than one job, working the day shift, working voluntary overtime, lower intent to stay at current employer, and higher work motivation. Mobilizing the nurse workforce toward higher education requires integrated efforts from policy makers, philanthropists, employers, and educators to mitigate the barriers to continuing education.
Clinical trial recruitment and retention of a vulnerable population: HIV patients with chronic diarrhea.
This article describes the recruitment and retention strategies implemented for a prospective, randomized, clinical trial conducted at a single study facility. The purpose of the study was to examine the effects of a nutritional intervention to reduce the episodes of diarrhea in patients with the human immunodeficiency virus/acquired immune deficiency syndrome. This article reviews the challenges faced by the research team during the conduct of the study and discusses the approaches implemented to reduce the barriers to study participation.
Cognitive functioning and driving simulator performance in middle-aged and older adults with HIV.
Nearly half of people living with HIV experience cognitive deficits that may impact instrumental activities of daily living. As the number of people aging with HIV increases, concerns mount that disease-related cognitive deficits may be compounded by age-related deficits, which may further compromise everyday functions such as driving. In this cross-sectional pilot study, during a 2.5-hour visit, 26 middle-aged and older adults (40 + years) were administered demographic, health, psychosocial, and driving habits questionnaires; cognitive assessments; and driving simulator tests. Although CD4+ T lymphocyte count and viral load were unrelated to driving performance, older age was related to poorer driving. Furthermore, poorer visual speed of processing performance (i.e., useful field of view) was related to poorer driving performance (e.g., average gross reaction time). Mixed findings were observed between driving performance and cognitive function on self-reported driving habits of participants. Implications for these findings on nursing practice and research are posited.
Comorbidities in the context of care transitions.
The growing number of individuals with comorbidities experiencing care transitions represents a challenge to the current health care system. A qualitative study of empirical literature, using the Dimensional Analysis approach, was conducted to elucidate the theoretical underpinnings of the phenomenon of individuals with comorbidities undergoing care transitions. The findings were arranged in a novel schematic demonstrating that the relationship among individual attributes, comorbidities, and care processes informed the individual's risk for adverse outcomes. This schematic is useful for future nursing research studies evaluating innovative programs implemented to improve health outcomes among vulnerable populations undergoing care transitions.
CPT coding patterns at nurse-managed health centers: data from a national survey.
Nurse-managed health centers (NMHCs) play an important role in delivering health care services to a wide range of communities and often serve as our nation's safety net providers. Unfortunately, NMHCs struggle to remain in business for a variety of reasons, including underdeveloped business practices. Until now, NMHCs had only data from the Centers for Medicare and Medicaid Services and the Medical Group Management Assocation for comparison with coding patterns in individual centers. This article is the first published report of national data for NMHCs that is available for comparison. Providers need to possess financial acumen to remain open for business. Assessment of CPT coding patterns is a key strategy to support long-term sustainability.
Cultural competence among staff nurses who participated in a family-centered geriatric care program.
The purpose of this training program was to prepare nursing staff in family-centered geriatric care that emphasizes providing culturally competent care to hospitalized elders at two major tertiary hospitals in New York. This research report corresponds to the first phase of a 3-year project. In this research project, a descriptive exploratory design was used to identify the levels of cultural awareness and cultural competence of nursing staff who participated in a family-centered geriatric care training program.
Depression, interferon therapy, hepatitis C, and substance use: potential treatments and areas for research.
Developing an integrative therapies in primary care program.
The authors describe the development and incorporation of an integrative therapies subspecialty curriculum into a graduate nursing education program. Specialized education in integrative therapies prepares nursing students more thoroughly for primary care practice because many patients now use what is called complementary and alternative medicine in conjunction with standard medical care. Students learn to determine the safety, efficacy, and cultural significance of complementary and alternative medicine practices of their diverse patient population.
Developing and refining interventions in persons with health disparities: the use of qualitative description.
Eliminating health disparities by the year 2010 has become a clear priority for nursing and health sciences research. To date, much of the research has relied on traditional analytic methods to identify the disparities and develop clinical interventions. However, health disparities are typically embedded in complex, cultural and contextual issues. Interventions to improve access, quality and care among vulnerable populations need to be developed with these factors in mind. This article illustrates the benefits of using Qualitative Description as one method for assessing, developing and refining interventions with vulnerable populations. Qualitative Description study results have tremendous potential to translate directly to pressing health care situations and provide clear information about ways to improve care.
Development and pilot testing of a parent education intervention for type 1 diabetes: parent education through simulation-diabetes.
To purpose of the pilot study was to evaluate the use of a pediatric human patient simulator (HPS) to teach parents diabetes management for their children newly diagnosed with type 1 diabetes, referred to as Parent Education Through Simulation-Diabetes.
Documenting an EBP project: guidelines for what to include and why.
In increasing numbers, nurses as members of intradisciplinary and transdisciplinary teams are implementing evidence-based practice (EBP) changes. These variations result in demonstrated improvement in outcomes for the patient and family, staff, organization, and community. Many of these EBP activities remain an untapped resource; however, they have potential for improving practice beyond a single facility or local area. Descriptions of EBP projects that dofind their way into the literature have yet to include detail on all of the steps of the EBP process from problem identification through critical appraisal and synthesis of relevant literature to development, implementation, and evaluation of the practice change. In this article, the authors aim to provide guidance to clinicians on how to document an EBP project. Guidelines addressed in the article are also included as criteria for the Evidence-Based Practice Award, as established by the Foundation of New York State Nurses Center for Nursing Research Planning Committee.
Early-career registered nurses' participation in hospital quality improvement activities.
We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.
Emergency response and public health in Hurricane Katrina: what does it mean to be a public health emergency responder?
Since 9/11, federal funds directed toward public health departments for training in disaster preparedness have dramatically increased, resulting in changing expectations of public health workers' roles in emergency response. This article explores the public health emergency responder role through data collected as part of an oral history conducted with the 3 health departments that responded to Hurricane Katrina in Mississippi and Louisiana. The data reveals a significant change in public health emergency response capacity as a result of federal funding. The role is still evolving, and many challenges remain, in particular, a clear articulation of the public health role in emergency response, the integration of the public health and emergency responder cultures, identification of the scope of training needs and strategies to maintain new public health emergency response skills, and closer collaboration with emergency response agencies.
Evidence-based care management of the late preterm infant.
Evidence-based practice improvement: merging 2 paradigms.
This article presents a new model, Evidence-Based Practice Improvement, for improving patient care. The model merges 2 extant paradigms currently used for quality improvement initiatives-evidence-based practice and practice or performance improvement. The literature expounds on the virtues of each of these approaches, yet no authors have moved beyond parallel play between them. The merged model, Evidence-Based Practice Improvement, may provide a more effective and practical approach to reach our quality goals.
Evidence-based practice: the paradigm shift.
Expanded HIV testing and trends in diagnoses of HIV infection—District of Columbia, 2004 – 2007
Factors Associated with Reported Infection and Lymphedema Symptoms among Individuals with Extremity Lymphedema.
This study aimed to examine factors associated with reported infection and symptoms among individuals with extremity lymphedema.
Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model.
Although evidence-based practice (EBP) improves health care quality, decreases costs, and empowers nurses, there is a paucity of intervention studies designed to test models of how to enhance nurses' use of EBP. Therefore, the specific aim of this study was to determine the preliminary effects of implementing the Advancing Research and Clinical practice through close Collaboration (ARCC) model on nurses' EBP beliefs, EBP implementation behaviors, group cohesion, productivity, job satisfaction, and attrition/turnover rates. A 2-group randomized controlled pilot trial was used with 46 nurses from the Visiting Nurse Service of New York. The ARCC group versus an attention control group had stronger EBP beliefs, higher EBP implementation behaviors, more group cohesion, and less attrition/turnover. Implementation of the ARCC model in health care systems may be a promising strategy for enhancing EBP and improving nurse and cost outcomes.
Functional status in older women following gynecological cancer surgery: can choice of measure influence evidence for clinical practice?
Although functional status serves as a major predictor of morbidity, researchers and clinicians use different terms and measures, limiting comparisons across studies. To demonstrate how differing measures may generate varied findings, we compared and contrasted data from the SF-12 Health Survey Physical Component Summary Scale (SF-12 PCS) and the Enforced Social Dependency Scale (ESDS). The sample consisted of 49 women aged 65 and older recovering from gynecological cancer surgery with data collection at baseline (postoperative period) and then at 3 and 6 months. Analysis of the relationship between SF-12 PCS and ESDS over time using generalized estimating equations (GEE) demonstrated the relationship was less than 1.0, signaling less than perfect agreement between measures (β = 0.16, P = .002). These findings suggest that that the 2 measures are not interchangeable and may produce conflicting evidence. This highlights the importance of researchers' and clinicians' careful conceptualization and operationalization of functional status before measure selection.
Generational differences among newly licensed registered nurses.
Responses of 2369 newly licensed registered nurses from 3 generational cohorts-Baby Boomers, Generation X, and Generation Y-were studied to identify differences in their characteristics, work-related experiences, and attitudes. These responses revealed significant differences among generations in: job satisfaction, organizational commitment, work motivation, work-to-family conflict, family-to-work conflict, distributive justice, promotional opportunities, supervisory support, mentor support, procedural justice, and perceptions of local job opportunities. Health organizations and their leaders need to anticipate intergenerational differences among newly licensed nurses and should provide for supportive working environments that recognize those differences. Orientation and residency programs for newly licensed nurses should be tailored to the varying needs of different generations. Future research should focus on evaluating the effectiveness of orientation and residency programs with regard to different generations so that these programs can be tailored to meet the varying needs of newly licensed nurses at the start of their careers.
Hartford Gerontological Nursing Leaders: From Funding Initiative to National Organization.
In 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program initiative, acknowledging nursing's key role in the care of the growing population of older adults. This program has supported 249 nurse scientists with pre- and postdoctoral awards. As a result of the program's success, several Building Academic Geriatric Nursing Capacity Program awardees formed an alumni organization to continue to advance the quality care of older adults. This group of Building Academic Geriatric Nursing Capacity Program awardees joined others receiving support from the John A. Hartford Foundation nursing initiatives to grow a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The purpose of this article is to present the development, accomplishments, and challenges of the HGNL, informing other professional nursing organizations that are experiencing similar accomplishments and challenges. This article also demonstrates the power of a funding initiative to grow an organization dedicated to impact gerontological health and health care through research, practice, education, and policy.
Hepatitis C treatment experiences and decision making among patients living with HIV infection.
Hepatitis C infection is a major problem for approximately 250,000 HIV-infected persons in the United States. Although HIV infection is well-controlled in most of this population, they suffer liver-associated morbidity and mortality. Conversely, hepatitis C virus (HCV) treatment uptake remains quite low (15%-30%). Therefore, the purpose of this qualitative study was to explore HCV treatment experiences and decision making in adults with HIV infection. The study sample included 39 coinfected adults; 16 in the HCV-treated cohort (who were interviewed a maximum of 3 times) and 23 in the HCV-nontreatment cohort. Analysis of interviews identified 2 treatment barriers (fears and vicarious experiences) and 4 facilitating factors (experience with illness management, patient-provider relationships, gaining sober time, and facing treatment head-on). Analysis of these data also revealed a preliminary model to guide intervention development and theoretical perspectives. Ultimately, research is urgently needed to test interventions that improve HCV evaluation and treatment uptake among HIV-infected patients.
HIV and general cardiovascular risk.
The incidence of cardiovascular disease (CVD) is increasing in HIV-infected people. Risk factors such as hyperlipidemia, impaired glucose tolerance, and insulin resistance have become common. CVD in HIV may also be related to nontraditional risk factors including accumulation of visceral fat, inflammation secondary to HIV, and effects of some antiretroviral drugs. This cross-sectional study described the CVD risk factors of 123 adults living with HIV and calculated the 10-year estimate for general cardiovascular risk score. Results showed that approximately 25% of the participants were considered to be at high risk for developing CVD in the next 10 years. Increased waist circumference and longer duration of smoking habit were associated with elevated general cardiovascular risk scores. Similar to the general population, most of the identified risks could be modified through lifestyle management.
Hospital staff nurses' shift length associated with safety and quality of care.
The objective of this study was to analyze hospital staff nurses' shift length, scheduling characteristics, and nurse reported safety and quality. A secondary analysis of a large nurse survey linked with hospital administrative data was conducted. More than 22 000 registered nurses' reports of shift length and scheduling characteristics were examined. Extended shift lengths were associated with higher odds of reporting poor quality and safety. Policies aimed at reducing the use of extended shifts may be advisable.
Integrating disaster preparedness into a community health nursing course: one school's experience.
It is not practical to wait for a disaster, whether natural or human-made, to learn how to respond and provide specialized care. The Long Island University School of Nursing in Brooklyn, New York, has developed a specific educational experience for undergraduate nursing students enrolled in community health. The course is offered in the senior semester and includes didactic material based on the International Nursing Coalition for Mass Casualty Education-recommended competencies. Students are given the opportunity to apply the learning and develop additional skills by participating in a mock drill. Although anecdotal comments from the students indicate that the coursework has been helpful, additional research is planned to evaluate the program.
Lesbian, gay, bisexual, and transgender health: disparities we can change.
Mentoring fathers of children newly diagnosed with T1DM.
To pilot test a social support intervention for fathers of children <13 years old newly diagnosed with type 1 diabetes mellitus (T1DM).
Nausea and vomiting in HIV/AIDS.
HIV infection has become a chronic illness with the availability of potent antiretroviral agents. Many of the agents used to manage HIV, however, have been associated with distressing symptoms such as nausea and vomiting posing challenges to maintain adherence to therapy and quality of life. This article highlights the mechanism, evaluation, and management of HIV-associated nausea and vomiting. Supportive symptom management information is also presented.
New guidelines for maternal and neonatal resuscitation.
New evidence has prompted changes in our national cardiopulmonary resuscitation guidelines for both neonates and adult patients. The purpose of this article is to provide an overview of the changes recommended by the American Heart Association, Academy of American Pediatrics, and the American College of Obstetrics and Gynecology. In addition, a strategy for implementing these guidelines into practice is suggested.
Nosocomial infection in an intensive care unit in a Brazilian university hospital.
This prospective study aimed to determine the nosocomial infection (NI) incidence in an Intensive Care Unit (ICU), its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fishers test and Relative Risk (RR). There were 383 NIs (20.3%). The infections were in the urinary tract (n=144; 37.6%), pneumonia (n=98; 25.6%), sepsis (n=58; 15.1%), surgical site (n=54; 14.1%) and others (n=29; 7.7%). Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6). The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.
Nurse practitioner services: content and relative work value.
The resource-based relative value scale is used to quantify work for reimbursement of services in the Medicare Fee Schedule. This pilot study explored use of the resource-based relative value scale for services provided by nurse practitioners. Estimation of relative work values for office visits by nurse practitioners was consistent with the Medicare Fee Schedule. Content analysis revealed that nurse practitioners provide additional services including comprehensive patient evaluation and education and attendance to social factors. Future research is needed to examine systems that identify and reimburse nurse practitioners for their services.
Nutrition profiles of African [corrected] American women in the third trimester.
To develop a profile of common nutritional patterns among pregnant African American women that will assist healthcare providers in identifying areas for improvement and change.
Our patients' lives are worth fighting for and electroconvulsive therapy (ECT) saves lives: a compendium of the evidence.
Parent mentor perspectives on providing social support to empower parents.
To describe the experience of parent mentors providing a social support intervention to parents of children < 13 years old newly diagnosed with type 1 diabetes mellitus.
Perceptions of physical restraints use in the elderly among registered nurses and nurse assistants in a single acute care hospital.
Physical restraint use among hospitalized older adults remains an important issue. Despite evidence indicating that restraints can be harmful and strict regulatory rules restricting the use of restraints, healthcare practitioners continue to utilize physical restraints, often in the name of safety. The purpose of this study was to examine the perceptions regarding physical restraint use among registered nurses (RNs) and nursing assistants (NAs). The Perceptions of Restraint Use Questionnaire (PRUQ) was used to evaluate nursing staff perceptions. The overall mean score for the PRUQ was 2.8 out of a possible 5, indicating a neutral perception. Both RNs and NAs identified treatment interference as the most important reason for restraining a patient and substituting of restraints for staff as the least important reason. This study revealed an overall less favorable perception of restraints than previous studies. NAs favored physical restraint for fall prevention more than RNs. It was also noted that protection from physical abuse and patient combativeness was the most salient reason cited by the emergency department staff.
Physical work environment: testing an expanded model of job satisfaction in a sample of registered nurses.
The impact of personal, organizational, and economic factors on nurses' job satisfaction have been studied extensively, but few studies exist in which the effects of physical work environment--including perceptions of architectural, interior design, and ambient features on job satisfaction-are examined.
Positive work environments of early-career registered nurses and the correlation with physician verbal abuse.
Verbal abuse in the workplace is experienced by registered nurses (RNs) worldwide; physicians are one of the main sources of verbal abuse.
Post lymphadenectomy complications and quality of life among breast cancer patients in Brazil.
This descriptive, cross-sectional, correlational study with a convenience sample of 96 women treated for breast cancer at an outpatient service in Brazil was designed to investigate post-lymphadenectomy complications after axillary lymph node dissection (ALND) and sentinel lymph node biopsy and explore the associative relationships between the complications and quality of life. Clinical evaluations using perimetry, goniometry, and muscle strength test were used to evaluate the complications. Pain and quality of life were assessed by the Short-Form McGill Pain Questionnaire and the Functional Assessment of Cancer Therapy-Breast. All participants had at least one complication. Incidence was higher for pain (57%), impaired shoulder strength (57%), and fibrosis (54%), followed by impaired shoulder range of motion (46%) and lymphedema (17%). The incidence of impaired shoulder flexion (P = .01) and lymphedema (P = .002) was higher in ALND group. Winged scapula (8.4%) only occurred in the ALND group. Quality of life was significantly correlated with pain (r = -0.53, P = .000) and impaired shoulder strength in flexion (r = 0.4; P = .000) and abduction (r = -0.5, P = .000). Future studies are needed to prospectively investigate the onset of the complications and identify appropriate interventions to promote quality of life in women treated for breast cancer.
Qualitative analysis of naturalistic decision making in adults with chronic heart failure.
Self-care of heart failure has been described as a naturalistic decision-making process, but the data available to defend this description are anecdotal.
Questioning: a teaching strategy to foster clinical thinking and reasoning.
Reconstructing a health system and a profession: priorities of Iraqi nurses in the Kurdish region.
To evaluate nurses' priorities for health system reconstruction and professional development in Iraq, a survey of 744 Iraqi nurses was conducted, with the research process managed via the Internet. Seven definite priorities emerged along with significant differences in priorities related to years of experience, age, speciality area of nursing practice, gender, level of education, and geographic location of practice. Results indicate that nurses should be included in health system reconstruction processes and that support for the development of the nursing profession should be included in the plan for overall reconstruction.
Relationships of religion and spirituality to glycemic control in Black women with type 2 diabetes.
Although religion and spirituality are prominent in the lives of Black women with type 2 diabetes (T2DM), there is little research on the relationships of religion and spirituality to glycemic control (GC) in this population.
Role of pediatric nurse practitioners in oral health care.
Dental caries remain the most prevalent unmet health need in US children. Access to care is particularly problematic for poor children and is compounded by the shortage of dentists to meet the needs of this patient population. Expanding the roles of pediatricians, family physicians, and pediatric nurse practitioners (PNPs) who provide primary care services to children may be a strategy to address in this issue. Enhancements in current PNP education and certification processes are needed to support the expansion of oral health-related clinical responsibilities. Although oral health is included in the published curriculum for PNPs and certification exams require specific oral health knowledge, gaps in postgraduate training persist and few data document the extent to which current oral health-related educational goals are being achieved. We recommend enhancements in oral health education and research to evaluate curriculum innovations, the development of partnerships between stakeholder groups to leverage existing resources, and ongoing surveillance of oral health-related practice patterns among PNPs. Leadership at the national level is needed to develop policies that support curriculum changes and the implementation of oral health practice guidelines for PNPs that will improve access and reduce health disparities.
Screening patients in busy hospital-based HIV care centers for hazardous and harmful drinking patterns: the identification of an optimal screening tool.
Because many HIV care providers fail to detect patients' hazardous drinking, we examined the potential use of the AUDIT-C, the first 3 of the 10 items comprising the Alcohol Use Disorders Identification Test (AUDIT), to efficiently screen patients for alcohol abuse. To perform this examination, we used Item Response Theory (IRT) involving individual AUDIT items and AUDIT instruments completed by patients (N = 400) at a Designated AIDS Center (DAC) in New York City. At various AUDIT-C cutoff scores, specificities and sensitivities were then examined using the AUDIT as a ''gold standard.'' For cutoff scores on the AUDIT from 4 to 8, cutoff scores on the AUDIT-C of 3 and 4, respectively, resulted in sensitivities between .94-.98 and .81-.89, respectively, and specificities between .82-.91 and .91-1.0, respectively. In busy HIV care centers, the AUDIT-C with cutoff scores of 3 or 4 is a reasonable alternative to the full AUDIT as an alcohol screening instrument.
Self-management of lymphedema: a systematic review of the literature from 2004 to 2011.
Little is known about the effectiveness of activities used to self-manage lymphedema.
Self-management of Type 1 Diabetes Across Adolescence.
The purpose of this study was to examine differences in self-management behaviors (Collaboration with Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals) between early, middle, and late adolescence. The role of regimen and gender as covariates in self-management behaviors was also examined.
Self-rated competency and education/programming needs for Care of the Older Adult with Cardiovascular Disease: a survey of the members of the Council of Cardiovascular Nursing.
An online survey, Care of the Older Adult with Cardiovascular Disease (COA-CVD), was used to describe self-rated competency in the care of the aging adult with cardiovascular disease and subsequently determine the future education and programming needs of the Council of Cardiovascular Nursing. Respondents indicated that developing relationships, patient teaching, and assessment were areas where they felt most competent. The areas of highest priority for future programming included assessment of the older adult, diagnosis of health status, deriving a plan of care, implementing a treatment plan, patient teaching, and ensuring quality care. Most stated that content relative to the care of the older adult should be available at the annual meeting, Scientific Sessions of the American Heart Association, followed by self-study modules (65%), local and regional conferences (64%), and stand-alone national conferences (53%). The conclusions are that the Council of Cardiovascular Nursing and its membership need to address the importance of care of aging adults with cardiovascular disease and stroke in future programming. Although the Scientific Sessions of the American Heart Association is an appropriate venue, efforts can be directed toward developing self-study modules and local and regional conferences. As always, there is a need to work collaboratively with the other councils of the American Heart Association and other nursing organizations who view the care of the older adult as a high priority.
Social Support to Empower Parents (STEP): an intervention for parents of young children newly diagnosed with type 1 diabetes.
The purpose of this study was to test the efficacy of a social support intervention with parents of children <13 years old newly diagnosed with type 1 diabetes mellitus (T1DM).
Sociocultural influences on heart failure self-care among an ethnic minority black population.
Heart failure (HF) places a disproportionate burden on ethnic minority populations, including blacks, who have the highest risk of developing HF and experience poorer outcomes. Self-care, which encompasses adherence to diet, medication, and symptom management, can significantly improve outcomes. However, HF self-care is notoriously poor in ethnic minority black populations.
State mandatory overtime regulations and newly licensed nurses' mandatory and voluntary overtime and total work hours.
Nurse overtime has been used to handle normal variations in patient census and to control chronic understaffing. By 2010, 16 states had regulations to limit nurse overtime. We examined mandatory overtime regulations and their association with mandatory and voluntary overtime and total hours worked by newly licensed registered nurses (NLRNs). For this secondary data analysis, we used a panel survey of NLRNs; the final dataset consisted of 1,706 NLRNs. Nurses working in states that instituted overtime regulations after 2003 or in states that restricted any type of mandatory overtime had a lower probability of experiencing mandatory overtime than those nurses working in states without regulations. Nurses who worked in states with mandatory overtime regulations reported fewer total hours worked per week. The findings of this study provided insight into how mandatory overtime regulations were related to nurse mandatory and voluntary overtime and the total number of hours worked. Future research should investigate institutions' compliance with regulations and the impact of regulations on nurse and patient outcomes.
Support, stigma, health, coping, and quality of life in older gay men with HIV.
As life expectancy for persons living with HIV has increased due to antiretroviral therapy, quality of life (QOL) has become an emerging issue for older gay men with HIV, who comprise more than 50% of older adults living with HIV in the United States. The purpose of this study was to determine predictors of QOL in older gay men with HIV. Sixty gay men ages 50-65 participated. Age, social support, and problem-focused coping were significantly and positively correlated with QOL, while medical comorbidities, social stigma, and emotion-focused coping were all significantly and negatively associated with QOL (p < .01). In stepwise linear regression analysis, emotional/informational support remained as a significant positive predictor, and medical comorbidities, HIV stigma, and emotion-focused coping remained as significant negative predictors, accounting for 64% of the variance in QOL. Study findings may help researchers develop interventions aimed at increasing QOL in this population.
Supporting breast-feeding when a woman is homeless.
This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings.
Symptom clusters and quality of life in Korean patients with hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, causing about 1 million deaths annually. Patients with HCC usually reported multiple concurrent symptoms. The purpose of this multivariate study was to explore whether multiple concurrent symptoms are clustered into groups of symptoms and to explore the effect of symptom clusters on the quality of life (QOL) in patients with HCC. A sample of 180 patients with HCC at a medical center in Korea was recruited. Patients completed a demographic questionnaire, a Symptom Checklist, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Hepatobiliary. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Four symptom clusters were identified: pain-appetite, fatigue related, gastrointestinal, and itching-constipation. Two patient subgroups were identified through cluster analysis: high- and low-symptom group. Patients in the high-symptom group had significantly poorer functional status and poorer QOL in all the domains, with the exception of social well-being. The differences between the 2 patient subgroups were not only statistically but also clinically significant. Patients in the high-symptom group were also statistically and clinically anxious and depressed. Further research is needed to explore whether compositions of symptom cluster phenotypes vary over time and whether the associations of symptom clusters with QOL and mood are changing along the disease and treatment trajectory as well as symptom status.
Symptom distress in older adults following cancer surgery.
Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes.
Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion.
The purpose of this pilot study was to assess the effect of an individualized traditional Chinese medicine (TCM) acupuncture and moxibustion (Acu/Moxa) treatment on symptom control in patients with irritable bowel syndrome (IBS) in a preliminary, randomized, sham/placebo-controlled trial. Twenty-nine men and women with IBS were randomized to either individualized Acu/Moxa (treatment group) or sham/placebo Acu/Moxa (control group). All subjects were assessed by a diagnostic acupuncturist for a TCM evaluation and individualized point prescription. Only those subjects assigned to the experimental group received the individually prescribed treatment. The diagnostic acupuncturist did not administer treatments and was blind to treatment assignments. All subjects kept a symptom diary for the duration of the study, enabling measurement of symptom frequency, severity, and improvement. The Clinical Global Impression Scale was administered preintervention to establish baseline severity and on completion of the 4-week, eight-session treatment intervention. After 4 weeks of twice-weekly Acu/Moxa treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS.
The nursing career process from application through the first 2 years of employment.
The purpose of this analysis is to describe the attrition process from application to associate and baccalaureate basic RN programs through the first 2 years of work using estimates from best available nationally representative data. Results of the analysis show that although about 41,000 qualified applicants are not admitted to basic RN programs, most students (76.2%) who enroll in basic RN programs graduate, and most RN graduates who pass the National Council Licensure Examination stay in their first nursing job (73.8%) and nursing (97.9%) for at least 2 years. The results suggest that room for improvement exists for retention across educational and work settings, but the system appears to be most leaky at the point of admitting qualified applicants. Precise data about attrition from educational and employment settings are essential for resolving educational capacity and workforce retention issues, but precise data are difficult to obtain. A solution may be to assign each applicant a unique identifier.
The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease.
The study objective was to describe the self-care behaviors of adherence to medication, diet, exercise, and symptom monitoring of older workers with cardiovascular disease (CVD) and explore the relationship among job characteristics (job demands, job control, and workplace support), self-care, and quality of life. More than 3.5 million workers have CVD with significant work limitations and increased disability. Workers must meet the challenges of today's work processes that include increased stress and intense production demands while managing the complexities of their CVD.
The research advisory committee: an effective forum for developing a research dynamic environment.
This article describes the role of a committee in the Graduate School of Nursing at the University of Massachusetts, Worcester, that is referred to as the research advisory committee. It was developed to sustain the research mission, to facilitate faculty scholarship, and to provide a venue for presubmission grant review (hence called mock review) in a graduate school of nursing that is not considered "research intensive." We present its historical framework, the development of a mock review process, faculty accomplishments thus far, and our plans for the future. It is hoped that our experiences of building and supporting faculty research efforts in a research dynamic environment may provide guidance for others working in similar institutions.
The role of the chief nursing officer in leading the practice: lessons from the Benner tradition.
There is a real danger that measurable tasks and procedures can be misconstrued for nursing practice in contemporary healthcare organizations focused on the measurement of quality, safety, and productivity. This study uses the work of Patricia Benner to address the complex nature of nursing practice and discusses why the chief nursing officer must create an environment within the organization for the practice to be fully lived out if he or she is to be successful as the leader of the discipline.
The sustainability budgeting model: multiplemode flexible budgeting using sustainability as the synthesizing criterion.
The Sustainability Budgeting Model (SBM) is presented in the context of a department of nursing of a major hospital. If successfully incorporated in the department of nursing, the SBM can easily be moved into the larger hospital context. The SBM was designed recognizing the three necessary components underlying all budgeting models. The SBM incorporates the inherent variability of the resource inflows and outflows and in that sense is robust; it is recommended these resource flows be calibrated for the various time horizons using the standard Present Value model so as to provide comparability across projects. Most importantly, the SBM focuses on financial sustainability considering all the relevant costs--variable and fixed--and so speaks to long-term coordinated planning and continuation of desired patient services.
The value of certification in HIV/AIDS nursing.
Tomando Control: a culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes mellitus--evaluation of a pilot project.
The purpose of this study was to pilot test the feasibility, acceptability, and efficacy of a culturally appropriate and culturally relevant Spanish-language cognitive-behavioral diabetes self-care educational intervention for Hispanic Americans with type 2 diabetes mellitus.
Translating the diabetes prevention program to primary care: a pilot study.
Research on the translation of efficacious lifestyle change programs to prevent type 2 diabetes into community or clinical settings is needed.
Type 2 diabetes in urban black and rural white women.
The purpose of this secondary analysis was to describe and compare physiological, psychosocial, and self-management characteristics of urban black and rural white women with type 2 diabetes (T2D) in the northeast United States.
Uncharacteristic bullous lesions on a newborn: what's your diagnosis?
Understanding diagnostic reasoning in TCM practice: tongue diagnosis.
Traditional Chinese medicine (TCM) diagnosis is a complex multifaceted process that often yields multiple differential diagnoses and subdiagnoses.
Wage, work environment, and staffing: effects on nurse outcomes.
Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes-less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes.
What does nurse turnover rate mean and what is the rate?
Registered nurse turnover is an important indicator of the nurse job market. Despite its wide use as a measure for health-care system analysis, there is a lack of consistency in the definition of turnover. Some definitions include any nurse leaving an organization; others may include involuntary and voluntary leaving. These inconsistent definitions also result in various turnover rates. The RN Work Project is a 10-year panel study of new nurses. Data were collected from the new nurses, rather than from a specific organization. About 17.5% of new nurses leave their first job within 1 year of starting their jobs. Consistent and accurate measurement of turnover is an important step in addressing organizational work environments and policies about the nursing workforce.
Work environment factors other than staffing associated with nurses' ratings of patient care quality.
The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions' ability to rely on RN staffing alone to ensure high-quality care.