Publications

Abstract

Introduction: Up to 87% of trafficking victims encounter a health care provider while being trafficked but are not recognized as victims. Most health care providers receive little or no training, and awareness remains low. To describe the knowledge, beliefs, and attitudes of pediatric advanced practice registered nurses about human trafficking. Method: A survey of the National Association of Pediatric Nurse Practitioners membership (n = 8,647) before the intervention measured knowledge, beliefs, and experience regarding child trafficking. An awareness campaign was implemented with continuing education, national media presence, Train the Trainer programs, and creation of a nonprofit organization to direct strategic initiatives. Results: Overall, 799 (9%) NAPNAP members completed the survey. Although 87% believed it possible that they might encounter a victim of trafficking in their practice, 35% were unsure if they had provided care for a victim. Only 24% reported confidence in their ability to identify a child at risk for trafficking. Discussion: These survey findings indicate the need for clinical practice guidelines to identify potential and actual victims of human trafficking. Pediatric advanced practice registered nurses are ideally equipped and situated to intervene on behalf of vulnerable children with health disparities in a myriad of care settings, advocating for prevention and optimization of equitable health outcomes.

Abstract

Objective The objective of this study was to investigate the role of gestational hypertension (gHTN) and chronic hypertension (cHTN) on rates of preterm birth (PTB) among black women. Study Design Singleton live births between 20 and 44 weeks' gestation among black women in California from 2007 to 2012 were used for analysis. Risk of PTB by subtype and gestational age among women with cHTN or gHTN, including preeclampsia, was calculated via Poisson's logistic regression modeling. Risks were adjusted for maternal factors associated with increased risk of PTB. Results A total of 154,950 women met the inclusion criteria. Of the 5,948 women in the sample with cHTN, 26.2% delivered preterm; for the 11,728 women with gHTN, 21.6% delivered preterm. Women with gHTN or cHTN had a higher risk of medically indicated and spontaneous PTB, both at less than 32 and 32 to 36 weeks, when compared with nonhypertensive women (adjusted relative risks [aRRs]: 3.4-11.6). Women with superimposed preeclampsia had higher risks of spontaneous (aRR: 2.8, 95% confidence interval [CI]: 2.3-3.4) and medically indicated PTB (aRR: 2.8, 95% CI: 2.0-3.8), especially PTB < 32 weeks, when compared with women with preeclampsia. Conclusion Among black women, superimposed preeclampsia increased the risk for spontaneous and medically indicated PTB, especially PTB < 32 weeks.

Abstract

Context: There exists a research interest shift from separate symptoms to symptom clusters among people living with HIV (PLWH), which may provide a better understanding of symptom management in HIV/AIDS care. However, the symptom clusters among Chinese PLWH are still unknown. Objectives: The aim of our study was to identify symptom clusters and to examine demographic and health-related factors associated with these symptom clusters among PLWH prescribing antiretroviral therapy (ART) in China. Methods: From April to September 2017, we recruited 1116 participants through a convenience sampling in five HIV/AIDS designated facilities in the eastern, middle, and southwest regions of China. The principal component analysis was used to identify the symptom clusters. Association network was adopted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and the prevalence of each symptom clusters. Results: Five symptom clusters were identified, including cognitive dysfunction, mood disturbance, wasting syndrome, dizziness/headache, and skin-muscle-joint disorder. Cognitive dysfunction was the most central symptom cluster. Variables including primary caregiver during ART treatment, years of HIV diagnosis and ART use, having comorbidity, self-rated health, and quality of life were associated with the prevalence of these five symptom clusters. Conclusion: Our study suggests that there is a need to evaluate symptom clusters for the improvement of symptom management among PLWH. It is particularly important to include assessment and treatment of cognitive symptoms as an essential component of the HIV care.

Abstract

The aim of this study was to evaluate the effectiveness of an innovative pediatric interprofessional education clinical experience using oral-systemic health as the clinical population example for improving the self-reported interprofessional competencies of family nurse practitioner, dental, and medical students. The objectives of the interprofessional experience were for students to apply pediatric oral health assessment, identify the pediatric oral-systemic connection, and practice a team-based approach to improve oral-systemic outcomes. In spring 2015, fall 2015, and spring 2016, a total of 162 family nurse practitioner, dental, and medical students participated in this interprofessional experience at Bellevue Pediatric Outpatient Clinics together with a pediatric dental resident. Team members collaborated in reviewing the patient chart, taking the patient's medical and dental history, performing an oral assessment, applying fluoride varnish, and providing education and anticipatory guidance. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used as a pretest and posttest to evaluate the degree to which students perceived changes in their attitudes about interprofessional competencies following the learning experience. In the results, all students had improved mean scores from pretest to posttest after the experience, and these changes were statistically significant for all students: nurse practitioner (p<0.01), dentistry (p<0.01), and medicine (p<0.001). The mean change from pretest to posttest was statistically significant for each of the six interprofessional competency domains (p<0.01). In both pediatric dental and primary care settings, the changes from pre- to posttest were significant (p<0.001). The experience was similarly effective for all groups of students in increasing their attitudes about interprofessional collaboration. These findings suggest that a clinical approach can be an effective strategy for helping health professions students develop interprofessional competence.

Abstract

Background: Infants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (SGA) or born to mothers with maternal placental syndrome. The objective of this study was to investigate the relationship between maternal placental syndrome, SGA, and gestational age (GA) on 1-year mortality in infants with CCHD. Methods and Results: In a population-based administrative database of all live-born infants in California (2007–2012) we identified all infants with CCHD without chromosomal anomalies. Our primary predictor was an impaired fetal environment (IFE), defined as presence of maternal placental syndrome or SGA. We calculated hazard ratios to quantify the association between different components of IFE and 1-year mortality and conducted a causal mediation analysis to assess GA at birth as a mediator. We identified 6863 infants with CCHD. IFE was present in 25.1%. Infants with IFE were more likely to die than infants without IFE (16.6% versus 11.1%; hazard ratios 1.55, 95% CI 1.34–1.78). Only SGA (hazard ratios 1.76, 95% CI 1.50–2.05) and placental abruption (hazard ratios 1.70, 95% CI 1.17–2.48) were significantly associated with mortality; preeclampsia and gestational hypertension had no significant association with mortality. The mediation analysis showed that 32.8% (95% CI 24.9–47.0%) of the relationship between IFE and mortality is mediated through GA. Conclusions: IFE is a significant contributor to outcomes in the CCHD population. SGA and placental abruption are the main drivers of postnatal mortality while other maternal placental syndrome components had much less of an impact. Only one third of the effect between IFE and mortality is mediated through GA.

Abstract

RATIONALE: Preterm birth and other poor birth outcomes disproportionately affect women of color. Emerging evidence suggests that socially-driven issues such as disrespect, abuse, and discrimination within the health care system influence how people of color experience care during pregnancy, birth, and postpartum, which contributes to poorer outcomes for the mother and baby.OBJECTIVE: As recommended by community partners, we explored how interactions with providers were perceived and understood in the context of seeking care for pregnancy and birth.METHOD: For this constructivist grounded theory study, we recruited 22 self-identified women of color 18 years of age or older and who were between six weeks and one year postpartum. Women participated in interviews exploring their experiences, which were audiorecorded and transcribed. Data were analyzed using dimensional analysis and situational analysis methods.RESULTS: The concepts of information and power surfaced in analysis, in which providers have control over the information they share and "package" information to exert power over women's ability to participate in decision-making. An established relationship with providers and acknowledged levels of privilege or marginalization influenced how information was shared. Contextual factors included provider bias and judgment towards their patients, health care system structural issues, and the overall power dynamic between patient and provider.CONCLUSIONS: Women of color's experiences during pregnancy and birth were influenced by how they were treated by providers, particularly in how information was shared and withheld. The providers' control over information led to a power dynamic that diminished women's ability to maintain autonomy and make health care decisions for themselves and their children. This study provides insight and impetus for change in how providers share information, utilize informed consent, and provide respectful care to women of color during pregnancy and birth care.

Abstract

Patients with limited English proficiency skills are accessing health care services more frequently around the world. Language barriers increase patient vulnerability for adverse events, and health care interpreters may mitigate this risk. Nursing education regarding the effective and appropriate use of health care interpreters has been limited. Interpreters are natural partners for nurses as a strategy to bridge language barriers with patients and could be integrated more regularly into nursing education using clinical simulation strategies. This article offers an overview of the different types of interpreters in health care, proposes recommendations for integrating them into simulation education, and provides a case example to illustrate implementation.

Abstract

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

Abstract

BACKGROUND: Facebook (FB) has been widely used recently to recruit participants for adult health research. However, little is known about its effectiveness, cost, and the characteristics of participants recruited via FB when compared to other recruitment methods. OBJECTIVES: The purpose of this integrative review was to examine the published evidence concerning the use of FB in participant recruitment for adult health research, as compared to other social media, online, and traditional recruitment methods. METHODS: In this integrative review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, SCOPUS, and Web of Science were the electronic databases used to identify the published articles. In regard to language, the search was limited. RESULTS: The efficacy and cost-effectiveness of using FB for recruitment in healthcare research as compared to more traditional forms of recruitment remain unclear. Reporting of recruitment strategies is inconsistent, and costs are often not included. FB is being used for recruitment frequently with other methods and, although often effective, can be costly. DISCUSSION: FB is used to recruit participants for a variety of studies, with researchers using both free and paid ads to reach potential participants. Reporting of recruitment methods needs to be more rigorous, streamlined, and standardized in scientific papers.

Abstract

The article describes the development, implementation, and evaluation of an interactive simulation activity to enhance student engagement and comprehension of evidence-based practice principles. An interprofessional team of nurse educators, simulation experts, information technology specialists, and nursing informatics graduate students collaborated on the simulation design. The results of this project support the need to develop innovative learning strategies to facilitate nursing students' understanding of the relevance of evidence-based practice research to improve patient outcomes.

Abstract

Early childhood caries is a major unmet population health care need that negatively affects the overall health of children, especially those from diverse racial/ethnic backgrounds and disadvantaged socioeconomic groups. Nurses and midwives who work with pregnant women to nurses and nurse practitioners who work with young children and their families have an opportunity to positively influence the health of these populations. Primary care settings are ideal for integrating oral health into the overall health care of children and adolescents. The nursing profession is well positioned to have a positive impact on oral health and, in so doing, their overall health.

Abstract

PROBLEM: Quality improvement (QI) and patient safety (PS) are cornerstones of health care delivery. Accreditation organizations increasingly require that learners engage in QIPS. For many faculty, these are new domains. Additional faculty development is needed for them to teach and mentor trainees. Existing programs, such as the Association of American Medical Colleges Teaching for Quality (Te4Q) program, target individual faculty and thus accommodate only limited participants at a time, which is problematic for institutions that need to train many faculty to support their learners. APPROACH: The authors invited diverse stakeholders from across the University of California, San Francisco (UCSF) School of Medicine and related health systems to participate in a team-based adaptation of the Te4Q program. The teams completed 5 projects based on previously identified priority areas to increase local capacity for QIPS teaching: (1) online modules for faculty new to QIPS, (2) a tool kit for graduate medical education programs, (3) a module for medical school clerkship directors, (4) guidelines for faculty to integrate early learners into QI projects, and (5) a "Teach-for-UCSF" certificate program in teaching QIPS. OUTCOMES: Thirty-five faculty members participated in the initial Te4Q workshop in January 2015, and by fall 2016, all projects were implemented. These projects led to additional faculty development initiatives and a rapidly expanding number of faculty across campus with expertise in teaching QIPS. NEXT STEPS: Further collaborations between faculty focused on QIPS in care delivery and those focused on QIPS education to promote QIPS teaching have resulted from these initial projects.

Abstract

Purpose: Nurses are at risk from handling chemotherapeutic agents. This study aimed to determine adherence to safety guidelines for chemotherapy administration by Korean nurses and to examine the relationship between the hospital safety climate and nurses' adherence to safety guidelines. Method: A descriptive, correlational design with a cross-sectional survey using data from the Korea Nurses' Health Study. For this study, participants included 872 female nurses who had administered chemotherapeutic agents to patients in the last 30 days. Results: Only a quarter of the participants had high adherence to the safety guidelines, while the majority had moderate to low adherence. The absence of job hindrances and feedback/training – two sub-factors of the hospital safety climate – enhanced the likeliness for nurses to comply with the safety guidelines by almost 1.3 and 1.7 times, respectively. Conclusion: The results imply that the hospital safety climate, particularly feedback/training, and the absence of job hindrances are significantly correlated with adherence to the safety guidelines for chemotherapy administration. Therefore, organisational and policy support is needed to improve the hospital safety climate.

Abstract

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

Abstract

Objective: This study aims to describe adverse maternal and neonatal outcomes in women diagnosed with anemia in pregnancy. Study design: This was a retrospective cohort study of California live births from 2007–2012, linked to maternal and infant hospital discharge records. Relative risks of adverse maternal and neonatal outcomes were calculated for women with and without anemia. Results: Anemic mothers were more likely to be diagnosed with hypertension, diabetes, placental abruption, or chorioamnionitis, or require a blood transfusion or admission to the intensive care unit (aRRs 1.2–6.8). Infants born to anemic mothers were more likely to be born preterm (8.9% versus 6.5%), but not more likely to suffer morbidities associated with prematurity. Conclusion: In a population-based study, the diagnosis of anemia in pregnancy carries a higher risk of peri-partum, intra-partum, and post-partum complications for the mother, and a higher risk of preterm birth for the infant.

Abstract

Objective: Examine factors influencing late (> sixth month of gestation) entry into prenatal care by race/ethnicity and insurance payer. Methods: The study population was drawn from singleton live births in California from 2007 to 2012 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes linked birth certificate and mother and infant hospital discharge records. The sample was restricted to infants delivered between 20 and 44 weeks gestation. Logistic regression was used to calculate relative risks (RR) and 95% confidence intervals (CI) for factors influencing late entry into prenatal care. Maternal age, education, smoking, drug or alcohol abuse/dependence, mental illness, participation in the Women, Infants and Children’s program and rural residence were evaluated for women entering prenatal care > sixth month of gestation compared with women entering < fourth month. Backwards stepwise logistic regression was used to create final multivariable models of risk and protective factors for late prenatal care entry for each race or ethnicity and insurance payer. Results: The sample included 2,963,888 women. The percent of women with late entry into prenatal care was consistently higher among women with public versus private insurance. Less than 1% of white non-Hispanic and Asian women with private insurance entered prenatal care late versus more than 4% of white non-Hispanic and black women with public insurance. After stratifying by race or ethnicity and insurance status, women less than 18 years of age were more likely to enter prenatal care late, with young Asian women with private insurance at the highest risk (15.6%; adjusted RR 7.4, 95%CI 5.3–10.5). Among all women with private insurance, > 12-year education or age >34 years at term reduced the likelihood of late prenatal care entry (adjusted RRs 0.5–0.7). Drugs and alcohol abuse/dependence and residing in a rural county were associated with increased risk of late prenatal care across all subgroups (adjusted RRs 1.3–3.8). Participation in the Women, Infants, and Children’s program was associated with decreased risk of late prenatal care for women with public insurance (adjusted RRs 0.6–0.7), but increased risk for women with private insurance (adjusted RRs 1.4–2.1). Conclusions: The percent of women with late entry into prenatal care was consistently higher among women with public insurance. Younger women, women with <12-year education, those who used drugs or alcohol or resided in rural counties were more likely to enter prenatal care late, with Asian women <18 years at especially high risk. Participation in the Women, Infants, and Children’s program and maternal age >34 years at delivery increased the likelihood of late prenatal care for some subgroups of women and decreased the likelihood for others. These findings can inform institutional factors influencing late prenatal care, especially among lower income women, and may assist efforts aimed at encouraging earlier entry into prenatal care. Rationale: Optimal prenatal care includes initiation before the 14th week of gestation. Beginning care in the first trimester provides an opportunity for sonographic pregnancy dating or confirmation with best accuracy, which can later prove critical for management of preterm labor, maternal or fetal complications, or prolonged pregnancy. In order to improve maternal and infant health by increasing the number of women seeking prenatal care in the first trimester, it is important to examine the drivers for late entry. Here, we examine factors influencing late (> sixth month of gestation) entry into prenatal care by race/ethnicity and insurance payer. We found the percent of women with late entry into prenatal care was consistently higher among women with public insurance. Younger women, women with <12-year education, those who used drugs or alcohol or resided in rural counties were more likely to enter prenatal care late, with Asian women <18 years at especially high risk. These findings can inform institutional factors influencing late prenatal care, especially among lower income women, and may assist efforts aimed at encouraging earlier entry into prenatal care.

Abstract

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