Healthy aging and care of the older adult with chronic disease: a qualitative needs assessment in 14 eastern and southern Caribbean islands / Envejecimiento saludable y atención de las personas mayores con enfermedades crónicas: evaluación cualitativa de las necesidades en 14 islas del Caribe oriental y meridional / Envelhecimento saudável e atenção à pessoa idosa com doença crônica: avaliação qualitativa das necessidades em 14 ilhas do Caribe oriental e meridional

ABSTRACT The objectives of this qualitative needs assessment were to assess perceived needs of health and social services professionals in the Caribbean Region to enhance services supporting healthy aging and care of older adults and to assess perceived facilitators and barriers to increasing capacity to serve their aging populations. The assessment, informed by the Consolidated Framework for Implementation Science, was conducted in 14 islands in the eastern and southern Caribbean. The results demonstrated need for education of professionals and the general population about the prevention and treatment of non-communicable diseases (NCDs), assessment and services for individuals with dementia, Alzheimer's disease, depression, and harmful alcohol use, all of which pose significant challenges for older adults. Education of health and social services professionals, families, and the public on the risk factors for NCDs and common mental and physical health problems is critical. Barriers to implementation of educational programs include lack of community awareness and resources within the islands. The needs assessment findings are foundational to planning educational interventions. These will be developed by local health providers with the collaboration and support of external resources including those of the Pan American Health Organization/World Health Organization Collaborating Centre in Gerontological Nursing Education.

Resumen Los objetivos de esta evaluación cualitativa de las necesidades fueron evaluar las necesidades que perciben los profesionales de la salud y de los servicios sociales en el Caribe a fin de mejorar los servicios de apoyo al envejecimiento saludable y el cuidado de las personas mayores, así como evaluar los factores percibidos como facilitadores y como obstáculos para mejorar su capacidad de atender a la población que está envejeciendo. La evaluación, basada en el marco consolidado para la ciencia de la implementación, se realizó en 14 islas del Caribe oriental y meridional. Los resultados mostraron la necesidad de capacitar a los profesionales y educar a la población en general acerca de la prevención y el tratamiento de las enfermedades no transmisibles (ENT), la evaluación y los servicios para las personas con demencia, alzhéimer, depresión y problemas de consumo nocivo de alcohol, todos los cuales plantean importantes desafíos para las personas mayores. Es imprescindible capacitar a los profesionales de la salud y de los servicios sociales, así como educar a las familias y al público en general sobre los factores de riesgo de las ENT y los problemas de salud mental y física más habituales. Entre los obstáculos a la aplicación de los programas educativos se encuentran la falta de concientización de la comunidad y la falta de recursos en las islas. Los resultados de la evaluación de las necesidades son fundamentales para planificar las intervenciones educativas, que serán formuladas por los prestadores de atención de salud locales con la colaboración y el apoyo de recursos externos, incluidos los del Centro Colaborador de la Organización Panamericana de la Salud/Organización Mundial de la Salud en Educación en Enfermería Gerontológica.

RESUMO Os objetivos desta avaliação qualitativa das necessidades foram avaliar as necessidades percebidas do pessoal da saúde e dos serviços de assistência social na região do Caribe, visando a melhorar os serviços de apoio ao envelhecimento saudável e de atenção às pessoas idosas e determinar os facilitadores e as barreiras percebidos, com vistas a melhorar a capacidade de prestar assistência às populações idosas. Esta avaliação foi realizada com base na Consolidated Framework for Implementation Science em 14 ilhas do Caribe oriental e meridional. Os resultados obtidos demonstraram que é necessário prover conhecimento aos profissionais e à população geral sobre a prevenção e o tratamento de doenças não transmissíveis, e a avaliação de pessoas com demência, doença de Alzheimer, depressão e uso prejudicial de álcool e os respectivos serviços, visto que são enormes desafios enfrentados pelas pessoas idosas. É fundamental que o pessoal da saúde e dos serviços sociais, os familiares e o público em geral conheçam os fatores de risco para doenças não transmissíveis e os problemas comuns de saúde mental e física que afligem a população idosa. A falta de sensibilização da comunidade e a escassez de recursos são barreiras à implementação de programas educacionais. As conclusões desta avaliação servem de base para o planejamento de intervenções educacionais a serem desenvolvidas localmente pelo pessoal da saúde, com a colaboração e o apoio de entidades internacionais, como o Centro Colaborador da Organização Pan-Americana da Saúde/Organização Mundial da Saúde para Educação em Enfermagem Gerontológica.

A commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres / Comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería / Comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia

ABSTRACT This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

RESUMEN En este artículo se presenta un comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería (PANMCC, por su sigla en inglés). Los objetivos son presentar una visión general de la formación y evolución de la red, sus repercusiones en los ámbitos de la educación, la investigación, la política y las comunicaciones, así como los beneficios de pertenecer a la red. También se destacan las ventajas de las redes internacionales como mecanismo para fortalecer al personal de enfermería y partería y mejorar los sistemas de salud. La Organización Panamericana de la Salud (OPS), Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas, supervisa los centros colaboradores en la Región. Fundada en 1999, la PANMCC consta de 17 centros ubicados en universidades y facultades de enfermería, los cuales proporcionan información crucial sobre enfermería y partería a la OPS/OMS. Esta red respalda el compromiso general y el desarrollo de capacidades mediante la colaboración, el intercambio de recursos y los coloquios de investigación. Los vínculos en la red mejoran el desarrollo profesional, aumentan el desarrollo de capacidades y aumentan la visibilidad de la PANMCC y el trabajo de sus miembros.

RESUMO Este artigo traz um comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia (PANMCC). Os objetivos são apresentar uma visão geral da formação e evolução da Rede, seu impacto em educação, pesquisa, políticas e comunicação e os benefícios da filiação. Também são destacadas as vantagens das redes internacionais como mecanismo para valorizar as forças de trabalho em enfermagem e obstetrícia e melhorar os sistemas de saúde. A Organização Pan-Americana da Saúde (OPAS) - o Escritório da Organização Mundial da Saúde (OMS) nas Américas - supervisiona os Centros Colaboradores na região. Criada em 1999, a PANMCC é composta por 17 centros situados em universidades e escolas de enfermagem. Esses centros fornecem informações essenciais sobre enfermagem e obstetrícia para a OPAS/OMS. A rede apoia o envolvimento global e o fortalecimento institucional por meio de colaboração, compartilhamento de recursos e colóquios de pesquisa. Os elos dentro da rede aprimoram o desenvolvimento profissional, estimulam o fortalecimento institucional e aumentam a visibilidade da PANMCC e do trabalho dos seus membros.

Substance Use Among Older People Living With HIV: Challenges for Health Care Providers.

Older people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol, and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes. They are especially impacted by stigma and stress, which have implications for HIV treatment and care. Recommendations for health care providers working with OPLWH who use substances include: (1) the need to screen and refer for multiple associated conditions, and (2) training/continuing education to enhance care management and maximize health outcomes.

Electronic Nicotine Delivery Systems (ENDS): What Nurses Need to Know.

BACKGROUND: Efforts to decrease adverse effects of tobacco use are affected by emergence of new nicotine delivery products. Advertising, product promotion, and social media promote use of these products, yet a lack of evidence regarding safety leaves nurses unprepared to counsel patients. OBJECTIVES: To critically evaluate current research, reviews of literature, expert opinion, and stakeholder policy proposals on use and safety of electronic nicotine delivery systems (ENDS). DESIGN: A targeted examination of literature generated by key stakeholders and subject matter experts was conducted using key words, modified by risk factors, and limited to the past 8 years. RESULTS: Current knowledge gaps in research literature and practice implications of the literature are discussed. CONCLUSIONS: The safety of ENDS is questionable and unclear. There are clear health risks of nicotine exposure to developing brains. Potential health risks of ENDS secondhand emissions exposure exist. Using ENDS to facilitate total tobacco cessation is not proven.

Nursing Education to Reduce Use of Tobacco and Alternative Tobacco Products: Change Is Imperative.

BACKGROUND: Tobacco use continues to be the leading cause of preventable death worldwide. OBJECTIVE: To assess perceived tobacco educational preparation of undergraduate and graduate nurses in a large urban university. DESIGN: A cross-sectional web-based survey of all nursing students in an urban college of nursing was conducted to assess perceived tobacco educational content, skills, and self-efficacy for cessation counseling with patients who smoke cigarettes and use alternative tobacco products (e.g., hookah and e-cigarettes). RESULTS: Participants reported the most education about health effects of tobacco use (67%), and less than 6% reported education about alternative tobacco products. While the majority of nurses agreed that advising patients to quit is a priority, less than 40% reported receiving sufficient training in cessation counseling. CONCLUSIONS: There continues to be a compelling need articulated by leaders in tobacco policy and research over the past decade for a more vigorous response by nurses to the tobacco epidemic.

Consumo de álcool e qualidade de vida em idosos na saúde da família / Consumo de alcohol y calidad de vida en mayor en la salud de la familia / Alcohol consumption and quality of life in elderly in the family health

Avaliar a associação entre o consumo de álcool e qualidade de vida em idosos. Método: trata-se de estudo transversal envolvendo idosos (n = 593), usuários de unidades básicas de saúde. Foram utilizados os instrumentos Alcohol Use Disorders Identification Test-Consumption para avaliar o consumo de álcool e World Health Organization Quality of Life-bref para avaliar a qualidade de vida. Regressão logística foi utilizada para verificar associação entre consumo de álcool e variáveis independentes; e técnica de análise de agrupamentos para análise de possíveis grupos homogêneos entre idosos com rastreamento positivo para alcoolismo e qualidade de vida. Resultados: Foi encontrado prevalência de consumo de bebida alcóolica de 8,9%. As variáveis escorem Qualidade de Vida Geral <60, depressão e faixa etária 70 a 79 anos mantiveram associação significativa com o desfecho. Obtiveram-se dois grupos homogêneos distintos dispostos em cinco subgrupos. Conclusão: Estratégias de enfrentamento devem ser contempladas nos planos de ações das políticas públicas e alerta metodológico na forma de expor a variável alcoolismo é necessário.

To evaluate the association between alcohol consumption and quality of life in the elderly. Method: Crosssectionalstudy involving elderly (n = 593), users of basic health units. It was used instruments Alcohol Use DisordersIdentification Test-Consumption to assess alcohol consumption and World Health Organization Quality of Life-bref to assess quality of life. Logistic regression was used to assess the association between alcohol consumption and independentvariables; and cluster analysis technique for analysis of possible homogeneous groups among elderly people with positive screening for alcohol and quality of life. Results: Alcohol consumption prevalence was 8.9%. The variables Overall Qualityof Life score < 60, depression and age group 70 to 79 years remained significantly associated with the outcome. There were obtained two distinct homogeneous groups arranged into five subgroups. Conclusion: Coping strategies should be included in the plans of actions of public policies and methodological alert in the form to expose the alcoholism variable is required.

Evaluar la asociación entre el consumo de alcohol y la calidad de vida en los ancianos. Método: Estudio transversal que involucra personas de edad (n = 593), los usuarios de las unidades básicas de salud. Fue utilizadoinstrumentos alcoholemia Test-Consumo para evaluar el consumo de alcohol y la Organización Mundial de la Salud Calidad de Vida-bref para evaluar la calidad de vida. Se utilizó regresión logística para evaluar la asociación entre el consumo de alcohol y las variables independientes; y la técnica de análisis de cluster para el análisis de posibles grupos homogéneosentre las personas de edad avanzada con detección positiva para el alcohol y la calidad de vida. Resultados: Laprevalencia del consumo de bebidas alcohólicas fue de 8,9%. La puntuación Calidad de Vida General < 60, la depresión y la edad del grupo de 70 a 79 años las variables permanecieron asociadas significativamente con el resultado. Se obtuvieron dos grupos homogéneos distintas dispuestas en cinco subgrupos. Conclusión: Las estrategias de afrontamiento debenincluirse en los planes de acción de las políticas públicas y de alerta metodológico con el fin de exponer la variable alcoholismo se requiere.

Smoking Cessation 1 Year or More: Experiences of Successful Quitters.

There is a paucity of research focused on the experience of maintaining cessation for a year or longer, and recidivism rates for smoking cessation are estimated at 50% to 97%. As cigarette smoking is one of the leading causes of death worldwide, there is a critical need for more knowledge about maintaining smoking cessation. Therefore, this study was undertaken to explore the lived experience of maintaining cigarette smoking cessation for a year or more. Using Streubert's nurse-developed descriptive phenomenological method, seven adults who sustained cessation for 1.5 to 18 years, after repeated relapses, were interviewed about their experience of sustaining cessation. Data collection included interviews, field notes, and a reflexive journal. Phenomenological analysis involved dwelling intensely with the data, extracting parts of the transcript, and identifying codes and themes, defined by Streubert as essences, common to all participants' descriptions of the experience of sustained cessation. Through this inductive process, the investigator ascertained relationships among the essences, forming the basis for a formalized, exhaustive description of the experience. Six essences captured participants' experiences of maintaining cigarette smoking cessation: (a) breaking free, (b) developing an olfactory aversion, (c) reframing, (d) learning through relapse, (e) reclaiming acceptance, and (f) self-transformation. The findings suggest that maintaining cessation for a year or more is shaped by biological, psychological, and social conditions, as reflected in the essences. The essences coalesced to a tipping point of motivation and conditions leading to sustained behavior change, allowing participants to maintain cessation.

Knowledge, Beliefs, Behaviors, and Social Norms Related to Use of Alternative Tobacco Products Among Undergraduate and Graduate Nursing Students in an Urban U.S. University Setting.

PURPOSE: The purpose of the study was to assess nursing students' knowledge, beliefs, behaviors, and social norms regarding use of alternative tobacco products (ATPs). DESIGN AND METHODS: This anonymous online survey was conducted with all students enrolled in a college of nursing. The survey utilized measures from several national tobacco studies to assess knowledge and beliefs about ATPs (hookahs, cigars or cigarillos, bidis, kreteks, smokeless tobacco, electronic cigarettes) compared to cigarettes, health effects of ATPs, personal use of ATPs, and social norms. Data were analyzed in SPSS 22.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics and frequencies were performed for basic sociodemographic data. Paired samples t tests were performed to determine differences for scaled measures. FINDINGS: Nursing students demonstrated very low levels of knowledge about ATPs and their health consequences, despite high rates of ATP personal use. About 76% of participants reported use of one or more ATPs once or more in their lifetimes. A greater proportion of students had used hookahs or waterpipes (39.6%) compared to cigarettes (32.7%). CONCLUSIONS: Nurses' lack of knowledge about the emerging use and health threats associated with ATPs may undermine their ability to provide appropriate tobacco cessation counseling. Research is needed to identify gaps in nurses' education regarding tobacco cessation counseling and to develop new counseling approaches specific to use of ATPs. CLINICAL RELEVANCE: Nurses play critical roles in counseling their patients for tobacco cessation. Further research and education about the risks presented by ATPs are critical to reducing excess tobacco-related mortality.

SBIRT goes to college: interdisciplinary screening for alcohol use.

Although risky/harmful drinking, in the form of binge drinking, remains a national problem, only recently have health services in universities systematically screened for drinking, drug use, and smoking. This article recounts "lessons learned" in two nurse-directed, interdisciplinary health services, which adapted the National College Depression Partnership model to include screening and brief intervention (SBIRT) for risky/harmful alcohol use in the form of binge drinking. Using a planned change model, nurse leaders worked with university administrators, providers, and health service staff to screen all students seeking health services for risky drinking. The outcomes suggest that this process may increase staff and student awareness of the importance of alcohol consumption to health, show the ease of using SBIRT screening along with standard screening tools, and yield information on the normalization of high-risk drinking in collegiate settings. Project findings indicate that common perceptions in college students minimize negative outcomes and stress the importance of additional quality assurance initiatives that review the efficacy of combinations of standardized screening tools.