Cultural Humility in Undergraduate Nursing Students and Faculty.

ABSTRACT: There exists a critical knowledge deficit in undergraduate nursing students when caring for multiculturally diverse clients. A mixed-methods study was conducted with a sample of undergraduate nursing faculty and students. Foronda's Cultural Humility Scale was used, along with a survey about cultural experiences in undergraduate nursing education. The study found that to provide opportunities for psychologically safe conversations and simulated cultural encounters, concepts related to cultural humility should be considered when redesigning nursing curricula.

Better Together: Collaboration to Enhance the Nursing Workforce.

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention.

Standardized Patients Versus Mannequins in Mental Health Simulation.

BACKGROUND: Mental health nursing simulation using various modalities can be useful in increasing student confidence, satisfaction, knowledge, and communication skills. Studies comparing the benefits of mental health nursing simulation using standardized patients versus mannequins are scarce. AIMS: The purpose of this study was to explore differences in knowledge, clinical learning, clinical reasoning, communication, confidence, and learner satisfaction when conducting mental health nursing simulation with standardized patients compared to mannequins. METHODS: A convenience sample of 178 senior level baccalaureate nursing students enrolled in the mental health nursing course participated in this study. Of the total sample, 41.6% (n = 74) participated in high-fidelity mannequin simulation and 58.4% (n = 104) in standardized patient simulation. Measures included a knowledge assessment, Satisfaction with Simulation Experience Scale (SSE), and a simulation evaluation survey. RESULTS: While knowledge levels increased regardless of simulation modality, clinical reasoning, clinical learning, communication, realism, and overall rating of the simulation experience were significantly higher among participants in standardized patient simulation compared to mannequins. CONCLUSIONS: Mental health simulations can be a useful learning tool for engaging in mental health scenarios in a safe simulated learning environment. While both mannequins and standardized patient modalities are helpful in increasing mental health nursing knowledge, standardized patient simulation has a greater impact on several other aspects including clinical reasoning and communication. Future multisite studies with larger samples are needed, including a wider variety of mental health scenarios.

Managing Medications and Medication Adherence Among US Adults During the Early Phase of the COVID-19 Pandemic.

Purpose: Before the COVID-19 pandemic and the disruptions it brought, medication adherence was already a challenging and complex health behavior. The purpose of this study was to describe patients' interactions in clinic, pharmacy, and home contexts and associated medication management and adherence during the early phase of the COVID-19 pandemic. Patients and Methods: A survey questionnaire was developed using the Medication Adherence Context and Outcomes framework and distributed via social media between May and July 2020 targeting adults taking a daily prescribed medication. Survey questions assessed sociodemographics, interactions with healthcare providers, clinics, pharmacies, medication management experiences, habit strength, and life chaos perceptions during the pandemic. Medication adherence was assessed by the self-report BAASIS© scale to measure implementation, discontinuation, and overall nonadherence. Results: A total of 134 adults from the United States, mean age 50.0 (SD 16.1) years were included in this analysis. Respondents took a median of 3.50 (interquartile range 4) daily medications. Delays in seeing a provider were reported by 47 (35.1%). Pharmacy encounters were impacted; 25 (18.7%) indicated their method for obtaining medication changed. Medication nonadherence was reported among 62 (46.3%) and was significantly greater among those who delayed prescription refills (p=0.032), pillbox users (p=0.047), and those who experienced greater life chaos (p=0.040) and lower habit strength (p<0.001) in the early phase of the pandemic. Conclusion: Although the early phase of the pandemic affected access to care for nearly one-third of the sample, distance-accessible care options and strategies to obtain needed services without being in-person supported respondents medication management. Helpful strategies included provider accessibility, telehealth, home delivery/mail-order, drive-thru's, 90-day supplies, and online/automatic refills. Methods to develop and reestablish habits are critical. Care providers in clinic and pharmacy settings can educate and remind patients about services like distance-accessible technologies and online ordering of medications and establishing routines to support medication adherence.

Foundations of Nursing: Comparing Face-to-Face Versus Blended Learning.

ABSTRACT: Research focusing on blended learning for foundations of nursing courses is limited. The purpose of this study was to compare course performance outcomes when teaching foundations using blended learning compared to face-to-face instruction and to evaluate learner satisfaction and perceptions of effectiveness regarding blended learning. No significant differences were found in exam or final course grades between the two modalities. Most participants perceived blended learning as effective in meeting the course objectives and rated the course as either excellent, very good, or good. Blended learning was a useful strategy for teaching foundations of nursing.

Multiple sclerosis and the risk of infection: Association of British Neurologists consensus guideline.

Infection in people with multiple sclerosis (MS) is of major concern, particularly for those receiving disease-modifying therapies. This article explores the risk of infection in people with MS and provides guidance-developed by Delphi consensus by specialists involved in their management-on how to screen for, prevent and manage infection in this population.

Understanding Filtering Facepiece Respirators.

How to ensure adequate protection.

SystemCHANGE™ Solutions to Improve Medication Adherence in Kidney Transplant Recipients: A Secondary Data Analysis.

The SystemCHANGE™ intervention has led to great improvements in medication adherence, which is a challenge for nearly one-third of kidney transplant recipients. This secondary data analysis sought to measure the frequency of individual solutions utilized by participants in a previously conducted randomized controlled trial of the SystemCHANGE™ intervention and to determine which classes of solutions had greatest impact on improved medication adherence. Solutions that were significant predictors of improving medication adherence to the 85% or higher level included alarm cues (p ≤ 0.0001), time cues (p = 0.006), restructuring the physical environment (p = 0.048), and social support (p = 0.023). Alarm and time cues, restructuring the environment, and social support were successful solutions largely influenced by personal routine and environment consideration that might be prioritized in future studies when implementing SystemCHANGE™.

Respiratory Protection in a Time of Crisis: NIOSH Testing of International Respiratory Protective Devices for Emergency Use.

National Institute for Occupational Safety and Health (NIOSH)-approved respirators are required by the Occupational Safety and Health Administration (OSHA) when personal respiratory protection is used in US occupational settings. During the COVID-19 pandemic, the demand for NIOSH-approved N95 filtering facepiece respirators overwhelmed the available supply. To supplement the national inventory of N95 respirators, contingency and crisis capacity strategies were implemented and incorporated a component that endorsed the use of non-NIOSH-approved respiratory protective devices that conformed to select international standards. The development and execution of this strategy required the collaborative effort of numerous agencies. The Food and Drug Administration temporarily authorized non-NIOSH-approved international respiratory protective devices through an emergency use authorization, OSHA relaxed their enforcement guidance concerning their use in US workplaces, and NIOSH initiated a supplemental performance assessment process to verify the quality of international devices. NIOSH testing revealed that many of the non-NIOSH-approved respiratory protective devices had filtration efficiencies below 95% and substantial inconsistencies in filtration performance. This article reports the results of the NIOSH testing to date and discusses how it has contributed to continuous improvement of the crisis strategy of temporarily permitting the use of non-NIOSH-approved respirators in US occupational settings during the COVID-19 pandemic.

Impact of a SystemCHANGE™ Intervention on Medication Adherence in Older Adults With Heart Failure: A Feasibility Study.

The purpose of the current study was to examine the feasibility and acceptability of a SystemCHANGE™ intervention in improving medication adherence in older adults with heart failure (HF). Adults age ≥50 years with HF who self-administered diuretics were screened for 2 months using electronic monitoring to determine baseline adherence scores. Participants were randomized into the SystemCHANGE™ or attention-control group if adherence scores were <88%. The SystemCHANGE™ intervention focuses on changing the individual's environment by including medication taking into existing routines, receiving support from individuals who impact routines, and using small experiments with feedback. Challenges were noted by participants in using the electronic medication monitor technology during the screening phase. Lessons learned from this study emphasize the need to revise recruitment procedures and include multiple sites. Education and counseling should be adapted to the cognitive level of the participant and address technology challenges. [Journal of Gerontological Nursing, 45(4), 15-19.].

A public health approach to mobilizing community partners for injury prevention: A scoping review.

OBJECTIVES: Reducing injuries in adults requires work with diverse stakeholders across many sectors and at multiple levels. At the local level, public health professionals need to effectively bring together, facilitate, and support community partners to initiate evidence-based efforts. However, there has been no formal review of the literature to inform how these professionals can best create action among community partners to address injuries in adults. Thus, this scoping review aims to identify theories, models or frameworks that are applicable to a community-based approach to injury prevention. METHODS: Searches of scientific and less formal literature identified 13,756 relevant items published in the English language between 2000 and 2016 in North America, Europe and Australia. After screening and review, 10 publications were included that (1) identified a theory, framework or model related to mobilizing partners; and (2) referred to community-based adult injury prevention. RESULTS: Findings show that use of theories, frameworks and models in community-based injury prevention programs is rare and often undocumented. One theory and various conceptual models and frameworks exist for mobilizing partners to jointly prevent injuries; however, there are few evaluations of the processes to create community action. CONCLUSIONS: Successful community-based injury prevention must build on what is already understood about creating partnership action. Evaluating local public health professional injury prevention practice based on available theories, models and frameworks will identify successes and challenges to inform process improvements. We propose a logic model to more specifically guide and evaluate how public health can work locally with community partners.

Improvement of Immunosuppressive Medication Adherence Using a SystemCHANGE Intervention: Case Study of an Older Adult Kidney Transplant Recipient.

This article reports a case study of an older adult kidney transplant recipient with poor medication adherence enrolled in an innovative six-month SystemCHANGE intervention that seeks to systematically improve medication adherence by identifying and shaping routines, involving others in routines, and using medication-taking feedback through small, patient-led experiments. Medication adherence increased immediately and was sustained throughout the intervention and maintenance phases. This is the first case study to demonstrate effectiveness of the SystemCHANGE intervention for promoting medication adherence in a kidney transplant recipient. The intervention improved the timing of doses by linking them to a regularly occurring behavior and providing feedback. The SystemCHANGE intervention represents a systems-thinking approach for both provider and patients, and gives healthcare providers the tools needed to assist patients in using habits and routines, and feedback to improve medication taking and timing.

Medication Adherence Interventions for Older Adults With Heart Failure: A Systematic Review.

Medication adherence is crucial in patients with heart failure; however, the rate of medication nonadherence in the heart failure population is 50%, making it a significant problem. The purpose of the current review was to summarize intervention studies designed to improve medication adherence in older adults with heart failure. A search was conducted to locate randomized controlled trials or quasi-experimental studies that tested interventions to improve medication adherence in patients 45 or older with heart failure. Five of eight studies (63%) showed a statistically significant improvement in medication adherence in intervention groups. Five of these six studies used a combination of educational, behavioral, and affective interventions, and focused on medication adherence alone versus multiple health behaviors. Interventions using combined approaches and focusing only on medication adherence show the most promise for future studies. [Journal of Gerontological Nursing, 43(10), 37-45.].

Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.

BACKGROUND: Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact. METHODS: Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers. RESULTS: The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted. CONCLUSION: To align stakeholders working towards fall prevention for community-dwelling older adults and establish a foundation for collective impact, public health professionals employed practices that reflected a collaborative leadership style. Looking ahead, public health professionals will want to shift their focus to evaluating the effectiveness of their group work within communities. They will also need to assess outcomes and evaluate whether the anticipated reductions in fall rates among community-dwelling older adults is being achieved.

Lean Forward and Listen: poetry as a mode of understanding in medicine.

Many claims have been made over recent years for the use of poetry (and, more broadly, literature) in the curriculum of medical students. Most often, poetry is put forward as having the potential to humanize medicine by promoting, for example, empathy, ethical sensitivity, and an appreciation for diverging interpretations. While these endpoints are all important, this essay uses the experience of a junior doctor undertaking a degree in creative writing to consider how the poetic way of seeing and thinking differs from clinical thinking, and why that might matter. In particular, the author considers the importance in medicine of the capacity to not know, as well as the possibilities for a deeper understanding of patients offered by thinking in terms of poetic voice.

A case of chest pain and hemoptysis in a young child.

Endobronchial atypical carcinoid tumors are rare in young children and can have a varied presentation. Early diagnosis and surgical resection provide an excellent outcome and good long-term survival. However, due to the risk of recurrence and later metastasis, long-term follow-up is necessary.

A Review of Concussion Management in the Young Adult; the Importance of Baseline Testing and Caregiver Education.

: Despite the increase in studies and media coverage, concussion continues to threaten the futures of young athletes and cause a great deal of concern among parents and practitioners. Questions continue regarding the management and return to play for injured adolescents and young adults, and regarding the long term consequences of repeated concussion in our youth. There appears to be a huge disparity between what health care professionals know and understand about concussion and what the average athlete and parent understands about what concussion is and the real risks involved. A review of current literature reveals a persistent lag between our knowledge and practice. This literature survey takes the athlete from the pre-participation sports physical, to the sidelines, to the doctor's office, to return to play and provides a comprehensive assessment of current recommendations. There is a significant need, especially in urban areas, for education and access to cheap and simple baseline functional assessments of adolescents and young adults. We recommend athletes be assessed at their yearly physical in order to properly determine their baseline function and readiness to return to play after concussion. Additionally, we recommend providing anticipatory guidance and a simple concussion evaluation tool to be used by parents and guardians to also annually assess a young person's baseline functional status and subsequent alterations. The goal of this review is to create an evidence-based, simple, cost-effective parental survey; increase awareness, understanding and diagnosis of concussion; and finally, expedited proper treatment and facilitate return to play. PUBLICATION INDICES: PubMed, lib.wayne.edu.