Topic: Intentional diversity in academia: Recruiting, admitting, enrolling, and retaining underrepresented students in nursing programs.

Currently, 60 % of the United States population is White, while the remaining belong to ethnic or racial minorities. By 2045, the Census Bureau predicts that there will no longer be any single racial or ethnic majority group in the United States. Yet, people across all healthcare professions are overwhelmingly non-Hispanic and White, leaving people from underrepresented groups severely underrepresented. The lack of diversity in healthcare professions is an issue because there is overwhelming evidence that patients from underrepresented groups experience disparities in healthcare at alarmingly high rates when compared to their White counterparts. Diversity is especially important in the nursing workforce since nurses are often the healthcare providers that engage with patients the most frequently and intimately. Additionally, patients demand a diverse nursing workforce that can provide culturally competent care. The purpose of this article is to summarize nationwide undergraduate nursing enrollment trends and discuss strategies to improve recruitment, admissions, enrollment, and retention of nursing students who belong to underrepresented groups.

COVID-19 pneumonia: What APRNs should know.

ABSTRACT: COVID-19-associated pneumonia is a complex acute care diagnosis that requires careful evaluation and management. This article includes pertinent recommendations for management of acutely ill patients with COVID-19 pneumonia.

Implementing Delirium Screening in an Intermediate Care Unit.

BACKGROUND: Delirium occurs in as many as 82% of hospitalized patients. Use of a valid and reliable tool allows for early detection and management to mitigate adverse effects, including a decrease in patient falls. OBJECTIVE: To conduct a quality improvement project to implement the confusion assessment method (CAM) tool in an intermediate care unit and measure delirium screening compliance, feasibility of the tool, and the effect on reported patient falls. METHODS: Web-based training using a 14-item pre-post assessment for knowledge comprehension. The CAM tool was added to the electronic health record (EHR), and documentation compliance was measured for eight weeks. Afterwards, a nurse perception survey was distributed, and 60-day pre- and post-intervention patient falls were compared. RESULTS: Forty-seven nurses completed the training. Post-test averages were higher than the pre-test (p = .16); five answers showed significant improvement (p < .02). Screening and documentation compliance were 79.1%. Twenty-one nurses completed the perception survey, demonstrating agreement that delirium CAM screening is a feasible intervention. Patient falls were reduced by 57%. CONCLUSION: Addition of the CAM tool into the EHR-enhanced screening compliance. IMPLICATIONS FOR NURSING: Early delirium detection may reduce patient falls. The CAM is a feasible instrument and delirium screening is a worthwhile intervention.

Academic-Practice Partnership in Rural Maryland: Opportunities for Advanced Practice Registered Nurse Training and Employment.

This case study describes how an innovative, triple-win, academic-practice partnership model can be used to deepen the clinical expertise of advanced practice registered nurse (APRN) students and improve rural Americans' access to quality patient care. It features the experience and strategies used by a school of nursing and a local rural hospital system collaborating to provide clinical experiences for APRN students pursuing doctor of nursing practice degrees.

Implementation of the Confusion Assessment Method for Noncritically Ill Adult Patients.

Several hospital interventions increase patient risk for developing delirium, including mechanical ventilation, monitoring devices, medication interactions, urinary catheters, interrupted sleep cycles, and use of physical restraints. Developing delirium leads to increased length of hospital stay, likelihood of requiring long-term care services after discharge, and risk of mortality following hospitalization. Longer periods of delirium worsen cognition, executive functioning, ability to complete activities of daily living, and sensorimotor functioning. Routine screening and early recognition prevent or reduce the long-term health and financial effects of delirium. The Confusion Assessment Method is a useable tool for screening noncritically ill adult patients for delirium.

Improving Health Care Provider Communication in End-of-Life Decision-Making.

Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement.

Gender differences in stroke, mortality, and hospitalization among patients with atrial fibrillation: A systematic review.

OBJECTIVE: To conduct a systematic review of gender differences in stroke, mortality, and hospitalization for patients with atrial fibrillation and/or flutter (AF/Afl). METHODS: Full texts, published, peer-reviewed, English language articles from 1999 through July 2014 were examined. Articles with populations of patients with AF/Afl were included if they conducted longitudinal analysis of any of three outcomes: stroke, mortality, and hospitalization, and reported or compared at least one of the outcomes according to gender. RESULTS: Seventeen articles were included: sixteen on stroke, nine on mortality, and one on hospitalization. In nine articles women had more strokes (RRs 0.89-1.9). Findings about gender differences in mortality (RRs 0.69-2.8) and hospitalizations were equivocal. CONCLUSIONS: Few articles examine differences in outcomes between men and women with AF/Afl. Given the prevalence of AF/Afl and health care costs it is vital to determine gender differences to evaluate appropriate therapies to decrease stroke, mortality, and hospitalizations.

The influence of depression and anxiety symptoms on health-related quality of life in patients with atrial fibrillation and atrial flutter.

BACKGROUND: The health-related quality of life (HRQoL) of patients with atrial fibrillation (AF) and atrial flutter (AFL) is an important issue in cardiovascular health management. Determinants of poor HRQoL of AF/AFL patients require further elucidation. OBJECTIVES: The purpose of this study was to evaluate the influencing factors related to the HRQoL of AF/AFL patients. METHODS: In 150 consecutively recruited patients in a multicenter, cross-sectional study from April 2010 to February 2011, depression and anxiety were measured with the Beck Depression Inventory II and the State Trait Anxiety Inventory, respectively, whereas HRQoL was assessed with the generic Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Linear regression modeling was performed to determine predictors of HRQoL among variables, including the patients' age, gender, race, marital status, type of AF/AFL, frequency of AF/AFL symptoms, time since diagnosis, and anxiety and depression symptoms. RESULTS: Female patients with AF/AFL reported poorer physical HRQoL than male patients did (P < .001, R² = 0.391). Symptoms of depression and anxiety were found to be associated with poorer HRQoL (P < .001, R² = 0.482). Anxiety was the strongest predictor of the mental component of the Medical Outcomes Survey 36-Item Short-Form Survey version 2 and the Symptom Checklist. Younger patients had worse AF/AFL-related symptoms and severity than older patients did (P < .001, R² = 0.302). Increased frequency of symptomatic episodes was associated with worse AF/AFL-related symptoms and severity. CONCLUSION: In conclusion, depression and anxiety symptoms and female gender emerged as clear indicators of poor HRQoL in AF/AFL patients. These risk factors should be used to identify patients who may require additional evaluation and treatment efforts to manage their cardiac conditions or HRQoL. Interventions to improve HRQoL in these individuals require further investigation.

Pathophysiological relationships between heart failure and depression and anxiety.

Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals.

Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation?

BACKGROUND: Little is known about predictors of mortality or hospitalization in women compared with men in patients with atrial fibrillation (AF). Although there are established gender differences in patients with coronary artery disease (CAD), differences have not been established in AF. OBJECTIVES: The aim of this study was to examine clinical and health-related quality of life (HRQOL) predictors of mortality and 1-year hospitalization in women compared with men with AF. METHODS: Limited-use data from the National Institutes of Health/National Heart, Lung, and Blood Institute Atrial Fibrillation Follow-up Investigation of Rhythm Management clinical trial provided the sample of 693 patients with AF, 262 women and 431 men. Clinical predictors examined were heart failure (HF), CAD, left ventricular ejection fraction, diabetes, stroke, and age. Predictors of HRQOL included overall HRQOL (Medical Outcomes Study Short Form-36 physical [PCS] and mental component scores) and cardiovascular HRQOL using Quality of Life Index-Cardiac Version. RESULTS: Mortality did not differ (women, 11.4%; men, 14.5%; χ(2)1 = 0.437, P = .509) according to gender, with mean 3.5-year follow-up. Different variables independently predicted mortality for women and men. For women, diabetes (hazard ratio [HR], 3.415; P = .003), HF (HR, 2.346; P = .027), stroke (HR, 2.41; P = .032), and age (HR, 1.117; P = .002), and for men, CAD (HR, 1.914; P = 02), age (HR, 1.103, P = < .001), worse PCS (HR, 1.089, P = .001), and worse Quality of Life Index-Cardiac Version score (HR, 1.402, P = .025) independently predicted mortality.One-year hospitalization (women, 38.9%; men, 36.4%) did not differ by gender (χ(2)1 = 0.914, P = .339). Different variables independently predicted 1-year hospitalization-for women: diabetes (odds ratio [OR], 2.359; P = .022), worse PCS (OR, 1.070; P = .003), and rhythm control trial arm (OR, 2.111; P = .006); for men: HF (OR, 2.072; P = .007), worse PCS (OR, 1.045; P = .019), living alone (OR, 1.913; P = .036), and rhythm control trial arm (OR, 2.113; P < .001). CONCLUSION: Only clinical status predicted mortality among women; HRQOL and clinical status predicted mortality among men. Both clinical and HRQOL variables predicted hospitalization for women and men. Increased monitoring of HRQOL and interventions designed to target the clinical and HRQOL predictors could impact mortality and hospitalization. Nursing interventions may prove effective for modifying most of the predictors of mortality and hospitalization for women and men with AF.

Effects of interventions on depression in heart failure: a systematic review.

OBJECTIVE: We sought to conduct a systematic review to evaluate the effects of interventions on depression in adults with heart failure (HF). METHODS: Published, peer-reviewed, English-language, prospective interventional studies were identified in a search of Medline, CINAHL, PsychINFO, and the Cochrane Libraries of Systematic Reviews and Clinical Trials from 1996 through August 2011 and relevant bibliographies. Eligible studies included patients with New York Heart Association functional class II and III HF with experimental or quasiexperimental designs and preintervention and postintervention measures of depression. Ineligible studies were nonpharmacologic with a sample size <50, and drug studies without a comparison group. RESULTS: Twenty-three experimental and quasiexperimental studies that enrolled a total of 3564 persons with HF contributed evidence about 6 types of interventions: selective serotonin reuptake inhibitors (SSRIs), an erythropoiesis-stimulating agent, exercise, disease management programs, complementary and alternative medicine (CAM), and a multimodal intervention of cognitive behavioral therapy and exercise. Studies with SSRIs examined effects of sertraline, paroxetine, and citalopram. The CAM interventions included tai chi, progressive muscle relaxation therapy, and mindfulness-based stress reduction. CONCLUSIONS: Evidence is strong that pharmacology and CAM may improve depression. Moderate evidence supports the use of exercise. A strong body of evidence indicates that disease management programs do not improve depression. This review does not support the development of guidelines for treatment of depression in persons with HF because evidence is insufficient and, at times, contradictory.