Publications

Abstract

Background: Among women living with HIV infection in the District of Columbia (DC), African American women are disproportionately affected, comprising > 90% of reported cases. Sociostructural exploration of local HIV epidemics among African American women has been understudied. We explored sociostructural correlates of health for HIVinfected African American women in DC to inform local HIV prevention and intervention efforts. Methods: HIV surveillance data from the District of Columbia Department of Health for African American women living with HIV were reviewed. We analyzed data for sociostructural correlates for progressing to acquired immune deficiency syndrome (AIDS) (CD4 counts < 200 cells/ml) among African American women. Data were analyzed using SAS 9.2 and mapped by census tracts using ArcGIS. Results: Of 4,619 women living with HIV, 4,204 (91%) were African American; 3,050 (72.5%) had census tract information available and were included. Median age at diagnosis was 36.6 years. Among these 3,050 African American women, 1,814 (59.4%) had ever progressed to AIDS, 1,109 (36.4%) had CD4 counts < 200 cells/μl (AIDS) at most recent clinical visit, and 208 of 1,109 (18.8%) had progressed to AIDS within 12 months of their HIV diagnosis (late testers). Women who progressed to AIDS had a higher probability of being diagnosed at private facilities compared with public facilities (PR=1.1, 95% CI=1.1-1.3) and of being exposed through injection drug use (IDU) compared to being exposed through heterosexual contact (PR=1.3, 95% CI=1.2-1.5). In multivariate and geomapping analyses, poverty, education levels and census tracts were not associated with an AIDS diagnosis. Conclusion: Progression to AIDS is prevalent among HIV-infected African American women in DC. Increased, early routine HIV screening and intensified treatment efforts with African American women living with HIV infection in DC, regardless of socioeconomic status, are warranted, to improve outcomes and decrease disparities.

Abstract

Aims and objectives: To examine relationships between practice environment ratings, workload, work engagement, job outcomes and assessments of quality of care in nursing personnel in psychiatric hospitals. Design: Cross-sectional survey. Background: A broad base of research studies in health care reveals important links between work environment factors, staff burnout and organisational outcomes that merit examination in inpatient mental healthcare settings. Work engagement, a positively framed parallel construct for burnout, may offer an additional insight into the impacts of work on staff. Methods: A sample of 357 registered nurses (65·5%), licensed practical nurses (23·5%) and non-registered caregiver (10·6%) of two Belgian psychiatric hospitals were surveyed. A causal model was tested using structural equation modelling, whereby it was proposed that work engagement would be influenced by work environment factors and itself impact perceived quality of care and staff job outcomes such as job satisfaction and turnover intentions. Results: An adjusted model was confirmed. Practice environment features influenced staff vigour and dedication and demonstrated positive effects on job satisfaction, turnover intentions and perceived quality of care through their effects on absorption. Conclusion: The findings of this study suggest that work engagement is a likely direct consequence of practice environments that may ultimately have impacts on both staff and patient outcomes. Relevance to clinical practice: Leaders, nurse managers, clinicians as well as nurses themselves should be aware of the importance of work environments in mental healthcare facilities that favour engagement. Future efforts should focus on developing and sustaining practice environments that engage mental healthcare workers within interdisciplinary teams with the goal of creating a stable workforce possessing optimal possible knowledge, skills and abilities for delivering care.

Abstract

Objectives. We reviewed data for the Minority HIV/AIDS Research Initiative (MARI), which was established in 2003 to support under represented minority scientists performing HIV prevention research in highly affected communities. Methods. MARI was established at the Centers for Disease Prevention and Control as a program of competitively awarded, mentored grants for early career researchers conducting HIV prevention research in highly affected racial/ethnic and sexual minority communities.We have described progress from 2003 to 2013. Results. To date, MARI has mentored 27 scientist leaders using low-cost strategies to enhance the development of effective HIV prevention interventions. These scientists have (1) developed research programs in disproportionately affected communities of color, (2) produced first-authored peer-reviewed scientific and programmatic products (including articles and community-level interventions), and (3) obtained larger, subsequent funding awards for research and programmatic work related to HIV prevention and health disparities work. Conclusions. The MARI program demonstrates how to effectively engage minority scientists to conduct HIV prevention research and reduce racial/ ethnic investigator disparities and serves as a model for programs to reduce disparities in other public health areas in which communities of color are disproportionately affected.

Abstract

Background: Ovarian cancer is the deadliest gynecologic cancer in the US. The consumption of refined sugars has increased dramatically over the past few decades, accounting for almost 15% of total energy intake. Yet, there is limited evidence on how sugar consumption affects ovarian cancer risk.Methods: We evaluated ovarian cancer risk in relation to sugary foods and beverages, and total and added sugar intakes in a population-based case-control study. Cases were women with newly diagnosed epithelial ovarian cancer, older than 21 years, able to speak English or Spanish, and residents of six counties in New Jersey. Controls met same criteria as cases, but were ineligible if they had both ovaries removed. A total of 205 cases and 390 controls completed a phone interview, food frequency questionnaire, and self-recorded waist and hip measurements. Based on dietary data, we computed the number of servings of dessert foods, non-dessert foods, sugary drinks and total sugary foods and drinks for each participant. Total and added sugar intakes (grams/day) were also calculated. Multiple logistic regression models were used to estimate odds ratios and 95% confidence intervals for food and drink groups and total and added sugar intakes, while adjusting for major risk factors.Results: We did not find evidence of an association between consumption of sugary foods and beverages and risk, although there was a suggestion of increased risk associated with sugary drink intake (servings per 1,000 kcal; OR=1.63, 95% CI: 0.94-2.83).Conclusions: Overall, we found little indication that sugar intake played a major role on ovarian cancer development.

Abstract

BACKGROUND:: 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. OBJECTIVE:: We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. METHODS:: This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. RESULTS:: A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). CONCLUSIONS:: Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. IMPLICATIONS FOR PRACTICE:: Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.

Abstract

Using Carper's fundamental patterns of knowing in nursing as a framework, the author reflects upon and intertwines experiences as a nurse leader and experiences in nature that called for resilience and courage.

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Nurse educators must meet the challenge of preparing a new generation of nurse leaders who can address the health care needs of an increasingly multicultural society. Institutional culture change that promotes inclusivity develops in response to an intentional embracement of diversity and is key to the success of any program initiatives. Providing resources for students can backfire if they experience the negative consequences of labeling, if incentives are distributed without thoughtful consideration of the related expectations, and if the advising system focuses on prescriptive, rather than developmental, principles. A deficit-thinking perspective that brands a student as at risk can undermine the goal of providing support. Faculty must engage in open discussions about labels, underlying assumptions about student aptitudes, and strategies for ensuring student success. Most importantly, faculty must actively solicit and seriously consider the students' accounts of their experiences and perspectives on changes that would make the climate more welcoming.

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Objective:To investigate the incidence and risk factors associated with uncomplicated maternal sepsis and progression to severe sepsis in a large population-based birth cohort.Methods:This retrospective cohort study used linked hospital discharge and vital statistics records data for 1,622,474 live births in California during 2005-2007. Demographic and clinical factors were adjusted using multivariable logistic regression with robust standard errors.Results:1598 mothers developed sepsis; incidence of all sepsis was 10 per 10,000 live births (95% CI = 9.4-10.3). Women had significantly increased adjusted odds (aOR) of developing sepsis if they were older (25-34 years: aOR = 1.29; ≥35 years: aOR = 1.41), had ≤high-school education (aOR = 1.63), public/no-insurance (aOR = 1.22) or a cesarean section (primary: aOR = 1.99; repeat: aOR = 1.25). 791 women progressed to severe sepsis; incidence of severe sepsis was 4.9 per 10,000 live births (95% CI = 4.5-5.2). Women had significantly increased adjusted odds of progressing to severe sepsis if they were Black (aOR = 2.09), Asian (aOR = 1.59), Hispanic (aOR = 1.42), had public/no-insurance (aOR = 1.52), delivered in hospitals with <1,000 births/year (aOR = 1.93), were primiparous (aOR = 2.03), had a multiple birth (aOR = 3.5), diabetes (aOR = 1.47), or chronic hypertension (aOR = 8.51). Preeclampsia and postpartum hemorrhage were also significantly associated with progression to severe sepsis (aOR = 3.72; aOR = 4.18). For every cumulative factor, risk of uncomplicated sepsis increased by 25% (95% CI = 17.4-32.3) and risk of progression to severe sepsis/septic shock increased by 57% (95% CI = 40.8-74.4).Conclusions:The rate of severe sepsis was approximately twice the 1991-2003 national estimate. Risk factors identified are relevant to obstetric practice given their cumulative risk effect and the apparent increase in severe sepsis incidence.

Abstract

Background: The Detection of Ischemia in Asymptomatic Diabetics (DIAD) study demonstrated a low 5-year hard cardiac event rate. We hypothesized that a blunted heart rate response (HRR, maximum percent change) to adenosine, a simple marker of cardiac autonomic neuropathy, will identify a cohort at higher cardiac risk. Methods: In DIAD, 518 participants were randomized to screening adenosine myocardial perfusion imaging (MPI) and had available data. HRR < 20% was considered abnormal. The primary endpoint was a composite of nonfatal myocardial infarction and cardiac death. Results: During 4.7 ± 0.9 years of follow-up 15 (3%) participants experienced the primary outcome. Participants with lower HRR experienced more events than those with higher HRR (8%, 3%, 1%, for HRR < 20% (n = 79), 20-39% (n = 182) and ≥ 40% (n = 257), respectively, p = 0.01). In a Cox proportional regression model that included MPI abnormalities and HRR, both were independently associated with cardiac events (p for model < 0.001). HRR < 20% was associated with 9-fold increased risk (p = 0.007) and moderate/large abnormal MPI was associated with 6-fold increased risk (p = 0.004). Participants with both abnormal MPI and HRR (n = 8) were at highest risk for cardiac events (38%) whereas those with HRR ≥ 40%, irrespective of MPI abnormalities (n = 234), were at extremely low risk (≤ 1%, log-rank p < 0.001). Conclusions: In DIAD, abnormal HRR to adenosine infusion is an independent predictor of cardiac events. This easily obtained marker of cardiac autonomic neuropathy identifies asymptomatic patients with type 2 diabetes mellitus at increased risk, particularly when associated with abnormal MPI, who may warrant further testing and more aggressive cardiovascular risk factor management.

Abstract

Aim: To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Background: Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Design: Cross-sectional survey. Method: Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses ( N = 1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Results: Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. Conclusion: The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended.

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Aim: 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. Background: Patricia Benner's corpus of research has demonstrated that reflection on clinical narratives comes closer than other pedagogical methods to replicating and enhancing the experiential learning required for the development of practical wisdom. Method: Using Benner's methodology of practice articulation, 91 nurse managers wrote and read to a peer group a narrative of their lived experience in the role. The groups interpreted the narratives to extract the skilled knowledge and ethics embedded in the practice of the nurse manager authors. One narrative was chosen for this paper because it is a particularly clear exemplar of how practical wisdom develops in nurse manager practice. Results: Articulating and reflecting on experiential learning led to an understanding of how practical wisdom developed in one nurse manager's practice. Conclusion: Interpretation of the narrative of one nurse manager illustrated how reflection on a complex ethical dilemma was a source of character development for the individual and the peer group. Implications for nursing management: Describing and interpreting how practical wisdom develops for individual nurse managers can be a source of learning for the narrative author and other role incumbents who need to make sound decisions and take prudent action in ethically challenging situations.

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This paper describes the development, implementation and assessment of an innovative approach to the dissemination of evidence-based research to clinical supervision through the use of Webbased technology. TheSubstance Abuse Treatment On-line Library: Focus on Clinical Supervision, known as the SATOL Project,was developed by an interdisciplinary faculty group at New York University. The findings of this study document the positive impact of SATOL in helping supervisors feel more capable of mentoring and supporting their staff, in better assessing and evaluating the quality of services provided by their supervisees, and in applying empirical evidence to their daily clinical supervision practice. Limitations of the project include the short time-frame andsmall sample size. This model is applicable to Web-based transmission of evidence-based knowledge of other content areas.

Abstract

Aim: The aim of this study was to examine the long-term effectiveness of the Sensitivity Training Clown Workshop (STCW) provided to 131 baccalaureate nursing students. Background: The STCW was designed and implemented through a collaboration between the artistic director of the Big Apple Circus and nurse faculty to help students understand emotions, learn peripheral awareness skills, and become engaged with patients. Method: Forty participants responded to an 18-month follow-up evaluation survey. Results: The majority of participants reported applying lessons learned in the workshop in their current practice, regardless of their area of nursing employment Conclusion: The STCW is an effective method of educating nursing students for pediatric practice. The techniques used in the workshop are applicable to other practice settings.