Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening.

Background: Screening for early detection of microalbuminuria signaling kidney disease should begin as early as the time of diagnosis of youth-onset type 2 diabetes. This quality improvement initiative aimed to standardize urine nephropathy screening in pediatric patients with type 2 diabetes at a tertiary academic medical center and increase a baseline screening rate of 56%-75% over 6 months (September 2022-February 2023) and sustain that increase for 6 months (March through August 2023). Methods: A multi-disciplinary team used quality improvement methods and iterative Plan-Do-Study-Act cycles. Targeted interventions included previsit planning workflow, education, and a new-onset triage protocol. The team collected data at baseline and prospectively by reviewing electronic medical records. The primary outcome measure was pediatric type 2 diabetes clinic visits in diabetes clinic with urine nephropathy screening before or on the visit date. Results: A total of 121 youth were scheduled for T2D clinic visits between September 2021 and August 2023. The mean age was 14.5 years, and 60% were women, 40% were non-Hispanic Black, 28% were Hispanic/Latino, and 15% reported Spanish as their preferred language. Following the interventions of this project, urine nephropathy screening increased from 56% to 75%, and this change was sustained for 6 months. Conclusions: Interventions focused on efficient recognition of the population needing screening, coordinated internal processes around screening, a shared understanding between all stakeholders, and practical support in the healthcare system increased urine nephropathy screening with sustained improvement.

Practical strategies for care of individuals impacted by suicide in the emergency department: A narrative review.

Introduction Suicide is among the leading causes of death and nurses care for survivors of suicide at many points in their grief journey. Every individual who dies by suicide leaves behind multiple affected survivors and how they are cared for immediately following the suicide influences how they cope with the death. The purpose of this article is to make recommendations for the care of survivors of suicide loss in the emergency department. METHODS: A narrative review of the current literature was conducted using the databases CINAHL and ProQuest. Articles focused on survivors of suicide loss and their care in the immediate period after the death were utilized. RESULTS: Four hundred and twenty-nine articles were found. Applying established inclusion and exclusion criteria and quality assessment using the SANSA guideline, 29 were included in the review. DISCUSSION: Three themes were identified: 1. Risks for suicide in survivors of suicide loss; 2. Interventions in the immediate period after suicide loss; and 3. Active suicide postvention as suicide prevention. Emergency department nurses need to have the ability to readily assess and recognize the survivors of suicide loss who are at higher risk for complicated grieving, and providing rapid and immediate services and resources will help promote coping and positive mental health outcomes in survivors.

Depression and anxiety symptoms amongst kenyan adolescents: Psychometric Properties, Prevalence Rates and Associations with Psychosocial Wellbeing and Sociodemographic factors.

This study assessed the psychometric properties of standard Western-derived instruments, the prevalence of depression and anxiety symptoms, and their associations with sociodemographic and wellbeing variables in a large sample of Kenyan adolescents. Self-report measures of depression (PHQ-8) and anxiety (GAD-7) symptoms, social support, gratitude, happiness, optimism, and perceived control were administered to 2,192 Kenyan youths (57.57% female) aged 12-19. Both the PHQ-8 (α = 0.78) and GAD-7 (α = 0.82) showed adequate internal consistency. EFA with a sub-sample (N = 1096) yielded a 1-factor structure for both PHQ-8 and GAD-7, a subsequent CFA conducted on the basis of a 1-factor model on another sub-sample (N = 1096) yielded good and moderate goodness of fit, respectively, for the PHQ-8 (χ2 = 76.73; p < 0.001; RMSEA = 0.05; CFI = 0.96; TLI = 0.95) and the GAD-7 (χ2 = 88.19; p < 0.001; RMSEA = 0.07; CFI = 0.97; TLI = 0.95). Some 28.06% and 30.38% of participants met the clinical cut-off for depressive and anxiety symptoms, respectively. Social support, gratitude, happiness, and perceived control were negatively associated with both depression and anxiety symptoms. Older adolescents reported higher symptoms while adolescents with more siblings reported lower symptoms. The western-derived PHQ and GAD met conventional psychometric standards with adolescents in Kenya; depression and anxiety symptoms showed relatively high prevalence and significant associations with important psychosocial and sociodemographic factors.

Single-session interventions for adolescent anxiety and depression symptoms in Kenya: A cluster-randomized controlled trial.

OBJECTIVE: Expanding mental healthcare for adolescents in low-income regions is a global health priority. Group interventions delivered by lay-providers may expand treatment options. Brief, positively-focused interventions conveying core concepts of adaptive functioning may help reduce adolescent symptoms of mental illness. In this trial, we tested three such interventions (growth mindset, gratitude, and value affirmation) as separate single-session interventions. METHOD: Consenting adolescents (N = 895; Mage = 16.00) from two secondary schools in Kenya were randomized by classroom (24 classrooms; Mclass = 37.29 students) into single-session interventions: growth (N = 240), gratitude (N = 221), values (N = 244), or an active study-skills control (N = 190). Mixed-effects models controlling for age and gender were used to estimate individual-level intervention effects on anxiety and depression symptoms. RESULTS: Within the universal sample, the values intervention produced greater reductions in anxiety symptoms than the study-skills control (p < .05; d = 0.31 [0.13-0.50]). Within the clinical sub-sample (N = 299), the values (p < .01; d = 0.49 [0.09-0.89]) and growth interventions (p < .05; d = 0.39 [0.01-0.76]) produced greater reductions in anxiety symptoms. There were no significant effects on depression. CONCLUSIONS: The values intervention reduced anxiety for the full sample, as did the growth mindset and values interventions for symptomatic youths. Future efforts should examine durability of these effects over time.

Learning With Laughter: Implementing Engaging Virtual Simulation During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has disrupted the methods used to develop clinical judgment in the simulation setting. In many cases, virtual simulation has replaced face-to-face simulation but lack of interaction between the students and educators is a limitation. SAMPLE: Ninety-six prelicensure baccalaureate nursing students at a Midwestern university participated in the end-of-semester simulation as part of the course. METHOD: Based on the review of aggregate standardized test results, a simulation scenario was developed using a synchronous online format with educators portraying nurses and patients using a fun approach. At three predetermined stopping points, students discussed further nursing actions which were performed by the educators, followed by debriefing at the end of the scenario. RESULTS: Simulation evaluation as part of routine systematic simulation program assessment indicated students perceived both pauses for discussion during the scenario and debriefing at the end were valuable in promoting their learning. CONCLUSION: This project is consistent with research which found virtual simulation enhances student learning and clinical judgment. The positive perception of students about the use of humor through implementation of the simulation scenario was consistent with current research related to student engagement and motivation to participate.

The Perceived Knowledge of Fall Prevention in Nurses Working in Acute Care Hospitals in China and the United States.

OBJECTIVE: The aim of the study was to investigate the perceived knowledge of fall prevention in nurses working in hospitals in China and the United States. METHODS: A cross-sectional survey with 17 items was used to measure perceived knowledge of fall prevention of nurses working in hospitals in China and the United States. RESULTS: A total of 1442 nurses at 2 hospitals completed the survey in China (90% return rate), and 260 nurses in 2 hospitals in the United States (42% return rate) for a total sample size of 1702. Six items had means less than 4, indicating less familiarity with these factors. These items included assessment of vertigo and vestibular dysfunction, vision, foot problems, balance and activity, cognitive changes, and medications. In both countries, there was a difference in 2 units worked, with those working in maternal-child having a lower perception of knowledge of fall prevention than those employed on medical-surgical units. Of the 17 items, 11 were significantly different between China and the United States, all with the United States having higher perceived knowledge. CONCLUSIONS: For both the United States and China, the perception of knowledge of fall prevention was high. However, nurses from both countries were less familiar with the items not commonly included on fall risk tools, such as vertigo and vestibular dysfunction, vision, foot problems, balance, and cognitive changes. The findings have implications for practice and education and suggest a need to include important factors related to falls in education and intervention in both countries.

Fear of Contagion Among Nursing Students in the Era of COVID-19.

BACKGROUND: COVID-19 quickly spread to pandemic proportions, resulting in anxiety and fear for many students. The Fear of Contagion model was explored in first-semester nursing students. METHOD: This study used a qualitative design with content analysis of narrative responses to questions derived from the Fear of Contagion model and an a priori template based on the model. RESULTS: The results included five themes: (a) doing their part to prevent the spread but wanting to do more; (b) making specific behavior changes to prevent the spread and effects of the virus; (c) experiencing fear, anxiety, and stress; (d) uncertainty but hopefulness; and (e) positive regard and concern for others. CONCLUSION: Fear of contagion in this study reflected many of the elements of the original model. Interventions to not only reduce fear but also facilitate education are recommended for nursing educators. [J Nurs Educ. 2021;60(7):404-407.].

Effect of Shamiri Layperson-Provided Intervention vs Study Skills Control Intervention for Depression and Anxiety Symptoms in Adolescents in Kenya: A Randomized Clinical Trial.

Importance: Low-cost interventions for adolescent depression and anxiety are needed in low-resource countries such as those in Sub-Saharan Africa. Objective: To assess whether Shamiri, a 4-week layperson-delivered group intervention that teaches growth mindset, gratitude, and value affirmation, can alleviate depression and anxiety symptoms in symptomatic Kenyan adolescents. Design, Setting, and Participants: This school-based randomized clinical trial included outcomes assessed at baseline, posttreatment, and 2-week and 7-month follow-up from 4 secondary schools in Nairobi and Kiambu County, Kenya. Adolescents aged 13 to 18 years with elevated symptoms on standardized depression or anxiety measures were eligible. Intent-to-treat analyses were used to analyze effects. Recruitment took place in June 2019; follow-up data were collected in August 2019 and February 2020. Intervention: Adolescents were randomized to the Shamiri intervention or to a study skills control. All adolescents in both conditions met in groups (mean group size, 9) for 60 minutes per week for 4 weeks. Main Outcomes and Measures: Primary outcomes were depression (Patient Health Questionnaire-8 item) and anxiety (Generalized Anxiety Disorder-7 item) symptoms. Analyses of imputed data were hypothesized to reveal significant reductions in depression and anxiety symptoms for adolescents assigned to Shamiri compared with those in the study skills group. Results: Of 413 adolescents, 205 (49.6%) were randomized to Shamiri and 208 (50.4%) to study skills. The mean (SD) age was 15.5 (1.2) years, and 268 (65.21%) were female. A total of 307 youths completed the 4-week intervention. Both Shamiri and study skills were rated highly useful (4.8/5.0) and reduced symptoms of depression and anxiety, but analyses with imputed data revealed that youths receiving Shamiri showed greater reductions in depressive symptoms at posttreatment (Cohen d = 0.35 [95% CI, 0.09-0.60]), 2-week follow-up (Cohen d = 0.28 [95% CI, 0.04-0.54]), and 7-month follow-up (Cohen d = 0.45 [95% CI, 0.19-0.71]) and greater reductions in anxiety symptoms at posttreatment (Cohen d = 0.37 [95% CI, 0.11-0.63]), 2-week follow-up (Cohen d = 0.26 [95% CI, -0.01 to 0.53]), and 7-month follow-up (Cohen d = 0.44 [95% CI, 0.18-0.71]). Conclusions and Relevance: Both the Shamiri intervention and a study skills control group reduced depression and anxiety symptoms; the low-cost Shamiri intervention had a greater effect, with effects lasting at least 7 months. If attrition is reduced and the clinical significance of outcome differences is established, this kind of intervention may prove useful in other global settings where there are limited resources, mental illness stigma, or a shortage of professionals and limited access to mental health care. Trial Registration: Pan-African Clinical Trials Registry Identifier: PACTR201906525818462.

The Shamiri group intervention for adolescent anxiety and depression: study protocol for a randomized controlled trial of a lay-provider-delivered, school-based intervention in Kenya.

BACKGROUND: Developing low-cost, socio-culturally appropriate, and scalable interventions for youth depression and anxiety symptoms in low-income regions such as countries in sub-Saharan Africa is a global mental health priority. We developed and intend to evaluate one such intervention for adolescent depression and anxiety in Kenya. The intervention, named Shamiri (a Swahili word for "thrive"), draws upon evidence-based components of brief interventions that involve nonclinical principles rather than treatment of psychopathology (e.g., growth mindset, gratitude, and virtues). METHODS: Four hundred twenty Kenyan adolescents (ages 13-18) with clinically elevated depression and/or anxiety symptoms will be randomized to either the 4-week Shamiri group intervention or a group study-skills control intervention of equal duration and dosage. Participating adolescents will meet in groups of 8-15, led by a high-school graduate trained to deliver Shamiri as a lay-provider. Adolescents will self-report primary outcome measures (depression-measured by the PHQ-8, and anxiety symptoms-measured by the GAD-7) and secondary outcome measures (perceived social support, perceived academic control, self-reported optimism and happiness, loneliness, and academic grades) at the 2-week intervention midpoint, 4-week post-intervention endpoint, and 2-week post-intervention follow-up. We predict that adolescents in the Shamiri group, when compared to the study-skills control group, will show greater improvements in primary outcomes and secondary outcomes. DISCUSSION: Results may suggest that a brief, lay-provider delivered, school-based intervention may reduce depression and anxiety symptoms, improving academic outcomes and other psychosocial outcomes in adolescents with clinically-elevated symptoms in sub-Saharan Africa. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201906525818462 . Registered on 12 June 2019.

Single-session digital intervention for adolescent depression, anxiety, and well-being: Outcomes of a randomized controlled trial with Kenyan adolescents.

BACKGROUND: Adolescent depression and anxiety symptoms are prevalent in sub-Saharan African countries, yet treatment options are scarce, and stigma limits help-seeking. Brief, computerized single-session interventions (SSIs) that contain empirically supported stigma-reducing elements may help expand access to treatment. We developed and evaluated such an intervention for Kenyan adolescents. METHOD: High school students (N = 103, age 13-18) were randomized to a digital SSI Shamiri-Digital (Shamiri means "thrive" in Kiswahili) or a study-skills control intervention. Shamiri-Digital consisted of reading and writing activities about 3 concepts: growth mindset, gratitude, and value affirmation. Both Shamiri-Digital and the study-skills control condition were delivered electronically in schools. RESULTS: Compared to the control, Shamiri-Digital produced a greater reduction in adolescent depressive symptoms in both the full sample (p = .028, d = 0.50) and a subsample of youths with moderate to severe depression symptoms (p = .010, d = 0.83) from baseline to 2-week follow-up. The effects exceed the mean effects reported in meta-analyses of full-length, face-to-face psychotherapy for youth depression. There were no significant effects on anxiety symptoms, well-being, or happiness. CONCLUSION: This is the first report that a brief, computerized SSI may reduce depressive symptoms in adolescents in sub-Saharan Africa. Replication trials with extended follow-ups will help gauge the strength and durability of these effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using evidence-based practice to prevent hospital-acquired pressure ulcers and promote wound healing.

A hospital and a nursing education program collaborate to improve skin care.

A pictorial overview of technology-assisted care options for bariatric patients: one hospital's experience.

Best practice guidelines to avoid pressure ulcers and skin breakdown among obese patients include early and progressive mobility, rigorous turning schedules, and proper skin care. However, implementation of some these guidelines may increase the risk of patient and caregiver injury. An acute care hospital implemented safe patient handling protocols that involved equipment purchase and extensive training for all care staff. The new equipment facilitated repositioning, including boosting and turning, lateral transfers, vertical transfers and ambulation, and bathing and toileting. All healthcare facilities are expected to see an increase in the number of bariatric patients and need for safe patient handling protocols and procedures. At the same time, research is needed to evaluate the safety, effectiveness, and cost-effectiveness of currently available devices designed to improve patient safety and reduce caregiver injury.

Mentoring for evidence-based practice: a collaborative approach.

This article describes a collaborative project between clinical staff development professionals and a university associate professor of nursing to increase implementation of evidence-based practice in a clinical setting. The faculty member served as a mentor, helping nurses at the point of care who often lack the knowledge and skills to integrate evidence into practice. Outcomes of this project of benefit to staff development included education of the nurses on evidence-based practice, integration of evidence into policies, and development of a sustainable process to increase evidence-based practice.

Immersion in China: lessons learned.

Students can learn a great deal from international experiences. Although one can learn about another culture from books and discussions, immersing oneself in a culture tends to have a greater impact on both intended and incidental learning. The authors describe the lessons learned and student outcomes during a faculty-led 5-week immersion trip to China.