Implementing Nurse Extracorporeal Membrane Oxygenation Specialists to Maintain a Sustainable Program.

Extracorporeal membrane oxygenation (ECMO) offers hope for patients with acute respiratory distress syndrome when other treatment methods fail. However, ECMO requires continuous hourly management leading to extremely high operating costs. With the onset of the COVID-19 pandemic, the high number of patients on ECMO led to a significant increase in the costs when using perfusionists to manage ECMO. Switching to a nurse-driven model resulted in a 52% decrease in costs related to the hourly management. Changing to a nurse-driven program provided increased nursing support and sustainability, and with determination and support, other ECMO centers can also change to nurse-driven programs.

A Framework for National Collaboration to Reduce Documentation Burden and Design for Usable and Reusable Data.

A focused effort is needed to capture the utility and usability of the electronic health record for providing usable and reusable data while reducing documentation burden. A collaborative effort of nurse leaders and experts was able to generate national consensus recommendations on documentation elements related to admission history. The process used in this effort is summarized in a framework that can be used by other groups to develop content that reduces documentation burden while maximizing the creation of usable and reusable data.

Assessment of Maya women's knowledge, attitudes, and beliefs on sexually transmitted infections in Guatemala: a qualitative pilot study.

BACKGROUND: Despite Guatemala's large indigenous population, indigenous health is often neglected in reported health data and interventions. Although this data is limited in scope, it shows that indigenous people have poorer health outcomes. Sexually transmitted infections (STIs) are now a growing threat in Guatemala and pose great risk to the wellbeing of its indigenous population. METHODS: This qualitative pilot study assessed the knowledge, attitudes, and beliefs of STIs through semi-structured interviews among a previously unstudied population of indigenous Maya women (n = 35, ages 18-50) in the six municipalities of Santa Cruz La Laguna, Guatemala. RESULTS: Four key themes were identified: 1) indigenous Maya women have limited factual knowledge about sex and STIs; 2) widespread partner infidelity minimizes women's control over preventing STI contraction; 3) close-knit communities and the resulting heightened fear of gossip prevents communication and hinders care seeking; and 4) lack of quality medical care and inaccessibility of biomedical healthcare systems pose barriers to seeking care for potential STIs. CONCLUSIONS: To address these findings, we suggest methods to improve sexual education, combat male infidelity, promote condom use, and improve health services to reduce the incidence of STIs in Maya Guatemala.

Effect of a traditional Chinese medicine course for undergraduate nursing students: A pre-/post-test study.

BACKGROUND: Traditional Chinese medicine is widely used for treating aging-related chronic conditions. Therefore, designing a TCM theoretical course for undergraduate nursing students will be a preparation for further clinical practice in TCM in the future. OBJECTIVES: To identify the effect of a TCM course designed for undergraduate nursing students on understanding four key parts of TCM theories. DESIGN: A quasi-experimental pre- and post-test study. SETTING: A university in China during the 2016 fall semester. PARTICIPANTS: A convenience sample of 47 senior undergraduate nursing students. METHODS: Each pair of pre- and post-tests were conducted before and after one lecture. Four pairs pre-/post-tests were conducted during lectures of fundamental theories, TCM diagnostic principles, herb properties, and treatment principles. Four questionnaires including ten multiple-choice questions were used for pre-/post-tests. Stata 14.0 was used for descriptive analysis and paired t-tests. RESULTS: Mean scores of post-tests were significantly higher than those of pre-tests (p < 0.001). Among pre-tests, the lowest correctness rates of key contents in the four lectures were the pathological relation of five elements (31.25%), the differentiation of symptoms for a case analysis (16.67%), the compatibility relation (12.77%), and the role of Monarch herbs (also called as "Principal herbs") and the characteristics of herbal pills (29.79%), separately; the highest were the nature of Yin-Yang (87.50%), identifying symptoms for a specific syndrome (85.42%), the herb usage (95.74%), and the principle of prescription composition (85.11%), separately. TCM knowledge in relation of nature of Yin-Yang and Five Elements and basic principles of TCM knowledge gained more increased correctness rates than that related to pathological-based and differentiation of symptoms. CONCLUSION: The TCM course has a positive effect to enhance TCM knowledge of undergraduate nursing students. The students were easier to gain TCM fundamental knowledge and principles than pathological based knowledge and differentiation of symptoms.

Early Initiation of Breastfeeding Among Maya Mothers in the Western Highlands of Guatemala: Practices and Beliefs.

BACKGROUND: Guatemala exhibits the sixth highest rate of child stunting worldwide, and stunting disproportionately affects Guatemala indigenous communities. In a country struggling to combat this result of malnutrition, early child nutrition is especially critical. Specifically, early initiation of breastfeeding is important for the development of newborn infants. Understanding beliefs and practices related to early initiation of breastfeeding in Maya Guatemala may provide an avenue to guide nutrition interventions in indigenous communities. Research aim: This study aimed to determine major beliefs and practices associated with early initiation of breastfeeding among Maya mothers in Lake Atitlán, Guatemala. METHODS: As part of a larger study to assess child nutrition in the Lake Atitlán region, we created a series of semistructured interview questions to document breastfeeding practices and beliefs among mothers. We conducted and audio-recorded in-person interviews that were translated from Kaqchikel, the local language, to Spanish by a community assistant. RESULTS: We conducted 178 interviews with mothers; 76% practiced early initiation. Early initiation was associated with the village and complementary feeding practices. Mothers held a variety of beliefs about the value of colostrum, and these beliefs were associated with the village. Mothers who held negative beliefs toward colostrum were more likely to delay breastfeeding initiation. CONCLUSION: Although most Maya mothers practice early initiation, the intervillage disparity in breastfeeding practices demonstrates a need to geographically focus breastfeeding interventions. Our novel insights into the breastfeeding beliefs among Maya mothers will serve as a guide to structure culturally competent breastfeeding education interventions in indigenous communities.

Yoga to Reduce Trauma-Related Distress and Emotional and Behavioral Difficulties Among Children Living in Orphanages in Haiti: A Pilot Study.

OBJECTIVES: To measure trauma-related distress and evaluate the feasibility, acceptability, and preliminary efficacy of an 8-week yoga intervention (YI) in reducing trauma-related symptoms and emotional and behavioral difficulties (EBD) among children living in orphanages in Haiti. DESIGN: Case comparison with random assignment to YI or aerobic dance control (DC) plus a nonrandomized wait-list control (WLC) group. SETTING: Two orphanages for children in Haiti. PARTICIPANTS: 76 children age 7 to 17 years. INTERVENTION: The YI included yoga postures, breathing exercises, and meditation. The DC group learned a series of dance routines. The WLC group received services as usual in the institutional setting. After completion of data collection, the WLC group received both yoga and dance classes for 8 weeks. OUTCOME MEASURES: The UCLA PTSD Reaction Index and the Strengths and Difficulties Questionnaire were used to indicate trauma-related symptoms and EBD, respectively. A within-subject analysis was conducted to compare pre- and post-treatment scores. A post-treatment yoga experience questionnaire evaluated acceptability of the YI. RESULTS: Analyses of variance revealed a significant effect (F[2,28]=3.30; p=0.05) of the YI on the trauma-related symptom scores. Regression analyses showed that participation in either 8 weeks of yoga or dance classes suggested a reduction in trauma-related symptoms and EBD, although this finding was not statistically significant (p>0.05). Respondents reported satisfaction with the yoga program and improved well-being. CONCLUSIONS: Children with trauma-related distress showed improvements in symptoms after participation in an 8-week yoga program compared to controls. Yoga is a feasible and acceptable activity with self-reported benefits to child mental and physical health. Additional research is needed to further evaluate the effect of yoga to relieve trauma-related distress and promote well-being among children.

Treatment of chronic conditions with traditional Chinese medicine: findings from traditional Chinese medicine hospitals in Hubei, China.

OBJECTIVES: This study aimed to document clinical use of Traditional Chinese Medicine (TCM) for chronic conditions in all TCM hospitals in a Chinese province and to recommend treatments most in need of evaluation for use in community health centers. DESIGN: A cross-sectional survey was conducted in the summer of 2010. It included 119 of 132 TCM hospitals in Hubei Province, China. TCM physicians were asked to recommend specific TCM treatments for common chronic conditions. Nine types of chronic conditions recommended more than 3.7 times (mean of frequencies of chronic conditions) are included in this analysis. Frequency of each TCM treatment and the number of visits by type of chronic conditions were calculated. RESULTS: The total number of recommendations by TCM physicians was 411. For seven types of treatments, six were recommended for musculoskeletal pain, five for soft tissue injuries, four for visceral pain and fractures, three for stroke and asthma, two for hemorrhoids, and one for hypertension. The most frequently recommended treatments for specific conditions include orally ingested herbs for visceral pain (n=3), type 2 diabetes (n=5), and hypertension (n=7); herbs for external use for soft tissue injuries (n=10), asthma (n=6), and hemorrhoids (n=8); acupuncture for musculoskeletal pains (n=43) and for stroke (n=10); and Chinese external fixation for fractures (n=24). The number of visits for recommended treatments per year of was 671,759. The most frequently recommended treatments for specific chronic conditions have most visits, except for chronic conditions such as musculoskeletal pains, visceral pains, soft tissue injuries, and asthma. CONCLUSIONS: Patients with musculoskeletal pain have more treatment options than other patients. Herbal medicine is the option most commonly used for chronic conditions. These treatments for these conditions should be targeted for further evaluation of effectiveness and, only if found effective, considered for use in primary care settings.

Public health literacy defined.

Public health literacy is an emerging concept necessary to understand and address the broad array of factors, such as climate change, globalization, and poverty, that influence the public's health. Whereas health literacy has traditionally been operationalized as an individual-level construct, public health literacy takes into account the complex social, ecologic, and systemic forces affecting health and well-being. However, public health literacy has not yet been fully articulated. This paper addresses this gap by outlining a broad, new definition of public health literacy. This definition was developed through an inductive analytic process conducted in 2007 by a multidisciplinary research team, and two expert-panel sessions were convened to assess the consensual validity of the emergent definition. Based on this process, public health literacy is defined as the degree to which individuals and groups can obtain, process, understand, evaluate, and act on information needed to make public health decisions that benefit the community. Three dimensions of public health literacy--conceptual foundations, critical skills, and civic orientation--and related competencies are also proposed. Public health literacy is distinct from individual-level health literacy, and together, the two types of literacy form a more comprehensive model of health literacy. A five-part agenda is offered for future research and action aimed at increasing levels of public health literacy.