The Use of the Acute Stroke Management Questionnaire to Measure Acute Care Nurses' Stroke Knowledge.

ABSTRACT: BACKGROUND: Nurses are key in identifying and treating in-hospital strokes (IHSs). Delayed treatment times and poor patient outcomes are associated with IHSs. Information is needed on nurses' stroke knowledge and the objective measurement of stroke knowledge using a validated tool. The Acute Stroke Management Questionnaire (ASMaQ) was recently developed to test stroke knowledge of healthcare professionals but has not been used on a nursing-specific population. METHODS: Through online surveying and use of ASMaQ, we will measure stroke knowledge of nurses caring for adult, hospitalized patients in an urban, southeast US health system. RESULTS: Total N is 196. Most participants (74.5%, n = 146) never worked on a stroke floor; however, almost all (95.9%, n = 188) cared for a stroke patient in the past. Most participants (65.3%, n = 128) reported receiving prelicensure stroke education, and 98.5% (n = 193) received postlicensure stroke education. Acute Stroke Management Questionnaire total scores ranged from 93 to 133 (mean [SD], 117.35 [8.15]). Most participants scored in the good stroke knowledge range for all 3 ASMaQ domains and total ASMaQ score. CONCLUSION: The online delivery of the ASMaQ was successful in testing nurses' stroke knowledge, and nurses were shown to have good stroke knowledge. Future initiatives should focus on discerning whether certain nurse characteristics predict higher or lower levels of stroke knowledge to help inform educational initiatives to improve IHS outcomes.

Characterization of nurses' duty to care and willingness to report.

BACKGROUND: Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care. RESEARCH AIM: The purpose of this study was to investigate nurses' perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care. RESEARCH DESIGN: A cross-sectional survey research design was used in this study. PARTICIPANTS AND RESEARCH CONTEXT: Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board. ETHICAL CONSIDERATIONS: Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas. FINDINGS: Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: "lower level of perceived duty to care group" and "higher level of perceived duty to care group." The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics. DISCUSSION: The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses' safety, minimize nurses' risk, and promote nurses' knowledge to confidently work during disaster situations. CONCLUSION: Level of perceived duty to care affects nurses' willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses' perceived duty to provide care and willingness to report to work during disasters.

RN-to-BSN Students' Intent to Become Faculty: A Multisite Study.

BACKGROUND: A nursing faculty shortage means fewer nurses, exacerbating nursing shortages. PURPOSE: The purpose was to determine RN-to-BSN students' intent for a future nurse faculty role. A secondary purpose was to evaluate differences between students who indicated high and low intent to pursue a faculty role. METHODS: The study was multisite and multimethod using 5 instruments. RESULTS: Of 137 RN-to-BSN students who completed the online survey, 20% indicated they intended to pursue a future faculty role. Students with high intent to pursue a faculty role reported higher self-efficacy and interests in faculty activities. Only 6 of the high-intent students had been encouraged to pursue a future faculty role. CONCLUSIONS: RN-to-BSN students may be receptive to encouragement to consider a nursing faculty role in the future.

Growing Your Own: Will Your Associate Degree Nursing Student Consider a Future Faculty Role?

AIM: The purpose of the study was to determine the intent of associate degree in nursing (ADN) students to pursue a future nursing faculty role. BACKGROUND: Nursing faculty shortages negatively affect the capacity to educate new nurses. METHOD: A prospective correlational research design was used to conduct a national survey of ADN students regarding their intent for a future nursing faculty role using constructs of social cognitive career theory. RESULTS: Twenty-nine percent of participants intended to pursue a future faculty role. The statistically significant predictors of future intent were semesters completed (OR = 2.4), interest in the activities of a faculty role (OR = 2.3), encouragement from faculty (OR = 2.0), outcome expectations-advantages (OR = 1.7), and outcome expectations-disadvantages (OR = 0.7). CONCLUSION: Encouraging ADN students toward graduate education and a future faculty role and informing them of all aspects of the role, including advantages and disadvantages, may inspire ADN students toward such a role.

Moral Distress Among School Nurses.

School nurses are well positioned to provide care to a diverse population of school-age children, but their role and work environment can present a variety of moral dilemmas leading to moral distress. The purpose of this study is to identify the moral distress level that exists in school nurses and to describe its relationship to common moral dilemmas and school nurse characteristics. Data were collected through face-to-face attendance at school nurse meetings in North Carolina where 307 school nurses participated in the survey. Moral distress was measured using the moral distress thermometer, and common moral dilemmas were identified using a researcher developed questionnaire. Almost all of the school nurses (97.3%) experienced some degree of moral distress. Each of the common moral dilemmas was positively correlated with moral distress levels. The findings suggest that many of the common moral dilemmas experienced by school nurses are strongly related to moral distress.

Parent and teacher perceptions of the impact of school nurse interventions on children's self-management of diabetes.

Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this relationship in a sample of 69 school-age children who received case management from school nurses. Our findings suggest that teachers and parents do not always agree on how well a child manages their illness. When school nurses provide more education and counseling, parents are more likely to perceive an improvement in their child's self-management. Teachers are more likely to perceive an improvement when the nurse provides more classroom visits and includes the physical education teacher and guidance counselor. These findings suggest that the roles of educator, counselor, and collaborator are important for school nurses who provide care to school-age children with diabetes.

The importance of assessing for depression with HRQOL in treatment seeking obese youth and their caregivers.

PURPOSE: The purpose of this manuscript is to (1) explore the health-related quality of life (HRQOL) of youth attending a tertiary obesity treatment center compared to healthy population reference data; (2) compare the congruence between the HRQOL of youth self-reports and caregiver proxy reports; and (3) examine the associations between youth HRQOL and (a) teen and (b) caregiver depression. METHODS: The sample included 267 youth and caregiver dyads. A cross-sectional descriptive design was used. Analyses included paired t tests, analyses of variance, correlations, and Chi-square cross-tabulations. RESULTS: Overweight youth reported significantly (P < 0.001) lower scores than a previously published healthy sample on all totals and subscales of the PedsQL. For younger overweight children and caregivers, there was closer agreement on social (r = 0.45) and emotional functioning (r = 0.32); whereas teens and caregivers agreed most on school functioning (r = 0.47) and emotional functioning (r = 0.44). Regardless of age, youth and caregivers disagreed most on physical functioning. Caregivers who reported higher depressive symptoms had less agreement with their child on their perceived HRQOL; however, teens with more depressive symptoms had stronger agreement with their caregivers on their previewed HRQOL. CONCLUSIONS: Based on our findings, there is not consistent agreement between youth and caregiver perceptions of youth HRQOL domains (physical, emotional, social, and school) and inconsistency in age groups (children and teens). Depressive symptoms in caregivers and teens can provide mechanistic insights into youth and caregiver HRQOL congruence. These findings underscore the importance of a comprehensive biopsychosocial assessment when providing treatment to overweight youth and their families.

A biopsychosocial pilot study of overweight youth and care providers' perceptions of quality of life.

This pilot study examined the relationship between youth and care provider self-reports of depressive symptoms assessed through the Patient Health Questionnaire and reports of youth physical and psychosocial functioning assessed by PedsQL4.0 in a rural outpatient overweight pediatric population (N = 66 child and care provider pairs). The relationship between youth body mass index (BMI), youth and care provider depression, youth quality of life (QOL), care provider perception of youth QOL, and youth and care provider congruence of QOL perceptions was examined. Paired t tests were completed to assess the differences between QOL scores for youth and care providers for subgroups based on age, age and gender, and age and race. The mean age of youth participants was 11.9 years; youth BMI ranged from 26.76 to 54.10 (M = 37.20). Our results showed that there are significant differences in youth and care providers' perceptions of QOL when specific demographic categories are assessed by age, gender, and race.

Pain experience of the elderly.

Too often, the elderly suffer silently and needlessly with chronic pain. To investigate the pain experience of the elderly living in the community, a descriptive research design was used. The aims of the study were to determine the prevalence of pain in an older population living in the community, to obtain a description of the older adult's pain experience, and to determine strategies used to manage their pain. The results of the study indicated that >90% of the elderly living in the community experienced pain within the past month, with 41% reporting discomforting, distressing, horrible, or excruciating pain. Musculoskeletal pain was found to be the most predominant pain, and inactivity was the most effective strategy used to lessen pain. Pain in the elderly continues to be a challenge which needs to be addressed more effectively by health care providers. Based on the high prevalence of pain experienced by the elderly and the expected demographic shifts in the next two decades, it is imperative to continue research in this area to assure the highest quality of life, as well as maximum functional ability, for the elderly. Health care providers need to understand the multidimensional pain experience that occurs in the daily life of the community-dwelling older adult and the most effective management strategies that can be used to provide pain relief.

A pilot study to reduce risk for antepartum depression among women in a public health prenatal clinic.

This pilot study evaluated the feasibility, effectiveness, and helpfulness of Insight-Plus, a brief culturally-tailored cognitive behavioral intervention for African-American and Caucasian rural low-income women at risk for APD [Edinburgh Postnatal Depression Scale (EPDS) > or = 10]. Forty two percent (63/149) of women in this non-randomized study were at risk for APD and 41% (26/63) of women, who met all eligibility criteria, initially agreed to participate. Seventeen participants completed all six intervention sessions. Ninety-four percent (16/17) who completed their one-month post-intervention interviews had an antepartum recovery rate of 81% (13/16, EPDS < or = 10). Participants reported that many aspects of the program were helpful and they continued to use the intervention exercises after the sessions ended.

Relationships of new nurses' perceptions and measured performance-based clinical competence.

BACKGROUND: This study examined the relationship between new nurses' performance-based measurements and perceptions of clinical competence. METHODS: Descriptive correlational designs were used to examine the relationships. Performance-based clinical competence was measured by the Performance Based Development System developed by Del Bueno (1990), and perceived competence was measured by specific items on the Casey-Fink Graduate Nurse Experience Survey (1999). RESULTS: Findings showed a significant difference in mean patient scores and professional role scores. Nurses who met the criteria for problem management had significantly higher scores on the patient care scale and the professional role scale than those who did not meet the criteria. Nurses with previous work experience (44%) were more likely to meet the criteria for problem management. Black participants scored lower on the patient care scale compared with others. CONCLUSION: This study provides a beginning understanding of the relationship between new nurses' perceptions and performance-based clinical competence.

The use of innovative pedagogies in nursing education: an international perspective.

The purpose of this global study was to explore the types of innovative pedagogies used in nursing education worldwide; transformative learning theory served as the theoretical basis for the study. A descriptive, mixed-method design with a researcher-developed instrument was used to conduct the electronic survey. Respondents were 946 nurse educator members of Sigma Theta Tau International; more than 93 percent were Caucasian women. Respondents indicated that the conventional teacher-centered approach remains the most prevalent pedagogical style (56 percent); fewer than 20 percent of respondents used feminist or postmodern approaches. Ninety percent of respondents reported using instruments to evaluate the effectiveness of their teaching. The majority viewed their faculty role as facilitator (88 percent) or information provider (65 percent). Greater efforts are needed to create an evidence base for nursing education through research that focuses on the effectiveness of innovative pedagogical strategies. This study, by describing the current patterns of teaching/learning strategies and approaches used by nurse educators, provides a beginning research base for improving nursing education.

Racial disparities in biopsychosocial factors and spontaneous preterm birth among rural low-income women.

In this descriptive prospective study, 269 African American, Hispanic, and Caucasian women from rural prenatal clinics were interviewed once between 16 and 28 weeks' gestation. Associations between biopsychosocial risk factors and preterm birth (PTB) were examined. African American women with spontaneous PTB were more likely to be older, and to have higher Bowman Gray Risk Index scores and hypertensive diseases of pregnancy than African American women who did not have a spontaneous PTB. There were significant differences in bacterial vaginosis, hypertensive diseases of pregnancy, smoking, social support from others, and self-esteem among the three racial groups. In the total sample after adjustment for sociodemographic and biopsychosocial factors, women with spontaneous PTB were three times more likely to be African American, to have oligohydramnios, hypertensive diseases of pregnancy, and had higher Bowman Gray Risk Index scores than the total sample of women without spontaneous PTB. Understanding the risks associated with spontaneous PTBs that are unique to African American women and why biopsychosocial risk factors vary by racial/ethnic group may lead to tailored interventions.

Risks and resources associated with antepartum risk for depression among rural southern women.

BACKGROUND: Seven to 13% of American women who are pregnant suffers from major depression and 11%-50% experience antepartum depressive symptoms. OBJECTIVE: To examine the prevalence of depressive symptoms in pregnancy and examine the biopsychosocial-spiritual risks and resources in low-income women of diverse racial/ethnic groups. METHODS: Prenatal interviews were conducted at 16-28 weeks gestation with 324 pregnant women from rural prenatal clinics in the southeastern United States; 43% were African American, 31% were Caucasian, and 26% were Hispanic. Multivariate logistic regression tested the contributions of psychosocial risks and psychosocial and spiritual resources to risk for depression (Beck Depression Inventory-II scores >or=16) for the aggregate and for each racial-ethnic group. RESULTS: Beck Depression Inventory-II scores indicating risk for depression were found in 33% of the women. There were no significant differences in symptom rates among African Americans, Caucasians, and Hispanics (37%, 25%, and 36%, respectively). African American race, abuse, more stress, less social support, less self-esteem, and less spirituality were associated with risk for depression, controlling for sociodemographic factors. DISCUSSION: A third of this diverse group of rural low-income women were at risk for depression in pregnancy. It is vital to screen for depressive symptoms in pregnancy and to identify psychosocial risks and resources associated with risk for depression in order to develop interventions for pregnant women with depressive symptoms.

Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy.

This article describes the risks and protective factors for symptoms of depression in pregnancy among low-income African American and Caucasian women. Data were collected from 130 women who were between 16 and 28 weeks' gestation and enrolled in an urban prenatal clinic. The questionnaires used in the face-to-face interviews consisted of sociodemographic items, the Beck Depression Inventory (BDI-II), the Prenatal Psychosocial Profile (PPP), 3 items from the Jarel Spiritual Well-Being Scale, the Spiritual Perspective Scale, and 4 items on health risk behaviors. Twenty-seven percent of the women reported depressive symptoms at levels indicating risk for clinical depression. However, there were no significant differences between African American and Caucasian women. Sociodemographic factors accounted for 13% of the variance (P < .01) in BDI-II scores. Psychosocial and behavioral risk factors accounted for an additional 19% of the BDI-II variance (P < .001), and psychosocial and spiritual resources accounted for 7% of the variance (P < .001), resulting in these variables accounting for 54% of the total variance in BDI-II scores. Higher levels of stress, lower levels of self-esteem and social support, and higher religiosity had a significant relationship with more symptoms of depression. This supports the need to routinely screen for and to assess factors associated with depressive symptoms in pregnant low-income women.

Suppression of Lewis lung tumor development in alpha 1,3 galactosyltransferase knock-out mice.

BACKGROUND: Humans lack the gene alpha 1,3 galactosyltransferase (GalT) and instead produce abundant cytolytic antibodies against cells bearing the antigen [gal alpha1,3 gal] (alphaGal). We have previously studied humoral anti-alphaGal responses in GalT knock-out (GalT KO) mice and shown that murine anti-alphaGal IgM, like human anti-alphaGal IgM, causes extensive complement-mediated cytolysis of GalT+ murine Lewis Lung carcinoma cells (LLCa) in vitro. Here we test the hypothesis that anti-alphaGal immune responses can inhibit the in vivo development of GalT+ tumors. MATERIALS AND METHODS: GalT KO mice orally immunized to produce anti-alphaGal antibodies (n =52) and naïve non-immunized KO mice (n=37) were challenged s.c. with 10(5) LLCa tumor cells. Anti-alphaGal antibody titers were measured before and after LLCa challenge. RESULTS: Anti-alphaGal IgM titers present at challenge correlated with protection from tumor development (p<0.04). Seventy-five percent of mice with titers > or = 1:1280 remained tumor-free versus 43% of naïve mice. Tumor onset was delayed in mice with circulating anti-alphaGal IgM versus naïve animals (p=0.02). LLCa challenge itself induced and augmented anti-alphaGal IgM and post-challenge titers correlated highly with protection from tumor development (p<0.001). No mice with post-challenge anti-alphaGal IgM titers > or = 1:1280 developed tumors, compared to 83% of mice lacking antibody. Inhibition studies showed that 30% of post-challenge IgM recognized LLCa antigens distinct from alphaGal. Anti-alphaGal IgG was low or undetectable both pre- and post challenge and did not affect tumor formation. CONCLUSION: The finding that anti-alphaGal IgM suppresses GaIT+ tumor development in vivo supports the premise that immunotherapy using GalT expression can utilize human anti-alphaGal responses and induce significant anti-tumor effects.

The relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury.

The predictive utility of the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) in relation to rehabilitative potential and functional outcome in traumatic brain injury (TBI) is untested. The purpose of this study was to define the relationship of ISS and GCS to rehabilitative potential using the functional independence measure (FIM) score. Trauma and inpatient rehabilitation (IR) registries were queried for demographic, disposition, and injury scoring data. FIM scores at admission (A) and discharge (D) were assessed including IR FIM gain (G). Analysis of variance was used to examine the relationship of ISS and GCS to FIM with predictive utility investigated through bivariate analysis. Of 5488 patients admitted to a Level I trauma center (1999-2000) 1437 suffered TBI with 285 (20%) entering IR. Compared with low-ISS patients the high-ISS patients had significantly lower FIM-A and FIM-D, but FIM-G was static. GCS results were similar, excluding FIM-G which was significantly higher for GCS < or = 8 compared with GCS > 8. Bivariate analysis revealed no ISS correlation with FIM-G (r = 0.16) and a weak GCS correlation (FIM-G r = -0.15). As prospective predictive measures ISS and GCS correlate weakly with rehabilitative potential in TBI patients. Severely injured patients including those with severe TBI have a rehabilitative gain toward functional independence that is similar to that of when compared with those less severely injured.

Impacting cultural attitudes in African-American women to decrease breast cancer mortality.

BACKGROUND: Over the past decade breast cancer mortality has decreased 1% or 2% per year in white women, but not in African-American women. The resulting "mortality gap" is a serious national problem, and it must be a high priority to understand the reasons for it and develop solutions. METHODS: The literature is reviewed to elucidate reasons for the mortality gap and the current status of possible solutions to the problem. In addition, new results of large population-based surveys in North Carolina are presented that may shed light on the problem. RESULTS: The most important reason for the mortality gap is that African-American women tend to be diagnosed with more advanced stage breast cancer than white women. This is due both to lower utilization of screening mammography and to delayed presentation for women with palpable lumps. This is related both to socioeconomic factors that influence access to medical care and to cultural factors that tend to discourage women from seeking care early for breast problems. CONCLUSIONS: Understanding the cultural beliefs that influence patient behavior will greatly aid physicians in caring for their African-American patients, and ultimately may help reduce the racial gap in breast cancer mortality.

Muscle fiber type is associated with obesity and weight loss.

The purpose of this study was to test the hypothesis that muscle fiber type is related to obesity. Fiber type was compared 1) in lean and obese women, 2) in Caucasian (C) and African-American (AA) women, and 3) in obese individuals who lost weight after gastric bypass surgery. When lean (body mass index 24.0 +/- 0.9 kg/m(2), n = 28) and obese (34.8 +/- 0.9 kg/m(2), n = 25) women were compared, there were significant (P < 0.05) differences in muscle fiber type. The obese women possessed fewer type I (41.5 +/- 1.8 vs. 54.6 +/- 1.8%) and more type IIb (25.1 +/- 1.5 vs. 14.4 +/- 1.5%) fibers than the lean women. When ethnicity was accounted for, the percentage of type IIb fibers in obese AA was significantly higher than in obese C (31.0 +/- 2.4% vs. 19.2 +/- 1.9%); fewer type I fibers were also found in obese AA (34.5 +/- 2.8% vs. 48.6 +/- 2.2%). These data are consistent with the higher incidence of obesity and greater weight gain reported in AA women. With weight loss intervention, there was a positive relationship (r = 0.72, P < 0.005) between the percentage of excess weight loss and the percentage of type I fibers in morbidly obese patients. These findings indicate that there is a relationship between muscle fiber type and obesity.

Identification of teaching excellence in operating room and clinic settings.

BACKGROUND: A system for obtaining learner feedback on surgical faculty teaching is a program-specific resource for recognizing faculty accomplishments as well as being a requirement of the Accreditation Council for Graduate Medical Education (ACGME). This investigation uses 5 years of feedback from residents to identify surgical teaching behaviors that define teaching excellence. METHODS: Between 1995 and 1999 full-time surgeons in a division of general surgery were evaluated biannually by every resident on their services, using two 10-item Likert scales to assess frequency of performing selected teaching behaviors. Response categories ranged from 0 (does not demonstrate) to 4 (demonstrates the behavior to a very high degree). Mean scores > or =3.7 (1 SD above the mean) were categorized as evidence of superior teaching, whereas mean scores < or =2.4 (1 SD below the mean) were categorized as mediocre. Residents wrote statements identifying teaching strengths. RESULTS: There were 753 individual resident assessments of 16 faculty. The overall mean rating for operating room and clinic teaching was 3.1, with 24% of the ratings > or =3.7 and 14% of the ratings < or =2.4. For operating room, discriminant behaviors were: demonstrates sensitivity to resident learning needs (3.85 versus 1.62, P <0.01) and provides direct feedback (3.60 versus 1.27, P <0.01). Residents' statements yielded themes tied to superior teaching: demonstrates technical expertise, allows resident participation, and maintains a learning climate of respect. CONCLUSIONS: A resident-based teaching assessment system can offer a reasonable and valid form of feedback to academic surgeons. The use of mixed methods to identify teaching behaviors that characterize excellence informs faculty of how they are perceived as educators and provides examples of specific behaviors that merit commendation.