Outcomes of LGBTQ culturally sensitive training among civilian and military healthcare personnel.

BACKGROUND: Lesbian, gay, bisexual, transgender, or queer (LGBTQ) military servicemembers are at higher risk of developing health problems compared to heterosexual peers. To improve outcomes and address negative attitudes, previous literature has recommended education of healthcare personnel. The purpose of our study was to evaluate the knowledge and skill outcomes of an LGBTQ cultural sensitivity training program. METHODS: We used a pretest/posttest design. Participants completed the Ally Identity Measure (AIM) to assess three subscales: knowledge and skills, openness and support, and oppression awareness. Participants included both military and civilian healthcare personnel from multiple disciplines. Descriptive statistics and pairwise analyses were used. RESULTS: A total of 101 participants answered both pretest and posttest. Across all AIM subscales, posttest scores demonstrated statistically significant (P < 0.001) increases from mean pretest scores. Completion rates for the pretest and posttest were 99% and 93%, respectively. The majority of participants were female (75%) and non-Hispanic (87%), composed of Caucasians (39%) and Asians (33%). Over one-third (39%) of participants were aged 30-39. Fifty percent were active-duty military and more than half (58%) of all participants did not have prior training in LGBTQ patient care. Statistically significant differences were found between the pretest and posttest scores for the knowledge and skills subscale (M = 2.64-3.70). The most significant increases were observed in Item 12 and Item 15 (M = 2.72-3.70) regarding awareness of theories and skill development to provide proper support, respectively. CONCLUSION: These significant findings contribute to the currently limited research exploring LGBTQ cultural sensitivity training in both civilian and military settings. To our knowledge, this is the first time a cultural sensitivity training of this depth has been provided to active-duty servicemembers. Further research and development of similar educational programs integrating interactive participation can potentially aid in the delivery of improved care and military readiness for all servicemembers.

Understanding Academic Success From the Perspective of Nursing Students: A Qualitative Study.

ABSTRACT: Baccalaureate nursing education programs must focus on social transition as well as academic preparedness to maximize student success. The purpose of this qualitative research study was to identify nontraditional nursing students' perspectives on strategies that enabled them to succeed. Focus groups were conducted with nontraditional students who graduated on time from a BSN program. Themes that emerged included resources, self-awareness, social support, and early engagement. Using findings from this study, the faculty and administration changed the new student orientation to include time management, test-taking skills, self-awareness assessments, and professional socialization.

Educating Nursing Students About Delivering Culturally Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus Patients: The Impact of an Advocacy Program on Knowledge and Attitudes.

AIM: This study evaluated the effects of a program designed to help students provide culturally competent care for lesbian, gay, bisexual, transgender, questioning/queer, intersex, plus (LGBTQI+) patients. BACKGROUND: The LGBTQI+ community faces disparities linked to stigma and discrimination. The Advocacy™ Program was developed to supplement the curriculum in schools of nursing. METHOD: Nursing students from six schools of nursing (n = 1,398) received advocacy training. Students were administered the Genderism and Transphobia Scale, the Homonegativity Scale, and additional knowledge questions before and after training. RESULTS: The findings were positive, indicating an increase in student attitude scores, vocabulary and disparity knowledge, and knowledge regarding care for an LGBTQI+ client (p < .05). CONCLUSION: By building a culture of inclusion through recognition of diverse patients in the curriculum, nursing schools can develop a culture of connection that strengthens patient-provider relationships and improves mental and physical health.

Perioperative Considerations for Patients Diagnosed With Pulmonary Hypertension Undergoing Noncardiac Surgery.

The prevalence of pulmonary hypertension (PH) has risen in adults of all races, genders, and ethnicities. PH is a fatal disease that presents many challenges to the perioperative health care team. Through increased knowledge of PH pathophysiological changes and anesthesia medications' effect on PH, perioperative health care teams can conduct a detailed preoperative evaluation to determine appropriate therapies to administer. This will assist the perioperative health care team in reducing the pulmonary vascular resistance, optimizing the matching of right ventricle and pulmonary circulations, and reduce the incidence of intraoperative and postoperative complications.

Perception of online teacher self-efficacy: A multi-state study of nursing faculty pivoting courses during COVID 19.

BACKGROUND: COVID-19 forced many colleges and schools of nursing to abruptly pivot face-to-face learning to online formats. Online teaching is not new, but some faculty have not taught in a virtual environment and rapidly transitioning courses online was challenging. It is not known if teacher self-efficacy was impacted by these circumstances. OBJECTIVES: We aimed to assess online teacher self-efficacy of nursing faculty who transitioned at least one-face-to face course to an online format. We hypothesized that faculty with previous online teaching experience and greater self-rated instructional support would demonstrate higher online teacher self-efficacy scores compared to faculty who had little or no online teaching experience or reported less satisfaction with instructional support. DESIGN: A cross-sectional, descriptive design was used. SETTING: Faculty from ten universities across the United States were recruited. PARTICIPANTS: Nursing faculty (N = 84) who transitioned at least one face-to-face course to an online format during COVID-19 were included in the study. METHODS: Participants completed the 32-item Michigan Nurse Educators Sense of Efficacy for Online Teaching (MNESEOT) instrument and a demographic questionnaire which included items about prior online teaching experience and instructional support. RESULTS: Participants scored overall teacher self-efficacy high (75th percentile). "Computer skills" were scored highest while "student engagement" scored lowest. Prior online teaching was a predictor of higher online teacher self-efficacy; however, instructional support was not a predictor of higher online teacher self-efficacy. CONCLUSION: Nursing faculty reported a high level of online teacher self-efficacy during an abrupt pivot from face-to-face teaching to a virtual format. Pre-emptive opportunities to teach online can build self-efficacy for novice faculty. Faculty and students will benefit from improving student engagement skills, especially during isolating and overwhelming events such as the COVID-19 pandemic.

Cardiogenic Shock in the Septic Patient: Early Identification and Evidence-Based Management.

Sepsis-induced cardiogenic shock is a lethal condition and the management of it is challenging. Cardiogenic shock in the septic patient involves myocardial systolic and diastolic dysfunction. The limited ability of the ventricles to contract effectively results in a decrease in oxygen delivery to the organs and tissues. Supportive therapy is provided to patients with sepsis and no specific drug can reverse the myocardial dysfunction. Rapid diagnosis, prompt antibiotic therapy, cautious protocol-driven fluid resuscitation and vasoactive agents, control of infectious source, and expeditious coronary artery revascularization is recommended to achieve a positive outcome.

Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors.

Pulmonary hypertension is a potentially fatal disease. Despite pharmacological advances in pulmonary hypertension, fatigue remains common in patients with pulmonary hypertension. A convenience sample of 120 participants at an international patient conference completed the Multidimensional Fatigue Inventory (MFI)-20 scale. Data on New York Heart Association Functional Class, body mass index, oxygen use and medication type/use were also collected. There was a high prevalence of "severe" to "very severe" fatigue for each dimension: General Fatigue (60%), Physical Fatigue (55.8%), Reduced Activity (41.7%), Reduced Motivation (32.5%) and Mental Fatigue (27.5%). The mean±sd overall MFI-20 score was 58±5.1. Dimensions with the highest averaged levels were General Fatigue (13.40±3.61), Physical Fatigue (13.23±3.67) and Reduced Activity (11.33±4.16). Body mass index correlated with higher fatigue scores. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination negatively predicted General Fatigue, Physical Fatigue, Reduced Motivation and Reduced Activity. Triple therapy was a significant predictor of General Fatigue, Physical Fatigue and Reduced Activity. There were no significant predictors of Mental Fatigue. Multidimensional fatigue is common and severe in patients with pulmonary hypertension. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination resulted in lower scores in most fatigue dimensions. Comprehensive assessment of fatigue should be considered in the clinical care of patients with pulmonary hypertension and clinical research to develop formal interventions that target this disabling symptom.

Management of Sepsis in Patients with Pulmonary Arterial Hypertension in the Intensive Care Unit.

Pulmonary arterial hypertension is a lethal condition, and the management of sepsis in patients with pulmonary arterial hypertension is challenging. As the disease progresses, the right ventricle is susceptible to failure due to a high pulmonary vascular resistance. The limited ability of the right ventricle to increase cardiac output in septic shock makes it difficult to deliver oxygen to the organ and tissues. Intravascular volume replacement and vasoactive drugs should only be considered after a thorough assessment. Priorities of care include improving cardiac output and oxygen delivery by optimizing preload, reducing afterload, and improving contractility.

A predictive model of the effects of depression, anxiety, stress, 6-minute-walk distance, and social support on health-related quality of life in an adult pulmonary hypertension population.

PURPOSE: Pulmonary hypertension (PH) is a life-limiting chronic disease that presents as an elevated blood pressure in the pulmonary artery. The uncertainty of the disease has a profound effect on relationships, cognitive ability, spirituality, emotions, and exercise ability and can negatively impact health-related quality of life (HRQOL). The purposes of this cross-sectional, predictive, correlational study were (a) to identify relationships among the psychological factors (depression, anxiety, stress), physiological factor (6-Minute Walk Test), situational factor (social support), and HRQOL and (b) to test a structural equation model in which depression, anxiety, stress, social support, and 6-minute walk distance predict HRQOL in adults with PH. SAMPLE AND SETTING: A convenience sample of 166 adults between the ages of 21 and 80 years were recruited from the Pulmonary Hypertension Association's 10th International Pulmonary Hypertension Conference and Scientific Sessions in Orlando, Florida, and a PH clinic in southeast Louisiana. Each subject completed 2 questionnaires: the 21-item Depression Anxiety Stress Scale and the Dartmouth Cooperative Functional Assessment Charts. RESULTS: The findings indicated a relationship between depression, stress, anxiety, 6-Minute Walk Test, social support, and HRQOL. The data collected from the adult PH population fit the proposed predictive model for adults with PH HRQOL. However, the researcher was unable to determine the best predictor of HRQOL in adults with PH. CONCLUSIONS: The findings indicate depression, anxiety, stress, 6-minute walk distance, and social support play important roles in HRQOL among patients with PH. Advanced practice nursing strategies to increase HRQOL include counseling, psychiatric referrals, psychotherapy, guided imagery, leading support groups, and low-grade resistance training.