Coping among Black college women: A transformative study of gendered racism.

Black women in the United States are placed at higher risk for mental health challenges, including distress and depression, due to structural inequities. Black college women enrolled in predominantly White institutions may be particularly exposed to stressors related to gendered racism, but there is limited knowledge about this population's coping strategies. A cross-sectional survey and focus group were utilized to understand and disrupt participants' experiences of gendered racism. In phase one, a survey assessing coping strategies and mental health outcomes was conducted with 168 Black women enrolled at a predominantly White institution in the southeastern United States. Logistic regression results indicated that several coping strategies including behavioral disengagement, self-blame, self-distraction, denial, and positive reframing were significantly associated with depression and psychological distress, all p < 0.05. Phase two included a single focus group with a subset of the sample from phase one. The focus group findings supplemented the survey results, suggesting education (more accurately consciousness-raising) as a foundational theme that seemed to create space for humor and social support as coping subthemes and created a transformative space where participants spoke openly about gendered racism. Findings from this study highlight the societal underpinnings that shape Black college women's experiences of gendered racism. College settings should endeavor to provide formal and informal support for Black women to minimize the harms related to gendered racism.

Examining the use of geriatric standardized patients with baccalaureate nursing students.

The need for clinical placements for undergraduate nursing programs heightened during the COVID-19 pandemic as nursing schools across the country faced restrictions with the high-risk geriatric client population. Nursing students experienced increased anxiety levels, decreased learning opportunities, and uncertainties about the decision to enter the workforce as healthcare professionals. In turn, this amplified the need for faculty support and feedback imperative for student success. One method for mitigating the gap between didactic content and clinical placement is using simulation-based learning experiences. The purpose of this observational study was to examine the impact of a newly developed home health geriatric simulation on student satisfaction and self-confidence in learning among 133 senior-level Baccalaureate nursing students from a large public university. Study measures included the National League of Nursing's Self-Confidence in Learning Scale (SCLS) and Simulation Design Scale (SDS). The primary outcome was satisfaction and self-confidence in learning. Higher SDS component scores were significantly correlated with higher SCLS scores (all p = <.0001), indicating that high satisfaction among Baccalaureate nursing students in simulation design relates to increased satisfaction and self-confidence in learning. Study findings support using standardized geriatric simulation scenarios to prepare students to communicate and care for older adults.

Contributors to Hospitalized Infective Endocarditis Outcomes Among Patients With Substance Use.

Background: Patients with substance use (SU) diagnosed with infective endocarditis (IE) have high rates of discharge against medical advice (DAMA) and 30-day readmission. Objective: Evaluate contributors associated with DAMA and 30-day readmission among patients with SU and IE. Methods: This retrospective chart review included patients >18 years, admitted to one hospital in the Northeastern, United States for SU and IE from January 2018 to December 2020. Patient demographic and clinical characteristics and their association with DAMA and 30-day readmission were summarized using descriptive statistics and Logistic Regression. Results: Of the 144 patients, 60.4% used more than one substance, 38.2% experienced DAMA, and 61.1% were readmitted within 30 days. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.92-0.98), Length of stay (LOS) (OR, 0.95; 95% CI, 0.93-0.98), Medicaid (OR, 2.98; 95% CI, 1.45-6.16), Medicare (OR, 0.29; 95% CI, 0.10-0.81), opioid usage (OR, 2.29; 95% CI, 1.01-5.16), and stimulant usage (OR, 2.89; 95% CI, 1.43-5.84) were all significantly associated with DAMA but not with 30-day readmission. Conclusions: Additional investigations of factors associated with DAMA and 30-day readmission are needed to help improve practices and reduce negative outcomes. Implications for Nursing: Multiple factors can affect patient adherence to treatment in this high-risk population. Nursing directly impacts the identification and addressing of unique SU IE patient needs to optimize treatment goals.

Undergraduate class standing, perceived social support, and depressive symptoms.

OBJECTIVE: Investigate the association between perceived social support and depressive symptoms at different stages of academic progress. PARTICIPANTS: Undergraduate students (n = 505) enrolled at a large southeastern university. METHODS: Students completed a cross-sectional survey about their self-reported physical and mental health. Logistic regression was used to assess the relationship between depressive symptoms, perceived social support, and academic class standing. RESULTS: Academic class standing and perceived social support were both significantly associated with depressive symptoms. Compared to freshman, odds of having depressive symptoms were 2.15 times higher for sophomores and 3.94 times higher for seniors. For every one unit increase in perceived social support, the odds of depressive symptoms decreased by 51%. CONCLUSIONS: A significant association between depressive symptoms and social support was identified for all undergraduates in this sample. The differences identified between social support and depressive symptoms reveal the need to tailor support provided at different academic stages.

Emergency Department Length of Stay: A Community Hospital Initiative.

OBJECTIVE: This quality improvement initiative was conducted to determine if a provider in triage and split flow model could decrease the length of stay (LOS) of discharged patients seen in a community hospital emergency department (ED). BACKGROUND: Extended LOSs within the ED lead to delays in the care of patients, increase the number of patients who leave without being seen by a provider, decrease patient satisfaction, and cause a loss of revenue for health care organizations. Using a provider in triage and a split flow model, where patients can be seen and dispositioned without delays, can improve ED throughput and decrease the overall LOS. METHODS: Through a structured, interdisciplinary approach using the Plan-Do-Study-Act Shewhart Cycle of Process Improvement, a provider was placed in triage, and an interior waiting room was used to evaluate emergency severity index level 3 and 4 patients to expedite diagnostic testing and perform procedures. This model allowed lower acuity patients to be cared for separately from higher acuity patients, who were being treated in the main ED. In addition, the median arrival to provider, arrival to bed, and LOS from arrival to departure of discharged patients were compared to the current departmental processes. RESULTS: There was a significant improvement in the LOS of discharged patients and the time of arrival to triage, arrival to bed, and arrival to provider using a provider in triage and a split flow model compared to the current intake. CONCLUSION: Implementation of a provider in triage and a split flow model can demonstrate a decrease in the LOS of discharged patients along with other ED metrics and improve efficiencies in patient care within a community hospital.

HIV Knowledge, Risk Factors, and Utilization of Services in the US Rural Deep South.

BACKGROUND: HIV prevalence in the rural South remains high among Black Americans due to limited access to prevention and treatment services and poverty. HIV care inequities for Black Americans living in the rural South are further intensified by high mortality rates, low HIV health literacy, stigma, and discrimination. Few studies have focused on HIV knowledge and risk factors within Black Americans in the rural South. METHODS: This cross-sectional study examined the association between HIV risk factors, HIV knowledge, and utilization of HIV and/or sexually transmitted infection (STI) testing services among Black Americans (N = 200) living in the rural South. HIV knowledge, risk factors, and utilization of testing services were assessed via The HIV Knowledge Questionnaire, The HIV Risk Factor Questionnaire, and three investigator-generated questions, respectively. Linear regression was used to examine the relationship between demographic characteristics, HIV knowledge, utilization of testing services, and HIV risk factors. RESULTS: Among 200 participants, a smaller percentage (37.7%, n = 75) reported using HIV/STI testing services compared to non-users. Controlling for demographic covariates in the model, HIV knowledge (p < .0001) and marital status (p = .010) were significantly associated with HIV risk factors. HIV risk factors decreased as HIV knowledge increased. Individuals who reported being single also reported having fewer risk factors. CONCLUSION: Future research should examine the impact of HIV education tailored for individuals with greater HIV risk factors within rural Black Americans. Studies exploring barriers to the utilization of HIV/STI testing services within Black American rural communities are warranted.