Body Mass Indices of Girls with and without ADHD: Developmental Trajectories from Childhood to Adulthood.

OBJECTIVE: We examined the predictive relation between childhood-diagnosed ADHD and trajectories of body mass index (BMI) from childhood to adulthood in an all-female sample, accounting for socioeconomic status (SES), childhood comorbidities (e.g., depression/anxiety), and stimulant usage. Childhood executive functioning (i.e., planning, sustained attention, and response inhibition) was also evaluated as a possible predictor of BMI trajectories. METHOD: We utilized longitudinal data from a full sample of 140 girls diagnosed with ADHD in childhood and 88 comparison girls matched on age and ethnicity. Girls were 6-12 years old at the first assessment and followed prospectively for 16 years. Data were collected on their BMI and stimulant medication usage across four evaluation waves. Using latent growth curve modeling, we evaluated the BMI trajectories of girls with ADHD and the comparison sample from childhood to adulthood. RESULTS: Although there was no significant difference in initial childhood BMI, girls with ADHD increased in BMI at a significantly faster rate than comparison girls across development, even when adjusting for covariates. Significant differences in BMI first emerged in adolescence; by adulthood, 40.2% of the ADHD sample met criteria for obesity versus 15.4% of the comparison sample. When covarying ADHD diagnosis, executive functioning measures were not significantly predictive of BMI increase. Adjusting for stimulant medication usage within the ADHD sample did not alter core findings. CONCLUSIONS: We discuss health-related implications for girls with ADHD, potential underlying mechanisms, and how our findings may inform both ADHD and obesity interventions.

Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors.

Medication administration errors are difficult to intercept since they occur at the end of the process. The study describes interruptions, distractions, and cognitive load experienced by registered nurses during medication administration and explores their impact on procedure failures and medication administration errors. The focus of this study was unique as it investigated how known individual and environmental factors interacted and culminated in errors.

An NCLEX-RN Improvement Project: A Study of Student Attributes Associated With Test Success.

BACKGROUND: A school of nursing developed a process to improve graduates' NCLEX-RN scores through a committee tasked with identifying approaches to assist students in passing the NCLEX-RN on the first attempt. METHOD: The process involved: (1) engaging the faculty to use current published evidence; and (2) conducting an anonymous survey of previous graduates to identify the factors associated with NCLEX-RN success in the school's student population. Logistic regression analysis was conducted on a sample of 165 graduates of the program. RESULTS: The analysis of the graduates' psychosocial, academic, and NCLEX-RN preparation attributes compared with NCLEX-RN outcome revealed grade point average was the strongest significant predictor of success. CONCLUSION: The NCLEX-RN success program served to engage the school of nursing faculty. In addition, a study of the program's graduates revealed a predictor of potential student success that can identify students who may need additional support early in the program. [J Nurs Educ. 2024;63(2):102-107.].

Blending evidence and innovation: improving intershift handoffs in a multihospital setting.

Ineffective handoffs have been identified as a barrier to patient safety and quality and as a key area for improvement. Handoffs require a process for effective transfer of critical information. A redesigned nurse-to-nurse intershift handoff was implemented in 7 hospitals of a multisite system. The redesign included combining evidence and an innovative approach developed by nurse managers to improve intershift report. Results included an increase in nurse and patient satisfaction.

Creating a culture of shared Governance begins with developing the nurse as scholar.

The relationship between shared governance and nursing scholarship is investigated with an emphasis on the connection between stages of scholarly development and nursing action in the evolution of professional practice models. The scholarly image of nursing is described and four critical stages of scholarship (scholarly inquiry, conscious reflection, persistent critique, and intellectual creation) are presented. The development of nursing scholars is described with emphasis on intellectual virtues as described by philosophers and values as described by nursing theorists that are foundational to this process. Shared governance is viewed holistically as a true scholarly process when these elements are in place and are used by nurses.

Emotion-related impulsivity predicts increased anxiety and depression during the COVID-19 pandemic.

INTRODUCTION: Emotion-related impulsivity, defined by poor constraint in the face of emotion, is related to internalizing symptoms, cross-sectionally and longitudinally. Internalizing symptoms, though, are profoundly tied to stress reactivity, and little is known about how emotion-related impulsivity relates to stress reactivity. METHOD: Taking advantage of a sample that had completed measures of depression, anxiety, suicidal ideation, and two forms of emotion-related impulsivity before the pandemic, we asked participants to complete three weekly follow-up internalizing assessments early in the pandemic. RESULTS: Among the 150 participants, pre-pandemic emotion-related impulsivity scores predicted higher depression, anxiety, general distress, and suicidal ideation during the COVID-19 pandemic. Controlling for pre-pandemic scores, one form of emotion-related impulsivity (Feelings Trigger Action) predicted increased anxiety and general distress. We also examined how pre-pandemic emotion-related impulsivity was moderated by weekly COVID-related stress. One form of emotion-related impulsivity (Pervasive Influence of Feelings) predicted internalizing symptoms at low stress levels, and a different form (Feelings Trigger Action) predicted internalizing symptoms at higher stress levels. LIMITATIONS: Limitations include the small sample size, the absence of repeat measures of impulsivity, the attrition of individuals with more internalizing symptoms, and the reliance on self-rated measures. CONCLUSIONS: Forms of emotion-related impulsivity predict increases in anxiety and distress over time, but the interactions with stress levels appear to vary. Emotion-related impulsivity can be addressed with accessible intervention tools, suggesting the promise of broader screening for those at risk for internalizing symptoms during periods of high stress.

Longitudinal associations between internalizing symptoms, social behavior, and social perceptions in the initial months of the COVID-19 pandemic: Findings from a transdiagnostic community sample.

BACKGROUND: Burgeoning evidence suggests that loneliness during the COVID-19 pandemic is tied to high levels of depression and anxiety. The current study is unique, though, in examining which facets of social behavior and perceived social quality are most tied to internalizing symptoms using longitudinal data, including a pre-pandemic baseline, collected from a community sample of adults with pre-existing mental health concerns (analyzed n = 144). METHODS: Participants completed measures of depressive and anxious symptoms pre-pandemic, followed by three weekly surveys during the pandemic. We distinguished four social variables: in-person social engagement, remote social engagement, social disruption, and social distress. OLS and mixed-effects regression models examined 1) pre-pandemic baseline symptoms as predictors of social functioning during the pandemic and 2) time-lagged associations between symptoms and social functioning during the pandemic. RESULTS: Social behavior and social perceptions were dissociable. Baseline depressive, but not anxious, symptoms predicted greater social distress during the pandemic. Both anxious and depressive symptoms were predicted by social variables, but the specific associations differed: depressive symptoms were related to perceived social quality, whereas anxious symptoms were more tied to reported social behavior. LIMITATIONS: We relied on self-report indices, and causality should not be inferred directly from these correlational data. CONCLUSIONS: Overall, our results indicate that it is possible to follow social guidelines and even to spend relatively few hours socializing with close others, while still feeling connected and rewarded; however, people who struggle with depression and anhedonia were particularly vulnerable to distressing feelings of social disconnection amid the pandemic.

Predictors and correlates of lifetime and persistent non-suicidal self-injury and suicide attempts among adult survivors of childhood sexual abuse.

Background: Childhood sexual abuse (CSA) is a well-established risk factor for non-suicidal self-injury (NSSI) and suicide attempts (SA); still few studies have examined predictors of individual differences in NSSI/SA amongst CSA survivors. Objective: To examine predictors of NSSI and SA among adult CSA-survivors. Methods: In a sample of 516, primarily female adult CSA-survivors recruited from support centres for sexual abuse survivors in Norway, we examined the role of abuse/perpetrator characteristics, and the degree/severity of exposure to other types of childhood maltreatment (cumulative childhood maltreatment; CCM), as predictors of lifetime NSSI and SA. In a subsample of 138 individuals responding to follow-up waves two- and four years later, these same distal factors, as well as previous NSSI and proximal factors in the form of symptoms of mental health disorders (posttraumatic stress, anxiety, depression, sleep disturbances, and eating disorders), relational problems, and perceived social support, were examined as predictors of persistent NSSI. Finally, those attempting new SA during the follow-up period were compared to those who did not on these variables. Results: Higher CCM scores and having had an unknown perpetrator positively predicted lifetime NSSI scores. Higher CCM scores, violent abuse, and having had an unknown perpetrator predicted lifetime SA. Higher CCM scores, previous NSSI, having had a known perpetrator, as well as higher depression-, anxiety- and eating disorder scores, positively predicted persistent NSSI during the four-year follow-up period. Compared to those with no new SA, those reporting new SA during the follow-up period had higher CCM, lifetime NSSI, mental health symptoms and relational problem scores, lower perceived social support scores, and were more likely to have done a past SA and to have experienced abuse involving physical violence. Conclusions: A broad range of both distal and proximal factors should be assessed as potential predictors of NSSI and SA among adult CSA-survivors.

Antecedentes: El abuso sexual infantil (CSA por sus siglas en inglés) es un factor de riesgo bien establecido para las autolesiones no suicidas (NSSI por sus siglas en inglés) y los intentos suicidas (SA por sus siglas en inglés); aun así, pocos estudios han examinado los predictores de las diferencias individuales en NSSI/SA en los sobrevivientes de CSA. Objetivo: Examinar los predictores de NSSI y SA entre adultos sobrevivientes de CSA.Métodos: En una muestra de 516, primariamente mujeres adultas sobrevivientes de CSA reclutadas de centros de apoyo para sobrevivientes de abuso sexual en Noruega, examinamos el rol de las características del abuso/perpetrador y el grado/severidad de la exposición a otros tipos de maltrato infantil (maltrato acumulativo infantil; CCM por sus siglas en ingles), como predictores de NSSI y SA en la vida. En una submuestra de 138 individuos que respondieron a las etapas de seguimiento dos y cuatro años después, se examinaron como predictores de NSSI persistente, estos mismos factores distales, así como NSSI previos y factores proximales en la forma de síntomas de trastornos de salud mental (estrés postraumático, ansiedad, depresión, trastornos del sueño y trastornos de la conducta alimentaria), problemas relacionales, y apoyo social percibido. Finalmente, se compararon en estas variables los que intentaron un nuevo SA durante el periodo de seguimiento con los que no lo hicieron.Resultados: Puntajes más altos de CCM y haber tenido un perpetrador desconocido, predijeron positivamente puntajes de NSSI en la vida. Puntajes de CCM más altos, abuso violento y haber tenido un perpetrador desconocido predijeron el SA en la vida. Los puntajes más altos de CCM, NSSI previos, haber tenido un perpetrador conocido, así como puntajes más altos de depresión, ansiedad y trastornos alimentarios, predijeron positivamente NSSI persistente durante el periodo de seguimiento de 4 años. Comparado con los individuos sin nuevos SA, los que reportaron SA nuevos durante el periodo de seguimiento tenían puntajes más altos de CCM, NSSI en la vida, síntomas de salud mental y problemas relacionales, puntajes más bajos de apoyo social percibido y tenían más probabilidades de haber realizado SA en el pasado y haber experimentado abuso que involucraba violencia física.Conclusiones: Se debe evaluar una amplia gama de factores distales y proximales como posibles predictores de NSSI y SA entre adultos sobrevivientes de CSA.

Transforming Nursing Education and the Formation of Students: Using the Humanbecoming Paradigm.

Transforming nursing education is a current focus across the country, the result of recent national reports that have made significant contributions for evaluating and changing curricula and ways students are taught. However, the need to ground these strategies for change within our discipline's ontological foundation through nursing theory must be addressed. The purpose of this article is to use Parse's Humanbecoming Paradigm to provide educators with exemplars of discipline-specific theory-based changes across educational levels. The exemplars are situated within the important tensions that educators face today in undergraduate, advanced practice, and doctoral programs. Conclusions are drawn regarding continuing efforts to ensure that nurse educators incorporate discipline-relevant theories when transforming nursing education.

Nicotine patch therapy based on smoking rate followed by bupropion for prevention of relapse to smoking.

PURPOSE: To determine whether (1) tailored nicotine patch therapy that is based on smoking rate can be carried out in a multisite oncology investigative group practice setting, (2) long-term use of bupropion reduces the rate of relapse to smoking in smokers who stop smoking with nicotine patch therapy, and (3) bupropion can initiate smoking abstinence among smokers who have failed to stop smoking after nicotine patch therapy. PARTICIPANTS AND METHODS: Fourteen North Central Cancer Treatment Group sites recruited generally healthy adult smokers from the general population for nicotine patch therapy and based the patch dosage on smoking rates. At completion of nicotine patch therapy, nonsmoking participants were eligible to be assigned to bupropion or placebo for 6 months (for relapse prevention). and smoking participants were eligible to be assigned to bupropion or placebo for 8 weeks of treatment. RESULTS: Of 578 subjects, 31% were abstinent from smoking at the end of nicotine patch therapy. Of those subjects not smoking at the end of nicotine patch therapy who entered the relapse prevention phase, 28% and 25% were not smoking at 6 months (the end of the medication phase) for bupropion and placebo, respectively (P =.73). For those still smoking at the end of nicotine patch therapy, 3.1% and 0.0% stopped smoking with bupropion or placebo, respectively (P =.12). CONCLUSION: Tailored nicotine patch therapy for the general population of smokers can be provided in a multisite oncology investigative group setting. Bupropion did not reduce relapse to smoking in smokers who stopped smoking with nicotine patch therapy. Bupropion did not initiate abstinence among smokers who failed to stop smoking with nicotine patch therapy.

The creative élan of nursing theory: indispensable to leadership.

The author discusses how nursing theoretical knowledge contributes to nursing leadership and how the use of nursing theory can build confidence in nurse leaders in all settings, drawing on examples from selected theorists' work. It is suggested that when nursing theory is not fully valued by the profession, not only knowledge is lost but also the language that helps nurses to lead. However, the vision and the voice of nursing theory will allow nurses to lead with creativity and to tap into innovation that facilitates contributions to healthcare. To be firmly, intellectually, and enthusiastically grounded in one's disciplinary knowledge sets the stage to being able to lead effectively. Four aspects of leadership are addressed: clinical, interdisciplinary, nursing education, and interpersonal nursing. Our accumulated nursing theories can help nurse leaders to meet contemporary healthcare challenges by providing answers that help to focus on improvement, patient-centered care, critical reflection, and caring.

Nursing's role in courage development in patients facing complications of diabetes.

The purpose of this study was to explore the experience of nurses in relation to courage development in patients with disabling complications of diabetes. The phenomenon of courage has been explored in philosophy, theology, literature, and other fields of inquiry rooted in the humanities. Nursing inquiry has not often been directed toward an exploration of courage, although coping, compassion, caring, and other experiences integral to the nurse-patient relationship have been examined. The holistic view of the cascading effect of complications on the individual patient is often overlooked. This qualitative study used phenomenological inquiry and included face-to-face interviews of nurses to explore their experience in assisting patients in the development of courage. The experience of courage is investigated as it relates to a specific group of patients who have complications of diabetes. Four categories representing the unique opportunities for courage development by nurses were generated. These categories included education, advocacy, relationship building, and humanization. Each category described nursing intentions and actions and taken together formed an essential structure of courage development. Conclusions indicated that nurses recognize and are able to describe their role in courage development. Implications for improved health through deliberate caring nursing interventions, aimed at courage development, are presented.

Promoting best-care practices in childhood asthma: quality improvement in community health centers.

OBJECTIVE: Outpatient asthma management remains suboptimal. We previously reported significant improvements in asthma guideline adherence and outcomes in children by using quality-improvement processes and community health workers. We hypothesized that a larger project could achieve comparable outcome improvements with streamlined quality-improvement processes and decreased technical assistance. METHODS: Seventeen clinics treating 12 000 children with asthma were evaluated through interviews of a subset of patients with persistent or high-risk asthma (n=761) at baseline and at 12 and 21 months and chart reviews randomly selected from all patients with asthma at baseline and 12 and 24 months (n=2040). Multidisciplinary teams developed data-driven continuous quality-improvement activities. Asthma coordinators provided patient education and were active team members. RESULTS: Study children were predominantly Hispanic (77%) and black (11%); 60% were enrolled in Medicaid, and 9% were uninsured. Comparing results between baseline and the 21-month follow-up, significantly fewer families reported emergency-department visits (29.6% vs 9.3%), hospitalizations (10.9% vs 3.4%), frequent daytime symptoms (44.0% vs 11.7%), and missed school days (28.7% vs 13.6%); significantly more reported confidence in asthma management (70.6% vs 95.5%); and quality-of-life scores increased significantly for both children and caregivers (all P<.05). Cross-sectional data revealed significant clinic-wide improvements in symptom documentation, health care use, and review of action plans. CONCLUSIONS: On a larger scale, this approach realized impressive changes in provider clinical practice associated with major improvements in health outcomes. It holds great potential for significantly reducing asthma-related morbidity among low-income children.

Methodology of a randomized clinical trial of symptom management strategies in patients receiving chronic hemodialysis: the SMILE study.

Despite the high prevalence of pain, sexual dysfunction, and depression in patients on chronic hemodialysis, these symptoms are often unrecognized and under-treated by renal providers. This report describes the rationale and methodology of the SMILE study (Symptom Management Involving End-Stage Renal Disease), a multi-center, randomized clinical trial comparing the effectiveness of two strategies for implementing treatment for these symptoms in patients receiving chronic hemodialysis. Approximately 250 patients from nine outpatient dialysis units will participate. Over a 2-12 month observational phase, participants complete monthly surveys characterizing their pain, sexual dysfunction, and depression. Following this observational period, subjects are randomized to one of two study arms to receive a 12-month intervention. In one study arm (feedback intervention), patients continue to complete the same three symptom surveys, and the presence and severity of the symptoms reported on these surveys is mailed to the patient's renal provider along with evidence-based algorithms outlining treatment options for these symptoms. Decisions on treatment are left at the discretion of the provider. Patients randomized to the other study arm (management intervention) also continue to complete the same monthly symptom surveys and are evaluated by a symptom management nurse trained in the management of these symptoms. This nurse then discusses the patient's symptoms with the renal provider, provides specific recommendations for treatment, and facilitates the implementation of treatment. The primary endpoints are changes in scores on pain, erectile dysfunction, and depression surveys. This report describes the rationale and methodology of this clinical trial.

School reentry for children with acquired central nervous systems injuries.

Onset of acquired central nervous system (CNS) injury during the normal developmental process of childhood can have impact on cognitive, behavioral, and motor function. This alteration of function often necessitates special education programming, modifications, and accommodations in the education setting for successful school reentry. Special education is not necessarily a special classroom, but an individualized set of educational needs, determined by a multidisciplinary school team, to promote educational success. The purpose of this article is to inform those pediatricians and pediatric allied health professionals treating children with CNS injury of the systems in place to support successful school reentry and their role in contributing to developing an appropriate educational plan.

Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies.

OBJECTIVE: The purpose of this work was to improve asthma-related health outcomes in an ethnically and geographically disparate population of economically disadvantaged school-aged children by using a team-based approach using continuous quality improvement and community health workers. PATIENTS AND METHODS: A demonstration project was conducted with 7 community clinics treating approximately 3000 children with asthma 5 to 18 years of age. The overall clinic population with asthma was assessed for care-process changes through random cross-sectional chart reviews at baseline and 24 months (N = 560). A subset of patients with either moderate or severe persistent asthma or poorly controlled asthma (N = 405) was followed longitudinally for specific asthma-related clinical outcomes, satisfaction with care, and confidence managing asthma by family interview at baseline and at 12 or 24 months. Patient-centered and care-process outcomes included patient/parent assessment of quality of care and confidence in self-management, asthma action plan review, and documentation of guideline-based indicators of quality of care. Direct clinical outcomes included daytime and nighttime symptoms, use of rescue medications, acute care and emergency department visits, hospitalizations, and missed school days. Each clinic site's degree of adherence to the intervention model was evaluated and ranked to examine the correlation between model adherence and outcomes. RESULTS: Cross-sectional data showed clinic-wide improvements in the documentation of asthma severity, review of action plans, health services use, and asthma symptoms. At follow-up in the longitudinal sample, fewer patients reported acute visits, emergency department visits, hospitalizations, frequent daytime and nighttime symptoms, and missed school days compared with baseline. More patients reported excellent or very good quality of care and confidence in asthma self-management. Linear regression analysis of the clinical sites' model adherence ranks against site-level combined scores estimating overall outcomes, clinical outcomes, and improvements in clinical care processes showed significant linear correlations with R2 > or = 0.60. CONCLUSIONS: The demonstration produced major improvements in asthma-related care processes and clinical outcomes. Closer adherence to the demonstration model was directly associated with better outcomes.