Social Determinants of Health: Considerations for Care of Older Veterans.

Social determinants of health (SDOH), the environments and circumstances in which people are born, grow, live, work and age, are potent drivers of health, health disparities, and health outcomes over the lifespan. Military service affords unique experiences, exposures, and social and health vulnerabilities which impact the life course and may alter health equity and health outcomes for older veterans. Identifying and addressing SDOH, inclusive of the military experience, allows person-centered, more equitable care to this vulnerable population. Nurses and other health professionals should be familiar with how to identify and address health-related social needs and implement interdiciplinary, team-based approaches to connect patients with resources and benefits specifically available to veterans.

Racial and Ethnic Disparities in Autism Spectrum Disorder: Implications for Care.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties with social interaction and communication and the presence of restrictive and repetitive behavior. Individuals with ASD, particularly those from diverse racial and ethnic backgrounds, are at higher risk of certain health conditions and mortality over the lifespan. Disparities in timing of diagnosis, access to services, and quality of care have a significant impact on the trajectory of individuals on the autism spectrum. Health care providers and law enforcement officers often interact with individuals with ASD and need adequate preparation to provide person-centered care to this vulnerable population.

Diversity in nursing and challenges with the NCLEX-RN.

High-stakes, standardized testing has historically impeded education/career attainment for members of underrepresented minority groups and people needing testing accommodations. This study was to understand how high-stakes, standardized testing, particularly the NCLEX-RN, impacts diversity, equity, and inclusion (DEI) in nursing. This study explored the history, context, perspectives surrounding standardized testing, with a focus on the NCLEX-RN. The authors consider content, form, and delivery of testing, including accommodations. They identify available data and data collection gaps relevant to DEI and the NCLEX-RN. No nursing organization published the national data necessary to evaluate/refine the NCLEX-RN from a DEI perspective. Preliminary nursing studies and data from other professions indicated disparities in testing outcomes. Nursing must determine if prospective nurses are experiencing disparities in testing outcomes. The authors highlight opportunities to advance DEI through improved data collection, reformed licensure processes, and the reframing of standardized testing as one of many tools to determine competency.

Diversity in Nursing Is Not Enough.

An introspective look.

Role Reversal: In-Situ Simulation to Enhance the Value of Interprofessional Team-Based Care.

BACKGROUND: Effective interprofessional team-based care relies critically on understanding and valuing the role of each team member. Using role reversal with multiple levels of interprofessional education trainees, we developed an in-situ simulation learning experience to enhance team-based care coordination. METHOD: A mixed-methods approach was used to examine participants' readiness, perceived value, and attitude toward interprofessional learning using in-situ simulation in the context of role reversal. RESULTS: Data collected to explore the attitudes related to collaboration in solving a complex clinical case revealed that trainees valued the interprofessional educational (IPE) experience, perceived simulation-based learning as conducive to understanding professional roles, and recognized the value of a team-based approach to Veteran-centered care. CONCLUSION: In-situ simulation using role reversal provides a rich and practical approach for IPE implementation where interdisciplinary role appreciation and team-based care can be promoted. [J Nurs Educ. 2022;61(10):595-598.].

Could Your Patient be Taking Uber or Lyft Post-Anesthesia? A New Era for Transportation Policy and Practice Considerations.

PURPOSE: The purpose of this project was to examine nurse anesthetists' practice and encounters with ambulatory surgery patients experiencing transportation difficulties after the provision of anesthesia. DESIGN: A mixed method approach was used. METHODS: An eleven-item questionnaire was disseminated nationally to 2,827 Certified Registered Nurse Anesthetists (CRNAs) practicing in the outpatient setting. The survey consisted of multiple-choice questions and open text for qualitative assessment. Questions focused on frequency of encounters with patients experiencing transportation difficulties post-anesthesia and policies for rideshare options. FINDINGS: A total of 43% of responding CRNAs work in a clinical practice setting in which patients have the option of being discharged using rideshare (Uber/Lyft) but only if accompanied by an adult. Issues emerged around patient safety when using a rideshare service for discharge postanesthesia. CONCLUSIONS: The proliferation of rideshare options may provide increased access to surgical services in the outpatient anesthesia care setting. Practice considerations associated with transportation policies for postanesthesia patients in the era of rideshare services are warranted.

A framework for evaluating SDOH curriculum integration.

Social determinants of health (SDOH) directly contribute to health inequities among populations and communities. These structural and social forces impact health and health outcomes. Nurses play a vital role in addressing the SDOH and closing gaps relative to disparate outcomes. Integration of SDOH in nursing curriculums has become highly prioritized in nursing education as marginalized communities continue to experience inequities in health, which have been highlighted during the COVID pandemic. Many schools of nursing have embedded SDOH in course content throughout curricula but lack a structured approach to appraise the effectiveness of incorporating these concepts. This paper describes a framework used to evaluate SDOH integration in pre-and post-licensure curriculum.

Exploratory evaluation of baseline cognition as a predictor of perceived benefit in a study of behavioral therapy for urinary incontinence in Parkinson disease.

AIMS: While behavior-based pelvic floor muscle exercise therapy is an effective treatment for overactive bladder in Parkinson's disease (PD) patients, cognitive function may be a predictor of rehabilitation outcomes. METHODS: In a planned exploratory analysis, participants who had a Montreal Cognitive Assessment (MoCA) with a score ≥18 who were randomized in a clinical trial to behavioral treatment were classified by perceived improvement (Benefit vs. No Benefit) as reported on a validated Satisfaction and Benefit Questionnaire. General cognition (MoCA), motor procedural learning (Serial reaction time task), verbal memory (Buschke delayed recall), spatial memory (Nonverbal/Spatial selective reminding test), and working memory (Wisconsin card sorting task) were compared between the two groups using Wilcoxon rank-sum test. RESULTS: Of the 26 participants randomized to behavioral treatment (70% male, mean age 71 ± 6.1 years), 22 participants (85%) reported Benefit and four reported No Benefit. General cognition, motor procedural learning, verbal memory, spatial memory, and working memory did not differ between these groups. While the difference between the time to complete the final practiced series and the random series of the Serial Reaction Time Task (SRTT) was statistically similar between the groups, the Benefit group performed the random sequence more quickly (567.0 ± 136.5 ms) compared to the No Benefit group (959.4 ± 443.0 ms; p = 0.03) and trended toward faster performance in the final practiced series. CONCLUSIONS: Perceived benefit from behavioral treatment for overactive bladder was not associated with measures of baseline cognition other than faster completion of the SRTT. This is noteworthy because many behavior-based therapy studies exclude participants with mild cognitive impairment. Additional studies may evaluate if domain-specific cognitive function, particularly the assessment of implicit memory, could lead to individualized behavioral therapy recommendations.

A syndemic effect: Interrelationships between systemic racism, health disparities, and COVID-19.

ABSTRACT: This article discusses the interconnection between the syndemic effect of racial inequities and disparities as well as the impact of the COVID-19 pandemic on Black Americans. It also highlights meaningful reforms and priorities to achieve health equity in Black communities.

Establishing competency-based measures for Department of Veterans Affairs post-graduate nurse practitioner residencies.

BACKGROUND: In the past decade, numerous nurse residency models have been created and implemented nationwide; however, validated specialty-specific competency standards have not been established to evaluate Nurse Practitioner (NP) resident core competencies. PURPOSE: To report the specialty-specific competency assessment tool devised to assess Department of Veterans Affairs (VA) NP residents' competencies and discuss the VA NP residency program's effectiveness in expanding new graduate NP knowledge and skills in the veteran-centric care setting. METHODS: The VA Nursing Academic Partnership NP residency faculty established and piloted a web-based Nurse Practitioner Resident Competency Assessment (NPRCA) instrument for the comprehensive, specialty-specific assessment of individual NP resident's skill competencies across 24 areas. RESULTS: The VA specialty-specific competency assessment instrument demonstrates strong internal consistency. The robust VA NP residency program enhances new graduate NP competencies. CONCLUSIONS: The VA NP residency model can further the goal of standardizing clinical competencies in NP residency programs.

Assimilation of Expert Clinician Into the Academy: A Competency-Based Faculty Development Plan.

BACKGROUND: As expert clinicians are recruited to academic positions in response to nursing faculty shortages, comprehensive plans are needed for transitioning and role development. PROBLEM: Schools of nursing often lack infrastructures to support and develop new faculty. APPROACH: Team members from an academic-clinical partnership with the Department of Veterans Affairs created a competency-based faculty development plan. OUTCOMES: A comprehensive self-directed faculty development plan was established that included a needs assessment, competency-based guide, and online modular resources. CONCLUSION: The faculty development plan provides a tailored approach to support the transition of clinicians to the academic role. This strategy is a potential solution to addressing the faculty shortage, retention, and role strain issues and builds capacity in schools of nursing. This innovative plan is a first step in establishing a mechanism to measure faculty competencies and professional growth.

Behavioral therapy for urinary symptoms in Parkinson's disease: A randomized clinical trial.

AIM: Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease. METHODS: Randomized trial of behavioral therapy compared with control condition among adults (aged 54-85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self-monitoring. Outcomes included diary-derived incontinence and ICIQ-overactive bladder (OAB) score (range, 0-16) with bother and quality of life questionnaires (higher scores = worse outcomes). RESULTS: Fifty-three participants randomized and 47 reported 8-week outcomes including 26 behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 ± 6.1 vs 69.7 ± 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 ± 9.6 vs 15.1 ± 11.1) and OAB symptoms (8.9 ± 2.4 vs 8.3 ± 2.2). Weekly incontinence reduction was similar between behavioral (-6.2 ± 8.7) and control participants (-6.5 ± 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (-3.1 ± 2.8 vs -1.9 ± 2.2, P = 0.19); however quality of life (-22.6 ± 19.1 vs -7.0 ± 18.4, P = 0.048) and bother (-12.6 ± 17.2 vs - 6.7 ± 8.8, P = 0.037) improved significantly more with behavioral therapy. CONCLUSION: Self-monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.

Growing a Robust Academic Practice Partnership in an Academic Health System.

Schools of nursing located within academic health centers have embraced expanded opportunities to lead in this era of rapid change and considerable uncertainty in US health care. These schools bear a unique responsibility to work with their clinical nursing partners to advance the care of patients, improve the health of communities and populations, and help steward the nation's health care resources. This article describes how the Emory University Nell Hodgson Woodruff School of Nursing has formed and sustained academic-practice partnerships in response to these imperatives. The structures and processes that have supported the partnerships are shared, as are the keys to success in a true partnership. The authors describe the work required to achieve mutually agreed-upon goals, along with the challenges that faculty and health care leaders have faced in their journey to system partnerships.

Critical questions: Advancing the health of female Veterans.

PURPOSE: Women are the fastest growing Veteran population in the United States and many receive all or part of their health care outside of the Department of Veterans Affairs (VA). The purpose of this article is to review the healthcare issues of women Veterans and discuss implications for care. DATA SOURCES: Review of selected literature, VA resources and guidelines, and expert opinion. CONCLUSIONS: Few providers are aware of the impact military service has on the health of women and fail to ask the all-important question, "Have you served in the military?" Recognizing women's military service can reveal important information that can answer perplexing clinical questions, aid in designing comprehensive plans of care, and enable women to receive the assistance needed to address complex physical and psychosocial issues to improve the quality of their lives. IMPLICATIONS FOR PRACTICE: There are gender disparities related to physical health conditions, mental health issues, environmental exposures, and socioeconomic factors that contribute to female Veterans' vulnerabilities. Many of the health conditions, if recognized in a timely manner, can be ameliorated and shift the health trajectory of this population. Clinicians play a critical role in identifying health risk and helping female Veterans start the sometimes arduous journey toward wellness. Discovering and acknowledging women's military history is critical in ensuring quality care and appropriate decision making.

Utilization of foot care services among homeless adults: implications for advanced practice nurses.

PURPOSE: To present the findings of a survey that examined the reason(s) for use of foot care services among homeless adults in a mid-size southeastern city. DATA SOURCES: Data were collected using an 18-item questionnaire. One hundred homeless adults (65 males, 30 females) were asked about their level of foot care use, including under what circumstances foot care services might be used. CONCLUSION: Foot conditions are an important concern among homeless individuals. To add to the complexity of foot-related problems, many respondents (N= 56) from this survey reported a history of diabetes, hypertension, and peripheral vascular disease. The majority (N= 92) of those surveyed value healthy feet and education related to foot care. Condition of shoes, socks, and foot odor was identified by participants (n= 62) as a major deterrent to using foot care services. IMPLICATION FOR PRACTICE: To increase use of foot care programs among homeless adults, services must be offered during the day time when they are not competing to secure nightly shelter. Foot care programs should be innovative and tailored to their unique needs and address concern for sensitivity to feet, sock, and shoe condition; cost; specific services provided; competing needs; source of care; and how to access these services.

The Interaction Model of Client Health Behavior: a model for advanced practice nurses.

PURPOSE: To present the Interaction Model of Client Health Behavior (IMCHB) as a model to guide nurse practitioners (NPs) in their practice. DATA SOURCES: Selected research-based articles on Cox's IMCHB and selected text and writings on the NP movement and nursing practice models. CONCLUSIONS: Many NPs practice in a medical setting where the boundaries between medicine and nursing are blurred. The IMCHB offers a nursing model to guide NPs in their practice. IMPLICATIONS FOR PRACTICE: A nursing model that examines the elements of client uniqueness and assesses the interaction between NP and client can achieve positive health outcomes.