Insights into fear: A phenomenological study of Black mothers.

AIM: The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN: A phenomenological approach was used. METHODS: Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS: Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION: Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT: Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.

Introduction to the Online Nursing Education Best Practices Guide.

INTRODUCTION: As online nursing education programs continue to increase to meet the demands of the growing market, nursing faculty are challenged to develop and deliver courses based on best practice principles. The Online Nursing Education Best Practices Guide (ONE Guide) builds on and extends the nationally recognized Quality Matters® program and serves as a roadmap guiding course development and delivery. The fundamental principle for success in online teaching is instructor presence; the teacher as a facilitator of learning is illustrated throughout the guide. An Online Instructor Checklist facilitates systematic implementation of best practice principles. METHODS: This article is based on a focused literature review and concept analysis resulting in a comprehensive guide for delivery of effective, quality nursing education through best practices in the online learning environment. A broad search of databases focused on articles during 2014 to 2019 was completed. The literature review included articles that examined over 1200 student perceptions of instructor presence in the online setting. CONCLUSION: Nurses carry a direct responsibility for the health and well-being of patients. Nursing quality education proves fundamental to the profession's long-term outcomes. The ONE Guide and Online Instructor Checklist apply comprehensive, evidence-based teaching strategies to give a roadmap for success in the online teaching environment.

Message Heard: Insights for Doctoral Program Design From Community Partners.

Developing a nursing doctoral program requires, among other considerations, thoughtful reflection on opportunities for graduates, and needs of the health-care community. To educate nurse clinicians, scientists, and leaders prepared to address complex health-care issues, colleges of nursing must engage with community stakeholders during program development. One college embraced this opportunity to dialogue through a series of semistructured focus groups and surveys to inform community partners of the developing doctoral program plan and to hear their related ideas and opinions. Themes arising from qualitative data analysis included driving forces, the value of education, and differing doctoral roles. The findings were far more enlightening than anticipated and ultimately guided the direction of program development. This study affirmed the power of meaningful dialogue with community partners to ensure a well-educated nursing workforce with the skills needed to advance nursing practice in the changing health-care environment.

Dementia Care Content in Prelicensure Nursing Curricula: A Pilot Mixed-Methods Study.

BACKGROUND: Having a nursing workforce equipped to provide quality care for patients living with dementia is essential. The purpose of this study was to investigate how undergraduate nursing programs integration of dementia care content into their curricula. METHOD: Using sequential explanatory mixed methods, a stratified sample of 137 representatives of programs in 11 states with dense elderly populations completed a quantitative survey. A subsample (n = 8) completed qualitative e-mail interviews. RESULTS: Most respondents indicated dementia care content was integrated into their curricula (n = 103, 92.8%). Clinical partnership with dementia care centers was associated with a greater proportion of students interacting with individuals having dementia (p = .02). Curriculum overload was the most significant challenge to integrating dementia content (n = 61, 43.9%). Qualitative themes supported the quantitative results. CONCLUSION: Future research is needed to identify best practices to ensure that nursing curricula provide essential content to meet the care needs of the growing population of individuals with dementia. [J Nurs Educ. 2018;57(2):88-95.].

The effects of hormone therapy decision support for women with mobility impairments.

Deciding about hormone therapy (HT) use is particularly complex for women with mobility impairments. While HT controls menopausal symptoms, the potential increased risk of blood clots resulting from physical inactivity can contraindicate HT use. These women, therefore, may benefit from interventions to help them tailor standard information about HT. We randomly assigned women to receive either a tailored decision support intervention or standard menopausal information. Both groups (n = 176) significantly decreased their decisional conflict and uncertainty and increased knowledge after receiving the treatment materials. We interpret the findings in the context of limited medical information about HT for women with disabilities.

Complementary and alternative medicine use for vasomotor symptoms among women who have discontinued hormone therapy.

OBJECTIVES: To explore the use and perceived usefulness of complementary and alternative medicine therapies and nonhormonal conventional medicine alternatives to treat vasomotor symptoms occurring after withdrawal from hormone therapy. DESIGN: Retrospective, single cross sectional descriptive study. SETTING: Study volunteers were recruited via a direct mailed questionnaire sent to a sample of women throughout the United States. Additional respondents were recruited through flyers and postcards advertising the study placed with permission at several health care provider offices and other locations. PARTICIPANTS: A sample of 563 menopausal women who had discontinued the use of hormone therapy completed a questionnaire describing their experiences with the use of complementary and alternative medicine. MAIN OUTCOME MEASURES: Responses to an investigator developed survey. RESULTS: Nearly half of the women surveyed used complementary and alternative medicine. The most common choices of complementary and alternative medicine were (a) multivitamins and calcium, (b) black cohosh, (c) soy supplements and food, (d) antidepressants, (e) meditation and relaxation, (f) evening primrose oil, (g) antihypertensives, and (h) homeopathy. Of the alternative therapies that were used by at least 5% of the sample, antidepressants were perceived as the most useful. CONCLUSIONS: With the increased adoption of complementary and alternative medicine, it is important for health care providers to be familiar with the various methods so they are comfortable discussing the benefits and risks with their patients to assist them in making informed decisions.

The potential role of glucose transport changes in hot flash physiology: a hypothesis.

PURPOSE: The purpose of this article is to detail a novel hypothesis regarding the role of changes in brain glucose delivery in menopausal hot flashes. ORGANIZING FRAMEWORK: The impaired glucose delivery hypothesis of menopausal hot flashes is presented as a potential model of hot flash physiology. As foundational to the hypothesis, brain glucose physiology, specifically neurobarrier coupling, is presented in detail. With brain activation, glucose needs immediate increase; additional glucose is supplied through increased production of glucose transporter 1 (GLUT1) at the blood-brain barrier (BBB) and through vasodilation. Estrogen is important to this system in stimulating production of GLUT1. As estrogen declines at menopause, upregulation of GLUT1 is less efficient. As a consequence, neurobarrier coupling overcompensates with an excess neurovascular response, or a hot flash. Research supporting this hypothesis is briefly reviewed and new questions raised are reviewed. CONCLUSIONS: The impaired glucose hypothesis of menopausal hot flashes proposes an inadequate neurobarrier response to neurometabolic stimulation as estrogen declines, resulting in additional neurometabolic stimulation with consequent neurovascular stimulation. In this model, the menopausal woman has diminished ability to respond to fluctuations in blood glucose over the course of the day, which results in hot flashes as a counter-regulatory response. This perspective accounts for observed physiological changes that have not been previously detailed. New research directions are identified.

Midlife women's responses to a hospital sleep challenge: aging and menopause effects on sleep architecture.

OBJECTIVE: To distinguish aging from menopause effects on sleep architecture, we studied an episode of disturbed hospital sleep in asymptomatic midlife women during the follicular phase of an ovulatory cycle and three control groups differing by age or menopause status. METHODS: Fifty-one studies were conducted in four groups of volunteers: young cycling (YC, 20-30 years, n = 14), older cycling (OC, 40-50 years, n = 15), ovariectomized receiving estrogen therapy (OVX, 40-50 years, n = 12), and spontaneously postmenopausal (PM, 40-50 years, n = 10). Subjects were admitted to the University Hospital General Clinical Research Center (GCRC) for a first-night sleep study conducted during a 24-hour, frequent blood sampling protocol. RESULTS: Despite similar estrogen concentrations in the YC (28 +/- 4 pg/ml) and OC (34 +/- 6 pg/ml) groups, OC women had reduced sleep efficiency (79% +/- 2%) vs. YC (87% +/- 3%; p = 0.009). In the OVX and PM groups where estrogen concentrations were markedly different, sleep efficiency was also reduced vs. the YC group (OVX vs. YC, 79% +/- 3% vs. 87% +/- 3%, p = 0.05; PM vs. YC, 75% +/- 3% vs. 87% +/- 3%, p = 0.007). Wake time was longer in the three older groups (103 +/- 10 minutes, 101 +/- 12 minutes, 123 +/- 12 minutes for OC, OVX, PM, respectively) vs. YC (63 +/- 13 minutes, p < 0.05). The number of stage shifts was positively associated with advancing age (rho = 0.3, p < 0.03) but not with estrogen concentration. CONCLUSIONS: Aging-related sleep deficits in response to an experimental stressor occur in midlife women prior to menopause.

Menopausal hot flash frequency changes in response to experimental manipulation of blood glucose.

OBJECTIVE: Although a majority of women (80%) at menopause experience hot flashes, the symptoms' physiological trigger has yet to be identified. To determine the relationship between glucose availability and hot flashes in menopausal women, hot flash frequency was compared between intervals while the subjects were fasting and/or infusing in a sample of menopausal women (38-55 years of age). DESIGN: An experimental study was conducted in 10 postmenopausal women taking hormone therapy (HT) between the ages of 38 and 55. Following a clinic visit to screen for general health and absence of diabetes, HT participants were asked to stop the medication for 7 to 10 days and to maintain a diary of hot flash frequency. When hot flashes were experienced at least four times per day in a consecutive 3-day period, participants were admitted to the General Clinical Research Center for a 30-hour experimental protocol, including frequent blood sampling and two experimental periods of intravenous infusion of glucose or normal saline. Blood glucose levels were manipulated to provide conditions of postprandial versus fasting states. RESULTS: There was a significant reduction in the incidence of hot flashes during the experimental elevation of glucose concentrations (130 to 140 mg/dl) compared to the fasting state (<110 mg/dl) (t= -2.4, df= 9, p=.04). CONCLUSIONS: Conditions of fasting may stimulate the trigger mechanism for menopausal hot flashes.

What we know about managing menopausal hot flashes: navigating without a compass.

Hot flashes and night sweats are frequently experienced as the cardinal symptoms of menopause. However, their physiological basis has not been explained; nor have any potential risks been explored. Current knowledge and theoretical perspectives regarding hot flashes will be presented and contrasted with evidence for an emerging hypothesis of altered brain glucose availability as the hot flash trigger. Perspectives regarding hormone therapy and alternative therapies for treatment of hot flashes will be presented and directions for future research reviewed.

An alternative to Unibase/glycol as an effective nonhydrating electrolyte medium for the measurement of electrodermal activity.

Although Unibase cream has been an effective medium for electrodermal recordings, its production has recently been discontinued. This study compared alternative media to Unibase for effectiveness. Three base creams similar to Unibase were initially compared for in vitro viscosity and effectiveness. Based upon this analysis one cream was eliminated. A volunteer sample of 6 postmenopausal women with hot flashes and 6 young women without flashes was recruited. Media were evaluated for viscosity and effectiveness of skin conductance. Results indicated that one electrolyte media produced readings within the normal range, identified true positive hot flashes, and produced few false negative readings whereas the second produced largely unreadable results with many false negative hot flashes. An appropriate substitute for Unibase as an effective electrolyte medium for measurement of electrodermal activity was identified.