Using Near-Infrared Spectroscopy and Education to Support Older Adults with Diabetic Foot Ulcers to Age-in-Place: A Case Series.

ABSTRACT: The objective of this article is to demonstrate the added value of foot care provided by an RN with foot care training to older adults in their home by focusing on four older adults with diabetic foot ulcers. The RN used a mobile multispectral near-infrared spectroscopy device to enhance the assessment of the diabetic foot ulcers. The Mobile Seniors Wellness Network methodically engaged with English-speaking adults 55 years and older living within a 90-minute radius of the city's community health center. Older adults were referred to the research project through various sources. The participation group included 366 participants with varying holistic healthcare concerns and financial stressors that impacted their ability to age well in place. Over the course of visits by the RN and registered social worker, positive outcomes were facilitated through the collaboration of the participant and the multidisciplinary team, thus enhancing the individual's confidence to remain at home longer. In a time of ongoing provincial health crisis, it may be cost-effective to provide in-home support to those who want to age well in their communities by deploying a Mobile Seniors Wellness Network system throughout the province and enhancing the RN's assessment of feet with a portable and innovative technology tool.

Aging in Place and 'The Little Things': Prioritizing Mobile Health and Social Care in Rural Communities.

Older adults are more frequently wanting to age in place. Governments are seeking cost-effective and efficient methods of supporting aging populations. Older adults who want to stay in their homes for as long as possible encounter multiple barriers, including struggling to maintain their homes, inadequate levels of social and healthcare support, and the lack of financial capacity to pay for home support services. The Mobile Seniors' Wellness Network (MSWN), a multi-disciplinary and person-centered mobile health and social support intervention study was designed to investigate and support aging in place for older adults living in rural New Brunswick, Canada. Secondary analysis of case notes and exit interviews using content analysis revealed concerns with the lack of affordable and mobile care services for vulnerable rural older adults. Older adults revealed that their needs include "the little things" rather than grand gestures or sweeping policies to age in place such as assistance with grounds and home maintenance, in addition to relational and person-centered health and social care in the home. Reliance on private service delivery and volunteer organizations can increase the likelihood that older adults will experience a breakdown of social support networks tied together loosely by friends, family, and their communities. When services are unattainable aging in place becomes an unreachable goal.

Specifications and feasibility of technology-based self-management of COPD: An exploratory qualitative study with patients and providers.

This article outlines the findings of a study that looked at the self-management needs of Chronic Obstructive Pulmonary Disease (COPD) patients and the feasibility of an eHealth intervention. This study found that patient self-monitoring is sub-optimal. Patients want the technology to include record keeping, feedback, the integration of biomedical and environmental data, exacerbation detection, and the ability to connect with providers. Health leaders could benefit from this information by working with their suppliers to eliminate system and technology barriers, and ensuring that technology is interactive, personalized and easy to use.

Marginalization and heterosexism: A lens for understanding the lesbian stepfamily experience and informing nursing practice.

Family composition is changing, as the rights of minority populations are acknowledged and legalized. The lesbian stepfamily is one such family. When people or systems outside the lesbian stepfamily question the family's existence, legitimacy is challenged. Using marginalization and its properties as a lens through which to view the experiences of the lesbian stepfamily we offer insight into how marginalization is operationalized and provide suggestions to address heterosexism in health care practice. Understanding the impact of marginalization on the health of vulnerable populations can assist health care providers to improve health outcomes, particularly in the area of mental wellness.

Teaching HIV-specific content for pre-licensure nursing and health professions students: a review and synthesis.

Persistent Human Immunodeficiency Virus (HIV) prevalence rates remain a challenge, particularly because health care providers (HCP) are not fully prepared to engage in HIV care. This hesitancy to engage creates access to care barriers for people living with HIV (PLWH). We conducted a systematic review to identify educational interventions focused on developing HIV competencies in higher education across health science disciplines. We searched databases for primary studies focused on interventions. Using PRISMA guidelines, we identified 20 articles from 19 distinct studies. While there was an overwhelming body of literature that assessed knowledge, skills, and attitudes in health sciences students on HIV and AIDS, the low number of intervention studies was notable. With the exception of two studies, PLWH were not included in the interventions. This finding stands in sharp contrast to the well-established Greater Involvement of People Living with HIV and/or AIDS (GIPA) and Meaningful Engagement of People Living with HIV and/or AIDS (MEPA) principles. The primary means of the educational intervention was focused on delivering lectures to address HIV and AIDS knowledge for HCP. There was a significant lack of focus on historical, cultural, policy and legal contexts of HIV and AIDS care; theoretical justifications for the interventions were absent. No study focused on the impact of an intervention on the care provided to PLWH by HCP after graduation. There is an urgent need to develop long-term sustainable and scalable interventions that address the consistently identified lack of knowledge and skills, and stigmatizing attitudes of HCP and students.

Digital Therapeutics for COPD Patient Self-Management: Needs Analysis and Design Study.

Timely management of Chronic Obstructive Pulmonary Disease (COPD) exacerbations can improve recovery and reduce the risk of hospitalization. Digital therapeutics are digital interventions, based on best evidence, designed to provide home-based, patient-centered and pervasive self-management support to patients. Digital therapeutics can be effectively used to offer personalized and explainable self-management and behaviour modification resources to patients to reduce the burden of COPD, especially the prevention of acute COPD exacerbations. The functionalities of COPD specific digital therapeutics for self-management need to be grounded in clinical evidence and behavioral theories, in keeping with the self-management needs of COPD patients and their care providers. In this paper, we report the functionalities of a COPD digital therapeutic mobile application based on a needs analysis qualitative study involving both COPD patients and physicians, and, based on the study's finding, we present a knowledge-driven digital therapeutic for COPD self-management.

Reaching out to diabetic soles: Outreach foot care pilot project.

OBJECTIVES: To assess the effectiveness of outreach foot care services as a tool for engagement with isolated vulnerable seniors. To improve foot health of diabetic seniors, thus avoiding expensive and potentially life-threatening diabetic complications. METHODS: Four validated tools are used to gather data: InLow 60-second Diabetic Foot Screen©, Short Diabetes Knowledge Instrument for Older and Minority Adults, Brief Healthcare Questionnaire (Patient Health Questionnaire-9), and the Health-Related Quality of Life Questionnaire. RESULTS: Five monthly visits to 20 participants resulted in multiple co-morbidities being identified, improvements in foot status and diabetic knowledge realized, and determinants of health addressed. Seniors needed support and resources to engage in diabetes self-management. CONCLUSION: The importance of regular foot care as a key element of any self-management plan for diabetes cannot be understated, nor can increasing social services spending to include coverage for foot care thereby avoiding expensive healthcare. Using foot care as a tool for engagement conferred access to vulnerable seniors who ultimately benefited from healthcare and social interactions with a provider.

Domestic/intimate partner violence in the lives of immigrant women: a New Brunswick response.

OBJECTIVES: This article highlights barriers in accessing public services for domestic and intimate partner violence (D/IPV) from the perspectives of immigrant women and service providers in the province of New Brunswick. Addressing these barriers can assist in building capacity among immigrant women to talk about D/IPV; increase awareness and facilitate the use of public services by immigrant women experiencing D/IPV; and improve collaboration among D/IPV service providers in different sectors. METHODS: The study is based on social determinants of health and intersectional theoretical frameworks. Semi-structured interviews and focus group discussions were conducted with immigrant women and public service providers, representing the province's linguistic and geographic (rural/urban) diversity. Qualitative data were coded thematically. Common and disparate themes between immigrant women and service providers were identified. RESULTS: Common themes include lack of understanding, the complexity of the intersection of D/IPV and Canada's immigration framework, and issues of trust. Disparate themes include differences in cultural values, the lack of collaboration between different types of service provision, and financial issues. Recommendations are made to mitigate structural barriers and increase collaboration. CONCLUSION: Acknowledgement and better understanding of the cultural differences between service providers and immigrant survivors of D/IPV would go a long way to improve trust and break down barriers in communication. Revision of the New Brunswick Woman Abuse Protocols will highlight the perspectives of immigrant women. Long-term and increased funding for D/IPV and settlement public services will ensure that women-centered programming and professional translation services are available and improved collaboration takes place.

The process of losing and regaining credibility when coming-out at midlife.

The purpose of this research was to investigate the coming-out process for women at midlife, and to understand how this process of coming-out affects women's health and health care relationships. Using feminist grounded theory, from the interview data we elicited an understanding of how women experienced the coming-out process, how the process influenced their health and health care, what they considered problematic about the process, and how they managed or resolved problematic issues. The basic social process (BSP) of confronting the taken for granted illustrated how the central problem of credibility was experienced. The BSP has three phases: facing scary love, finding me, and settling in. Variables that impact on these phases are support and the concomitant microprocess of enduring perpetual outing. The findings provide a theoretical framework needed for health care providers to understand the coming-out process for midlife women and how it influences their health and health care. The theory provides new insights into the complexity for women transitioning to lesbian at midlife.