Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group.

Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.

Adherence to Treatment by African Americans Undergoing Hemodialysis.

End stage renal disease (ESRD) affects African Americans more than any other ethnic group. Adherence is a challenge. Patients with ESRD must adhere to medication, diet, fluid restrictions, and dialysis treatment schedules if they do not receive a kidney transplant. The purpose of this exploratory, descriptive study was to assess adherence in 120 African Americans with ESRD undergoing hemodialysis (HD). Participants completed a demographic questionnaire and the ESRD Adherence Questionnaire (ESRD-AQ). Biomarkers were collected from medical records. Few participants (24%) adhered to dietary restrictions; however, fluid restriction was reported as the most difficult to manage, which was consistent with the interdialytic weight gain biomarker. Older participants were more adherent. Participants were adherent with HD attendance and medication. Participants reported frequent communication with the healthcare team, but a more formal process needs to be implemented with follow up to ensure understanding and reinforce adherence.

Bowel Control Strategies Used by Veterans With Long-Standing Spinal Cord Injuries.

STUDY PURPOSE: The aim of the study was to describe strategies used by veterans with spinal cord injury to achieve control over bowel function and fit their bowel programs into their lifestyles in the years following the initial injury. METHODS/DESIGN: Using a qualitative descriptive design, 18 outpatient veterans with spinal cord injuries were interviewed at a Veteran's Administration hospital. Recorded interviews were transcribed verbatim and analyzed to determine major themes. FINDINGS/CONCLUSIONS: Fourteen of 18 participants had gained control over bowel function and led active lives. They emphasized the importance of positive attitudes, listening to their bodies, being physically active, taking charge, and using trial and error to find the best bowel control strategies. Findings also highlighted the value of peer support and the problem of military service connected back injury leading to spinal cord injury. CLINICAL RELEVANCE: Participants provided practical advice for adapting strategies learned during rehabilitation for long-term bowel control after discharge home.

Safe storage time for reprocessed flexible endoscopes: a systematic review.

BACKGROUND: Flexible endoscopes are used to diagnose and treat gastrointestinal and pulmonary diseases. They have narrow, internal channels which are used to insert instruments, air and water into hollow organs and to remove tissues and secretions. Since endoscopes are contaminated during use and have heat sensitive components that cannot be sterilized, they are reprocessed with cleaning and high-level disinfection to destroy microorganisms. Knowing how long reprocessed endoscopes can be safely stored is essential for preventing infection and decreasing unnecessary costs. OBJECTIVE: The objective was to systematically review the best available evidence related to safe storage time (in days) of flexible endoscopes that have undergone reprocessing in order to determine when they can be safely used again without posing any risk of contamination from pathogens. INCLUSION CRITERIA: The types of equipment were flexible endoscopes that had been reprocessed according to recommended guidelines, stored for a specified period of time, and tested for microorganisms.The intervention was the length of time (in days) that reprocessed endoscopes were appropriately stored before use.This review included non-randomized controlled trials and prospective cohort studies.This review considered studies that included the outcome measure: microbial growth on endoscopes which was measured with microbiological cultures. SEARCH STRATEGY: The search strategy aimed to find studies in English and Spanish and included published and unpublished studies from 1990 to 2014. An initial search of CINAHL, MEDLINE/PUBMed and EMBASE was conducted followed by an analysis of the text words contained in the title and abstract and index terms used to describe the articles. Next, a search using all identified keywords and index terms was undertaken across all included databases. Then, the reference lists of all identified reports and articles were searched for additional studies. A citation search was performed in order to find additional studies that cited those already located. METHODOLOGICAL QUALITY: The Joanna Briggs Institute's critical appraisal instruments were used to assess methodological quality. DATA EXTRACTION: Data were extracted from studies in the review using the Joanna Briggs Institute data extraction form. DATA SYNTHESIS: Since the findings were expressed using descriptive statistics, a meta-analysis was impossible. Therefore, the findings have been summarized in a narrative form with tables and a figure. RESULTS: Ten studies met the appraisal criteria and were included in the review. Storage time ranged from two to 56 days, and all 10 studies concluded that endoscopes could safely be stored for the time measured. Seven studies measured microbial growth in all channels; six involved storing the endoscopes for at least three days and five for at least seven days. The contamination rates were low (2% at three days and 4% at seven days) and pathogens were rare. The contamination rate remained consistent over time. CONCLUSIONS: Endoscopes can be stored for seven days if they have been effectively reprocessed and appropriately stored. Ongoing surveillance cultures are necessary to verify reprocessing effectiveness.

Gastrointestinal Symptoms among African Americans Undergoing Hemodialysis.

The incidence of end stage renal disease is more than three times higher in African Americans. Treatment regimens contribute to gastrointestinal (GI) complaints. This study's purpose was to examine the incidence of GI symptoms in African-American patients undergoing hemodialysis. Younger participants were more likely to report mild indigestion, while older participants reported severe indigestion or none at all. Females were more likely to report gastrointestinal symptoms. Commonly reported co-morbidities included hypertension, diabetes, and heart disease. Time on hemodialysis ranged from 1 to 279 months. Those who had been on hemodialysis the longest were more likely to report acid reflux, stomach rumbling and mild diarrhea. This study provides a foundation for early identification of GI symptoms in African-Americans patients undergoing hemodialysis.

A national study comparing the tolerability and effectiveness of colon-cleansing preparations.

The aim of this multisite study (N = 412) was to identify which colon-cleansing preparations used before colonoscopy work best with specific patient populations. A comparative, descriptive approach was used to (1) describe bowel-cleansing preparations being used across the United States, (2) compare their cleansing effectiveness and tolerability, and (3) compare their effectiveness in patients with various health characteristics. A descriptive demographic data form adapted from the Society of Gastroenterology Nurses and Associates Minimum Data Set was used to collect baseline information, identify preprocedure instructions, and describe compliance with preparations. Subjects completed an 11-item subject experience with the bowel-cleansing form before their colonoscopy. A colon cleanliness scale was completed during the colonoscopy to evaluate the effectiveness of the preparation. The preparations revealed a "good" to "excellent" rating and there was no statistical difference in the cleansing effectiveness of the preparations. Subjects experienced a variety of discomforts. Future studies that involve the pooling of data from multiple sites in different geographical areas may provide more precise criteria for the selection of colon-cleansing preparation for specific patients and increase the cultural diversity of the sample.