Publications

Publications

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

Brody, A. A., Guan, C., Cortes, T., & Galvin, J. E. (2016). Geriatric Nursing, 37(3), 200-6. 10.1016/j.gerinurse.2016.01.002
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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 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

Brody, A. A., Guan, C., Cortes, T., & Galvin, J. E. (2016). Geriatric Nursing, 37(3), 200-206. 10.1016/j.gerinurse.2016.01.002
Abstract
Abstract
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.

Differences in demographic, clinical, and symptom characteristics and quality of life outcomes among oncology patients with different types of pain

Posternak, V., Dunn, L. B., Dhruva, A., Paul, S. M., Luce, J., Mastick, J., Levine, J. D., Aouizerat, B. E., Hammer, M., Wright, F., & Miaskowski, C. (2016). Pain, 157(4), 892-900. 10.1097/j.pain.0000000000000456
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The purposes of this study, in oncology outpatients receiving chemotherapy (n 926), were to: describe the occurrence of different types of pain (ie, no pain, only noncancer pain [NCP], only cancer pain [CP], or both CP and NCP) and evaluate for differences in demographic, clinical, and symptom characteristics, and quality of life (QOL) among the 4 groups. Patients completed self-report questionnaires on demographic and symptom characteristics and QOL. Patients who had pain were asked to indicate if it was or was not related to their cancer or its treatment. Medical records were reviewed for information on cancer and its treatments. In this study, 72.5% of the patients reported pain. Of the 671 who reported pain, 21.5% reported only NCP, 37.0% only CP, and 41.5% both CP and NCP. Across the 3 pain groups, worst pain scores were in the moderate to severe range. Compared with the no pain group, patients with both CP and NCP were significantly younger, more likely to be female, have a higher level of comorbidity, and a poorer functional status. In addition, these patients reported: higher levels of depression, anxiety, fatigue, and sleep disturbance; lower levels of energy and attentional function; and poorer QOL. Patients with only NCP were significantly older than the other 3 groups. The most common comorbidities in the NCP group were back pain, hypertension, osteoarthritis, and depression. Unrelieved CP and NCP continue to be significant problems. Oncology outpatients need to be assessed for both CP and NCP conditions.

Differences in the Molecular Species of CA125 Across the Phases of the Menstrual Cycle

McLemore, M. R., Miaskowski, C., Lee, K., Chen, L. M., & Aouizerat, B. E. (2016). Biological Research for Nursing, 18(1), 23-30. 10.1177/1099800414565879
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Background: CA125, a tumor-associated antigen, is primarily used to monitor epithelial ovarian cancer. There is evidence that different species of CA125 exist; however, it is not known if any of these species are present in healthy women during the menstrual cycle and if they are associated with serum concentrations of CA125. The purpose of this study was to determine if the molecular species of CA125 differ across the three phases of the menstrual cycle in healthy women. Methods: Healthy, Caucasian women between the ages of 18 and 39 were enrolled using strict criteria to exclude factors known to contribute to CA125 fluctuations. Menstrual cycle regularity was determined using calendars maintained by participants for 3 months. After cycle regularity was established, blood was drawn at three time points for Western blot analysis. Results: Western blot analysis yielded 17 distinct profiles (i.e., patterns of species) of CA125, with 80% of the sample exhibiting 5 common profiles. No differences in demographic characteristics and serum CA125 values were found among the various CA125 profiles. Conclusions: Different molecular species of CA125 exist in healthy women with regular menstrual cycles. These data provide evidence that CA125 is not a homogeneous molecular species. Future research should evaluate the molecular composition and the clinical importance of these species.

The discriminatory patient and family: Strategies to address discrimination towards trainees

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Purpose Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families. Method A purposeful sample of pediatric faculty educational leaders was recruited from April-June 2014 at Stanford University. Using a constructivist grounded theory approach, semistructured one-on-one interviews were conducted. Participants were asked to describe how they would respond to clinical scenarios of families discriminating against trainees (involving race, gender, and religion). Interviews were audio-recorded, transcribed, and anonymized. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. This project was IRB approved. Results Four themes emerged from interviews with 13 faculty: assess illness acuity, cultivate a therapeutic alliance, depersonalize the event, and ensure a safe learning environment. Participants wanted trainees to feel empowered to remove themselves from care when necessary but acknowledged that removal was not always possible or easy. Nearly all participants agreed that trainee and faculty development was needed. Suggested educational strategies included team debriefng and critical reffection. Conclusions Discrimination towards trainees by patients and families is an important issue. As this type of mistreatment cannot be fully prevented, effective preparation is essential. Effective response strategies exist and can be taught to trainees to empower responses that protect learners and preserve patient care.

Education and role title as predictors of enacted (actual) scope of practice in generalist nurses in a pediatric academic health sciences center

Déry, J., & Clarke, S. P. (2016). Journal of Nursing Administration, 46(5), 265-269. 10.1097/NNA.0000000000000341
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OBJECTIVE: The aim of this study is to document the enacted (actual) scope of practice (SOP) of nurses in pediatric settings in relation to education level and position. BACKGROUND: Baccalaureate-prepared staff nurses routinely carry out only a fraction of the activities essential for quality of care and patient safety they have been educated for. A direct care nurse clinician role exists for nurses with bachelor’s degrees in Quebec, Canada. METHOD: Survey of 301 nurses in a pediatric university hospital in Quebec was conducted. RESULTS: Enacted (actual) SOP for baccalaureate-educated nurses was significantly broader than that of nurses with junior college diplomas and nurse clinicians (baccalaureate-educated) carried out complex activities more frequently. CONCLUSION: The creation of job titling and role descriptions that reflect the upper range of nursing competencies could be an important tool for promoting broadened SOP for baccalaureate nurses.

Enhancing medication safety teaching through remediation and reflection

McCabe, D., & Ea, E. (2016). QSEN Institute Teaching Strategy (online).

Ensuring positive capstone experiences for students and staff

Smith, A., & Clarke, S. P. (2016). Nursing Management, 47(3), 12-14. 10.1097/01.NUMA.0000480767.08955.61

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Stewart, S., Riegel, B., Boyd, C., Ahamed, Y., Thompson, D. R., Burrell, L. M., Carrington, M. J., Coats, A., Granger, B. B., Hides, J., Weintraub, W. S., Moser, D. K., Dickson, V. V., McDermott, C. J., Keates, A. K., & Rich, M. W. (2016). International Journal of Cardiology, 212, 1-10. 10.1016/j.ijcard.2016.03.001
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Background Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide. Methods To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population. Results We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol - adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals. Conclusions We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF.

Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey

Kovner, C. T., Djukic, M., Fatehi, F. K., Fletcher, J., Jun, J., Brewer, C., & Chacko, T. (2016). International Journal of Nursing Studies, 60, 251-262. 10.1016/j.ijnurstu.2016.05.003
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Background: Registered nurse job turnover is an ongoing problem in the USA resulting in significant financial costs to both organizations and society. Most research has focused on organizational turnover with few studies about internal or unit-level turnover. Turnover of new nurses in hospitals has particular importance as almost 80% of new nurses work in hospitals and have higher turnover rates when compared to experienced nurses. This paper focuses on new nurses' unit-level turnover rates in hospitals. Objectives: The purpose of this study is to: (1) identify factors that predict new nurses staying in the same units, positions, and job titles to inform unit-level retention strategies, and (2) examine the changes in work environment perceptions over time between nurses who remain in the same unit, position, and title to those who changed unit, position and/or title. Study design: A panel survey design was used to analyze changes over time. Participants: Participants were newly licensed registered nurses who were licensed for the first time between August 1st, 2004 and July 31st, 2005. The nurses came from metropolitan statistical areas or rural areas that were nested to reflect a nationally representative USA sample (58% response rate). The analytic sample for this study was 1335. Data sources: Data were collected in January 2006 and 2007 following the Dillman total design approach. All potential respondents received paper surveys and non-responders received repeated mailings. Results: Using multinomial regression the five variables with the largest effects on unit retention were (1) variety (positive), (2) having another job for pay (negative), (3) first basic degree (having a bachelors or higher degree increased the probability of staying), (4) negative affectivity (positive), and (5) job satisfaction (positive). Nurses who changed unit, and/or position, and/or title reported more positive change scores on a variety of work attitudes. Discussion: Almost 30% of new nurses working in hospitals leave their unit, and/or position, and/or title during their first year of work. Our results point to the variables on which managers can focus to improve unit-level retention of new nurses. Although participants were from a nationally representative sample of nurses who were newly licensed in 2004-2005, with the geographical shifts in the USA population in the last 10 years the sample may not be geographically representative of new nurses who graduated in 2015.

Ethnic differences in sleep duration and morning-evening type in a population sample

Malone, S. K., Patterson, F., Lu, Y., Lozano, A., & Hanlon, A. (2016). Chronobiology International, 33(1), 10-21. 10.3109/07420528.2015.1107729
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This cross-sectional population study examined associations of sleep duration and morning-evening type with sociodemographic and cardiometabolic disease in adults participating in the UK Biobank study (N = 439 933). Multivariable Poisson regression models of sleep duration and morning-evening type with a robust error variance were generated to estimate adjusted prevalence ratios and their 95% confidence intervals. All models were adjusted for sex, race, college attendance, employment status and age. Twenty five percent of the sample reported short sleep; 27% were morning, 64% intermediate and 9% evening type. Black ethnicity emerged as most strongly associated with sleep behavior. Short sleep was twice as prevalent, and morning versus intermediate type was 1.4 times more prevalent in Black than White participants. The greater prevalence of short sleep and morning type among Blacks suggests that sleep-based approaches to improving cardiometabolic outcomes may require a more multidimensional approach that encompasses adequate sleep and circadian alignment in this population.

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

Brody, A. A., Edelman, L., Siegel, E. O., Foster, V., Bailey, D. E., Bryant, A. L., & Bond, S. M. (2016). Nursing Outlook, 64(4), 332-338. 10.1016/j.outlook.2016.03.004
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Background 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. Purpose This evaluation of a peer mentorship program for predoctoral and postdoctoral gerontological nurses examined its efficacy, utility, and potential for improvement. Methods A web-based survey was developed, implemented, and completed by 22 mentees and 17 mentors (71% and 61% response rates, respectively) as part of the evaluation. Discussion The peer mentorship program was found to be valuable by both mentors (64.7%) and mentees (72.7%) in helping mentees further develop their careers and networks and providing mentors with supported mentorship experience. Conclusion The peer mentorship program could serve as a model for other professional organizations, academic institutions, and consortiums to enhance and extend the formal vertical mentorship provided to early academic career individuals.

Evaluation of an electronic module for reconciling medications in home health plans of care

Kramer, H. S., Gibson, B., Livnat, Y., Thraen, I., Brody, A. A., & Rupper, R. (2016). Applied Clinical Informatics, 7(2), 412-424. 10.4338/ACI-2015-11-RA-0154
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Objectives: 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. Methods: Nineteen physicians with experience in managing home health referrals were recruited to participate in this within-subjects experiment. Participants completed medication reconciliation for three clinical cases in each of two conditions. The first condition (paper-based) simulated current practice – reconciling medication discrepancies between a paper plan of care (CMS 485) and a simulated Electronic Health Record (EHR). For the second condition (electronic) participants used our medication reconciliation module, which we integrated into the simulated EHR. To evaluate the effectiveness of our medication reconciliation module, we employed repeated measures ANOVA to test the hypotheses that the module will: 1) Improve accuracy by reducing the number of unaddressed medication discrepancies, 2) Improve efficiency by reducing the reconciliation time, 3) have good perceived usability. Results: The improved accuracy hypothesis is supported. Participants left more discrepancies unaddressed in the paper-based condition than the electronic condition, F (1,1) = 22.3, p < 0.0001 (Paper Mean = 1.55, SD = 1.20; Electronic Mean = 0.45, SD = 0.65). However, contrary to our efficiency hypothesis, participants took the same amount of time to complete cases in the two conditions, F (1, 1) =0.007, p = 0.93 (Paper Mean = 258.7 seconds, SD = 124.4; Electronic Mean = 260.4 seconds, SD = 158.9). The usability hypothesis is supported by a composite mean ability and confidence score of 6.41 on a 7-point scale, 17 of 19 participants preferring the electronic system and an SUS rating of 86.5. Conclusion: We present the evaluation of an electronic medication reconciliation module that increases detection and resolution of medication discrepancies compared to a paper-based process. Further work to integrate medication reconciliation within an electronic medical record is warranted.

Examining the influence of country-level and health system factors on nursing and physician personnel production

Squires, A., Uyei, S. J., Beltrán-Sánchez, H., & Jones, S. A. (2016). Human Resources for Health, 14(1). 10.1186/s12960-016-0145-4
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Background: 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. Methods: This exploratory observational study is grounded in complexity theory as a guiding framework. Variables were selected through a process that attempted to choose macro-level indicators identified by the interdisciplinary literature as known or likely to affect the number of healthcare workers in a country. The combination of these variables attempts to account for the gender- and class-sensitive identities of physicians and nurses. The analysis consisted of 1 year of publicly available data, using the most recently available year for each country where multiple regressions assessed how context may influence health worker production. Missing data were imputed using the ICE technique in STATA and the analyses rerun in R as an additional validity and rigor check. Results: The models explained 63 % of the nurse/midwife-to-population ratio (pseudo R 2=0.627, p=0.0000) and 73 % of the physician-to-population ratio (pseudo R 2=0.729, p=0.0000). Average years of school in a country's population, emigration rates, beds-per-1000 population, and low-income country statuses were consistently statistically significant predictors of production, with percentage of public and private sector financing of healthcare showing mixed effects. Conclusions: Our study demonstrates that the strength of political, social, and economic institutions does impact human resources for health production and lays a foundation for studying how macro-level contextual factors influence physician and nurse workforce supply. In particular, the results suggest that public and private investments in the education sector would provide the greatest rate of return to countries. The study offers a foundation from which longitudinal analyses can be conducted and identifies additional data that may help enhance the robustness of the models.

An exercise counseling intervention in minority adults with heart failure

McCarthy, M. M., Dickson, V. V., Katz, S. D., & Chyun, D. A. (2016). Rehabilitation Nursing, 42(3), 146-156. 10.1002/rnj.265
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Purpose: The primary aimof this study was to assess the feasibility of an exercise counseling intervention for adults of diverse race/ ethnicity with heart failure (HF) and to assess its potential for improving overall physical activity, functional capacity, and HF self-care. Design: This study was a quasi-experimental, prospective, longitudinal cohort design. Methods: Twenty adults were enrolled and completed the 6-minute walk and standardized instruments, followed by exercise counseling using motivational interviewing. Each received an accelerometer, hand weights, and a diary to record self-care behaviors. Participants were followed via phone for 12 weeks to collect step-counts, review symptoms, and plan the following week's step goal. Findings: Results indicate that this interventionwas feasible formost participants and resulted in improvements in physical activity, functional capacity, and self-care behaviors. Conclusion/Clinical Relevance: Brief exercise counseling may be an appropriate option to improve outcomes for stable patients with HF and may be tailored to fit different settings.

Experience of older adults adapting to residential life in long-term care (LTC) facilities in China

Wang, J., Wang, J., Cao, Y., Jia, S., & Wu, B. (2016). Journal of Geriatric Nursing, 42(8), 34-43.

Explaining racial/ethnic dietary patter ns in relation to type 2 diabetes: An analysis of NHAN ES 2007-2012

Nowlin, S. Y., Cleland, C. M., Vadiveloo, M., Parekh, N., Melkus, G. D. E., & Hagan, H. (2016). Ethnicity and Disease, 26(4), 529-536. 10.18865/ed.26.4.529
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Objective: The purpose of this article is to examine sociodemographic and health behavior factors associated with dietary intake as measured by the healthy eating index (HEI-2010) for persons with and without diabetes (T2D). Design: A secondary data analysis of three NHANES data cycles spanning 2007-2012. Multiple linear regression assessed racial/ ethnic differences in HEI-2010 scores in those without T2D, with T2D, and with undiagnosed T2D. Participants: The sample included nonpregnant adults aged ≥20 years who had two days of reliable dietary recall data. Outcome Measures: Total scores for the HEI-2010. Results: For those without T2D, there was a significant association between race/ ethnicity and HEI score, with non-Hispanic Blacks achieving significantly lower scores than their non-Hispanic White counterparts. Differences in HEI-2010 score were also associated with age, sex, smoking status and time spent in the United States. Racial/ ethnic differences in dietary patterns were present, but not significant in those with undiagnosed or diagnosed T2D. Conclusions: Racial/ethnic disparities in dietary patterns are present in individuals without T2D, but differences are not statistically significant in those with undiagnosed or diagnosed T2D. Non-Hispanic Blacks without T2D received significantly lower HEI-2010 scores than non-Hispanic Whites. Further research is necessary to determine whether or not similarities in dietary intake across racial/ethnic groups with T2D will be reflected in diabetes-related health outcomes in this population.

Exploring longitudinal shifts in international nurse migration to the United States between 2003 and 2013 through a random effects panel data analysis

Squires, A., Ojemeni, M. T., & Jones, S. (2016). Human Resources for Health, 14. 10.1186/s12960-016-0118-7
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Background: 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. Methods: In this random effects panel data analysis, we analyzed 11 years (2003-2013) of annual IEN applicant numbers and pass rates for registered nurse credentialing. Data were obtained from publicly available reports on exam pass rates. With the global economic crisis and NCLEX-RN changes in 2008 coupled with the WHO Code passage in 2010, we sought to compare if (1) the number of applicants changed significantly after those 2 years and (2) if pass rates changed following exam modifications implemented in 2008 and 2011. Results: A total of 177 countries were eligible for inclusion in this analysis, representing findings from 200,453 IEN applicants to the United States between 2003 and 2013. The majority of applicants were from the Philippines (58 %) and India (11 %), with these two countries combined representing 69 % of the total. Candidates from Sub-Saharan African countries totalled 7133 (3 % of all applications) over the study period, with half of these coming from Nigeria alone. No significant changes were found in the number of candidates following the 2008 economic crisis or the 2010 WHO Code, although pass rates decreased significantly following the 2008 exam modifications and the WHO Code implementation. Conclusion: This study suggests that, while the WHO Code has had an influence on overall IEN migration dynamics to the United States by decreasing candidate numbers, in most cases, the WHO Code was not the single cause of these fluctuations. Indeed, the impact of the NCLEX-RN exam changes appears to exert a larger influence.

Factors Associated with HPV Vaccination among Cambodian American Teenagers

Lee, H., Kim, M., Kiang, P., Shi, L., Tan, K., Chea, P., Peou, S., & Grigg-Saito, D. C. (2016). Public Health Nursing, 33(6), 493-501. 10.1111/phn.12294
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Objectives: Parents have general influence over their children's health and health behavior. However, given the dearth of specific literature regarding knowledge level and social and cultural factors influencing HPV vaccination behaviors among Cambodian American (CA) parent, it is difficult to develop an effective, evidence-based public health HPV vaccination program. Therefore, the objectives of this study were to determine the HPV vaccine uptakes among CA teenagers and to examine factors influencing HPV vaccine uptakes. Design and Sample: A descriptive, cross-sectional survey design and a combination of network and targeted sampling methods were used. Results: CA mothers (n = 130) completed a health survey through face-to-face interviews in either English or Khmer language. Girls vaccination rates were 29% while that of boys was 16%. Awareness and knowledge of HPV among CA mothers was very low, and many believed that their daughters, who speak English and were educated in the U.S., had more knowledge about health than they did. Logistic regression analysis showed that CA girls had significantly higher odds of vaccination when their mothers possessed a higher level of English reading ability and had greater awareness and knowledge of HPV. Conclusions: The strikingly low rates of HPV vaccination among CA girls and boys underscore the need to improve vaccination outreach, education, and uptake. The findings can be used to develop targeted public health HPV vaccination programs for CAs, which will reduce cervical cancer disparities.

Factors associated with resident influenza vaccination in a national sample of nursing homes

Travers, J. L., Stone, P. W., Bjarnadottir, R. I., Pogorzelska-Maziarz, M., Castle, N. G., & Herzig, C. T. (2016). American Journal of Infection Control, 44(9), 1055-1057. 10.1016/j.ajic.2016.01.019
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Influenza vaccination remains the cornerstone of influenza prevention, yet national goals for nursing home residents and staff vaccination have not been met. Few studies have examined associations between facility and resident characteristics; employee processes, such as staff vaccination policies; and resident influenza vaccination. In this national survey of nursing homes, employee processes were not associated with resident influenza vaccination; however, various facility and resident characteristics were.

Family caregivers of patients with frontotemporal dementia: An integrative review

Caceres, B. A., Frank, M. O., Jun, J., Martelly, M. T., Sadarangani, T., & De Sales, P. C. (2016). International Journal of Nursing Studies, 55, 71-84. 10.1016/j.ijnurstu.2015.10.016
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Objectives: The purpose of this integrative review is to: (1) identify the characteristics of family caregivers of patients with frontotemporal dementia, (2) explore the impact of providing care on family caregivers' health and well-being, and (3) identify coping strategies used by family caregivers. Background: Frontotemporal dementia is thought to be the second most common form of dementia after Alzheimer's disease. Family caregivers of patients with frontotemporal dementia face unique challenges due to its early onset, behavioral symptoms, and slow progression of decline. However, there is a dearth of research evaluating the health and wellbeing of family caregivers of patients with frontotemporal dementia. Design and data sources: An integrative review was conducted using the Whittemore and Knafl methodology. An electronic search of the literature was conducted using four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe Critical Appraisal tool was used to evaluate the quality of the selected articles. Results: Findings of 11 articles informed this integrative review. Family caregivers of patients with frontotemporal dementia identify behavioral disturbances as most troubling. Spouses and female caregivers experience greater caregiver burden, distress, increased rates of depression, as well as decreased sleep related to behavior disturbances. Though less explored, providing care to those with behavioral disturbances may also impact caregiver physical health. Additionally, female caregivers are most likely to employ coping strategies, most commonly, adaptation and reframing. Effective interventions to reduce family caregiver burden are poorly understood but family caregivers suggest education and internet-based support groups are most helpful. Conclusions: Family caregivers of patients with frontotemporal dementia experience significant distress, which impacts their health and wellbeing. It is important for healthcare providers who care for patients with frontotemporal dementia to recognize the unique needs of family caregivers. Future research should focus on examining interventions and strategies to reduce caregiver burden.

Feasibility and acceptability of an audio computer-assisted self-interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary care patients

Spear, S. E., Shedlin, M., Gilberti, B., Fiellin, M., & McNeely, J. (2016). Substance Abuse, 37(2), 299-305. 10.1080/08897077.2015.1062460
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Background: This study explores the feasibility and acceptability of a computer self-administered approach to substance use screening from the perspective of primary care patients. Methods: Forty-eight patients from a large safety net hospital in New York City completed an audio computer-assisted self-interview (ACASI) version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and a qualitative interview to assess feasibility and acceptability, comprehension, comfort with screening questions, and preferences for screening mode (interviewer or computer). Qualitative data analysis organized the participants' feedback into major themes. Results: Participants overwhelmingly reported being comfortable with the ACASI ASSIST. Mean administration time was 5.2 minutes (range: 1.6–14.8 minutes). The major themes from the qualitative interviews were (1) ACASI ASSIST is feasible and acceptable to patients, (2) Social stigma around substance use is a barrier to patient disclosure, and (3) ACASI screening should not preclude personal interaction with providers. Conclusions: The ACASI ASSIST is an appropriate and feasible approach to substance use screening in primary care. Because of the highly sensitive nature of substance use, screening tools must explain the purpose of screening, assure patients that their privacy is protected, and inform patients of the opportunity to discuss their screening results with their provider.

Feeling Heard and Understood: A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting

Gramling, R., Stanek, S., Ladwig, S., Gajary-Coots, E., Cimino, J., Anderson, W., Norton, S. A., Aslakson, R. A., Ast, K., Elk, R., Garner, K. K., Grudzen, C., Kamal, A. H., Lamba, S., Leblanc, T. W., Rhodes, R. L., Roeland, E., Schulman-Green, D., & Unroe, K. T. (2016). Journal of Pain and Symptom Management, 51(2), 150-154. 10.1016/j.jpainsymman.2015.10.018
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Context As endorsed by the palliative care "Measuring What Matters" initiative, capturing patients' direct assessment of their care is essential for ongoing quality reporting and improvement. Fostering an environment where seriously ill patients feel heard and understood is of crucial importance to modern health care. Objectives To describe the development and performance of a self-report field measure for seriously ill patients to report how well they feel heard and understood in the hospital environment. Methods As part of a larger ongoing cohort study of inpatient palliative care, we developed and administered the following point-of-care item: "Over the past two days, how much have you felt heard and understood by the doctors, nurses and hospital staff?" (completely, quite a bit, moderately, slightly, not at all). Participants completed the measure before and the day after palliative care consultation. For the postconsultation version, we changed the time frame from "past two days" to "today." Results One hundred sixty patients with advanced cancer completed the preconsultation assessment, and 87% of them completed the postconsultation version. Responses encompassed full use of the ordinal scale, did not exhibit ceiling or floor effects, and showed improvement from preassessment to postassessment. The item was quick to administer and easy for patients to complete. Conclusion The "Heard & Understood" item is a promising self-report quality measure for the inpatient palliative care setting.

Find out how to respond appropriately when patients express bigotry at the bedside

Lim, F. A., & Borski, D. B. (2016). Nursing Management, 47(8), 48-52. 10.1097/01.NUMA.0000473515.84420.ad

First trimester pregnancy-associated plasma protein-A and birth weight

Baer, R. J., Lyell, D. J., Norton, M. E., Currier, R. J., & Jelliffe-Pawlowski, L. L. (2016). European Journal of Obstetrics and Gynecology and Reproductive Biology, 198, 1-6. 10.1016/j.ejogrb.2015.12.019
Abstract
Abstract
Objective To evaluate first trimester pregnancy-associated plasma protein-A (PAPP-A) and birth weight percentile. Study design Included were women who underwent first trimester prenatal screening through the California Prenatal Screening Program with expected dates of delivery between August 2009 and December 2010, linked birth certificate and hospital discharge records, known birth weight, and no chromosomal abnormality (n = 134.105). PAPP-A results were reported as multiples of the median. The frequency of small or large for gestational age (SGA, ≤10%; LGA, ≥90%) versus appropriately grown for gestational age birth was examined by PAPP-A percentile. Patterns were studied by gestational age at delivery. Relative risks (RRs) and their 95% confidence intervals were adjusted for race/ethnicity. Results Women with PAPP-A ≤10th percentile and an infant born after 32 weeks were increasingly more likely to have an SGA infant ( adj RRs 1.5-4.6) as the PAPP-A percentile declined, and were increasingly less like to have an LGA infant born at term ( adj RRs 0.5-0.7) compared to women with PAPP-A measurement >10th to <90th percentile. PAPP-A ≥90th percentile was protective for SGA among infants born after 32 weeks gestation ( adj RRs 0.3-0.7) and was associated with LGA among infants born at term ( adj RRs 1.2-8.2). Conclusion Women with PAPP-A ≤10th percentile are more likely to have an SGA infant at all gestational ages. PAPP-A ≥90th percentile is protective against SGA and is associated with an increased risk of LGA for infants born after 32 weeks gestation.