Developing Political Engagement Competency Among Primary Care Advanced Practice Nursing Students.

Developing political engagement among nurses who care for rural and underserved communities can help mitigate health inequities. An experiential learning opportunity informed by Lobby Day was developed to prepare primary care advanced practice nursing students with the policy skills needed to actively serve as advocates for their patients and communities.

Enhancing Provider Mental Health Screening in Primary Care: A Quality Improvement Project.

Background: Depression and anxiety occur in 7.8% and 19.1% of the US population, respectively. About half of those patients are diagnosed in primary care. Objective: The purpose of this quality improvement project was to improve the screening and diagnosing of anxiety and/or depression among adult patients at a primary care clinic by implementing an evidence-based mental health screening interview technique. Methods: The team implemented a mental health screening interview technique that incorporates background, affect, trouble, handling, and empathy and motivational interviewing techniques in addition to self-report surveys. Pre- and post-intervention surveys were conducted to assess providers' perceptions of the new interview technique. ICD-10 code data were gathered to assess the effectiveness of the new mental health screening interview technique. Results: The number of documented diagnoses of single-episode major depressive disorder decreased by 18%, recurrent major depressive disorder increased by 34%, and anxiety disorders increased by 3%. There were more favorable provider perceptions of the new screening interview technique versus the traditional screening method. Conclusions: The results show an improvement in provider comfort and providers preferred the new mental health screening when using an evidence-based mental health screening interview technique. Implications for nursing: The results show the potential benefits of using a structured mental health interview with self-report screening tools when diagnosing anxiety and depression in primary care.

Enhancing Provider Mental Health Screening in Primary Care: A Quality Improvement Project.

Background: Depression and anxiety occur in 7.8% and 19.1% of the US population, respectively. About half of those patients are diagnosed in primary care. Objective: The purpose of this quality improvement project was to improve the screening and diagnosing of anxiety and/or depression among adult patients at a primary care clinic by implementing an evidence-based mental health screening interview technique. Methods: The team implemented a mental health screening interview technique that incorporates background, affect, trouble, handling, and empathy and motivational interviewing techniques in addition to self-report surveys. Pre- and post-intervention surveys were conducted to assess providers' perceptions of the new interview technique. ICD-10 code data were gathered to assess the effectiveness of the new mental health screening interview technique. Results: The number of documented diagnoses of single-episode major depressive disorder decreased by 18%, recurrent major depressive disorder increased by 34%, and anxiety disorders increased by 3%. There were more favorable provider perceptions of the new screening interview technique versus the traditional screening method. Conclusions: The results show an improvement in provider comfort and providers preferred the new mental health screening when using an evidence-based mental health screening interview technique. Implications for nursing: The results show the potential benefits of using a structured mental health interview with self-report screening tools when diagnosing anxiety and depression in primary care.

Risk factor control among Black and White adults with diabetes onset in older adulthood: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

The objective of this study was to determine whether attainment of clinical and lifestyle targets varied by race and sex among adults with diabetes onset in older adulthood. This study included 1420 black and white adults from the REGARDS study without diabetes at baseline (2003-07) but with diabetes onset at the follow-up exam (2013-16). Attainment of clinical targets (A1c <8%; blood pressure < 140/90 mmHg; and statin use) and lifestyle targets (not smoking; physical activity≥ 4 times/week; and moderate/no alcohol use) was assessed at the follow-up exam. Modified Poisson regression was used to obtain prevalence ratios (PR) for meeting clinical and lifestyle targets stratified by race and sex, separately. The mean age was 71.5 years, 53.6% were female, and 46.1% were black. The majority were aware of their diabetes status (85.7%) and used oral or injectable hypoglycemic medications (64.8%). Overall, 39.4% met all 3 clinical targets and 18.8% met all 3 lifestyle targets. Meeting A1c and blood pressure targets were similar by race and sex. Statin use was more prevalent for men than women among white adults (PR = 1.13; 95% CI = 0.99-1.29) and black adults (PR = 1.23; 95% CI = 1.06-1.43). For lifestyle factors, the non-smoking prevalence was similar by race and sex, while white men were more likely than white women to be physically active. Although the attainment of each clinical and lifestyle target separately was generally high among adults with diabetes onset in older adulthood, race and sex differences were apparent. Comprehensive management of clinical and lifestyle factors in people with diabetes remains suboptimal.

Associations of Depression, Physical Activity, and Diabetes with Self-Rated Health in Black Men.

Black men have higher rates of diabetes that are compounded by obesity and limited physical activity leading to poor self-rated health. The purpose of this study was to provide a nationally representative snapshot of indicators for lower self-rated health in Black men with diabetes. An exploratory secondary analysis was conducted of self-report data, physical measurements, and clinical assessments from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) dataset. The analytic sample included 270 Black men 45 years of age or older, who were randomly selected from the dataset through statistical processes. After adjusting for sociodemographic and physiologic characteristics, having diabetes (ß = -0.13), fewer days of physical activity (ßß = 0.13), and more depressive symptoms (ßß = -0.34) had statistically significant associations with self-rated health scores (ps < 0.05). Such associations support the use of self-rated health indices as a monitor for quality of life in clinical practice and identify gaps in research related to self-rated health in Black men.

Understanding the Dietary Habits of Black Men With Diabetes.

Diabetes is highly prevalent in African American men. To provide nurse practitioners with practice strategies we explored African American men's perceived needs for dietary health and diabetes self-management using the Social Cognitive Theory. Twenty-five African American men participated in four focus groups. The data were analyzed using a combination of inductive/deductive content analysis approach. Focus group analysis identified personal, behavioral and environmental barriers to and facilitators for diabetes self-management. Nurse practitioners may need to provide extra emotional support in the absence of informal social support from families for diabetes self-management and dietary health in African American men with diabetes.

Return to Work Among Stroke Survivors.

Despite improvements in the treatment of stroke, many individuals still face cognitive, emotional, and physical impairments. Stroke is a leading cause of serious long-term disability and subsequent failure to return to work (RTW). The purpose of this literature review was to synthesize and discuss the literature relevant to factors affecting RTW for stroke survivors, summarize the identified gaps, and discuss steps occupational health nurses can take to facilitate RTW among stroke survivors. A literature search was conducted using the keywords: "stroke," "cerebrovascular disease," "return to work," and "employment." After excluding articles based on inclusion/exclusion criteria, 19 quantitative research articles were reviewed. Consistent themes found in the literature affecting RTW following stroke included physical, social, and cognitive factors. One of the most consistent predictors of RTW found was stroke severity. Individuals who experienced a mild to moderate stroke, those of Caucasian ethnicity, and higher socioeconomic levels were more likely to RTW. Findings suggest the importance of future studies to examine factors among African American stroke survivors that predict RTW and the role of occupational health nurses.

Effectiveness of Diabetes Self-Management Education in Community Health.

BACKGROUND: Diabetes self-management education (DSME) programs utilize a multidisciplinary, skills-based approach allowing participants to make self-management choices and follow a comprehensive plan of care, improving their glycemic control. OBJECTIVE: The purpose of this quality improvement project was to evaluate the effectiveness of DSME on the reduction of hemoglobin A1c (HgbA1c) and body mass index (BMI) in overweight/obese community health center patients. METHODS: The free program met 2 hours weekly for 6 consecutive weeks. A retrospective chart review was conducted to compare baseline to post-session HgbA1c and BMI 12 weeks after completion of the program. Pre- and post-session surveys were also conducted to assess improved diabetes knowledge and confidence. RESULTS: Mean HgbA1c decreased by 1.6% (p = .003) 12 weeks after completion of the program; however, BMI remained unchanged (p = .582). Diabetes knowledge and confidence also improved significantly following DSME (p = .000 and p = .001, respectively). CONCLUSIONS: The study demonstrated that a reduction in HgbA1c levels and an increase in diabetes knowledge and confidence can occur in low income, community health center patients following participation in DSME. IMPLICATIONS FOR NURSING: Community health center patients who have access to free DSME can improve their health, self-efficacy, and diabetes self-management practices.

Texting Older Sisters to Step: The TOSS Study.

The purpose of our two-phase study was to develop acceptable text messages to increase physical activity. Four focus groups (two for each phase) were conducted with older African American women who had access to texting-capable mobile phones and were in the contemplation stage for physical activity. The mean age of Phase 1 participants (n = 12) was 71 and ranged from 65 to 86 years. Content analysis was used to identify fundamental themes that were later used to develop text messages. Six categories emerged from the data and 31 text messages were developed based on focus group input and national recommendations. The mean age of Phase 2 participants (n = 9) was 67 and ranged from 65 to 75 years. Descriptive statistics revealed 100% of participants understood all messages. When messages were evaluated individually, a minimum of 78% felt each message motivated activity and 67% said lengths were perfect. Findings identified messages that were relevant and potentially motivational to stimulate physical activity among this population.

Understanding health policy to improve primary care management of obesity.

NPs are ideal candidates for implementing positive health changes for obese patients. Providers have medical expertise and can promote obesity reduction strategies to their patients. Increased awareness of the influence of health policy and clinical implications for obesity management are needed.

Depression and physical functioning among older Americans with diabesity: NHANES 2009-2010.

BACKGROUND: Caring for older adults with diabesity can be challenging for primary care nurse practitioners. The purpose of this study was to examine whether there would be an additive effect of diabesity on depressive symptoms and physical functioning of older adults. We hypothesized that there is an additive effect of diabesity on depressive symptoms and physical functioning among older adults with one or neither condition. METHODS: We performed a cross-sectional analysis of data from National Health and Nutrition Examination Surveys collected from African-American and Caucasian adults aged 65 and over between 2009 and 2010. Multivariate linear regression models were utilized. The sample consisted of 918 participants. In covariate-adjusted models, participants with diabesity reported more depressive symptoms than people with neither condition. Individuals with diabesity and those with obesity alone reported significantly more difficulty with physical function when compared to participants with neither condition. CONCLUSION: Findings suggest that diabesity was more burdensome to older adults than either condition alone. More research is needed to understand the interplay between depression, physical function, and diabesity. IMPLICATIONS FOR PRACTICE: To disrupt the adverse effects of diabesity burden, increased nurse practitioner awareness of this phenomenon may be beneficial in improving and maintaining physical and mental health among older adults.

Factors Influencing Participation in the YMCA Diabetes Prevention Program: A DNP Project.

Pre-diabetes is the underlying pathology for type 2 diabetes. The Diabetes Prevention Program is a proven, effective strategy to control or prevent type 2 diabetes; however, there is limited data on what motivates people with pre-diabetes to participate in a Diabetes Prevention Program. Cross-sectional analysis of survey data from adults with pre-diabetes was conducted from October to November 2015. Fisher's exact test was utilized to examine relationships between study variables. Findings indicated that muscle strength was related to commitment to healthy lifestyle behaviors (p = 0.02). Findings also suggested that perceived muscle strength could impact healthful living for patients with pre-diabetes. Future studies for individuals with pre-diabetes are needed to provide afull assessment of motivationfactors for participation in the Diabetes Prevention Program. Nurse Practitioners should work to improve perceived muscle strength in patients with pre-diabetes, which could translate into increased Diabetes Prevention Program attendance.

Challenges to Healthy Eating Practices: A Qualitative Study of Non-Hispanic Black Men Living With Diabetes.

PURPOSE: The purpose of this study was to explore current dietary practices and perceived barriers to healthy eating in non-Hispanic black men with type 2 diabetes. METHODS: Four 90-minute focus groups held in September and October 2011 were led by a trained moderator with a written guide to facilitate discussion on dietary practices and barriers to healthy eating. Participants were recruited from the diabetes database at a public safety-net health system in Jefferson County, Alabama. Two-independent reviewers performed content analysis to identify major themes using a combined deductive and inductive approach. RESULTS: There were 34 male participants aged 18 years and older. Mean years living with diabetes was 9.6 ± 5.9. Sixty-two percent of participants perceived themselves to be in fair or poor health. Participants' self-reported eating practices did not always relate to hunger. Internal cues to eat included habit and response to emotions, and external cues to eat included media messaging, medication regimens, and work schedules. Men identified multiple barriers to healthy eating including hard-to-break habits, limited resources and availability of food at home and in neighborhood grocery stores, and perceived poor communication with health care professionals. CONCLUSION: Non-Hispanic black men acknowledged the importance of healthy eating as part of diabetes self-management but reported various internal and external challenges that present barriers to healthy eating. Tailored strategies to overcome barriers to healthy eating among non-Hispanic black men should be developed and tested for their impact on diabetes self-management.

Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes.

Older adults are disproportionately affected by diabetes, which is associated with increased prevalence of cardiovascular disease, decreased quality of life (QOL), and increased health care costs. The purpose of the current study was to assess the relationships between social support, self-efficacy, and QOL in a sample of 187 older African American and Caucasian individuals with diabetes. Greater satisfaction with social support related to diabetes (but not the amount of support received) was significantly correlated with QOL. In addition, individuals with higher self-efficacy in managing diabetes had better QOL. In a covariate-adjusted regression model, self-efficacy remained a significant predictor of QOL. Findings suggest the potential importance of incorporating the self-efficacy concept within diabetes management and treatment to empower older adults living with diabetes to adhere to care. Further research is needed to determine whether improving self-efficacy among vulnerable older adult populations may positively influence QOL.

Race, regionality and pre-diabetes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

OBJECTIVE: To determine the association between race, region and pre-diabetes. METHOD: The study used 2003-2007 United States baseline data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study for this cross-sectional analysis. Participants in this study were 45years or older at recruitment. Logistic regression was used to assess whether race and region are associated with pre-diabetes independent of demographics, socioeconomic factors and risk factors. RESULTS: Twenty-four percent of the study participants (n=19,889) had pre-diabetes. The odds ratio (95% confidence interval) for having pre-diabetes was 1.28 (1.19-1.36) for blacks relative to whites and 1.18 (1.10-1.26) for people living in the Stroke Belt region relative to the other parts of the United States. The odds of having pre-diabetes for Stroke Belt participants changed minimally after additional adjustment for race (OR=1.20; 1.13-1.28), age and sex (OR=1.24; 1.16-1.32), socioeconomic status (OR=1.22; 1.15-1.31) and risk factors (OR=1.26; 1.17-1.35). In the adjusted model, being black was independently associated with pre-diabetes (OR=1.19; 1.10-1.28). CONCLUSION: The prevalence of pre-diabetes was higher for both blacks and whites living in the Stroke Belt relative to living outside the Stroke Belt, and the prevalence of pre-diabetes was higher for blacks independent of region.

Glycemic control in the diabetic patient after stroke.

Hyperglycemia is a common problem in the diabetic patient after an acute stroke. Maintaining therapeutic blood glucose levels in diabetics during extreme physiologic stress can present extreme challenges. Reasonably tight, yet therapeutic, control of glycemia in the diabetic stroke patient must be a priority. This article evaluates strategies for lowering glycemia to improve neurologic outcome in acute stroke patients. It reviews the literature of the epidemiology, describes the pathophysiologic process, discusses the debate over the glycemic target goal, and gives algorithms for glucose control methods for acute care.