Achieving Health Equity for LGBTQ+ Adolescents.

The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adolescent population experiences health disparities due to barriers to care, including lack of access to culturally competent health care providers. The purpose of this quality improvement project was to increase access to culturally competent care through continuing education, a physical makeover of clinic space, and a social marketing campaign. The impact of the project on the number of LGBTQ+ adolescent patients at the clinic and the rate of documentation of sexual orientation and gender identity data was evaluated via a chart audit. Changes in nurses' and health care providers' knowledge as a result of the continuing education were evaluated with a pretest and a posttest. The number of LGBTQ+ patients and provider knowledge increased following the continuing education. Sexual orientation and gender identity data were documented during 87.5% of visits. The participants' knowledge increased by 4.7% following the continuing education. Further, five physical changes to the clinic were completed and a social marketing campaign was launched. This quality improvement project demonstrates that continuing education can be an effective way to increase cultural competence for the care of LGBTQ+ individuals. [J Contin Educ Nurs. 2022;53(8):348-354.].

Mental Health of LGBTQ Older Adults.

More than 54 million people in the United States are aged ≥65 years, including an estimated 2.4 million people who identify as lesbian, gay, bi-sexual, transgender, or queer (LGBTQ). As a group, LGBTQ older adults experienced criminalization, discrimination, and social stigma the majority of their lives, with rates of victimization and stigma increasing with age. LGBTQ older adults continue to experience social and health disparities compared to heterosexual individuals. To meet the needs of LGBTQ older adults, it is necessary to understand the impact of politics, culture, and social norms as they came of age. Unique mental health needs, such as social isolation, loneliness, disenfranchised grief, and long-term social support, are discussed through the lens of the minority stress model. Implications and recommendations for health care, research, and policy, such as creating a safe and welcoming environment and providing culturally competent care for LGBTQ older adults, are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 60(4), 7-10.].

LGBTQ Older Adults in Long-Term Care Settings: An Integrative Review to Inform Best Practices.

OBJECTIVES: To synthesize literature about lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults in long-term care (LTC) facilities and provide recommendations for best practice guideline development to inform practice, research, and policy. METHODS: Four electronic databases were searched in June 2019 for studies conducted between 2000- 2019 related to caring for LGBTQ older adults in LTC settings. An integrative literature review was conducted on the twenty eligible studies. RESULTS: LGBTQ participants fear discrimination in LTC settings leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. LTC staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. LTC staff experience training deficits and require more expansive modalities. CONCLUSIONS: LGBTQ participants and LTC staff both advise that LTC facilities revise forms and policies to ensure all sexual orientations and gender identities are affirmed and protected in addition to providing widespread training. CLINICAL IMPLICATIONS: This review calls to attention the need for LTC settings to uniformly follow best-practices. Clinical recommendations to promote equitable healthcare include: staff training at all levels and communication that does not assume heterosexuality or cisgender identity.

Restoring Speech to Tracheostomy Patients.

Tracheostomies may be established as part of an acute or chronic illness, and intensive care nurses can take an active role in helping restore speech in patients with tracheostomies, with focused nursing assessments and interventions. Several different methods are used to restore speech, whether a patient is spontaneously breathing, ventilator dependent, or using intermittent mechanical ventilation. Restoring vocal communication allows patients to fully express themselves and their needs, enhancing patient satisfaction and quality of life.

Philanthropy as a source of funding for nursing initiatives.

Nurse leaders are challenged with ensuring that research and evidence-based practices are being integrated into clinical care. Initiatives such as the Magnet Recognition Program have helped reinforce the importance of advancing nursing practices to integrate best practices, conduct quality improvement initiatives, improve performance metrics, and involve bedside nurses in conducting research and evidence-based practice projects. While seeking research funding is an option for some initiatives, other strategies such as seeking funding from grateful patients or from philanthropic resources are becoming important options for nurse leaders to pursue, as the availability of funding from traditional sources such as professional organizations or federal funding becomes more limited. In addition, more institutions are seeking and applying for funding, increasing the pool of candidates who are vying for existing funding. Seeking alternative sources of funding, such as through philanthropy, becomes a viable option. This article reviews important considerations in seeking funding from philanthropic sources for nursing initiatives. Examples from a multiyear project that focused on promoting a healthy work environment and improving nursing morale are used to highlight strategies that were used to solicit, obtain, and secure extension funding from private foundation funding to support the initiative.

The importance of tracheostomy progression in the intensive care unit.

A plan to progress a tracheostomy toward decannulation should be initiated unless the tracheostomy has been placed for irreversible conditions. In most cases, tracheostomy progression can begin once a patient is free from ventilator dependence. Progression often begins with cuff deflation, which frequently results in the patient's ability to phonate. A systematic approach to tracheostomy progression involves assessing (1) hemodynamic stability, (2) whether the patient has been free from ventilator support for at least 24 hours, (3) swallowing, cough strength, and aspiration risk, (4) management of secretions, and (5) toleration of cuff deflation, followed by (6) changing to a cuffless tube, (7) capping trials, (8) functional decannulation trials, (9) measuring cough strength, and (10) decannulation. Critical care nurses can facilitate the process and avoid unnecessary delays and complications.

Tracheostomy care and complications in the intensive care unit.

Tracheotomy is a common procedure in intensive care units, and nurses must provide proper care to tracheostomy patients to prevent complications. One of the most important considerations is effective mobilization of secretions, and a suction catheter is the most important tool for that purpose. Each bedside should be equipped with a functional suctioning system, an oxygen source, a manual resuscitation bag, and a complete tracheostomy kit, which should accompany patients wherever they go in the hospital. Complications include infection, tracheomalacia, skin breakdown, and tracheoesophageal fistula. Tracheostomy emergencies include hemorrhage, tube dislodgement and loss of airway, and tube obstruction; such emergencies are managed more effectively when all necessary supplies are readily available at the bedside. This article describes how to provide proper care in the intensive care unit, strategies for preventing complications, and management of tracheostomy emergencies.