Ensuring accountability for consideration of sex as a biological variable in research.

The National Institute of Health (NIH) policy, Consideration of Sex as a Biological Variable (SABV) in NIH-funded Research (2015), focuses on the expectation that researchers account for the influence of SABV in vertebrate animal and human studies and provide a strong justification for single-sex investigations. When SABV is considered in the research design, data analyses, and reporting, the rigor and reproducibility of the research are elevated and inform best practices and precision health for all people. Additional recommendations include the appropriate use of terminology, integration into curricula, intersection with social determinants of health, and application of sex and gender equity guidelines when disseminating research. This paper is a "call to action" for nurse researchers to lean into and apply this policy's principles and our recommendations, from the bench to the bedside, to advance the equity and health of all people.

Recreational-vehicle-dwelling American nomads' experiences seeking healthcare: A qualitative field study.

AIM: To explore the experiences of recreational-vehicle-dwelling American nomads when seeking healthcare in the United States. DESIGN: This exploratory, qualitative study employed interpretive description design to maintain a disciplinary focus in nursing. METHODS: Twenty-five participants were recruited from campgrounds in eight states. Semi-structured interviews were conducted face-to-face. Thematic analysis was conducted using a phronetic iterative approach. RESULTS: Three overarching themes described participants' experiences seeking healthcare: overwhelming logistics, don't need healthcare, and orchestrating a web of care. CONCLUSION: Recreational-vehicle-dwelling nomads in the United States face additional complexity when accessing healthcare related to seeking care in unfamiliar locations and policies that prevent the portability of healthcare across state lines. IMPLICATIONS: More research is needed to evaluate solutions to improve healthcare access for recreational-vehicle-dwelling nomads. Nurses and policymakers should consider healthcare practices through the lens of nomads' lifestyle mobility. The impact of policy decisions on people who are geographically mobile should be considered, and barriers to healthcare portability should be addressed. IMPACT: This was the first study focused on the healthcare experiences of recreational-vehicle-dwelling nomads in the United States. Nomads face additional complexity and barriers to healthcare access. Some nomads developed strategies to overcome barriers, while others disengaged from healthcare. The findings will impact researchers and nurses who study and care for nomads. REPORTING METHOD: The SRQR reporting guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: Recreational-vehicle-dwelling nomads reviewed the recruitment flyer and interview guide and provided input on recruitment methods and sites.

Information displays for automated surveillance algorithms of in-hospital patient deterioration: a scoping review.

OBJECTIVE: Surveillance algorithms that predict patient decompensation are increasingly integrated with clinical workflows to help identify patients at risk of in-hospital deterioration. This scoping review aimed to identify the design features of the information displays, the types of algorithm that drive the display, and the effect of these displays on process and patient outcomes. MATERIALS AND METHODS: The scoping review followed Arksey and O'Malley's framework. Five databases were searched with dates between January 1, 2009 and January 26, 2022. Inclusion criteria were: participants-clinicians in inpatient settings; concepts-intervention as deterioration information displays that leveraged automated AI algorithms; comparison as usual care or alternative displays; outcomes as clinical, workflow process, and usability outcomes; and context as simulated or real-world in-hospital settings in any country. Screening, full-text review, and data extraction were reviewed independently by 2 researchers in each step. Display categories were identified inductively through consensus. RESULTS: Of 14 575 articles, 64 were included in the review, describing 61 unique displays. Forty-one displays were designed for specific deteriorations (eg, sepsis), 24 provided simple alerts (ie, text-based prompts without relevant patient data), 48 leveraged well-accepted score-based algorithms, and 47 included nurses as the target users. Only 1 out of the 10 randomized controlled trials reported a significant effect on the primary outcome. CONCLUSIONS: Despite significant advancements in surveillance algorithms, most information displays continue to leverage well-understood, well-accepted score-based algorithms. Users' trust, algorithmic transparency, and workflow integration are significant hurdles to adopting new algorithms into effective decision support tools.

Community Engagement in Research: An Updated Systematic Review of Quantitative Engagement Measurement Scales for Health Studies.

Though the interest in community engagement in research (CEnR) protocols has increased, studies reporting on the findings of tested CEnR engagement measurement scales for health studies are sparse. A systematic review was conducted from January 1 to March 1, 2023, to identify validated, quantitative CEnR engagement measurement tools for health studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed. The rigor of scale development, testing, and implementation was explored, and a `best practices evaluation conducted. Themes on the readiness of scales for implementation in health research studies were narratively compiled. Nineteen studies met the search inclusion criteria-reporting on the development, testing, and implementation of seven CEnR engagement measurement scales for health studies. Scale implementation studies precipitated only two of the studies. None of the scales followed the rigorous process dictated in best practices; however, at this time, three scales have gone through the most robust testing processes. Advancement of the science of engagement measurement requires consensus on terminology, application of best practices for scale development and testing protocols, and consistency of reporting findings.

Renin-Angiotensin System Components and Arachidonic Acid Metabolites as Biomarkers of COVID-19.

Through the ACE2, a main enzyme of the renin-angiotensin system (RAS), SARS-CoV-2 gains access into the cell, resulting in different complications which may extend beyond the RAS and impact the Arachidonic Acid (ArA) pathway. The contribution of the RAS through ArA pathways metabolites in the pathogenesis of COVID-19 is unknown. We investigated whether RAS components and ArA metabolites can be considered biomarkers of COVID-19. We measured the plasma levels of RAS and ArA metabolites using an LC-MS/MS. Results indicate that Ang 1-7 levels were significantly lower, whereas Ang II levels were higher in the COVID-19 patients than in healthy control individuals. The ratio of Ang 1-7/Ang II as an indicator of the RAS classical and protective arms balance was dramatically lower in COVID-19 patients. There was no significant increase in inflammatory 19-HETE and 20-HETE levels. The concentration of EETs was significantly increased in COVID-19 patients, whereas the DHETs concentration was repressed. Their plasma levels were correlated with Ang II concentration in COVID-19 patients. In conclusion, evaluating the RAS and ArA pathway biomarkers could provide helpful information for the early detection of high-risk groups, avoid delayed medical attention, facilitate resource allocation, and improve patient clinical outcomes to prevent long COVID incidence.

Our Patients Need Empathy Training across Healthcare Professions.

Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.

Factors contributing to vaccine hesitancy and reduced vaccine confidence in rural underserved populations.

Vaccination remains one of the most effective ways to limit the spread of infectious diseases, and reduce mortality and morbidity in rural areas. Waning public confidence in vaccines, especially the COVID-19 vaccine, remains a cause for concern. A number of individuals in the US and worldwide remain complacent, choosing not to be vaccinated and/or delay COVID-19 vaccination, resulting in suboptimal herd immunity. The primary goal of this study is to identify modifiable factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to vaccines in two under-resourced rural states, Alaska and Idaho. This qualitative study used semi-structured interviews with providers and focus groups with community participants in Alaska and Idaho. A moderator's guide was used to facilitate interviews and focus groups conducted and recorded using Zoom and transcribed verbatim. Thematic, qualitative analysis was conducted using QDA Miner. Themes and subthemes that emerged were labeled, categorized, and compared to previously described determinants of general vaccine hesitancy: established contextual, individual and/or social influences, vaccine and vaccination-specific concerns. Themes (n = 9) and sub-themes (n = 51) identified during the qualitative analysis highlighted a factor's contributing to COVID-19 vaccine hesitancy and poor vaccine uptake. Relevant influenceable factors were grouped into three main categories: confidence, complacency, and convenience. Vaccines are effective public health interventions to promote health and prevent diseases in rural areas. Practical solutions to engage healthcare providers, researchers, vaccine advocates, vaccine manufacturers, and other partners in local communities are needed to increase public trust in immunization systems to achieve community immunity.

Social Networks in Retirement and Assisted Living Communities: A Literature Review.

Research has substantiated that social isolation and loneliness are linked to poorer health, earlier death, and reduced quality of life among older adults. Although there has been research focusing on social networks of nursing home residents and interventions to decrease loneliness and improve social interactions for older adults in varied settings, there is a gap in research relating to social networks of older adults in assisted living and retirement communities. The goal of the current review was to summarize relevant research findings related to this topic published in the past 5 years. The literature review included searching three electronic databases (CINAHL, EBSCOhost, and PubMed) for research articles published between January 2015 and March 2020. A total of 475 articles were identified, which was narrowed to 16 articles included for full review after inclusion and exclusion criteria were applied. Following analysis, three themes were identified in the literature: Social Connections Within an Assisted Living Community, Social Networks Between Residents and Their Adult Children, and Influence of Physical Structure on Social Networks of Residents. [Journal of Gerontological Nursing, 48(1), 42-46.].

Health belief model factors as predictors of parental misclassification of the weight of the preschool child.

BACKGROUND: Parental misperception and underestimation of their child's weight are documented in studies. Demographic factors like age and gender have been linked to misclassification. However, modifiable factors that could potentially frame future intervention and prevention strategies have not been explored. This study aimed to assess factors that could predict parental misclassification of their preschool child's weight. METHODS: This was a cross-sectional study with 198 parents and their 2- to 5-year-old children who attended standalone preschools or childcare centers with preschools. Parents completed a questionnaire that asked about demographic features, personal and family health, and the assessment of their child's weight using the three most frequently utilized measures. Logistic regression was conducted to assess the association between parental factors and child weight classification status. Instruments included the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD), the Obesity Risk Scale (ORK-10), and the Adolescent Obesity Risk Scale (AORK). Analyses included frequencies, chi-square tests, Kappa coefficients, and logistic regressions. RESULTS: Parents were least accurate (35.9%) identifying child weight when selecting a picture (κ = -.028, p = .42). The pictorial and Likert method (κ = -.032, p = .37) showed parental agreement with child weight was not significantly better than chance. Statistically, a significant agreement was found in the weight-reporting method (κ = .21). Two of the three HBM-related measures were significantly related to accurate classification. Logistic regression showed child sex, PSEPAD scores, and ORK-10 scores were statistically significant predictors in the Likert method. The model had no statistical significance for the pictorial or weight-reporting method. CONCLUSION: Results indicate parents support intervening if aware of child weight problems. However, parents do not accurately recognize healthy versus unhealthy weights and report that health providers are not informing them of weight deviations. Further, important relationships between the HBM variables were identified. Results show barriers (self-efficacy) mediate the impact of perceived severity (knowledge) regarding the parental ability to assess child weight accurately. These relationships and incorporation of the HBM principles of barriers and severity into prevention/intervention strategies need further exploration.

Examination of parental knowledge of child weight status and associated potential health risks.

BACKGROUND: The identification of parental health knowledge related to obesity and overweight status in children is an important area. Its importance relates to understanding gaps in knowledge that can be used to create targeted intervention and prevention strategies to improve the management of child's weight. AIM: There is a growing awareness of the potential health risks associated with increased childhood weight. It is currently unclear how well the public understands these risks and if understanding is linked to improvement in obesity or overweight levels in children. This review focused on determining if the current research is available to describe parental knowledge and whether it is connected to improved outcomes in the child's weight status. METHODS: The search for original research articles published between 2003 and 2018 involved six databases, including CINAHL, EBSCOhost, PubMed, PsycINFO, Psychology, and Behavioral Sciences Collection, and OneSearch. The OneSearch database is a comprehensive search engine that allows simultaneous searching of the entire library category and results that are ranked by relevance to the search terms. The terms used included for the keyword search in each database included: "knowledge" or "awareness," "health risk" or "consequence," "obesity" or "overweight," and "weight" or "body mass index," "child," and "parent" or "parental." A content analysis of included articles was performed to synthesize available literature into a review. RESULTS: This review included nine articles dealing specifically with parents of children and their knowledge levels. As there was limited information about if child's weight status connected to parental knowledge, an additional seven articles addressing how knowledge affects weight at any age was examined. The findings for parental knowledge and its effect have mixed results and varying methods of measurement. CONCLUSIONS: While some studies have indicated the importance of knowledge, it is difficult to establish a reliable connection due to the limited examination of this subject. This is, therefore, an underexplored area that needs further study.

Transforming nursing education in a 140-character world: The efficacy of becoming social.

A generational gap exists across educational settings today. The potential and actual mismatch of learning styles and curriculum delivery suggests that the current educational models are in need of change. The advent of social media has transformed students from passive recipients of information to co-creators and engaged members of a global and information rich community. Responding proactively with social media integration through a responsive curriculum delivery system would serve to enhance student engagement and improve collaborative learning opportunities. Future implications for social media use in research and education will allow for rapid and efficient research to practice dissemination.

Informed Consent and the Limited English Patient: A Pilot Project with Dental Hygiene Students to Assess Student Knowledge, Perceptions, and Attitudes.

Informed consent is the process by which a patient agrees to or rejects a proposed plan of treatment after a discussion with the provider about the benefits, risks, and alternative treatments available. In the United States, a signed informed consent form is required before any treatment plan may be implemented. However, there is no literature addressing how students in health professions understand informed consent in the context of encounters with limited English proficient (LEP) patients. The purpose of this interprofessional, interdisciplinary pilot project was to explore and assess Idaho State University's dental hygiene students' knowledge, perceptions, and attitudes associated with the process of informed consent when working with LEP patients in a dental hygiene setting. Using mixed-methods methodology, we administered a pre-immersion survey to 28 second-year dental hygiene students. These students then participated in a simulated encounter with Spanish-speaking mock-patients and trained interpreters. After the immersive experience, students completed a post-immersion survey. Study results indicate overall positive increases in student knowledge, perceptions, and attitudes toward various aspects of the provider-LEP patient encounter.

Alzheimer's and Dementia: The Next War for Rural Veterans and Their Families?

Nurse-led interventions can prepare a vulnerable population.

Doctor of Nursing Practice Student Perceptions of Providing Care to Refugees: Implications for Doctoral Nursing Practice.

Although there is no doubt that expanding scientific innovations provide timely information, in the case of refugees and their primary care providers, it is possible their voices have been partially obscured by this rapidly expanding technological and global society. The authors are currently involved in addressing health disparities by providing education and training for doctoral nursing students, in the delivery of home based primary care to culturally diverse and marginalized populations in a mountain west state. Doctor of nursing practice (DNP) student perspectives may provide essential information to improve patient-centered care for this very vulnerable population. The purpose of this article is to relay the perceptions of DNP nursing students providing care to refugees.

What Does it Mean to be Healthy? Hispanics in the Southeastern Idaho Agricultural Industry.

In contrast to many studies of first generation Hispanics residing in the U.S., our study focused on participants of both genders who were formally employed outside the home. The purpose of this study was to explore the meaning of health among southeast Idaho Hispanics employed in the agro-industry. Using qualitative methodology, we interviewed twenty participants employed at a potato processing plant. We found that men and women had differing concepts of health based upon their gender roles and the value placed on work outside the home, which influenced their willingness to access formal health care. Based on our findings, there is a need for public health officials in Idaho to collaborate with employers to develop and implement workplace clinics.

Importance of Interprofessional Healthcare for Vulnerable Refugee Populations.

The refugee population in the United States is steadily increasing. These populations face a plethora of diseases and chronic health problems (i.e. obesity, hypertension and depression) as they resettle into their new environment. Due to the lack of understanding, minority population refugee health is scarce and minimal at best. Refugees and healthcare professionals face similar barriers when it comes to seeking treatment and treatment itself. For example, refugees might not be able to communicate efficiently and understand the referral process while healthcare professionals do not understand the culture and language of their patients. However, more data is needed to determine if interprofessional teams consisting of differing healthcare professionals such as nurses, pharmacists, and dieticians that conduct home visits might be able to bridge the health care gap between individualized treatment and refugee needs.

Spatial and Census Data to Evaluate Obese Persons and their Environment (SCOPE).

OBJECTIVE: To evaluate the built environment and its relationship to BMI for individuals in eastern Idaho. METHODS: Geospatial analyses were coupled to demographic data of adult individuals. ArcGIS Community Analyst was used to compare demographics relative to median BMI. RESULTS: For every kilometer increase in distance to prepared food sites, BMI went down by 1.3% and every kilometer increase in distance to green space, BMI went down by 0.8% (p < .001). For every kilometer increase in distance to trails, BMI went up by 1.5%. No other built environment variables had a statistically significant association with BMI. CONCLUSION: The distance to prepared foods and trails was associated with expected changes in BMI. Conversely, increased distance to green space was associated with a lower BMI.

Physical activity in American schools and body mass index percentile.

The international physical inactivity epidemic among children has contributed to child obesity. Schools can be an effective source of physical activity opportunity. A cross-sectional sample of 1306 American children was drawn from the Panel Study of Income Dynamics - Child Development Supplement, 2007. The aim of this study was to determine the role of in-school physical activity on body mass index (BMI) percentile among middle and high school-aged children. Multinomial logistic regression was used to assess the associations between the independent variable, physical activity, and the dependent variable, BMI percentile. After adjusting for covariates, children who had no physical activity during physical education (PE) were much more likely to be obese than normal weight in comparison with those who met the US national requirements (odds ratio = 1.58, confidence interval = 1.14, 2.20). This study suggests that meeting US national guidelines for PE-related physical activity may be effective in preventing obesity.