Feasibility of Motivational Interviewing and Physical Activity Counseling Sessions for Improving Physical Activity Self-Management for Latina Women Either at Risk for or Diagnosed With Type 2 Diabetes Mellitus.

Introduction: Latinas have a greater chance of dying from diabetes than non-Latina Whites. As a population group, the literature has shown that Latinas do not meet physical activity (PA) guidelines. Motivational interviewing (MI) is a patient-centered counseling method that promotes self-efficacy for behavior change. The purpose of the study was to examine the feasibility of using MI/PA counseling for self-management of type 2 diabetes mellitus with Latinas. Methods: Latinas (n = 12) were recruited from an occupational program in Southern California. Two MI and PA sessions were conducted over 2 months. Feasibility measures included recruitment, retention, protocol adherence, and attrition. Impact outcomes included PA, PA stage of change, and waist circumference. Results: Participants attended all sessions and completed all questionnaires. Half progressed into a later stage of change for PA. Discussion: Results suggest MI and PA counseling is feasible for improving PA with Latinas at risk/diagnosed with type 2 diabetes mellitus.

A prism of excellence: The Charleston Veterans Administration Nursing Academic Partnership.

BACKGROUND: The Veterans Administration (VA) has been committed to academic affiliate training partnerships for nearly 70 years in efforts to enhance veteran-centric health care. One such effort, the VA Nursing Academy (VANA) program, was developed in 2007 in response to the nationwide nursing shortage and began as a five-year pilot with funding competitively awarded to 15 partnerships between local VA medical centers and schools of nursing. The VANA program evolved into the VA Nursing Academic Partnership (VANAP) program following the initial pilot. PURPOSE: This article describes the development and evolution of the Charleston VANAP, which includes the Ralph H Johnson VA Medical Center (RHJ VAMC) and the Medical University of South Carolina College of Nursing (MUSC CON). METHODS: The VA Office of Academic Affiliations (OAA) funded a large portion of the initial five years of the Charleston VANAP. Once the national funding source ceased, the RHJ VAMC and the MUSC CON entered into a Memorandum of Understanding (MOU) to offer in-kind contributions to the partnership. DISCUSSION: The Charleston VANAP is the only program in the nation to offer three different nurse trainee programs and this article highlights some of the more notable achievements from each program. CONCLUSION: The Charleston VANAP is a comprehensive partnership between the RHJ VAMC and the MUSC CON that truly demonstrates a commitment to assure that the very best care be provided to Veterans, our Nation's heroes.

Qualitative Study of Cervical Cancer Screening Among Lesbian and Bisexual Women and Transgender Men.

BACKGROUND: Lesbian, bisexual, and queer (LBQ) women, as well as transgender men, are less likely than their heterosexual and female-identifying counterparts to access cervical cancer screening services. Although numerous factors that influence receipt of cervical screening have been identified, several gaps in research and knowledge merit additional research. OBJECTIVE: The aims of this study were to examine cervical cancer screening behaviors of LBQ women and transgender men using American Cancer Society guidelines as the standards for comparison and to determine factors that influence participation in cervical cancer screening. METHODS: A convenience sample of 21- to 65-year-old LBQ women and transgender men was recruited from the Internet and community events. Qualitative data were collected through in-depth telephone interviews and open-ended questions on an online questionnaire. A deductive-inductive content analysis approach was used. RESULTS: The sample was mostly non-Hispanic white women who identified as lesbian. Most were routine cervical cancer screeners. Eighteen factors/themes were identified in the data and were contextualized within a health services theoretical framework. CONCLUSIONS: This study showed that although some factors overlap with the general female population, there are other areas that are specific to LBQ women and transgender men. Creating welcoming and inclusive healthcare environments is particularly important to facilitating cervical screening among LBQ women. IMPLICATIONS FOR PRACTICE: Nurse leaders can modify clinical environments, and clinical nurses can be educated to provide safe care for LBQ women and transgender men.

Expanding Simulation Capacity: Senior-Level Students as Teachers.

BACKGROUND: The effectiveness of using senior-level nursing students as teachers to junior-level students in simulated learning was examined in a prelicensure nursing program. Simulation requires considerable financial resources in faculty time and effort. It was theorized that using senior students as teachers for junior students in peer-assisted simulation for learning health assessment clinical skills would offer an equally effective learning experience as faculty instructors. METHOD: A total of 60 junior-level students were randomized into a simulated learning experience taught by 20 senior-level students or nursing faculty. RESULTS: Evaluation of junior students' clinical performance, postsimulation debriefing assessment, and satisfaction with the simulation learning experience indicated that senior nursing students were equally effective as faculty simulation instructors. CONCLUSION: Findings suggest that the Senior Students as Teachers program, using the train-the-trainer model, was successful in preparing students as simulation instructors and has the potential for reducing faculty time and cost, as well as enhance student peer-to-peer learning.

Mental health and addiction workforce development: federal leadership is needed to address the growing crisis.

The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action.

Institutionalization of community partnerships: the challenge for academic health centers.

Current public health priorities emphasize the elimination of health disparities, translational research, and transdisciplinary and community alliances. The Center for Community Health Partnerships is a proactive initiative to address new paradigms and priorities in health care through institutionalization of community-university partnerships. This report highlights innovative strategies and lessons learned.

Blueprint for development of the advanced practice psychiatric nurse workforce.

The mental health system is inefficient and ineffective in providing behavioral health care services to the 1 in 4 Americans who have a mental illness or a substance abuse problem. Current health care reform initiatives present a significant opportunity for advanced practice psychiatric nurses-psychiatric mental health (APRN-PMH) to develop action-oriented recommendations for developing their workforce and thereby increasing access to high-quality and full-spectrum behavioral health care services. If endorsed by the professional nursing associations and the APRN-PMH workforce, the strategies presented in this paper provide a blueprint for developing the APRN-PMH workforce. Achieving these goals will significantly reform the APRN-PMH workforce, thereby contributing to the overall goal of supporting an integrated model of behavioral health care. No change has as much potential to influence the APRN-PMH workforce as the uniting of all APRN-PMHs in a "Blueprint for APRN-PMH Workforce Development."

Allocating resources in a data-driven college of nursing.

Three years ago our college of nursing faced a critical strategic planning question: How could the college initiate and offer a Doctor of Nursing Practice (DNP) degree program without additional human and financial resources? This article describes the process used to open a new educational program with no new resources by suspending educational programs that were not financially viable. While the process was difficult, shared governance and data-driven decision-making fostered trust and openness that allowed faculty members to make critical decisions, assuring the viability and future growth of the college. At the end of this process, faculty members were united in their decisions and actively and energetically engaged in the development of a new DNP curriculum that built upon their strengths and expertise.

A national action plan for workforce development in behavioral health.

Across all sectors of the behavioral health field there has been growing concern about a workforce crisis. Difficulties encompass the recruitment and retention of staff and the delivery of accessible and effective training in both initial, preservice training and continuing education settings. Concern about the crisis led to a multiphased, cross-sector collaboration known as the Annapolis Coalition on the Behavioral Health Workforce. With support from the Substance Abuse and Mental Health Services Administration, this public-private partnership crafted An Action Plan for Behavioral Health Workforce Development. Created with input from a dozen expert panels, the action plan outlines seven core strategic goals that are relevant to all sectors of the behavioral health field: expand the role of consumers and their families in the workforce, expand the role of communities in promoting behavioral health and wellness, use systematic recruitment and retention strategies, improve training and education, foster leadership development, enhance infrastructure to support workforce development, and implement a national research and evaluation agenda. Detailed implementation tables identify the action steps for diverse groups and organizations to take in order to achieve these goals. The action plan serves as a call to action and is being used to guide workforce initiatives across the nation.

The inextricable nature of mental and physical health: implications for integrative care.

There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.

Implementing change in primary care practices using electronic medical records: a conceptual framework.

BACKGROUND: Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). METHODS: Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. RESULTS: A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. CONCLUSION: This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement.

Report of recommendations: the Annapolis Coalition Conference on Behavioral Health Work Force Competencies.

In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.

Evidence-based teaching practice: implications for behavioral health.

Educational practices and strategies have changed very little over the years, and even emerging advances in technology have become the prisoners of traditional academic norms. Thus, while there is increasing emphasis on evaluating and aligning caregiving processes with the strongest evidence of effectiveness, there is little demonstration or role-modeling of this same expectation in either the formal or continuing educational processes of behavioral healthcare providers. This "disconnect" is a significant problem in the field. This paper addresses the urgent need to inform the education and training of the behavioral health workforce with current theories regarding the teaching-learning process and evidence about the effectiveness of various teaching strategies. The relevant theories and available bodies of evidence are described, and the implications for workforce education and training are identified.