mHealth Intervention for Elevated Blood Pressure Among College Students: Single-Arm Intervention Study.

BACKGROUND: Current evidence reveals a growing pattern of hypertension among young adults, significantly increasing their risk for cardiovascular disease later in life. Young adults, particularly those of college age, often develop risk factors related to lifestyle choices in diet, exercise, and alcohol consumption. Developing useful interventions that can assist with screening and possible behavioral modifications that are suitable and appealing to college-aged young adults could help with early identification and intervention for hypertension. Recent studies indicate mobile health (mHealth) apps are acceptable and effective for communication and message delivery among this population. OBJECTIVE: The purpose of this study was to examine the feasibility of using a mobile smartphone delivery system that provides tailored messages based on participant self-measured blood pressure (BP) with college-aged young adults. METHODS: Using a single-arm intervention, pilot study design, the mHealth to Optimize BP Improvement (MOBILE) intervention was implemented with college students aged 18 years to 39 years who had systolic BP >120 mm Hg and diastolic BP ≥80 mm Hg. Participants were required to measure their BP daily for 28 days, submit the readings to the app, and receive preset educational text messages tailored to their BP value and related to encouraging healthy lifestyle modifications. Changes in a participant's BP was evaluated using a mixed regression model, and a postintervention survey evaluated their perspectives on the mHealth intervention. RESULTS: The participants' (N=9) mean age was 22.64 (SD 4.54) years; 56% (5/9) were overweight, and 11% (1/9) were obese. The average daily participation rate was 86%. Of the 9 participants, 8 completed the survey, and all indicated the intervention was easy to use, found it increased awareness of their individual BP levels, indicated the text messages were helpful, and reported making lifestyle changes based on the study intervention. They also provided suggestions for future implementation of the intervention and program. Overall, no significant changes were noted in BP over the 28 days. CONCLUSIONS: The mHealth-supported MOBILE intervention for BP monitoring and tailored text messaging was feasible to implement, as our study indicated high rates of participation and acceptability. These encouraging findings support further development and testing in a larger sample over a longer time frame and hold the potential for early identification and intervention among college-aged adults, filling a gap in current research.

Fluctuating cohesion: A grounded theory study of nursing students engaged in a combined debriefing format.

AIM: This study explored the social processes enacted by nursing students when they engage in a combined format of structured peer debriefing followed by instructor-led debriefing after in-person simulation. The aim was to gain insight into nursing students' perceptions and how peer processes influenced reflection and learning. BACKGROUND: Debriefing, a key component of clinical simulation, promotes development of nursing students' reflective processes and enhances learning. In-person group-debriefing led by faculty/instructors is the most used debriefing format in healthcare simulation education. Yet, recent studies indicate instructor-led formats may increase students' anxiety and limit their capacity for reflection, a crucial step in clinical reasoning and decision making. Investigations into learner-centered formats support peer debriefing as a reasonable alternative to traditional instructor-led debriefing. However, current peer debriefing studies provide little insight into the social interactions and processes supporting reflection and learning; and little theoretical basis exists for the integration of alternatives to instructor-led debriefing formats (such as peer debriefing) into simulation-based education. DESIGN: This qualitative study used a Straussian grounded theory design. METHODS: Senior-level baccalaureate and associate degree nursing students from an U.S. public university with first-hand experience using the combined format of peer debriefing followed by instructor-led debriefing were recruited to participate in focus-group interviews. Data gathered from semi structured interviews were analysed using the iterative process of constant comparison. Theory building was aided using memoing, theoretical sampling and conceptual diagramming. RESULTS: The sample consisted of 34 students. Study findings revealed the core category of the constructed theory, 'Fluctuating cohesion', involved students' pervasive sense of going back and forth between a sense of unity (we-ness) and separatism (me-ness) while engaged in the combined debriefing format. The theory integrated five related categories: discovering the process, normalizing experiences, developing mutuality, dynamic balancing and engaging informal social connections. Findings illustrated the processes students enacted to take ownership for learning and proactively discuss their clinical decision-making with the instructor. In turn, reflection was enhanced by increased receptiveness to subsequent expert feedback. CONCLUSIONS: The study findings demonstrated that augmenting instructor-led debriefing with peer debriefing leveraged the beneficial nature of peer interactions, promoted psychological safety, facilitated nascent team behaviors and enhanced reflective thinking. The resultant theory that was generated from the findings and grounded in participants' experience, provides a meaningful framework that may inform future learner-centered debriefing formats aimed at optimizing debriefing effectiveness.

Effects of a Discourse Intervention on End-of-Life Knowledge and Attitudes of Bachelor of Science in Nursing Students.

Several challenges exist to providing effective, formalized end-of-life education for undergraduate nursing students. The purpose of this study was to determine whether the addition of a discourse intervention to the End-of-Life Nursing Education Consortium Undergraduate Nursing Modules effectively improved junior-level prelicensure bachelor of science in nursing students' knowledge and attitudes toward end-of-life care. This quasi-experimental 2-group comparison, pretest/posttest design consisted of a sample of 135 enrolled in a medical-surgical nursing class. Applying Mezirow's transformational learning theory, a 2-hour discourse intervention that included a self-reflective journal, an unfolding case study focused on loss, and a discussion with question-and-answer session was implemented at the completion of the Undergraduate Nursing Modules for the intervention group. Knowledge and attitude toward end-of-life care were measured before and after the intervention with the Palliative Care Quiz for Nurses and the Frommelt Attitude Toward Care of the Dying. The findings indicated increased knowledge and positive attitude changes. This study supports the value of theory-based educational interventions, like a discourse intervention, to enhance effective pedagogy when addressing emotionally laden content such as end-of-life care. This study may have also given a glimpse of how a global pandemic may affect end-of-life knowledge and attitudes.

Reconciling Incongruencies: A Straussian Grounded Theory Approach to Defining Oncology Nurses' Professional Quality of Life.

This grounded theory study explored the processes and actions enacted by oncology nurses to enhance professional quality of life and the related meaning, facilitators, and barriers. Oncology nurses described a process by which they continually Reconcile Incongruencies. This process involves 4 categories: Accepting the Context of Oncology Nursing, Bettering the World, Pursuing a Calling, and Being Valued. External facilitators and barriers, self-driven actions to maintain, and consequences of professional quality of life were also revealed. The findings from this study offer an operational definition, a foundation for instrument development, and the consequences of oncology nurses' professional quality of life.

Medication Decision Making in Low-Income Families of Black Children With ADHD: A Mixed Methods Study.

OBJECTIVES: The purpose of this study was to explore how and why some low-income Black caregivers seek medication treatment for their children with ADHD. METHODS: Using a sequential exploratory mixed method design, Phase 1 comprised an indepth case study design of seven low-income Black caregivers of children receiving medication for ADHD. Based on findings from Phase 1, the second phase involved a secondary analysis of data on Black uninsured or publicly insured children age 6 to 17 with ADHD (n = 450). RESULTS: Factors influencing medication decision-making included child safety and volatility, caregiver mental health, caregiver aggravation, family centered care (FCC), shared decision making (SDM), sole caregiver status, and school involvement. After adjusting for ADHD severity, previous receipt of special education services and experiences of FCC and SDM were independently associated with receipt of a medication for ADHD. CONCLUSIONS: Clinicians and school personnel can intervene to decrease disparities in the treatment of ADHD.

Measuring Professional Quality of Life in Nurses: A Realist Review.

Oncology nurses are at risk for compassion fatigue, which is often assessed using the Professional Quality of Life Scale (ProQOL). Nursing researchers and leaders use the ProQOL to determine risk for compassion fatigue or effectiveness of interventions to reduce compassion fatigue. However, the ProQOL was designed for social workers, and research has shown it to be less suitable to assess the work of nurses. This article synthesizes a realist review of the literature about instruments measuring nurses' professional quality of life (QOL). The following three themes emerged: (a) a robust body of literature aimed at defining professional QOL, (b) a limited historical context of the ProQOL instrument, and (c) newer instruments. Findings suggest that the ProQOL-21 and the Risk Factors for Compassion Fatigue Inventory are more specific to nursing and better suited to measure nurses' perceived professional QOL.

Diagnostic and Medication Treatment Disparities in African American Children with ADHD: a Literature Review.

BACKGROUND: Despite a national focus on achieving health equity, limited attention has been paid to behavioral and pediatric health disparities. As the most common pediatric neurobehavioral disorder, attention-deficit/hyperactivity disorder (ADHD) provides an opportunity to assess the status of pediatric behavior health disparities. The purpose of this literature review is to provide a synthesis of existing research on ADHD diagnostic and treatment disparities between African American and White children. METHODS: Studies were systematically identified through searches in PubMed, CINAHL, and APA PsycInfo using the terms attention-deficit/hyperactivity disorder, disparity, race, ethnicity, diagnosis, medication, and treatment. Summary calculations were conducted to report the proportions of studies with statistically significant differences in ADHD diagnosis and treatment between White and African American children, and to describe trends in disparities over time. RESULTS: Forty-one studies were included in this review. The majority of studies identified significant disparities in ADHD diagnosis and medication treatment between African American and White children. While diagnostic disparities show a trend toward reduction over time, a similar trend was not observed in medication treatment disparities. This synthesis provides a critique of the existing literature and recommendations for practice and future research.

Implementation and outcomes of complementary therapies in hospice care: an integrative review.

Complementary therapies are increasingly integrated into hospice care, emphasizing the need to examine the evidence regarding implementation and effects on end-of-life outcomes. This review synthesizes the evidence regarding the implementation of complementary therapies and effects on end-of-life outcomes in hospice care. Whittemore and Knafl's five-step integrative review process was applied. Using predefined search terms, research-based articles between 2006 and 2020 were reviewed. Twenty-three quantitative/mixed method studies conducted across eight countries met the final review criteria. Most commonly used complementary therapies were music, biofield therapies (reiki, therapeutic touch), and massage therapy. Most studies reported significant findings on physical symptoms (pain, dyspnea, fatigue, gastrointestinal symptoms, agitation) and/or psychosocial/spiritual symptoms (anxiety, depression, spirituality, well-being, quality of life); 40% of studies had both significant and nonsignificant findings. Methodological limitations included study design (few randomized controlled trials), small sample size, high attrition rate, lack of racial/ethnic diversity, unstandardized intervention implementation, and multiple outcome measurement instruments. Complementary therapies are promising components of hospice care; however, rigorous studies are needed to validate the effect on end-of-life outcomes and determine the most efficacious implementation. Complementary therapy studies face challenges consistent with end-of-life research; however, efforts to design rigorous trials and address methodological issues are required to enhance the state of the science.

Medication Decision Making Among African American Caregivers of Children With ADHD: A Review of the Literature.

Background: Significant pharmacotherapy disparities exist among children from ethnic minorities with ADHD. Objective: The purpose of this review is to synthesize existing evidence on African American caregiver medication decision making (MDM) for children with ADHD. Method: Databases queried for this review included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychINFO, PubMed, and Education Resources Information Center (ERIC). Information regarding the unique culturally specific barriers and supports to MDM were examined through the relevant literature search. Results: Fourteen articles were included in this review (seven observational studies, four qualitative studies, three mixed methods studies). Three main themes were identified which include (a) fundamental perspectives of ADHD, and cultural norms for child behavior; (b) the impact of fundamental perspectives on MDM in ADHD; and (c) ADHD diagnosis and treatment as forms of social control. Conclusion: Evidence-based recommendations for clinicians are provided, along with direction for future research.

Perception and Beliefs Regarding Cardiovascular Risk Factors and Lifestyle Modifications Among High-Risk College Students.

BACKGROUND: Studying risk factors and corresponding behavior in young adults is important as atherosclerotic plaque begins to form in early adulthood, resulting in cardiovascular disease (CVD) later in life. The purpose of this study was to explore the perceptions and beliefs regarding cardiovascular risk and lifestyle modification among high-risk college students (based on Framingham 30-year risk score). METHODS: Semistructured qualitative interviews were conducted and analyzed using qualitative content analysis. RESULTS: Risk factors included overweight/obesity, alcohol consumption, elevated blood pressure, family history, and smoking. Qualitative interviews revealed six themes: (a) recognizing risk, (b) lifestyle trajectories, (c) factors influencing lifestyles, (d) ideal healthy lifestyle modifications, (e) perceived benefits of healthy lifestyles, and (f) integrating technology and health apps. Participants demonstrated a lack of understanding of how the various factors contributed to CV risk. Influencing factors to a healthy lifestyle were categorized as environmental, relational, financial, work/life/school balance, and internal/intrinsic motivation. CONCLUSIONS: Understanding high-risk college students' beliefs and perceptions regarding CVD risk factors and lifestyle modification is the first step to assessing the problem facilitating early intervention in the young adult population. Clinicians should assess, develop, and implement risk reduction programs that are tailored to individuals who need it the most, those at high risk.

Sociocultural Factors Associated with Awareness of Palliative Care and Advanced Care Planning among Asian Populations.

Objective: Underutilization of palliative care (PC) among racial/ethnic minorities remains consistent despite projected demand. The purpose of this study was to examine knowledge of palliative care and advanced care planning (ACP) and potential variations among subgroups of Asian Americans. Design: A survey was conducted to collect information about awareness, knowledge, and perspective of PC and ACP in the southwestern region of the United States, from October 2018 to February 2019. A total of 212 surveys were collected from the general public at such places as health fairs, New Year celebration events, church, and community centers; 154 surveys were included in the descriptive and multivariate data analysis. Results: About 46.1% and 40.3% participants reported having heard of palliative care and advanced care planning, respectively. The average score of the Knowledge of Care Options Instrument (KOCO) was 6.03 out of 11 and the average score of the Palliative Care Knowledge Scale (PaCKS) was 4.38 out of 13. Among those who have heard of PC, both Chinese (odds ratio (OR) .19 [CI, .05, .73]) and Vietnamese (.22 [.06, .84]) were less likely to have heard of palliative care compared with Filipinos (1.00). Among those who have ever heard of advanced care planning, age (.60 [.43, .84]) was negatively and education level (1.91 [1.18, 3.08]) was positively associated with awareness about advanced care planning. The majority of survey participants preferred family members to serve as their power attorneys. Conclusion: The low levels of palliative care and advanced care planning awareness and knowledge in the diverse Asian groups living in the United States raise concerns and shed light on the critical need for culturally appropriate education programs.

Inner Strength-State of the Science.

The phenomenon of inner strength has been investigated since 1990. Foundations for inner strength have been developed using inductive designs that have led to a middle-range theory of inner strength and a conceptual model. Two instruments have been developed to measure and test inner strength and have been predominantly used in samples of women and the elderly. This paper will trace the development of inner strength knowledge from two distinct paradigms in North America and Northern Europe. Empirical testing is described. Gaps in the current state of knowledge of inner strength are identified as well as implications for future research.

A Community-Based Approach to Assessing the Physical, Emotional, and Health Status of Hispanic Breast Cancer Survivors.

INTRODUCTION: Latina breast cancer survivors in the United States face disproportionate risk for poorer quality of life and physical health, as well as greater emotional distress. METHOD: A cross-sectional survey was conducted to describe the physical, emotional, and general health status of 135 Latina breast cancer survivors served by a community-based program. RESULTS: Of the 135 surveys sent, 48 survivors responded. Of those who responded, time since diagnosis ranged from 0 to 24 years ( M = 4.37; SD = 5.54); and 45.9% of the women rated physical health as poor or fair. Fatigue prevalence was high, with 60.5% reporting fatigue as moderate or severe. Nearly 80% reported having pain (score >0); 38.3% reported pain was moderate or severe. The women reported mild levels of anxiety and depression but high levels of stress ( M = 4.14; SD = 3.02). CONCLUSIONS: Latina breast cancer survivors could benefit from interventions focused on commonly shared problems while tailoring specific interventions for subsets with more severe symptoms.

The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship.

BACKGROUND: Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty and anxiety about potential cancer recurrence for many years after treatment. Physiologic alteration can also occur as a stress response, triggered by an upcoming surveillance visit. Survivor-provider communication can theoretically allay emotional distress. OBJECTIVE: The aim of this study was to evaluate associations between emotional (uncertainty, anxiety, concerns about recurrence) and physiologic responses (cytokine levels, lymphocyte counts), and survivor-provider communication (women's plans for their visit, negotiation of decision-making roles). METHODS: Twenty-seven community-dwelling breast cancer survivors participated. Blood specimens, and self-reported data focusing on the previous month, were collected immediately before and the morning after a regularly scheduled medical oncology visit. RESULTS: Global concerns about cancer recurrence and acute anxiety and uncertainty were associated with changes in immune status before and after the visit. Postvisit natural killer cells increased in 70% of women, and uncertainty/anxiety decreased. Thirty-three percent of women reported a previous minor illness. Most women had a visit plan; 66% successfully negotiated decision-making roles with providers. CONCLUSIONS: Triggered by an upcoming medical oncology visit, women experience uncertainty, anxiety, and altered immunity, potentially placing them at risk of disease exacerbations. IMPLICATIONS FOR PRACTICE: Not all women respond similarly to a routine surveillance visit; thus, providers must determine who may be at increased risk of emotional distress and physiologic alteration. Survivor-provider communication facilitates immediate resolution of concerns. Explanations of symptom meaning reduce anxiety and uncertainty and by extension may help resolve immune alteration. Between visits, this could be done by nurse-operated telephone-based "help lines."

Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.

BACKGROUND: Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. OBJECTIVE: We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. METHODS: We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. RESULTS: Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. CONCLUSIONS: Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. IMPLICATIONS FOR PRACTICE: Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.

The role of inner strength in quality of life and self-management in women survivors of cancer.

The role of inner strength in quality of life (QOL) and self-management, primary variables in the Theory of Inner Strength, were examined with demographic and clinical characteristics in 107 women with cancer. The strongest predictors of QOL were depressive symptoms, inner strength, and time since diagnosis, respectively, accounting for 82% of the variance in QOL. When depressive symptoms were excluded due to multicollinearity, 64% of variance in QOL was explained by inner strength, time since diagnosis, and comorbidities, with inner strength the strongest predictor. The strongest predictors of self-management were depressive symptoms and inner strength, accounting for 17% of the variance. Results contribute to theory development and suggest the value of supporting inner strength to enhance QOL in cancer survivors.

Health disparities in practice and research for aging women with cancer.

The purpose of this article is to examine health needs as well as disparities in practice and research pertaining to aging women with cancer. Given the increasing number of aging women with cancer and the concomitant challenges in survivorship, caregivers need research and improved clinical care to identify needs and enhance cancer survivors' quality of life. The authors use inner strength as a theoretical framework to discuss examples of practice and strategies to improve health outcomes and assess health needs in aging women with cancer. Because researchers find it difficult to identify gender-specific and culturally appropriate instruments, the authors conducted a pilot test on an inner strength questionnaire to identify potential problems in instrumentation and data collection with aging women. Ultimately, a therapeutic partnership between patient and care provider should be based on mutual goal setting and identifying all the dimensions of a women's health status with valid and reliable research instruments and practice strategies.

Development and testing of the inner strength questionnaire.

The aim of this research brief is to describe the results of psychometric evaluation of a new instrument to measure inner strength in women with chronic illness. Inner strength is defined as a central human resource that promotes well-being and healing (Roux, Dingley, & Bush, 2002). The instrument can be used in clinical settings to examine women's inner strengths associated with cognitive, social, physical, and mental needs to improve health outcomes and enhance well-being. The theory of inner strength has important implications for health care providers to improve health outcomes and symptom management for women living with chronic illness.

Inner strength in older Hispanic women with chronic illness.

The phenomenon of inner strength has been studied in women with various chronic illnesses (Dingley, 1997; Dingley, Bush, & Roux, 2001; Koob, Roux, & Bush, 2002; Roux, Bush, & Dingley, 2001), demonstrating commonalities in the experiences that bridge the boundaries created by disease taxonomy or individual circumstance. Despite the richness of previous qualitative studies, the current state of the science reflects the interpreted reality of inner strength from the perspective of primarily middle class Caucasian women. Therefore, the purpose of this qualitative descriptive study was to explore the experience of inner strength in older Hispanic women living with chronic illness. The primary research question was: How do older Hispanic women experience inner strength as they live with chronic illness? The purposive sample consisted of women who met the criteria for the term "Hispanic", were 60 years of age or older, and had been diagnosed with a chronic illness. Data generation methods included observation and semi-structured interviews. Data analysis was based on qualitative methodology informed by grounded theory and the constant comparative method. Findings from the current study suggested the experience of inner strength in older Hispanic women involved the following interrelated dimensions: (a) Drawing Strength from the Past, (b) Focusing on Possibilities, (c) Being supported by Others, (d) Knowing One's Purpose, and (e) Nurturing the Spirit. The current study contributes to a cumulative program of research on the phenomenon of inner strength, furthering theory generation, cultural awareness, and future intervention studies.