Publications

Abstract

Simulation in obstetrics and gynecology (OBGYN) training captures a range of interpersonal, cognitive, and technical skills. However, trainee perspectives on simulation-based assessment remain unexplored. After an observed structured clinical examination (OSCE) simulation hybrid exam, two focus groups of residents were conducted. Analysis grounded in a thematic coding guided the qualitative research process. Responses suggest a valuation of cognitive and technical skills over interpersonal skills. Realism was seen as critical and residents perceived the assessment as more valuable for the educator than the learner. Feedback was highly valued. Resident perspectives on this exam give insight into their perceptions of simulation-based assessment as well as their conceptions of their own learning through simulations.

Abstract

nurse practitioner, advanced nursing practice, United States, nurse practitioner outcomes, nurse practitioner education, nurse practitioner regulation

Abstract

Approximately one quarter of all Medicare beneficiaries hospitalized for heart failure (HF) are discharged to long-term care (LTC) for skilled nursing care, and, of those, 25% are readmitted to the hospital within 30 days. We implemented a 3-month pilot quality improvement project using a pre-post design that included an educational intervention for certified nursing assistants (CNAs) conducted by a nurse practitioner (NP). The three aims of the project were to: (1) improve CNAs' knowledge of heart failure (HF) management strategies; (2) improve CNAs' reporting of acute changes in the condition of residents with HF; and (3) reduce rehospitalizations of the facility's skilled unit residents with HF. The percentage of HF resident 30-day hospital readmission rates fell 7.8% during the project's 3-month implementation period. The results of this project support future NP-led clinical education for CNAs working in this facility.

Abstract

Aims: To explore pressing issues identified by nurses caring for older patients in US NICHE (Nurses Improving Care for the Healthsystem Elders) hospitals, regarding palliative care and end-of-life (EOL) decision-making. Objectives are to (1) identify the most pressing palliative care and EOL decision-making issues and strategies to address them and (2) identify the association of nursing demographics (age, gender, race, education and experience), institutional/unit characteristics and these issues. Background: Critical care nurses have an integral role in supporting older patients and families faced with palliative care and EOL decision-making issues. Despite national imperatives to improve the quality of palliative care, patients continue to experience uncontrolled pain, inadequate communication, disregard of their wishes and life prolonging interventions. These contribute to increased hospitalizations and costs. Understanding the prevalent issues is needed to address patient needs at the end-of-life. Design: It is a mixed method study. Methods: A secondary analysis of the NICHE Geriatric Institutional Assessment Profile (GIAP) database (collected 1/08-9/13) was conducted using the sample of Critical Care RNs who provided comments regarding palliative care and EOL decision-making. Qualitative data were analyzed using Dedoose software. Data clusters and patterns of co-occurring codes were explored through an iterative analysis process. Themes were examined across nurse demographics, institutional and unit characteristics. Results: Comments specifically addressing issues regarding EOL decision-making were provided by 393 critical care nurses from 156 hospitals ( age = 42·3 years, 51% BSN degree). Overarching theme was discordance in goals of care (prolonging life versus quality of life), ineffective physician-patient-family communication, lack of time and unrealistic expectations. Conclusions: Nurses' descriptions highlight the need for increased communication, staff education and availability of palliative care services. Relevance to Practice: Palliative care and EOL decision-making will remain a nursing priority as people age and require increased care.

Abstract

AIM The aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons. BACKGROUND There is paucity of research to assess the attitudes of nursing students toward LGBT persons. METHOD An electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice RESULTS Less than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes. CONCLUSION There are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.

Abstract

China's formal long-term care (LTC) system is in its developmental stage due to lack of standardized health assessments for resident admission, limited government funding, an acute shortage of qualified staffat all levels, and regional disparities in quality of care. Relocation to LTC facilities changes the lives of older adults because they have to leave behind their homes and previous social networks. The current study aimed to provide an in-depth exploration of 25 older adult residents' lives in four LTC facilities in China. A conventional content analysis approach was used to interpret participant interviews. Residents experienced losses and gains from residential life. Three themes emerged: (a) influences of cultural beliefs, (b) basic care needs fulfilled in LTC facilities, and (c) lack of quality care in LTC facilities. Findings show that residents' basic needs were met in Chinese LTC facilities, but there is room for improvement in delivering quality care.

Abstract

Background: More than 1.2 million people in the United States are living with human immunodeficiency virus (HIV), and 3.2 million are living with hepatitis C virus (HCV). An estimated 25% of persons living with HIV also have HCV. It is therefore of great public health importance to ensure the prompt diagnosis of both HIV and HCV in populations that have the highest prevalence of both infections, including individuals with substance use disorders (SUD). Methods/design: In this theory-driven, efficacy-effectiveness-implementation hybrid study, we will develop and test an on-site bundled rapid HIV/HCV testing intervention for SUD treatment programs. Its aim is to increase the receipt of HIV and HCV test results among SUD treatment patients. Using a rigorous process involving patients, providers, and program managers, we will incorporate rapid HCV testing into evidence-based HIV testing and linkage to care interventions. We will then test, in a randomized controlled trial, the extent to which this bundled rapid HIV/HCV testing approach increases receipt of HIV and HCV test results. Lastly, we will conduct formative research to understand the barriers to, and facilitators of, the adoption, implementation, and sustainability of the bundled rapid testing strategy in SUD treatment programs. Discussion: Novel approaches that effectively integrate on-site rapid HIV and rapid HCV testing are needed to address both the HIV and HCV epidemics. If feasible and efficacious, bundled rapid HIV/HCV testing may offer a scalable, potentially cost-effective approach to testing high-risk populations, such as patients of SUD treatment programs. It may ultimately lead to improved linkage to care and progress through the HIV and HCV care and treatment cascades. Trial registration: ClinicalTrials.gov: NCT02355080.

Abstract

Aims and Objectives: To explore nurse-practitioner's attitudes towards working with lesbian, gay and bisexual patients. Background: Literature suggests that lesbians, gay men and bisexuals have significant health disparities compared to heterosexuals. Although the reasons are multifactorial, research suggests that attitudes of healthcare providers (HCPs) may be a contributing factor in both accessing and receiving care. There is currently no literature exploring the attitudes of the approximately 300,000 nurse-practitioners in the United States. Thus, nurse-practitioners strengths and challenges in providing care to sexual minorities are unknown. Design: As part of a larger study, Corbin & Strauss’ grounded theory methodology was used to explore the attitudes towards lesbian, gay and bisexual patients among primary care nurse-practitioners in NYC. Methods: Data were collected via individual semi-structured interviews with nurse-practitioners currently in practice in primary or outpatient care in NYC (n = 19). Data were evaluated using the three-step constant comparison method. Results: Nurse-practitioners in this study had varied, often overlapping and sometimes conflicting, attitudes about working with lesbian, gay and bisexual patients. The main theme identified was ‘open arms, conflicted hearts’ with three major subthemes – feeling at home, struggling to maintain professionalism and finding comfort under the umbrella of diversity. Conclusions: Nurse-practitioner participants in this study had varied attitudes about working with lesbian, gay and bisexual patients, ranging from open, confident and comfortable to ambivalent, cautious and unsure about working with lesbian, gay and bisexual patients generally and specifically regarding the health needs of this population. Relevance to clinical practice: This study highlights the inadequate didactic and clinical preparation most nurse-practitioners feel they have to care for lesbian, gay and bisexual patients. There is a need for increased education for registered nurses and nurse-practitioners regarding lesbian, gay and bisexual culture, their unique healthcare needs, as well as the role of stigma and marginalisation in caring for vulnerable populations.

Abstract

Background: Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care. Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact. Method: We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes. Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes. Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.

Abstract

The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Background and purpose Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Methods Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. Conclusion A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care.

Abstract

Oral health is crucial to overall health. Because of normal physiologic changes, pregnancy is a time of particular vulnerability in terms of oral health. Pregnant women and their providers need more knowledge about the many changes that occur in the oral cavity during pregnancy. In this article we describe the importance of the recognition, prevention, and treatment of oral health problems in pregnant women. We offer educational strategies that integrate interprofessional oral health competencies.

Abstract

When nurses care for women during labor, they encounter numerous alerts and alarms from electronic fetal monitors and their surveillance systems. Notifications of values of physiologic parameters for a woman and fetus that may be outside preset limits are generated via visual and audible cues. There is no standardization of these alert and alarm parameters among electronic fetal monitoring vendors in the United States, and there are no data supporting their sensitivity and specificity. Agreement among professional organizations about physiologic parameters for alerts and alarms commonly used during labor is lacking. It is unknown if labor nurses view the alerts and alarms as helpful or a nuisance. There is no evidence that they promote or hinder patient safety. This clinical issue warrants our attention as labor nurses.

Abstract

Background/Objectives: Regular self-weighing has been associated with weight loss and maintenance in adults enrolled in a behavioral weight loss intervention; however, few studies have examined the patterns of adherence to a self-weighing protocol. The study aims were to (1) identify patterns of self-weighing behavior; and (2) examine adherence to energy intake and step goals and weight change by self-weighing patterns. Subjects/Methods: This was a secondary analysis of self-monitoring and assessment weight data from a 12-month behavioral weight loss intervention study. Each participant was given a scale that was Wi-Fi-enabled and transmitted the date-stamped weight data to a central server. Group-based trajectory modeling was used to identify distinct classes of trajectories based on the number of days participants self-weighed over 51 weeks. Results: The sample (N=148) was 90.5% female, 81.1% non-Hispanic white, with a mean (s.d.) age of 51.3 (10.1) years, had completed an average of 16.4 (2.8) years of education and had mean body mass index of 34.1 (4.6) kg m-2. Three patterns of self-weighing were identified: high/consistent (n=111, 75.0% self-weighed over 6 days per week regularly); moderate/declined (n=24, 16.2% declined from 4-5 to 2 days per week gradually); and minimal/declined (n=13, 8.8% declined from 5-6 to 0 days per week after week 33). The high/consistent group achieved greater weight loss than either the moderate/declined and minimal/declined groups at 6 months (-10.19%±5.78%, -5.45%±4.73% and -2.00%±4.58%) and 12 months (-9.90%±8.16%, -5.62%±6.28% and 0.65%±3.58%), respectively (P<0.001). The high/consistent group had a greater mean number days per week of adherence to calorie intake goal or step goal but not higher than the moderate/declined group. Conclusions: This is the first study to reveal distinct temporal patterns of self-weighing behavior. The majority of participants were able to sustain a habit of daily self-weighing with regular self-weighing leading to weight loss and maintenance as well as adherence to energy intake and step goals.

Abstract

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.

Abstract

Purpose: Not all oncology patients and their family caregivers (FCs) experience the same quality of life (QOL). The purposes of this study were to identify latent classes of oncology patients (n = 168) and their FCs (n = 85) with distinct physical, psychological, social, and spiritual well-being trajectories from prior to through 4 months after the completion of radiation therapy and to evaluate for demographic, clinical, and genetic characteristics that distinguished between these latent classes. Methods: Using growth mixture modeling, two latent classes were found for three (i.e., physical, psychological, and social well-being) of the four QOL domains evaluated. Results: Across these three domains, the largest percentage of participants reported relatively high well-being scores across the 6 months of the study. Across these three QOL domains, patients and FCs who were younger, female, belonged to an ethnic minority group, had children at home, had multiple comorbid conditions, or had a lower functional status, were more likely to be classified in the lower QOL class. The social well-being domain was the only domain that had a polymorphism in nuclear factor kappa beta 2 (NFKB2) associated with latent class membership. Carrying one or two doses of the rare allele for rs7897947 was associated with a 54 % decrease in the odds of belonging to the lower social well-being class [OR (95 % CI) = .46 (.21,.99), p = .049]. Conclusions: These findings suggest that a number of phenotypic and molecular characteristics contribute to differences in QOL in oncology patients and their FCs.

Abstract

Purpose The purpose of this study was to examine sociodemographic, clinical, and psychological factors associated with engaging in regular physical activity (PA) in adults with type 1 diabetes. Secondary cross-sectional analysis based on data from the Type One Diabetes Exchange clinic registry was conducted. Adults ≥18 years old enrolled in the clinic registry who had completed PA self-report data (n = 7153) were included in this study. Mean age was 37.14 ± 17 years, and 54% (n = 3840) were men. Type 1 diabetes duration was 19.5 ± 13.5 years, and mean A1C level was 7.9% ± 1.5% (62 mmol/mol). Twelve percent (n = 848) of the sample reported no PA; 55% (n = 3928) reported PA 1 to 4 days per week; and 33% (n = 2377) reported PA ≥5 days per week. Factors that were associated with increased odds of no PA were older age, less-than-excellent general health, increased body mass index, longer duration of diabetes, and increased depressive symptoms. More blood glucose meter checks per day decreased odds of no PA. Factors associated with lower odds of ≥5 days of PA included minority race/ethnicity, education, less-than-excellent general health, presence of a foot ulcer, increased body mass index, and depressive symptoms. Male sex, less-than-full-time employment, and being single increased the odds of ≥5 days of PA. Several demographic, clinical, diabetes-related, and psychosocial factors were related to PA. Potential interventions may target those with depressive symptoms or self-reported poor general health, or they may be tailored to working adults who may find it harder to be physically active.

Abstract

Objective: Breast cancer survivors do not engage in appropriate levels of physical activity, despite the known benefits of such activity. This study aims to describe physical-activity levels and the barriers to it in a group of Puerto Rican breast cancer survivors, as well as detailing their preferences for an intervention. Methods: Participants who finished their chemotherapy and/or radiotherapy for breast cancer at least 4 months prior to the study were included. Demographic, anthropometric, and clinical data were obtained. The Godin Leisure-Time Exercise Questionnaire (GLTEQ) and questionnaires on exercise self-efficacy, barriers to self-efficacy, modeling, and social support were filled out by study participants. Data on access to exercise equipment and preferences regarding a physical-activity intervention were collected. Descriptive statistics and correlation analyses were performed. Results: Fifty breast cancer survivors were recruited. Almost all the participants reported that they did not engage in any kind of strenuous physical activity (94%), with more than three fourths (76%) reporting that they did not even participate in any kind of moderate physical activity. The GLTEQ score was associated with barriers to selfefficacy, while the association with exercise self-efficacy approached significance (p = 0.055). Nearly half of the patients (44%) had access to exercise equipment. Preferred methods for the delivery of physical-activity interventions were participating in group settings (72%) and receiving material in the postal mail (44%). Conclusion: The study described herein reports on the low levels of physical activity being practiced by a group of Puerto Rican breast cancer survivors, despite the fact that many of them had access to exercise equipment and facilities. Further studies aimed at understanding breast cancer survivors’ barriers to physical activity and at developing culturally competent interventions to increase the levels of such activity are warranted.

Abstract

Introduction Before and after breast cancer surgery, women have reported varying anxiety levels. Recent evidence has suggested that anxiety has a genetic basis and is associated with inflammation. The purposes of the present study were to identify the subgroups of women with distinct anxiety trajectories; to evaluate for differences in the phenotypic characteristics between these subgroups; and to evaluate for associations between polymorphisms in cytokine genes and subgroup membership. Patients and Methods Patients with breast cancer (n = 398) were recruited before surgery and followed up for 6 months. The patients completed the Spielberger State Anxiety Inventory and provided a blood sample for genomic analyses. Growth mixture modeling was used to identify the subgroups of patients with distinct anxiety trajectories. Results Two distinct anxiety subgroups were identified. The women in the higher anxiety subgroup were younger and had a lower functional status score. Two single nucleotide polymorphisms in tumor necrosis factor-α (rs1799964, rs3093662) were associated with the higher anxiety subgroup. Conclusion The results of the present exploratory study suggest that polymorphisms in cytokine genes could partially explain the interindividual variability in anxiety. The determination of phenotypic and molecular markers associated with greater levels of anxiety can assist clinicians to identify high-risk patients and initiate appropriate interventions.

Abstract

Objective: The objective of this study is to examine the effect of small or large for gestational age (SGA/LGA) status on mortality and morbidity by gestational age. Study design: Logistic binomial regression was used to calculate relative risks (RRs) and 95% confidence intervals for infant mortality and preterm morbidities for SGA or LGA compared with appropriately grown (AGA) deliveries stratified by gestational age group. Results: Compared with AGA infants of similar gestational age, SGA infants were at increased risk for infant mortality. Mortality risk was decreased for LGA infants born between 25 and 27 weeks (RR: 0.6) but increased for LGA infants born between 28 and 31 weeks (RR: 1.9). Risk of preterm morbidity was increased for SGA infants born between 28 and 38 weeks, but decreased for LGA infants born before 37 weeks. Conclusion: This study demonstrates the importance of considering birth weight for gestational age when evaluating morbidity and mortality risks.