Broadening their horizons: A rural and urban nursing student exchange program in primary care.

Educational strategies that allow students to experience patient care in both rural and urban settings are imperative to the recruitment and retention of nurses for medically underserved populations or health professional shortage areas. Two state schools of nursing (one urban-oriented and one rural-oriented) in the Mid-Atlantic region were awarded Health Resources and Service Administration (HRSA) project funding to educate nursing students and registered nurses in community-based primary care settings. This article will discuss an innovative rural-urban baccalaureate nursing student exchange model intended to increase understanding of enhanced RN roles in community-based primary care settings. Two project teams collaborated to create a new learning model, a rural-urban exchange, by implementing a Primary Care Camp. The camp included shared didactic content, reflection exercises, historical and cultural considerations, and clinical immersion to allow students in both programs to have on-site rural and urban learning experiences. Faculty collected informal voluntary student feedback through a debrief after their Primary Care Camp experience to assess their understanding of the enhanced RN Role in primary care and how it may affect their future nursing practice. Student feedback suggests that the students met project goals and appreciated the rural and urban exchange experience. This project is an innovative approach that offers guidance for implementing primary care education in a way that supports the current primary care RN role, builds the future workforce, and provides suggestions for replicability.

Therapeutic Horticulture for Dementia: A Systematic Review.

Dementia is on the rise globally and includes complex cognitive and neuropsychiatric manifestations. Prioritizing neuropsychiatric symptom management in persons living with dementia (PLWD) can reduce rates of adverse events and reduce caregiver burden. Therefore, health care providers and caregivers should explore all available therapeutic modalities for PLWD to provide high-quality care to these individuals. The current systematic review synthesizes the evidence concerning the use of therapeutic horticulture (TH) as a nonpharmacological tool for decreasing neuro-psychiatric symptoms, such as agitation and depression, in PLWD. Findings support the use of TH as a low-cost intervention that nurses can use as an important aspect of the care plan for PLWD, particularly in dementia care facilities. [Journal of Gerontological Nursing, 49(7), 49-52.].

Blaming in women with breast cancer subjected to intimate partner violence: A hermeneutic phenomenological study.

Objective: The present study was conducted to determine the blaming experiences of women with breast cancer subjected to intimate partner violence (IPV). Methods: This hermeneutic phenomenological study explored blaming experiences of women with breast cancer subjected to IPV. Nine women with a mean age of 47.5 years referred to oncology hospitals in Tabriz (Iran) were interviewed using semi-structured in-depth interviews. Data analysis was performed based on Van Manen's thematic analysis method. Results: The main theme emerged from the data is "blaming as a shifting cognitive judgment" with three subthemes of patient blaming partner, partner blaming patient, and self-blame. Conclusions: The findings of the present study revealed that cognitive judgment shifting could be emerged as different types of blaming in the patients with breast cancer exposed to IPV. It is suggested that oncology nurses heed the psychological needs of women with breast cancer through holistic nursing considering couple and family-centered care.

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review.

AIM: The current study aimed to systematically review the data obtained from studies on women with breast and gynaecologic cancers subjected to Intimate Partner Violence (IPV). DESIGN: Systematic review without meta-analysis. DATA SOURCES: PubMed, ProQuest, Google Scholar, Scopus, Web of Science; databases were searched without time limit. REVIEW METHOD: The PRISMA model was guided the systematic literature search using Boolean keywords and operators. PICO statement was used to develop a question of this review. Studies examining women with breast and gynaecologic cancers subjected to IPV were included in the study after the quality of the articles was reviewed. RESULTS: Eight studies that met the inclusion criteria and were conducted between 2000 and 2021 were included in the study. CONCLUSIONS: Studies confirm the effect of IPV on the severity and consequences of breast and gynaecologic cancers. Having a history of IPV can indirectly lead to breast and gynaecologic cancers. On the other hand, women suffering from IPV are more likely than other women to delay screening or not perform screening for cancer. IMPACT: The dimensions and nature of violence and the disclosure or non-disclosure of violence in vulnerable women are strongly affected by society's culture. Therefore, researchers need to have sufficient knowledge of the culture and social factors governing the community to achieve reliable findings related to IPV in qualitative, quantitative, and psychometric studies and the design of IPV assessment tools. It is recommended that IPV screening teams, that is, multidisciplinary teams of trained physicians, nurses and social workers, participate in two-way screening programmes: IPV screening for women with gynaecological cancer and screening for gynaecological cancer in women with IPV.

Implementing Enhanced Primary Care Registered Nurse Reimbursement in Rural Health Clinics: A Policy Analysis.

Rural Health Clinics (RHCs) were created in 1977 to address the high health care needs, limited provider access, and poor health outcomes of rural Americans. Although innovative at their inception, the provider-centric model of RHC cost-based reimbursement structures has not evolved, leaving limited opportunities for change; many have failed. Comprehensive, proactive change is needed. Registered nurses (RNs) working at the top of their practice scope are a neglected clinical resource that can improve access, quality, value, and satisfaction for rural patient communities. RHC reimbursement policy must evolve to sustain and support this significant RN role. RNs have demonstrated value in care continuity and disease management, but there is little research on the utilization of RNs using their enhanced skill set in RHCs. Using the Bardach and Patashnik's eight steps of policy analysis, the authors will describe the background and regulations of RHCs, identify current barriers to improving the health of America's rural residents, and then provide evidence to support a new policy option according to the Quadruple Aim framework. The result is a sustainable policy recommendation designed to best serve rural communities.

Ethical Reasoning Debriefing in Disaster Simulations.

BACKGROUND: With disasters occurring often, nurses must understand and ethically implement disaster management and patient care coordination. Yet these topics are often not discussed in nursing education curricula. Simulations are a potential solution to this ethical educational deficit, allowing students to act as professional nurses in a realistic scenario with minimal threat of harm to themselves or others. AIM: This study investigates the effect of a high fidelity, multiple-casualty disaster simulation followed by a structured faculty-led debriefing session on perceived ethical reasoning confidence on senior Bachelor of Science in Nursing (BSN) students. Additionally, the effect of the intervention on students' perceived importance of ethical reasoning and perceptions of such skills was explored. METHODS: Students were provided with preparatory materials on the START (Simple Triage and Rapid Treatment) System and The Madison Collaborative's Ethical Reasoning in Action Eight Key Questions (8KQ) frameworks one week before the simulation exercise. In total, 90 students worked in pairs during the 15-minute disaster simulation. Participants' ethical reasoning attitudes were measured before and after the exercise, employing the Survey of Ethical Reasoning (SER) to indicate the importance of each of the 8KQ in students' ethical reasoning process using a five-point Likert scale. The SER was administered electronically using Qualtrics and statistical analysis was completed using SPSS. The 8KQ was also used in the debriefing led by faculty. RESULTS: Comparative assessment of pre and post-results demonstrate significant growth in students' ethical reasoning confidence scores (t(89) = -6.609, p < 0.001). CONCLUSIONS: Simulations are shown to be effective educational approaches in developing ethical reasoning confidence and promoting the development of students' ethical preparedness.

From Systematic Review to Call for Action.

INTRODUCTION: Intimate partner violence (IPV) is a global public health and criminal justice concern with significant impacts; especially high rates are seen among rural Hispanic American (HA) communities, the fastest growing population in the United States. They experience additional barriers to care including extreme poverty, lesser education, gender norms, and language and immigration issues. METHOD: A systematic literature review was conducted using Cooper's framework to identify evidence supporting associations between interventions and prevention, reduction, and elimination of IPV among rural HA women. Searches conducted on databases including CINAHL, PubMed, Medline, Women's Studies International, MedicLatina, and JSTOR used the MeSH terms Hispanic Americans (Latino/a and Hispanic), domestic violence, and intimate partner violence. Selected studies were published between January 1, 2000, and January 1, 2014. RESULTS: Of the 617 yielded articles, only 6 met the inclusion criteria. Of these, none closely examined rurality or provided valid and reliable measures of outcomes, instead reporting program descriptions and suggested interventions. We identify key findings to guide program, screening, and tool development. CONCLUSION: Our study identifies a gap in knowledge, research, and effective practices and issues a call for action to create evidence-based tools to prevent, reduce, and eliminate IPV in these underserved populations.

Evaluating the Impact of the Life of a Caregiver Simulation on Student Attitudes, Understanding, and Knowledge of Frail Older Adults and Their Family Caregivers.

Many older adults age at home, cared for by family caregivers. Nurse educators need effective educational strategies to teach students family caregiving issues. This article examines how the Life of a Caregiver (LOC) simulation influences students' understanding and knowledge of aging, family caregiving issues, and related community services. A descriptive mixed-methods study was used with a student sample (n = 46). Participants reported significantly higher knowledge of caregiving terminology and significantly greater understanding of caregiving challenges and community services. The LOC simulation was found to be an effective strategy to teach students to care for older adults and their caregivers.

Life of a caregiver simulation: teaching students about frail older adults and their family caregivers.

The number of older adults with caregiving needs is rapidly escalating, and the majority of these adults are cared for at home by unpaid family members. Nurse educators must better prepare nurse graduates to meet the needs of this population, as well as to include family caregivers as part of the health care team. This article describes the design, implementation, and preliminary outcomes of a unique learning experience, the Life of a Caregiver Simulation, which uses narrative pedagogy to increase students' awareness and understanding of the needs of older adults, their family caregivers, and the community services they use. Subjective data from students (N = 25) indicated the simulation served as an effective catalyst for students to experience first-hand and understand the stress and burdens of caregiving.

"The Body Gives Way, Things Happen": older women describe breast cancer with a non-supportive intimate partner.

PURPOSE: Many women identify their intimate partner as important source of support during cancer diagnosis and recovery, but little is known about how women deal with breast cancer while in a relationship self-described as difficult. The purpose of this article is to describe the aging-related experiences of older women who were diagnosed with breast cancer while in a non-supportive, difficult intimate relationship. METHOD: Semi-structured qualitative interviews were conducted with a convenience sample of 16 women aged 55-84 years (mean 68.1 years) in community settings in the mid-Atlantic United States. Data were analyzed using hermeneutic phenomenological analysis. RESULTS: Participants self-identified as being in a difficult intimate relationship (relationship length range: 1 year- 60 years, mean 35.6 years). Reasons for relationship difficulty ranged from intimate partner abuse to terminal illness. The findings included the themes: "At my Age": participants reflect on aging and breast cancer; breast cancer, sexuality, and aging; and silence. CONCLUSIONS: Issues related to aging such as changes in sexual relationships, comorbidities, and partner illness complicated the women's breast cancer experience. Despite relationship difficulties, these women coped effectively with breast cancer in various ways. Study findings will increase awareness about the unique, complex needs of older women facing breast cancer with non-supportive intimate partners. Nurses should assess older breast cancer patients keeping in mind physical functioning, comorbidities, social support network, and quality of intimate partner support.

"If looks would kill then I would be dead": intimate partner abuse and breast cancer in older women.

The objective of this study was to describe the experiences of older women diagnosed with breast cancer while experiencing intimate partner abuse (IPA), determined by scores on the Women's Experience With Battering (WEB) Scale. Semi-structured qualitative interviews were conducted with a convenience sample of 11 women ages 51 to 84 (mean age = 64.8). Data were analyzed using hermeneutic phenomenological analysis. Themes that emerged were Cancer and Control, Negative Relationship Changes, Changes in Intimacy, and Moving On. Older women simultaneously experiencing IPA and breast cancer have unique needs due to the complex interplay among three factors: age, IPA, and breast cancer. Gerontological nurses should be aware of issues surrounding older women with breast cancer and older women experiencing IPA. Assessment of older breast cancer patients should take into consideration patients' social support network and quality of intimate partner support.

Breast cancer in the context of intimate partner violence: a qualitative study.

PURPOSE/OBJECTIVES: To describe the experiences of women who were diagnosed with breast cancer while also encountering intimate partner violence (IPV). IPV was determined by scores on the Women's Experience With Battering Scale and the Abuse Assessment Screen. RESEARCH APPROACH: Qualitative interviews were conducted with a convenience sample of seven women. Data were analyzed with a hermeneutic phenomenologic approach. SETTING: Community settings in central Virginia and Maryland. PARTICIPANTS: 7 participants ranging in age from 37-63 years (X = 50 years); age at diagnosis ranged from 36-58 years (X = 46 years). All were in relationships with men, and relationship length ranged from 2-29 years (X = 12 years). METHODOLOGIC APPROACH: Each participant had one semistructured qualitative interview. MAIN RESEARCH VARIABLES: Experiences of women simultaneously experiencing breast cancer and IPV. FINDINGS: A number of themes emerged, including: (a) reassessing life, (b) believing that stress from the relationship caused the cancer, (c) valuing support from others, and (d) the significance of the breast. CONCLUSIONS: For all of the participants, the breast cancer diagnosis changed their intimate relationships in some way. The cancer was an opportunity for the women to engage in life review, focus inward, and, in some cases, change the relationship status. INTERPRETATION: Increased awareness and screening for IPV are needed in oncology clinical settings. Women with cancer are members of a vulnerable population and use the diagnosis to reassess their intimate relationships.

Forgiveness, and other themes, in women whose fathers killed their mothers.

The purpose of this article is to describe the experiences of adult women who, when they were children, experienced the homicide of their mother by their father. Two qualitative interviews were conducted with a convenience sample of 31 women survivors of uxoricide to create a qualitative description of the phenomenon. A number of themes have emerged including descriptions of the daughter "seeking understanding," "forgiving the father" (or not), and descriptions of the father in terms of his being her father or in terms of his behavior and the homicide.