Retirement Financial Planning and the RN: An Integrative Literature Review.

This integrative literature review examined the current research on RN retirement. The review identified 3 critical gaps in knowledge: (a) minimal knowledge regarding the economic impact on RN retirement, (b) incomplete information regarding the demographics of RN retirement, and (c) a scarcity of prospective longitudinal RN workforce studies. Future research must address these gaps to better address RN workforce sustainability.

Retirement financial planning and the RN: an integrative literature review.

This integrative literature review examined the current research on RN retirement. The review identified 3 critical gaps in knowledge: (a) minimal knowledge regarding the economic impact on RN retirement, (b) incomplete information regarding the demographics of RN retirement, and (c) a scarcity of prospective longitudinal RN workforce studies. Future research must address these gaps to better address RN workforce sustainability.

An advanced practice nursing program for foreign medical doctors: a practical approach.

AIM: This article articulates lessons learned about an accelerated family nurse practitioner course offered to foreign medical doctors who also held baccalaureate nursing degrees (BSN). BACKGROUND: In the last decade, many physicians in the Philippines returned to school to obtain BSN degrees and licensure as registered nurses (referred to as nurse-medics) to emigrate to the United States in the hope of a better life. Once in the United States, many remain in nursing even though they prefer the practice of medicine. METHOD: This fast-track master's degree program began in fall 2006 at a university in the southwestern United States in collaboration with St. Jude College in the Philippines. By the end of this program (2010), 76 students had graduated. All who sat for the FNP national certification exam passed on the first attempt. RESULTS: Due to a decrease in qualified applicants, the program eventually closed, but a number of important lessons were learned. CONCLUSION: Nursing programs planning to undertake accelerated programs to transition medical doctors to nurse practitioners should consider they retake courses such as physical assessment, pharmacology and pathophysiology.

A teaching intervention to improve the self-efficacy of internationally educated nurses.

Increasingly, the U.S. health care system relies on internationally educated nurses to meet the staffing shortage. Many of these nurses come to the United States from Asian countries, especially the Philippines, India, Korea, and increasingly China. Because of conflicting professional and socioeconomic expectations, a growing body of literature has documented a range of challenges experienced by internationally educated nurses during their transition to the U.S. health care environment and American society. This article describes an increase in perceived self-efficacy for a group of internationally educated nurses (N = 18) who participated in an adverse cardiac event with the use of computer-assisted simulation training. The findings indicate that internationally educated nurses may increase their self-efficacy in caring for patients in U.S. health care facilities if they receive some pre-employment simulation training to help them transition to the U.S. health care work force.

Asthma severity in children and the quality of life of their parents.

This study examines the effect of asthma severity of children aged 7-17 years and sociodemographic characteristics on the caregiver's quality of life. For parents of asthmatic children, there was a negative correlation between overall asthma severity and quality-of-life score. Measuring parental quality of life enables the development of effective asthma programs.

The effect of a senior jazz dance class on static balance in healthy women over 50 years of age: a pilot study.

The purpose of this pilot study is to assess the impact of a senior jazz dance class on static balance for healthy women over 50 years of age using the NeuroCom Smart Balance Master System (Balance Master). A total of 12 healthy women aged 54-88 years completed a 15-week jazz dance class which they attended 1 time per week for 90 min per class. Balance data were collected using the Sensory Organization Test (SOT) at baseline (pre), at 7 weeks (mid), and after 15 weeks (post). An equilibrium score measuring postural sway was calculated for each of six different conditions. The composite equilibrium score (all six conditions integrated to 1 score) was used as an overall measure of balance. Repeated measures analyses of variance (ANOVAs) were used to compare the means of each participant's SOT composite equilibrium score in addition to the equilibrium score for each individual condition (1-6) across the 3 time points (pre, mid, post). There was a statistically significant difference among the means, p < .0005. Pairwise (Bonferroni) post hoc analyses revealed the following statistically significant findings for SOT composite equilibrium scores for the pre (67.33 + 10.43), mid (75.25 + 6.97), and post (79.00 + 4.97) measurements: premid (p = .008); prepost (p < .0005); midpost (p = .033). In addition, correlational statistics were used to determine any relationship between SOT scores and age. Results indicated that administration of a 15-week jazz dance class 1 time per week was beneficial in improving static balance as measured by the Balance Master SOT.

The Impact of Shift Work on Diabetes Self-Management Activities.

BACKGROUND: Once a person is diagnosed with diabetes, aggressive management is imperative to minimize poor glycemic control devastating outcomes. However, for some patients reaching optimum blood glucose levels is challenging due to the complexity of diabetes care. To achieve good blood glucose control, patients affected by diabetes must engage in self-care activities that include routine blood glucose check, dietary control, physical activity, medication regimen, and routine medical provider visits. Diabetes-associated self-care activities aimed to reach good blood glucose control can be hindered by multiple factors including shift work. OBJECTIVE: To evaluate self-management activities of individuals affected by diabetes who are employed as shift workers. This study also informs primary care nurse practitioners of the challenges shift workers face in managing their disease. METHODS: This was a cross-sectional descriptive study. Participants were individuals affected by type II diabetes from a single primary care practice (N = 86); 45 were individuals working on the dayshift and 41 worked on the evening/night shift. Each participant completed the diabetes self-management questionnaire and author-developed demographic/supplemental questionnaire. CONCLUSIONS: There were no differences in self-reported diabetes management activities (i.e., physical activity, glucose management, and healthcare use) between the two groups. Thirty-nine percent of participants working shifts reported worse sleep patterns compared to their dayshift counterparts (X 2[1, N = 85] = 8.73, p = .003). Evening/night shift workers also reported more symptoms such as leg pain, fungal infection, numbness of the feet and legs, dizziness, and vision changes (X 2[1, N = 79] = 43.037, p < .001). IMPLICATIONS FOR PRACTICE: A better understanding of the impact that shift work has on diabetes care may help healthcare providers formulate meaningful treatment plans to meet the needs of evening/night shift diabetic workers. The use of a patient-centered medical home is one strategy.

Overweight and obesity in nurses, advanced practice nurses, and nurse educators.

PURPOSE: To quantify the incidence of overweight and obesity in nursing professionals and assess nurses' knowledge of obesity and associated health risks. DATA SOURCES: A mailed survey to 4980 randomly selected registered nurses from one state in each of six geographic regions. Response rate was 15.5% (n= 760). Descriptive statistics were calculated for continuous variables; categorical variables were summarized with frequency counts. RESULTS: The grand mean body mass index (BMI) of nurses surveyed was 27.2. Almost 54% were overweight or obese. Fifty-three percent of these nurses report that they are overweight but lack the motivation to make lifestyle changes. Forty percent are unable to lose weight despite healthy diet and exercise habits. Only 26% of respondents use BMI to make clinical judgments of overweight and obesity. Although 93% of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, 76% do not pursue the topic with overweight and obese patients. DISCUSSION: Many nurses provide weight-related health information to the public. These data suggest that they may benefit from continuing education on obesity and its risks. Because 76% of nurses do not pursue the topic of obesity with patients, they may benefit from education on pursuing sensitive topics during a professional encounter. Nurse practitioners may play a key role in the education of both patients and registered nurses.

Japanese American Nursing Education Leadership.

Why are there so few Japanese-American Nursing Education leaders in the United States when Asians in general are considered the "model minority"? Several reasons point to the cultural and value differences of an Eastern versus Western perspective. Many who have addressed this issue in other professional fields explain this phenomenon as the bamboo ceiling. This article provides the experiences of two Japanese American Nurse Leaders framed through a theoretical framework proposed by Bolman and Deal (1991), which seems to relate to their "human resource leadership" style and the strong belief and empowerment of others. These leadership types develop symbols and cultures to shape human behavior with the shared mission and identity of the organization in mind which is in concert with the Japanese American cultural values of collectivism. Explanation and recommendations for future leaders are provided along with examples by two nurse leaders which may provide better insight into an answer to the question of "Why so few?"

The effects of vitamin D deficiency and insufficiency on the endocrine and paracrine systems.

Individuals are capable of producing vitamin D with proper exposure to sunlight. However, several factors can interfere with the effectiveness of this process. Most sunscreens filter out UVB light, thus inhibiting vitamin D production. Individuals with more darkly pigmented skin have greater difficulty producing vitamin D because melanin acts as an effective natural sunscreen, requiring longer sun exposure to produce an adequate daily allotment of vitamin D. Additionally, solely breastfed infants whose mothers suffered from vitamin D deficiency or insufficiency when pregnant have smaller reserves of the nutrient and are at greater risk of developing nutritional rickets. Vitamin D deficiency leads to rickets, osteomalacia, and osteoporosis. Long-term vitamin D insufficiency can lead to paracrine effects such as type 1 diabetes, cancer, and multiple sclerosis. This article reviews the current literature on vitamin D deficiency and insufficiency and their relation to different disease states. Potential areas for research are discussed.

Promising new causal explanations for obesity and obesity-related diseases.

Current explanations for obesity center around a predisposition in genotype and phenotype, possibly triggered by an inflammatory process or event, and exacerbated by environmental and psychological factors. It is likely that a variety of physiologic factors may act in combination to produce clinical obesity. Leptin resistance may be an important neurochemical cause of obesity; elevated leptin levels have been correlated with weight gain over extended time periods. Genetic studies support the postulate that a gene originating with our cave-dwelling ancestors, critical to survival when food was scare, has evolved into a trigger for obesity and related diseases. A variety of biochemical markers are prevalent in obesity and obesity-linked disease states. C-reactive protein, interleukin-6, and others are elevated in obesity, supporting the hypothesis that inflammation plays a role in the condition. Tumor necrosis factor-alpha is overexpressed in obesity and diabetes, suggesting that it may be part of the link between the 2 conditions.

Budd-Chiari syndrome from an advanced practice nurse perspective.

PURPOSE: To provide nurse practitioners (NPs) with a case study and literature review of Budd-Chiari syndrome (BCS). This rare liver disease has a multitude of clinical presentations that NPs may encounter in the primary care setting. DATA SOURCE: A literature search was conducted in Pub-Med and CINAHL using key search words. Information for the case study was obtained from a patient and his gastroenterology specialist, who is a foremost expert in this field. CONCLUSION: BCS is complex and may be difficult to diagnose because of its atypical clinical presentation. Delayed diagnosis can affect the quality and quantity of a patient's life. Increasing NPs' awareness about this rare condition through a case presentation and review of the literature emphasizes the major factors for accurate diagnosis. IMPLICATIONS FOR PRACTICE: Knowledge of BCS can assist the NP in identifying this syndrome and making prompt, appropriate referrals.

Pediatric systemic lupus erythematosus: management issues in primary practice.

PURPOSE: To provide nurse practitioners (NPs) with an update on pediatric systemic lupus erythematosus (SLE) with an emphasis on management considerations for primary care practitioners. DATA SOURCES: An extensive literature review was conducted using both Medline and CINAHL databases. Research articles reflecting the most compelling findings were included in this review. CONCLUSIONS: NPs who care for children with SLE may be able to prevent or delay the morbidities associated with this disease and its treatments, if they keep abreast of the new information evolving in this realm of rheumatologic diseases. IMPLICATIONS FOR PRACTICE: As more is learned about pediatric SLE, better treatments have evolved such that the survival rates have increased. The primary care of pediatric SLE patients that is focused on preventing or delaying SLE morbidities may help to restore, maintain, or improve the quality of life for these patients.

Assessment and differential diagnosis of abdominal pain.

Abdominal pain as a chief complaint can present a significant diagnostic challenge in the primary care setting. It is incumbent upon the primary care provider to have a thorough understanding of the many potential causes of abdominal pain, as well as a methodical, comprehensive, yet concise approach to its assessment.

Hybrid Palliation in the Treatment of Hypoplastic Left Heart Syndrome.

Purpose: To discuss hypoplastic left heart syndrome (HLHS) and inform nurse practitioners (NPs) working in primary care settings of this rare congenital heart deformity. This case study also examines the ethical issues advancements in medicine poses and illustrates issues NPs face when caring for a child with HLHS. Data Source: Large databases such as PubMed and CINAHL were accessed to obtain evidence-based articles for the specific heart condition and latest treatments. The data from the case was derived from an actual case, but the identity of the patient was changed to assure confidentiality. Conclusion: HLHS is a rare congenital heart deformity. Many treatment options are available, but a new treatment, the hybrid palliation, has offered new hope for many patients and their families. Implication for Practice: Patients with congenital heart conditions, including HLHS are living longer with new procedures being undertaken. The NP is likely to provide primary care to patients with congenital heart conditions, specifically HLHS. Patient care may be guided by awareness of this condition and the latest advancements in treatment.

Using the Transtheoretical Model of Change to Improve Lifestyle Behaviors in a Woman With Metabolic Syndrome.

Purpose: To provide information on how the stages of change theory can be initiated using a case study of a 64-year-old African American woman with metabolic syndrome. A questionnaire on lifestyle modifications operationalizes the stages of change theory and the case patient illustrates the process of change using this questionnaire. Data Source: An exhaustive literature review was conducted on the stages of change theory. The questionnaire used in the clinical setting presented as part of this case study encapsulates the stages of change theory after being modified from a similar tool used by the Ohio Department of Health Fresh Start Program. Conclusion: Using an objective tool to assess progress made by this case patient demonstrates the value of being able to monitor lifestyle modifications for patients with chronic diseases. Significance for Practice: This questionnaire provides a means to assess change over time and can help both patient and provider identify outcomes of treatment.

Polypharmacy in Older Adults.

Polypharmacy, by definition, is the concurrent use of several different medications consumed by a person. Often these multiple medications are in the same class and are used to treat more than one chronic condition. Older individuals are often faced with issues of polypharmacy due to multiple chronic conditions and multiple providers. The risks associated with polypharmacy can lead to increased adverse effects, falls, and decreased risk of medication compliance. This paper will discuss the issues surrounding polypharmacy and provide a case example to illustrate the significance of this problem.

Activation to self-management and exercise in overweight and obese older women with knee osteoarthritis.

Knee osteoarthritis (OA) affects approximately 1 in 10 adults in the United States, with higher prevalence in women, aggravated by increased weight. This quasi-experimental pilot study implemented an online self-management (SM) program for older overweight and obese women with knee OA combined with a two-arm progressive exercise trial (walking and stepping groups). After the 10-week intervention using an interprofessional approach, activation to SM scores were significantly higher in all participants (N = 16) and between groups, with a higher increase in the stepping group. Those with higher activation scores pre-intervention obtained higher scores post-intervention. Activation levels also increased significantly among all participants with majority at the highest activation level. Follow-up data at 6 weeks and 6 months showed sustained SM and health-directed behaviors. These findings, although preliminary, highlight the value of combined SM and progressive exercise intervention using an interprofessional approach. Further investigations are essential toward potential practice and policy changes.

Association of Leisure-Time Physical Activity to Cardiovascular Disease Prevalence in Relation to Smoking among Adult Nevadans.

It is well known that cigarette smoking and physical activity have significant impacts on cardiovascular disease (CVD) mortality and morbidity. Meanwhile, it is of interest to understand whether physical activity protects against CVD for smokers in a similar manner as it does for non-smokers. The present study examined how leisure-time physical activity (LTPA) is associated with the prevalence of CVD in relation to smoking status among adult Nevadans, using data from the 2010 Nevada Behavioral Risk Factor Surveillance System. Of the 3,913 survey respondents, 8.5% self-reported that they had ever been diagnosed with CVD. People with a history of CVD were significantly less likely to engage in LTPA than those with no history of CVD (p < 0.05). After adjusting for common sociodemographic variables, it was revealed that people with CVD were twice more likely to not engage in LTPA than their counterparts independent of smoking status. Without taking LTPA into account, the odds of having CVD for current and former smokers was 1.87-2.25 times higher than the odds for non-smokers. Interestingly, however, if LTPA was accounted for, there was no significant difference in the odds of having CVD between current and non-smokers. These results indicate that LTPA is inversely associated with the prevalence of CVD independent of smoking status, and that regular physical activity may protect against CVD for smokers as well as for non-smokers. Physical activity, along with smoking cessation, should be promoted to better prevent and control CVD among smokers.

New and emerging theories of cardiovascular disease: infection and elevated iron.

Heart disease is the leading cause of death in both men and women in industrialized countries. Despite the tremendous gains made in decreasing the number of deaths due to cardiovascular disease, it still is health care's greatest challenge. Traditional risk factors account for only 50% of the incidence of cardiac disease. In fact, many individuals who develop heart disease have normal cholesterol and blood pressure levels. This suggests that other less well-studied risk factors may also play a role. The purpose of this report is to examine the role that recently suggested risk factors may play in the development of heart disease: coronary artery infection, specifically from Chlamydia pneumoniae, and elevated iron levels. Both initiate an inflammatory response, which might explain the elevated C-reactive protein levels frequently found in those who suffer from cardiac disease.