Provider cultural competence and humility in healthcare interactions with transgender and nonbinary young adults.

PURPOSE: Transgender and nonbinary (TGNB) patients experience many barriers when seeking quality healthcare services, including ineffective communication and negative relationships with their providers as well as a lack of provider competence (including knowledge, training, and experience) and humility (engagement in the process of self-reflection and self-critique) in treating TGNB individuals. The purpose of this qualitative study was to identify factors associated with cultural competence and humility that facilitate and impede effective relationships between TGNB young adults and their healthcare providers. METHODS: Data came from individual interviews with 60 young adults aged 18 to 24 from Florida who self-identified as transgender or nonbinary. We analyzed the data using inductive thematic approaches, and a feminist perspective, to identify themes associated with patient-provider relationships. CONCLUSIONS: We identified 4 themes related to patient-provider relationships: (1) Participants indicated effective patient-provider communication and relationships are facilitated by providers requesting and utilizing TGNB patients' correct names and personal pronouns. (2) Participant narratives conveyed their preferences that providers "follow their lead" in terms of how they described their own anatomy, reinforcing the utility of cultural humility as an approach for interactions with TGNB patients (3) Participants discussed the detrimental effects of TGNB patients having to educate their own providers about their identities and needs, suggesting clinicians' competence regarding gender diversity is paramount to fostering and maintaining patient comfort. (4) Finally, participants' responses indicated concerns regarding the confidentiality and privacy of the information they provided to their providers, suggesting a lack of trust detrimental to the process of building rapport between patients and their providers. CLINICAL RELEVANCE: Our findings indicate balancing the use of cultural humility and cultural competence during clinical encounters with TGNB young adults can enhance patients' experiences seeking healthcare. Nursing education is often devoid of focus on caring for transgender and nonbinary persons. Additional provider training and education on approaching clinical encounters with TGNB patients with cultural humility and competence should improve patient-provider communication and relationships, leading to a higher quality of patient care.

Mpox in the United States: Current implications for public health nursing.

In 2022, mpox, an orthopoxvirus first isolated in 1958 in cynomolgus monkeys, became a global public health threat. While the virus can be communicated through skin-to-skin contact from any infected person to non-infected person, most cases in the United States have been in gay and bisexual men. Consequently, early public health and community-based efforts concentrated on reducing infections in this population. This article explores current mpox case count epidemiologic data and trends. In addition, vaccination indications, contraindications, adverse events, and national administration data are provided along with directions for nurses and other clinicians moving forward in the outbreak.

An early pop-up mpox vaccine clinic.

ABSTRACT: Mpox, formerly known as monkeypox, emerged as a viral zoonotic disease in 2022. The World Health Organization (WHO) declared a global pandemic in July 2022. Through the U.S. Food and Drug Administration's emergency use authorization, JYNNEOS became the dominant vaccine for prevention of mpox. California leads the nation in the number of U.S. cases, and the outbreak created opportunities for a nurse practitioner-led pop-up vaccination clinic in Los Angeles County. Interprofessional teamwork with pharmacists and public health officials increased the number of individuals vaccinated. By November, the WHO released operational planning guidelines. Nurse practitioners can use these guidelines in anticipation of the next pandemic.

Social Media as a Recruitment Strategy with Transgender-Identified Individuals: Using an Ethical Lens to Direct Methodology.

Introduction: Researchers are limited when using traditional recruitment methods to access hidden and vulnerable populations, including transgender persons. Social media platforms such as Facebook can provide access to the transgender population and facilitate recruitment of a representative sample. There is little regulatory guidance for using social media as a recruitment strategy. Methodology: This article presents recruitment recommendations based on a study that generated a diverse sample of transgender-identified persons using Facebook as the sole recruitment method. Results: Despite taking precautions, computer bots penetrated the initial survey. A second survey distribution collected data from a diverse sample of transgender-identified individuals. Discussion: Researchers should design social media recruitment methods with attention to privacy and transparency. Thus, using social media platforms such as Facebook to recruit transgender participants that otherwise would be challenging to reach is a viable and ethically sound alternative to traditional recruitment methods.

Monthly injectable cabotegravir/rilpivirine to manage HIV infection in adults.

ABSTRACT: The FDA recently approved a unique treatment regimen for management of HIV-1 infection in adults. A one-time per month injection of cabotegravir/rilpivirine can replace a current, stable antiretroviral regimen in those with virologic suppression, without history of treatment failure, or known or suspected resistance with cabotegravir or rilpivirine. A one-month oral trial should be initiated before switching to the extended-release injectable formulation. Cabotegravir/rilpivirine showed continued virologic suppression without clinically relevant changes in CD4+ cell counts. Clinicians should understand this new HIV regimen, its indications and suitability for select patients, administration and dosing, interactions, and most reported adverse events.

Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis.

This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD -1.50 [-1.93, -1.08] kg/m2) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox-a sustained catabolic state presenting with lower BMI-is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.

Chronic Popliteus Tendon Avulsion Fracture with Chronic Knee Pain and Locking: A Case Report.

CASE: A 31-year-old man who had a chronic popliteus avulsion fracture 18 years earlier treated with physical therapy presented with new onset left knee locking after exercising at the gym. Magnetic resonance imaging demonstrated a chronic popliteus avulsion fracture of the lateral femoral condyle. Surgical excision of the nonunited bone fragment was performed. CONCLUSION: Isolated popliteus avulsion fractures are extremely rare injuries that occur primarily in a skeletally immature patient population and for which treatment options are not well understood. Treatment options include conservative management and early surgical intervention, both of which have inherent risks and benefits. We recommend prompt imaging with computed tomography (CT) to better characterize the degree of injury and follow-up CT imaging in patients who do not undergo early surgical intervention.

COVID-19 vaccination in adults living with HIV.

ABSTRACT: The Centers for Disease Control and Prevention has recommended use of vaccines manufactured by Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen to prevent COVID-19 infection in the United States. Although these vaccines are safe and have been administered to millions of persons nationwide, special populations warrant closer focus. Adults living with HIV may have specific clinical considerations that should be acknowledged when making COVID-19 vaccination prescribing decisions. This article discusses these practice considerations and provides clinical and additional guidance for nurse practitioners and other clinicians responsible for prescribing COVID-19 vaccines in adults living with HIV.

Standardizing nurse practitioner student evaluation during high-stakes clinical examinations.

ABSTRACT: Nurse practitioners (NPs) require clinical competence in advanced health assessment skills to differentiate between normal, variations of normal, and abnormal patient findings. High-stakes clinical examinations, using live hands-on simulation scenarios and standardized patients (SPs) or other human role players, are accepted teaching and evaluation tools for NP students. Providing objective, valid, and reliable feedback to students during high-stakes clinical examinations is of considerable value for ongoing skill development. The study examined opportunities to improve the quality of student evaluation in simulation testing modes. A purposive sample of 17 video recordings of health students' comprehensive examination of an SP or physical examination teaching associate (PETA) from a nursing graduate level health assessment course was evaluated. Using a standardized rubric, students were scored live and after a comprehensive examination of a SP/PETA and via a secure web-based video platform by the faculty and an independent reviewer. Evaluator group examination score comparisons revealed that distributions of examination scores within evaluator groups were not similar. Median examination scores were significantly different between groups; faculty median examination scores significantly higher than SPs/PETAs. Efficiency of student evaluation may be increased by improving reviewer training, reducing checklist length, and adopting electronic scoring. Development of an exemplary teaching video providing explanation and detail for expected student skill performance will allow reviewers to practice and improve competence in reliable scoring, reduce time and effort of scorers, and increase accuracy of scoring.

Conflict resolution between physicians and nurse practitioners.

BACKGROUND: In the United States health care system, nurse practitioners (NPs) and physicians work very closely in the delivery of high-quality patient care across lifespans and acuities. In fact, advanced practice nurses work closer with physicians in their day-to-day care delivery than with any other group of professionals. This remains true even in states with independent practice for NPs. Because of the significant relationships between physicians and NPs, assessment of how these professionals resolve conflict is essential. PURPOSE: The purpose of this study was to determine the style of conflict resolution employed by NPs and physicians. METHODS: Nurse practitioners (n = 57) and physicians (n = 58) were randomly sampled from the Florida Department of Health-Health Care Practitioner Data Portal (N = 115). Participants completed a demographic questionnaire assessing experience in conflict resolution training and the Rahim Organizational Conflict Inventory-II, Form C, which defined the style of conflict resolution they most used and preferred. RESULTS: Results showed that 29.8% of physicians and 40.4% of NPs received formal conflict resolution/management education/training (p = .24). The dominant style of conflict resolution used for 78% of physicians and 74% of NPs was the integrating style, with no statistical difference between the two professions (p = .87). IMPLICATIONS FOR PRACTICE: Physicians and NPs lack formal education on conflict resolution in their graduate studies. In addition, both professionals tend to use similar styles of conflict resolution among one another in clinical practice, which affects their collaboration and ultimately how optimal care is delivered to patients.

Reducing sexually associated transmission of COVID-19 in men who have sex with men.

ABSTRACT: Believed to be zoonotic in origin, COVID-19 is a novel coronavirus subtype, which spreads from person to person through droplet transmission. As of late April, 2020, 895,766 cases of COVID-19 infections were recorded in the United States. This infection was responsible for 50,439 deaths. Because of close, person-to-person proximity, coupled with possible contact with body fluids, transmission of COVID-19 during sexual activity is possible. However, some activities carry higher risks of transmission than others. This article explores the risks of COVID-19 transmission associated with kissing, oral sex (fellatio and annilingus), and anal receptive and anal insertive intercourse among men who have sex with men (MSM). Recommendations for counseling MSM on safer sexual decision-making, many of which are applicable in the general prevention of sexually transmitted infections, are also provided. Nurse practitioners can serve as advocates in preventing sexually associated COVID-19 communication in MSM and contribute to the advancement of this continuously evolving area of public health science.

Use of electronic nicotine delivery systems (ENDS) in lesbian, gay, bisexual, transgender and queer persons: Implications for public health nursing.

Smoking and rates of tobacco abuse remain higher in lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons. There has been very little scholarly inquiry about the emerging trend of use of electronic nicotine delivery systems (ENDS; e.g., vaping and eCigarettes [eCigs]) in LGBTQ populations. The purpose of this article is to: (a) explore the most recent prevalence data regarding smoking and tobacco abuse in LGBTQ persons, (b) reveal strategies the tobacco industry has historically used in marketing their products to the LGBTQ community, (c) review data from the few studies evaluating use of ENDS in LGBTQ persons, (d) provide evidence-based methods public health nurses can employ to discourage use of ENDS in LGBTQ persons by addressing two identified causes of ENDS use in LGBTQ populations (harassment/discrimination in LGBTQ youth and binge drinking in LGBTQ adults), and (5) encourage cessation among those already using ENDS.

Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support.

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.

Volumetric 3D display in real space using a diffractive lens, fast projector, and polychromatic light source.

We present a method for realizing a solid-state volumetric display based on the chromatic dispersion properties of a 150 mm diffractive lens that images a series of planar patterns presented by a digital micro-mirror device projector. The projector is driven by a narrowband polychromatic source, where the position of each image plane is defined by a distinct wavelength of light. The volumetric display system achieves 20 image planes at a volume refresh rate of 20 Hz, creating a volume of 17.4 cm3 with 13 mm of depth and a field of view of 10° floating 145 mm above the lens in real space.

Reducing Risk: Counseling Men Infected with HIV Who Have Sex with Men on Safer Sex Practices with Seroconcordant Partners.

The incidence of new HIV infections in the United States continues to be greatest among men who have sex with men (MSM). MSM infected with HIV often seek seroconcordant sexual partners based on intent to limit psychosocial, legal, and health risks they perceive as higher with serodiscordant sexual partners. However, the rationales for limiting sexual relationships exclusively with other MSM infected with HIV may be rooted in misinformation or misperception. Thus, these clients may have a unique sexual health knowledge deficit that nurses, social workers, and other clinicians need to address to help them reduce risk. This article focuses on sexually related health risks that are distinct to MSM infected with HIV seroconcordant partners. Data on the most recent HIV-infection incidence rates in MSM in the United States is provided. Discussion concentrates on the risk these individuals may have in communicating and acquiring sexually transmitted diseases other than HIV, the risk of HIV superinfection, and how sexually transmitted diseases affect persons who are immunocompromised differently than those who are immunocompetent. Finally, recommendations for healthcare professionals who counsel MSM infected with HIV in sexual decision making is provided.

Meningococcal Vaccination in Men Who Have Sex with Men.

Recent outbreaks of meningitis in men who have sex with men (MSM) in Los Angeles, Chicago, New York City, and other locations across the United States have heightened public health concerns regarding the increasing incidence of meningococcal infections in this vulnerable population. MSM have unique risk factors that result in greater threat from certain infectious diseases, including meningococcal infection. Men who have sex with men who are infected with HIV are at even higher risk. This article explores the increased risks among MSM in contracting and communicating meningococcal infection, use of vaccination as primary prevention, and outreach strategies that may help address this issue and lessen the disease burden associated with meningococcal infection in these sexual minorities.

Knowledge of Vaccination Needs of HIV-Infected Men Who Have Sex with Men in a National Sample of "Gay Friendly" Health care Providers.

OBJECTIVES: The purpose of this study was to assess knowledge levels regarding vaccination needs of healthy, HIV-infected (with CD4 counts >200 cells/mm(3) ) men who have sex with men (MSM) in a national sample of "gay friendly" health providers. DESIGN AND SAMPLE: Participants (n = 92) were sent a demographic questionnaire and case vignette asking for correct identification of vaccine needs of an HIV-infected MSM with a CD4 count >200 cells/mm(3) . Participants were recruited from the Gay and Lesbian Medical Association's Health Provider Index. MEASURES: Descriptive statistics and Fisher's exact test were used to answer the research questions and define the sample. RESULTS: The vast majority of the sample (n = 83; 90%) misidentified correct vaccine needs of and/or selected inappropriate vaccines for the HIV-infected MSM. Greater familiarity with the CDC Adult Vaccination Schedule (p = .027), practice specialization (p = .004), and administration of vaccinations within location of practice (p = .009) were associated with greater knowledge of the patient's vaccine needs. CONCLUSIONS: Health care providers who prescribe vaccines to HIV-infected MSM need more education regarding their vaccine needs. Nurses can reduce disparities in HIV-infected MSM by advocating for vaccination and augmenting providers' comprehension of vaccine needs of this population.