Empirical assessment of wounds among people who use substances.

BACKGROUND: Wounds are a significant source of morbidity among people who use substances (PWUS). This project sought to identify the incidence and severity of wounds among PWUS in the South Bronx, a region of New York City with one of the highest morbidities of substance use disorder. METHODS: This study recruited PWUS within the past 30 days. Research staff were trained to document the presence and severity of wounds. The primary outcome measure was the incidence of wounds. Acceptability of on-the-street wound care was assessed by the number of participants encountered. The association between participant characteristics and wounds was also evaluated. RESULTS: In total, 586 PWUS were assessed (19.4 % female: 69 % Hispanic; 23 % Black; 5 % White). Heroin (65.7 %) and psychostimulants (58.3 %) were the most commonly used drugs. Approximately 23 % of outreach recipients disclosed a wound. Among those with a wound, 60.9 % reported one wound, 27.8 % had two wounds, and 11.3 % had three or more wounds. Small wounds (approximately the size of a cherry) were the most common (78.6 %). Recent use of stimulants or heroin, along with intravenous use of any substance were significantly associated with having a wound. CONCLUSIONS: This study found that drug-related wounds were common among PWUS. Toxicology data from other sources indicate that xylazine was present in the NYC market at the time, though its prevalence among the current sample is difficult to determine. The occurrence and severity of substance-related wounds in NYC should continue to be monitored as a function of changes in the xylazine adulteration.

Creating a Pathway to Health-Care Professions for Historically Marginalized Students.

Developing a diverse talent pool starting at the high-school level, while students are making future education and career decisions, should be a national priority, given the need to build a diverse health-care workforce. This article describes a 6-week immersive simulation-based summer program to introduce 20 junior high-school students (13-15 years old) to the range of health professions. Because precollege students typically receive limited exposure to clinical settings, high-fidelity simulation is an excellent surrogate for providing realistic experiences in health care. Students heard lectures on health careers, earned basic life support certification, learned to perform basic vital signs measurement, practiced the management of acute asthma, and received an introduction to the daily activities in the life of a nurse and an anesthesiologist. They researched, developed, and presented public service announcement videos about a health-care issue affecting their community. Participants reported being excited about health careers. Future programs will focus on longitudinal support and mentoring, essential for mitigating the higher rates of attrition from health professions among minoritized individuals.

Manifesto for healthcare simulation practice.

A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment. While simulationists around the world have responded to this crisis, it has also provided a stimulus for the continued evolution of simulation. We have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Healthcare simulation as a practice forms the foundation for the three tenets comprising the manifesto: safety, advocacy and leadership. Using these three tenets, we can powerfully shape the resilience of healthcare simulation practice for now and for the future. Our call to action for all simulationists is to adopt a commitment to comprehensive safety, to advocate collaboratively and to lead ethically.

Simulation-Based Operations.

Simulation pedagogy and the operations of simulation-based experiences have become an integral part of healthcare education. Academic and healthcare institutions constructed simulation centers or dedicated simulation spaces to provide simulation-based experiences for multiple health professions. Architectural designs resemble acute care settings that have the flexibility to change or include virtual reality and enhanced technology. Professional organizations have standards of best practice, credentialing requirements, and accreditation standards that support the need for high-quality, high-fidelity simulation experiences. Within healthcare education, simulation operation has become a specialty in itself that requires knowledge and experience of healthcare, education, and simulation pedagogy (INACSL Standards Committee, 2017). Simulation center administration needs an understanding of personnel management, including standardized patients (SPs), staff, faculty, and learners, as well as knowledge of budgeting, revenue streams, and technology. Personnel with unique skills and knowledge in engineering, healthcare, or information technology are required to support the simulation activities. Resources that manage inventory, supplies, equipment assets, and audiovisual requirements will increase efficiency and enhance fiscal responsibility. Technology assets such as high-fidelity human patient simulators can be used to enhance high-quality simulation, while audiovisual and data capturing software can be used for assessment, evaluation, and quality improvement. Simulation operations provides the infrastructure that supports the daily activities of simulation-based education.

Interprofessional Development of a Livestream Simulation Activity to Enhance an Undergraduate Nursing Research Course.

The article describes the development, implementation, and evaluation of an interactive simulation activity to enhance student engagement and comprehension of evidence-based practice principles. An interprofessional team of nurse educators, simulation experts, information technology specialists, and nursing informatics graduate students collaborated on the simulation design. The results of this project support the need to develop innovative learning strategies to facilitate nursing students' understanding of the relevance of evidence-based practice research to improve patient outcomes.

Contraceptive use and attitudes among female college students.

Unintended pregnancy is a social issue that severely jeopardizes the quality of life for parents and their children. College age women between the ages of 20-24 have one of the highest rates of unintended pregnancies due to lack of contraceptive use and unsafe sexual practices. Since 80% of college females are sexually active and not seeking to become pregnant, it is important to provide these women with effective contraceptive options. Among this population, Black and Hispanic woman have a disproportionate rate of unintended pregnancies. The purpose of this study was to examine contraceptive attitudes and demographic characteristics among female college students. Participants were grouped into those who use contraceptives consistently, intermittently, or not at all. The sample consisted of 120 racially diverse female college students who were sexually active within the past 3 months. Participants completed the Contraceptive Attitude Scale, contraceptive use tool, and demographic tool. The results showed that there was no significant difference in demographic characteristics and contraceptive attitudes for race, age, marital status, years of college education and income between the contraceptive groups. A majority of participants had a positive attitude regarding contraceptives. Women with higher contraceptive attitude scores were significantly more likely to be consistent contraceptive users. Uninterrupted contraceptive users had significantly higher mean contraceptive attitude scores than intermittent users and nonusers. The results of this study may enable healthcare providers to develop more effective methods of increasing contraceptive use and simultaneously decrease unintended pregnancy rates. Nurses play an integral role by providing women with contraceptive counseling that will assist these women in making an informed decision about contraception use.

Update on adolescent pregnancy in the Black community.

Adolescent pregnancy is a social issue that severely jeopardizes the quality of life for young parents and their children. It is estimated that if fertility rates remain unchanged, the United States will see a 26% increase in the number of adolescent pregnancies and births due to an increase in the adolescent population (Henshaw, 1996). With a disproportional rate of Black adolescents becoming pregnant, there is a need to examine factors related to the high adolescent pregnancy rate among the Black community. Black adolescent mothers and their children face additional adverse psychosocial effects due to healthcare disparities, a higher incidence of health problems, and an increase risk of financial hardship (Hogan, Astone, & Kitagawa, 1985; J. V. Horn, 1998; Morgan, Chapar, & Fisher, 1995). Although the teenage pregnancy rate has declined, it is important for practitioners to continue to implement interventions that promote abstinence and increase contraceptive use among sexually active adolescents.

Promoting children's health through understanding of genetics and genomics.

PURPOSE: To describe the effects of genetics and genomics on children's health care. ORGANIZING CONSTRUCT: The breakthroughs in the Human Genome Project have great potential for disease prediction, treatment, and prevention in the health care of children with chronic health conditions. Most childhood conditions based on a single gene are influenced by a complex interaction of genetic and environmental factors. METHODS: A review of the literature was conducted to determine the most common childhood diseases linked to genetic causes. FINDINGS: Two examples were selected to depict how a health professional would use genetic knowledge to provide holistic health promotion and disease prevention. CONCLUSIONS: Knowledge of the interaction of the genetic profile coupled with a person's lifestyle, work environment, and family context provide a more holistic picture of a person's health profile. The clinical implications are that this knowledge will provide opportunities for health professionals to advise families on individualized treatment options or to tailor health promotion to future disease states based on genes and their interaction with the environment.