Using Social Media as a Platform for Increasing Knowledge of Lung Cancer Screening in High-Risk Patients.

BACKGROUND: Uptake in lung cancer screening for high-risk patients remains low. Eligible patients may not know that this preventive service is available and covered by insurance. OBJECTIVES: The objective of this study was to explore using social media to educate patients about lung cancer screening and assess motivation to discuss lung cancer screening with health-care providers after viewing the educational program. METHODS: Subjects ages 55 to 77 who were current smokers or former smokers who quit in the past 15 years with a more than 30-pack-year smoking history were recruited via a Facebook advertisement. Subjects completed a demographic survey and the Lung Cancer Screening-12 (LCS-12) knowledge measure tool, watched a YouTube video about lung cancer screening, and completed the LCS-12 tool (post-test). Subjects rated their level of motivation to discuss lung cancer screening with their health-care provider. RESULTS: This study used a pre-experimental, one-group pre-test and post-test design. Scores from the pre- and post-test were analyzed using the paired t-test. Descriptive statistics were used to analyze subject self-reporting of motivation to discuss screening with their provider. The mean knowledge score of participants (n = 31) significantly increased from 5.26 to 8.19 after viewing the video (t = -5.956, p < .001). The mean motivational level (1-5) was 3.52, with a mode of 5. CONCLUSIONS: A lack of knowledge regarding lung cancer screening may negatively impact the health of high-risk patients. This study suggests that social media can be used to increase knowledge of lung cancer screening. These findings demonstrate that the use of social media has a role in improving access to health information.

Effectiveness of a Primary Care-Based Pediatric Weight Management Program.

BACKGROUND: Childhood obesity is a growing epidemic of great concern for our nation, including pediatric populations treated at military treatment facilities. OBJECTIVE: This study aims to retrospectively evaluate the effectiveness of a primary care-based structured weight management program in a sample of pediatric patients with obesity at a military treatment facility. METHODS: This study was a retrospective chart review of patients enrolled in the All About Me Program (AAMP) from August 1, 2011, through July 10, 2012. Baseline demographics, 5-2-1-0 behavioral targets, and anthropometric measures were obtained from 54 enrollees. Pre- and post-program weight, body mass index (BMI) percentile, and 5-2-1-0 behavioral targets were compared for 20 patients who completed the program which consisted of a total of five visits over 3 months. RESULTS: Participants showed a significant reduction in their BMI, improvement in daily servings of fruits and vegetables, reduction in recreational screen time from baseline, improvement in daily physical activity, and reduction in consumption of sugary beverages. CONCLUSIONS: These preliminary findings are a promising indicator that primary care-based obesity interventions may be effective for the management and treatment of pediatric obesity. IMPLICATIONS FOR NURSING: This evidence-based toolkit provides a practical point-of-care guidance on the prevention, assessment, and treatment of childhood obesity and can be easily implemented in other primary care settings.

Development of an obstetric vital sign alert to improve outcomes in acute care obstetrics.

Maternal morbidity and mortality is a national health problem. Causal analysis of near-miss and actual serious patient safety events, including those resulting in maternal death, within obstetric units often highlights a failure to promptly recognize and treat women who were exhibiting signs of decompensation/deterioration. The Obstetric Vital Sign Alert (OBVSA) is an early warning tool that leverages discrete data points in the electronic health record, calculating a risk score that is displayed as a visual cue for acute care obstetric staff. When studied in a cohort of women with postpartum hemorrhage, use of the OBVSA reduced symptom-to-response time and intervention time, as well as key process and outcome measures.

Telehealth: preparing advanced practice nurses to address healthcare needs in rural and underserved populations.

Healthcare is being confronted with questions on how to deliver quality, affordable, and timely care to patients, especially those in rural areas, in systems already burdened by the lack of providers. Advanced Practice Registered Nurses (APRNs) have been challenged to lead this movement in providing care to these populations through the use of technologies, specifically telehealth. Unfortunately, APRNs have limited exposure to telehealth during their educational experience, thereby limiting their understanding and comfort with telehealth. To address this problem, a telehealth program was developed at a large university that prepares Doctor of Nursing Practice (DNP) APRN students. The telehealth program, embedded into the DNP curriculum, consisted of a simulation workshop, practice immersion, and written project. This program was well received by students, making them aware of the benefits and barriers to the implementation of telehealth as a care delivery modality. Telehealth was embraced as students implemented the program in their own practices.

Routine hearing screening in primary care for adult populations using distortion product Otoacoustic Emissions testing.

PURPOSE: The purpose of this study was to determine the prevalence of undiagnosed hearing loss in adults in two busy primary care rural health centers. DATA SOURCES: Using Otoacoustic Emissions (OAE) testing, participants were screened for hearing loss by trained personnel. Participants were those who presented to the primary care provider with complaints other than hearing loss or ear problems. CONCLUSION: Of the 86 participants, 48.8% were found to have failed OAE testing, indicating some type of undiagnosed hearing loss. The average age of the participants was 49.27 years, yet nearly half had hearing loss. This finding makes hearing screening in the adult population, other than the elderly, an important issue. IMPLICATIONS FOR PRACTICE: Hearing loss affects over 40% of the adult population. Undiagnosed and untreated hearing loss can be associated with depression, decreased social activities, and low self-esteem. The project identified the need for routine hearing screening and thus may become the foundation for the development and implementation of a hearing-screening program for primary care. The primary care nurse practitioner needs to incorporate hearing screening into the exam for early identification and for proper referral.

Preparing emotionally intelligent doctor of nursing practice leaders.

The Institute of Medicine (IOM) identified the need for interdisciplinary teams that collaborate, communicate, and integrate care across settings to improve health care delivery. Focusing on innovative strategies that address leadership skills in graduate nursing education could have an effect on interdisciplinary partnerships, transformation of patient care, and new styles of leadership to change current practice models. In response to the IOM guidelines, we incorporated emotional intelligence as a component in our Doctor of Nursing Practice (DNP) leadership curriculum. This article describes a new action-oriented leadership model that prepares the DNP graduate for leadership roles to serve the public and the nursing discipline during a time of radical changes in health care. Behavioral profile, nontraditional readings, and online discussions form the basis of the model. The principles and strategies in this article can be applied to nursing education in multiple arenas, at both the undergraduate and graduate settings.

Educating advanced practice nurses in using social media in rural health care.

Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting.

We are mothers too: childbearing experiences of lesbian families.

OBJECTIVE: To describe lesbians' personal and health care experiences of becoming pregnant, giving birth, and being mothers and comothers within the context of potentially oppressive family, social, and political structures. DESIGN: Critical ethnography. SETTING: Participants' homes, lesbian mother support group, and prenatal clinics and hospitals in the Pacific Northwest. PARTICIPANTS: English-speaking self-identified lesbian women, including 21 interview and six focus-group participants and approximately 43 observed in a support group. DATA COLLECTION: In-depth open-ended interviews, focus group, and participant observation. DATA ANALYSIS: Content/categorical analysis followed by discussion of the mother's stories and a critical conversation about lesbian mothering. RESULTS: The seven organizing themes are as follows: preparing the way: becoming ready; conception: you can't just fall into it; you can hear a heartbeat: pregnancy; birthing our babies; the work of mothers and mothers who work; families who sustain and families who oppose; and sources of support in everyday life. The first four are described in this article. CONCLUSIONS: Health care providers, policy makers, and the public can be better informed about the specific needs of childbearing lesbians.

Therapeutic misconception and the appreciation of risks in clinical trials.

Studies repeatedly have shown that clinical research subjects have trouble appreciating the implications for their clinical care of participating in a clinical trial. When this failure is based on a lack of appreciation of the impact on individualized clinical care of elements of the research design, it has been called the "therapeutic misconception". Failure to distinguish the consequences of research participation from receiving ordinary treatment may seriously undermine the informed consent of research subjects. This article reports results concerning appreciation of the risks of trial participation from intensive interviews with 155 subjects from 40 different clinical trials at two different medical centers in the USA. Working from transcripts of the interviews, every statement of a risk or disadvantage of trial participation was identified and coded into one of 5 different categories. Totally, 23.9% of subjects reported no risks or disadvantages in spite of being explicitly asked about them. Another 2.6% reported only incidental disadvantages such as having to drive a long way to get to the experimental site. In all 14.2% reported only disadvantages associated with the standard treatment (usually side effects). Another 45.8% told the interviewer about disadvantages and risks associated with the experimental intervention (usually side effects). Only 13.5% could report any risks or disadvantages resulting from the research design itself, such as randomization, placebos, double-blind designs and restrictive protocols. The results of this research suggest that subjects often sign consents to participate in clinical trials with only the most modest appreciation of the risks and disadvantages of participation.

Use of the parenting stress index in mothers of preterm infants.

PURPOSE: This report describes parenting stress experienced by mothers of preterm infants following hospital discharge. SUBJECTS: Twenty-nine mothers and their preterm infants were included in the analysis. DESIGN AND METHODS: The study was conducted using a descriptive and exploratory single group design. The analysis included 29 mothers of preterm infants, mean gestational age 33.14 weeks, mean postnatal age 78.59 days, 6 to 10 weeks after discharge. Mothers were administered the Parenting Stress Index (PSI), a 101-item questionnaire that includes a total score and Parent and Child Domains. It also includes the following 13 scales: Adaptability, Acceptability, Demandingness, Mood, Distractibility/Hyperactivity, Reinforces Parent, Depression, Attachment, Restriction of Role, Sense of Competence, Social Isolation, Relationship with Spouse, and Parent Health. PRINCIPAL RESULTS: A high rate of missing items was noted on the PSI. In particular, missing items occurred predominantly in the Child Domain. By following guidelines for scoring the PSI when items are missing, summary scores were calculated for 16 of the 29 participants. Total scores demonstrate the stress experienced by parents of preterm infants. Parent Domain scores were comparable with normative samples; however, Child Domain scores were above the 50th percentile for all child scales. CONCLUSIONS: Mothers of preterm infants experience stress that is largely attributable to the particular characteristics of low gestation infants. The PSI may provide insight into parenting stress; however, future research should examine missing items more closely.