Implementing the nurse practitioner role in Oman: Implications for policymaking.

BACKGROUND: In Oman, limited access to adequately prepared healthcare providers in primary healthcare threatens the provision of quality care to patients and families and access to healthcare services. Nurse practitioners (NP) are in an excellent position to address safety issues and ensure quality healthcare with their advanced nursing skills, knowledge, and acumen for acceptable cultural and religious practices. AIMS: To explain Oman's national strategic plans, processes, challenges, opportunities, and both regional and global implications for the facilitation of NP role implementation and policies. SOURCES OF EVIDENCE: The Nursing and Midwifery Human Resources framework guided the NP implementation project. Guided by the framework, the World Health Organization and the Omani Ministry of Health conducted multiple situational analyses (2004-2016). Later, the NP role was planned and implemented in Oman. During and after implementation, monitoring and evaluation of the NP role implementation were continuously conducted using multiple focus groups, individual interviews, and field visits. DISCUSSION: The NP role implementation revealed multiple challenges and opportunities that either hinder or support NP role implementation. Additionally, the NP implementation project revealed various lessons learned. IMPLICATIONS FOR NURSING AND HEALTH POLICY: National and global nursing leaders and health policymakers should collaborate to discuss NP issues, especially NP role sustainability, legal approval and recognition, prescriptive authority, title protection, practice acts, and professional regulation. CONCLUSION: This paper informs nursing leaders and policymakers in the Middle East and other countries in the global community about Oman's experience regarding NP role implementation.

Application of the Toxic Stress Schema: An Exemplar for School Nurses.

For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.

Barriers to and Facilitators of Using mHealth Technology Among African-Americans Living with Hypertension.

MHealth provides a new way of promoting hypertension self-management behaviors. However, the acceptance, feasibility, and effectiveness of interventions incorporating mHealth technology have been understudied in African-Americans with hypertension. This study aimed to explore participants' (n = 30) experiences using a community and technology-based intervention to self-manage their hypertension (COACHMAN). Focus groups were conducted with African-Americans living with hypertension. Focus groups were audio-recorded, and the data were transcribed verbatim and analyzed qualitatively using thematic analysis. Regarding the use of mHealth-enabled self-management hypertension interventions to support hypertension control among African-Americans, the thematic analysis produced the following five barrier themes: (a) lack of knowledge regarding how to use technology, (b) resistance to learning new technology, (c) lack of access to technology, (d) privacy and security concerns, and (e) issues with the medication management support features. Facilitator themes that emerged from the thematic analysis were all related to the intervention components, which were: (a) reminders, (b) rewards, and (c) education modules. This study focused on mHealth barriers and facilitators as described by African-Americans living with hypertension. Results provide a starting point for developing a mHealth intervention for African-Americans that incorporates a self-management program.

Sleep and immune function among people living with human immunodeficiency virus (HIV).

People living with HIV are at increased risk for sleep disturbances. Up to 75% of the HIV-infected individuals in the United States experience sleep disturbances of some kind. Previous studies have suggested an association between patient-reported sleep disturbances and impaired immune function. This study evaluates data obtained via sleep actigraphy to evaluate the relationship between objectively measured sleep, HIV viral load, and immune function. While this study found no relationship between objective sleep and CD4+ T- lymphocyte count, higher sleep efficiency was weakly correlated with lower HIV viral loads, τb(93) = -.165, p = .043. More research is warranted to clarify the nature of these relationships.

Tragedy in Haiti: Suicidality, PTSD, and Depression Associated with Intimate Partner Violence Among Haitian Women After the 2010 Earthquake.

Across the world, suicidal behaviors are responsible for more than one million deaths each year. In Haiti, suicidal behaviors were found to be related to intimate partner violence (IPV) against women. This study was conducted after the 2010 earthquake in Haiti and women were asked about IPV before and after that event. A sample of women between 18 and 44 years of age responded to a questionnaire about physical, psychological, or sexual abuse by an intimate or non-intimate partner. The women were divided into two groups: (a) women who were abused by partners (n = 133) and (b) women who were not abused (n = 75). Those who were abused had 2.2 times higher odds for suicidal thoughts and 1.9 times higher odds for suicidal attempts and were significantly more likely to suffer from depression and PTSD. For each 1-unit increase in a measured PTSD score, the odds of being abused increased by 105.7%. For each 1-unit increase in the measured depression score, the odds of being abused increased by 14.9%.

Medical Mistrust Among Black Women in America.

This qualitative research study highlights medical mistrust as a significant barrier to quality health care for Black women. Unraveling mistrust is essential for reducing health disparities and improving well-being for women and their families. Three research sites were included: Florida, Ohio, and the U.S. Virgin Islands. Three 90-minute focus groups were convened with 10 women in each of them. The discussions were recorded. Five themes will be discussed through the voices of women from each of the sites. Mistrust of healthcare professionals was associated with fears about being rejected, embarrassed, and misunderstood during the clinical encounter. Others reported that providers who were reluctant to make physical contact with them during the clinical visits provoked feelings that the color of their skin might seem "dirty." Finally, this research will help to inform discussions about COVID-19 vaccine hesitancy, which remains a critical health concern among Black women and healthcare providers.

Chronic Stress and Depressive Symptoms in Midlife African-American Women.

Chronic stress and depressive symptoms in midlife southern rural African-American women were examined because little is known about the intersections among them in this population. The research used Vitaliano's model of chronic stress to guide a secondary analysis of a convenience sample 206 (N = 206) midlife (40-65 years) African-American women from a southern rural community in Florida. Data were obtained from a larger study that focused on menopausal health and well-being among women. It also included brief comments from the women during focus group meetings, indicating that they experienced stress and were feeling "down." Statistical data showed that although the women reported relatively low levels of chronic stress and depressive symptoms, associations with certain personal vulnerabilities and social resources emerged as significant. The results from this secondary analysis will help to inform healthcare professionals about the role of personal vulnerability and social resources.

A Power Conundrum: Black Women and Their Sexual Partners in the Midwest.

The purpose of this research was to determine the extent to which women of African ancestry manifested power in their relationships regarding sexual activities and to examine the influence that specific variables had on their sexual partnerships. A sample (N = 200) of midlife women aged 40-65, who lived in the Midwest participated in this research. The Sexual Relationship Power Scale was used to examine these relationships. Face-to-face interviews occurred in community settings. Multiple regression equations were used to examine the potential impact of specific variables on sexual functioning. Results of the analysis revealed that variables such as mental quality of life, decision-making, and health promotion were positively associated with sexual relationships. Conversely, depression and life stress scores were negatively linked to sexual relationships. Knowledge gained from this research could be used to explore the phenomena of power as expressed in the daily lives of women of African descent. The research can also be discussed from the perspective of a "Black tax," that has burdened Black women for centuries and is manifested through years of discrimination, bias, and the lack of equity in most domains of American institutions.

A Novel Mentoring Program for Inner-City Middle and High School Students.

This article discusses the Provost Scholars, a novel University five-year Mentoring Program for middle and high school students in an inner-city school district. The Provost Scholars is an innovative enrichment Program in which a partnership was formed between an under-resourced inner city school district and a private research university in Cleveland, Ohio. The Program was formed to help students graduate from high school. As these students experience success and empowerment, their willingness and ability to give back to the health of the community is enhanced. The primary goal of the Provost Scholars Mentoring Program is to prepare students for entry into and graduation from colleges/universities, technical/vocational schools, or to find a successful place in the workforce. This article describes a number of initiatives established to ensure the success of the Scholars. One key aspect of the Programs' success is a strong personal interest, caring, engagement, and partnership between the administrative staffs of the following two educational institutions: Case Western Reserve University and the East Cleveland School District, as well as the committed relationships of the university Mentors and the Scholars. Students who participate in the Program are expected to demonstrate improved grades, higher ACT/SAT scores, and to meet the requirements for admission to the colleges and universities of their choice, or to develop skills for meaningful employment in industry.

Swazi Pregnant Women's Knowledge on Consuming Alcoholic Beverages.

Fetal alcohol spectrum disorders (FASD) affect all nations harshly, however, very little is known about the scope of FASD in Swaziland. Alcohol exposure in utero is one of the leading preventable causes of poor fetal birth outcomes. This study assessed the knowledge and practices of pregnant Swazi women, revealing that most participants had knowledge deficit on the effects of consuming alcohol on both the woman (63.3%, n = 19) and her fetus (83.3%, n = 25). The majority (83.0%, n = 25) of the participants reported that they did not drink alcohol, while 16.7% (n = 5) reported that they did consume alcohol. In health facilities, there is a need to intensify health education concerning the effects of alcohol consumption to both the fetus and the pregnant woman. A policy that enforces screening of pregnant women at risk for giving birth to infants with FASD is essential.

Beck Depression Inventory-II: Factor Analyses with Three Groups of Midlife Women of African Descent in the Midwest, the South, and the U.S. Virgin Islands.

This research encompasses a factor analysis of the Beck Depression Inventory-II (BDI-II), which involves three groups of midlife women of African descent who reside in the Midwest, the South, and the U.S. Virgin Islands. The purpose of the study was to determine the factor structure of the BDI-II when administered to a sample of women aged 40-65 of African descent who reside in the three distinct geographical regions of the United States. A correlational, descriptive design was used, and 536 women of African descent were invited to participate in face-to-face interviews that transpired in community settings. Results of the factor analysis revealed a two-factor explanation. Factor one included symptoms such as punishment feelings and pessimism (cognitive), and the second factor included symptoms such as tiredness and loss of energy (somatic-affective). The application of the Beck Depression Inventory-II among the three groups of women generated specific information about each group and common findings across the groups. Knowledge gained from the research could help to guide specific intervention programs for the three groups of women, and explicate the common approaches that could be used for the three groups.

Culturally Anchoring an Intervention for Gender-Based Violence.

Haitians continue to rebuild following the devastating earthquake in 2010, as many also strive to recover and heal from associated horrific events. Immediately following the earthquake, domestic and international agencies reported dramatic increases in violence against women and girls in this small Caribbean nation that shares the island of Hispaniola with the Dominican Republic. In this article we highlight one segment of a situational analysis used as groundwork for developing an intervention to address gender-based violence (GBV). We sought to rapidly identify existing and needed resources and services for internally displaced women and girls in Haiti and to facilitate an immediate and sustainable response. During an eight-day period, we convened focus groups in Port au Prince. Displaced women and older girls, directors of nongovernmental organizations (NGOs), healthcare providers and administrators, and community youth leaders participated in the focus groups. Findings from these focus groups illuminate the multiple influences of GBV on displaced women and girls. Gaps, strengths, and limitations of existing resources, capacities, systems, and services for internally displaced Haitian women and girls were identified. In addition, factors that could potentially support or hinder effective implementation of preventive and response interventions were revealed. Our findings provided a foundation and structure for developing a culturally- specific educational and safety plan which was used in Haiti following the earthquake and continues to have relevance for use, today.

Experiences of violence and abuse among internally displaced adolescent girls following a natural disaster.

AIM: To describe the physical, psychological and sexual violence among internally displaced adolescent girls following the 2010 Haiti earthquake and related risk factors, health concerns and cultural norms. BACKGROUND: Thousands of adolescents were displaced following the earthquake, leaving them vulnerable to abuse and violence. Displaced survivors are disproportionately vulnerable to violence after natural and man-made disasters. DESIGN: A descriptive-correlational design was used to: (1) describe the extent of violence, health risks and concerns in the displaced adolescent girls; and (2) identify correlations in the strength and magnitude of relationships between selected variables including demographics, risk factors and cultural tolerance of violence. METHODS: Data were collected from participants using computer-assisted self-interviews between 2011-2013 including demographics, pre- and post-earthquake violence, perpetrators, risk factors and health consequences. Analysis included frequency, logistic regression and multiple regression. RESULTS/FINDINGS: A majority reported physical, psychological, or sexual abuse both pre- (59%) and post- (64.1%) earthquake. Pre-earthquake, abused adolescents reported the perpetrator as a boyfriend (50%) or family member (30%). Post-earthquake, 20.5% of physical abuse perpetrators were family members. Pre- and post-earthquake physical and sexual abuse did not change. The risk of being sexually abused post-earthquake increased after controlling for age and education. CONCLUSION: Displaced adolescent girls reported similar rates of physical and sexual abuse pre- and post-earthquake. These findings show the importance of preventive policies for adolescent girls in disaster situations in countries with low resources. Social and cultural change is critically needed since abuse was at an unacceptably high rate prior to the earthquake.

Full Practice Authority for Nurse Practitioners.

Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well. Revisiting outdated state practice laws, and considering Full Practice Authority (FPA) for nurse practitioners (NP), is needed for improving access to care while creating greater flexibility for development of patient-centered health care homes and other emerging models of care delivery. Currently, 21 states and the District of Columbia have adopted FPA for NPs, with 15 more states planning legislation in 2016. Allowing FPA and Prescriptive Authority (PA) enables NPs to become more efficient and effective patient care team members. However, physician resistance to FPA and PA presents barriers to implementation.

"The women, they maltreat them therefore, we cannot assure that the future society will be good": Male perspectives on gender-based violence: A focus group study with young men in Haiti.

The purpose of this study was to explore the perceptions of violence against women (VAW) held by Haitian men to gain a better understanding of why VAW occurs. Women in Haiti have experienced significant violence, both before and following the 2010 earthquake. Fifteen men aged 26 to 47 participated in a focus group. The data revealed three themes: men's beliefs about VAW and its context, factors influencing VAW, and recommended interventions. When approaching VAW, men must be part of the collective effort. Their insights are valuable when planning and implementing interventions to decrease VAW in Haiti and worldwide.

Transition-Aged Youths With Dual Diagnoses.

The current study provides an overview of the research knowledge about unique problems encountered by transition-aged youths with dual diagnoses. A description of the considerable physical and emotional changes experienced by transition-aged youths provides a foundation for exploring the pressures and challenges compounded by mental health issues and substance abuse. Programs that provide intensive support throughout the transition years pay valuable dividends. However, transition-aged youths with dual diagnoses of mental disorders and substance abuse find themselves faced with limited or nonexistent options. There is a confusing lack of continuity and consistency of supports and services, which complicates the already perplexing circumstances that beleaguer the lives of young adults with dual diagnoses.

Social Support and Self-Coping of Depressed African-American Cancer Patients.

This study examined the differences among 57 depressed and nondepressed African-American cancer patients and their use of social support and self-coping resources. In-depth interviews were used to elicit narrative responses and Fisher's exact test was used to compare the 2 groups. The depressed patients, as determined by 3 depression scales, more frequently reported having no supportive family, lacking a support system, having sedentary hobbies, or using alcohol or drugs as coping strategies compared to the nondepressed patients. To better detect and treat depression, health-care providers must carefully evaluate the social support and coping resource needs in this vulnerable population.

The Transition to Independence Process: Promoting Self-Efficacy in Transition-Aged Youths.

Transition to adulthood is a developmental stage that presents unique and challenging problems. For individuals with dual diagnoses of mental disorders and substance abuse, the tragic dilemma confronting them is one of limited or nonexistent options as they attempt to navigate their way from child and adolescent services to adult programs. The Transition to Independence Process (TIP) is designed to facilitate more successful outcomes in the transition to adulthood by offering continuity of support. Nursing plays a crucial role in enabling young adults to develop a healthy sense of self-efficacy, thus facilitating the success of a TIP program. [Journal of Psychosocial Nursing and Mental Health Services, 54(2), 49-53.].

Attitudes toward cancer and implications for mental health outcome in African-American cancer patients.

This study examined African-American cancer patients' attitudes toward cancer and their relationship with long-term mental health outcomes. Using mixed methods, 74 breast and prostate cancer patients including 34 depressed and 23 nondepressed African-Americans and 17 depressed Whites were interviewed. The interviews were audiotaped and transcribed. Qualitative data analysis identified themes that were coded. The codes were entered into SPSS software. Fisher's exact test was performed to examine group differences in the identified themes. Nondepressed African-Americans more frequently reported cancer as an adaptive experience (p = 0.047) and less frequently as a struggle (p = 0.012) than the depressed African-Americans and Whites. Groups did not significantly differ in the belief that cancer has no cure (p = 0.763), but depressed African-Americans more frequently reported unwillingness to share a cancer diagnosis with family or friends than depressed Whites (p = 0.50). African-Americans' adaptive attitudes to cancer exhibit a pragmatist approach and a worldview shaped by their lived experience. Participants' narratives were examined to illuminate the meanings of these findings. Adaptive attitudes to cancer are associated with better long-term mental health outcomes, and conversely, unpreparedness and inability to cope are associated with a higher risk of depression among African-American cancer patients. Education about cancer and supports for treatment navigation are important measures for improving the long-term mental health of African-Americans living with cancer.

Gender-related sexual abuse experiences reported by children who were examined in an emergency department.

The purpose of this study was to examine the experiences of sexual abuse by 95 children of two gender groups to determine differences in their reported sexual exploits by perpetrators. Significant differences between female and male children were reported. Male child-victims experienced more anal penetration by penis (54.5%, 10.7% respectively) and finger (27.3%, 2.7% respectively), however; female child-victims experienced more mouth contact to their genitalia (22.7%, 10.0% respectively) and body kisses (47.9%, 9.1% respectively). A more gender-specific approach could help to facilitate prevention, and produce better outcomes.