A systematic review of U.S. nursing faculty's knowledge, awareness, inclusion, and perceived importance of sexual and gender minority-related content in nursing curricula.

BACKGROUND: In the US, sexual and gender minority (SGM) individuals continue to experience health inequities, and nursing curricula content and nursing faculty with SGM health expertise in the US remain limited. Addressing health disparities begins with the preparation of future nurses-US nursing faculty must be supported to meet these growing needs. PURPOSE: To describe, appraise, and synthesize research from 2000-2020 on US nursing faculty knowledge, awareness, inclusion, and perceived importance of SGM health content. METHODS: Following PRISMA 2020 guidelines, we registered a systematic review and appraisal protocol in PROSPERO, and then executed the protocol and synthesized the literature. DISCUSSION: We found an empirical evidence base surrounding US nursing faculty and SGM health much more limited than expected. Only four cross-sectional, descriptive empirical articles fit the a priori inclusion criteria. The studies were of moderate quality at best and often relied on unvalidated or older measures. In general, the studies focused on examining characteristics of nursing programs, faculty comfort with content, faculty perceptions of content importance, and hours dedicated to content. CONCLUSION: Since the close of the review, new commentaries and editorials expanding the call for change in the US were published-the time for commentary has passed. It remains unclear whether US nursing faculty are adequately prepared to educate future nurses about SGM health issues-and an unprepared healthcare workforce is yet another barrier to SGM health equity. The evidence base supporting US nursing faculty development desperately needs more studies using rigorous methodologies.

Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting.

PURPOSE: This study aims to identify the incidence and risk/protective factors for (1) unplanned emergency department (ED) visits and hospital admissions (HA) and (2) nausea/vomiting/dehydration (NVD) at time of treatment in older adults under treatment for cancer. MATERIALS AND METHODS: This is a exploratory retrospective cohort study of adults (60 and older) with cancer. Adults were included if they had a new cancer diagnosis and were being treated with chemotherapy. Study outcomes included the number of ED visits and HA (cycles 1-4) and NVD at the time of receiving chemotherapy (cycles 2-4). Repeated measures, Poisson regression was used to obtain risk ratios with 95% confidence intervals for independent predictors of outcomes. RESULTS: Of 402 study participants, 20% experienced an ED visit, and 18% experienced a HA. Common reasons for ED visits were pain (23.5%) and NVD (20.4%). Common reasons for HA were infection (34.4%) and NVD (22.2%). Multivariate analysis showed risk factors for ED visits included chemotherapy cycle 1, having esophageal cancer, being treated with ≥ 3 chemotherapy agents, and increasing levels of functional impairment. Risk factors for HA included chemotherapy cycle 1, increasing levels of functional impairment, intravenous fluids between treatment, and being prescribed antiemetics for home use. Predictors of NVD at time of chemotherapy treatment included Hispanic ethnicity, insurance status, cancer type, chemotherapy emetic potent, treatment frequency, intravenous fluids between cycles, and number of home antiemetics. CONCLUSION: Unplanned ED visits and HA occur in older adults under treatment for cancer due to numerous treatment-related side effects. Helping older adults identify and manage side effects early may reduce the number of unplanned admissions.

Effects of an eHealth Intervention on Patient-Provider Interaction and Functional Health Literacy in Adults With Hypertension.

INTRODUCTION: Hypertension is a life-limiting, chronic condition affecting millions of Americans. Modifiable factors, quality of the patient-provider interaction and functional health literacy, have been linked to effective hypertension self-management. However, there has been limited interventional research targeting these modifiable factors. Electronic hypertension self-management interventions, in particular those incorporating virtual simulation, may positively influence the quality of the patient-provider interaction and functional health literacy status of adults with hypertension. Yet there is a dearth of evidence examining the efficacy of eHealth interventions targeting these modifiable factors of hypertension self-management. OBJECTIVE: Evaluate the effects of two electronic hypertension self-management interventions on the quality of the patient-provider interaction and functional health literacy in adults with hypertension. METHODS: A convenience sample of community-dwelling adults (>18 years) with hypertension were recruited and randomized to an avatar-based simulation (eSMART-HTN) or a video presentation on hypertension self-management (attention control). Participants were administered questionnaires to capture demographic characteristics, the quality of the patient-provider interaction, and functional health literacy. Questionnaire data were collected at baseline, and then monthly across three months. Two separate repeated measures analysis of covariance models were conducted to assess the effects of the interventions across the time points. RESULTS: The sample included 109 participants who were predominately middle-aged and older, nonwhite, and female. Scores for the quality of the patient-provider interaction demonstrated significant within-group changes across time. However, there were no significant differences in the quality of the patient-provider interaction or functional health literacy scores between experimental conditions while adjusting for covariates. CONCLUSION: An avatar-based simulation (eSMART-HTN) intervention proved to have a positive effect on patient-provider interaction compared to an attention control condition. Although the results are promising, future research is needed to optimize the effectiveness of eSMART-HTN and enhance its efficacy and scalability in a larger cohort of adults with hypertension.

Using Serious Games to Increase Prevention and Self-Management of Chemotherapy-Induced Nausea and Vomiting in Older Adults With Cancer.

OBJECTIVES: To examine the frequency and types of preventive and self-management behaviors reported by participants, as well as report acceptability and usability data for the electronic Symptom Self-Management Training-Chemotherapy-Induced Nausea and Vomiting (CINV) serious game. SAMPLE & SETTING: 80 adults who were aged 60 years or older and newly diagnosed with cancer were recruited from a community cancer center. METHODS & VARIABLES: Participants were randomized to an intervention or control group. A symptom management checklist was used to record preventive and self-management behaviors used after each chemotherapy treatment at home. Acceptability and usability were assessed using a brief survey. RESULTS: The intervention group reported using more preventive behaviors, and the control group reported using more self-management behaviors. Antiemetics were the most common strategy used, followed by dietary strategies. Participants rated all aspects of the serious game highly for usability and acceptability. IMPLICATIONS FOR NURSING: Oncology providers can help older adults plan for self-managing treatment-related side effects at home. Recording self-management behaviors may reinforce the importance of active prevention and management of CINV.

Conflicts Within the Discipline of Nursing: Is There a Looming Paradigm War?

This paper presents a view of the current sources of potential conflicts in the academic discipline of nursing. It suggests that these conflicts could lead, in the Kuhnian sense, to a paradigm war. The differing paradigms underlying the education and traditions of the PhD prepared nurse scientist/researcher/scholar and the DNP prepared nurse practitioner are a challenge for the discipline. DNP programs are swelling and faculty are needed to teach in these programs, and their position with regard to the usual rank and tenure structures of academe are not yet clear. Concern arises when the tenured PhD nurse scientist faculty numbers drop as the DNP faculty numbers increase. The body of nursing science is threatened as fewer students enter PhD programs and faculty retire. The DNP faculty paradigm does not provide for the rigor and preparation need to carry forward the disciplinary scientific knowledge mission. Rather than a fruitless war between the two paradigms, ways are suggested to fully embrace the differences as important to nursing, and to increase the number of PhD prepared nurse scientists.

Intervention Mapping Approach in the Design of an Interactive Mobile Health Application to Improve Self-care in Heart Failure.

Heart failure is a complex syndrome among older adults who may experience and interpret symptoms differently. These differences in symptom interpretation may influence decision-making in symptom management. A well-informed and motivated person may develop the knowledge and skills needed to successfully manage symptoms. Therefore, the patient-centered mobile health application HeartMapp was designed to engage patients with heart failure in self-care management by offering tailored alerts and feedback using mobile phones. The main objective of this article is to describe the six-step intervention mapping approach including (1) the initial needs assessment, (2) proximal program objective, (3) selection of theory-based methods, (4) the translation of objectives into an actual program plan for mobile health intervention, (5) adaptation and implementation plan, and (6) evaluation plan that assisted the team in the development of a conceptual framework and intervention program matrix during the development of HeartMapp. The HeartMapp intervention takes the information, motivation, and behavioral skills model as the theoretical underpinning, with "patient engagement" as the key mediator in achieving targeted and persistent self-care behavioral changes in patients with heart failure. The HeartMapp intervention is proposed to improve self-care management and long-term outcomes.

Construct Validity and Reliability of the Questionnaire on the Quality of Physician-Patient Interaction in Adults With Hypertension.

BACKGROUND AND PURPOSE: There are limited reliable and valid measures of the patient- provider interaction among adults with hypertension. Therefore, the purpose of this report is to describe the construct validity and reliability of the Questionnaire on the Quality of Physician-Patient Interaction (QQPPI), in community-dwelling adults with hypertension. METHODS: A convenience sample of 109 participants with hypertension was recruited and administered the QQPPI at baseline and 8 weeks later. RESULTS: The exploratory factor analysis established a 12-item, 2-factor structure for the QQPPI was valid in this sample. The modified QQPPI proved to have sufficient internal consistency and test- retest reliability. CONCLUSIONS: The modified QQPPI is a valid and reliable measure of the provider-patient interaction, a construct posited to impact self-management, in adults with hypertension.

Zika virus: emergency and aftercare of patients.

Zika virus, a mosquito-borne vector, is an emerging population health threat, and is linked to fetal microcephaly, pregnancy loss and neurologic symptoms like Guillain-Barré syndrome. Global travel and migration increase the risk of transmission significantly, and growing numbers of cases are expected internationally. This article describes transmission of the virus, early and late clinical manifestations, and emergency and supportive care. It also recommends interventions for prevention.

From scientific discovery to health outcomes: A synergistic model of doctoral nursing education.

Across the globe, health system leaders and stakeholder are calling for system-level reforms in education, research, and practice to accelerate the uptake and application of new knowledge in practice and to improve health care delivery and health outcomes. An evolving bi-dimensional research-practice focused model of doctoral nursing education in the U.S. is creating unprecedented opportunities for collaborative translational and investigative efforts for nurse researchers and practitioners. The nursing academy must commit to a shared goal of preparing future generations of nurse scientists and practitioners with the capacity and motivation to work together to accelerate the translation of evidence into practice in order to place nursing at the forefront of health system improvement efforts and advance the profession.

Leveraging the lived experience of surrogate decision makers of the seriously ill to develop a decision support intervention.

BACKGROUND: Surrogate decision makers of seriously ill patients are frequently asked to make healthcare decisions without evidence-based decision support. AIMS: To describe the lived experiences of surrogate decision makers who have made advance care decisions and identify relevant features of a decision support intervention from their perspectives. METHODS: A convenience sample of surrogate decision makers (n=10) of seriously ill patients discharged to an extended care facility within the past 6 months participated in focus group discussions. Data were analyzed using content analysis. RESULTS: Three salient themes were identified: (1) limited preparation, (2) decisional and emotional burden, and (3) content and features of a decision support intervention. CONCLUSIONS: Surrogate decision makers of the seriously ill are not prepared for their new role, and experience decisional and emotional burden. Effective decision support interventions must address the decisional and emotional needs of surrogate decision makers to enhance the quality of their decisions.

Validation of an Interaction Model of Health Behavior Among Adults With Hypertension.

The purpose of this study was to test the Interaction Model of Client Health Behavior among adults with hypertension. The predictive associations among health literacy, quality of the provider interaction, perceived communication skills, and behavioral activation on blood pressure control were examined. Participants were 109 adults with hypertension recruited from community settings. A path analysis using maximum likelihood estimation was conducted in Analysis of Moment Structures for Windows (AMOS). The model fit to these data was excellent (χ(2) = 1.1, p = .76, Tucker-Lewis index [TLI] = 1.1, comparative fit index [CFI] = 1.0, root mean square error of approximation [RMSEA] = .00, standardized root mean residual [SRMR] = .03). As hypothesized, health literacy, quality of the provider interaction, and perceived communication skills directly affected behavioral action. The quality of the provider interaction, perceived communication skills, and behavioral activation had direct effects on systolic blood pressure control. The study results support health literacy screening and communication skill building, and improving the quality of provider interactions to enhance blood pressure control among adults with hypertension.

Assessing the Critical Parameters of eSMART-MH: A Promising Avatar-Based Digital Therapeutic Intervention to Reduce Depressive Symptoms.

PURPOSE: To assess, from the young adults' (YAs') perspectives, the critical parameters (necessity, acceptability, feasibility, fidelity, and safety) of an avatar-based intervention, eSMART-MH, to reduce depressive symptoms. DESIGN AND METHODS: YAs (n = 60) were randomly assigned to eSMART-MH or control and observed for 12 weeks. Qualitative and quantitative data were collected. FINDINGS: Necessity, acceptability, fidelity, and safety of eSMART-MH were supported. Feasibility results were mixed. When benchmarked against usual care, eSMART-MH demonstrated greater feasibility. PRACTICE IMPLICATIONS: eSMART-MH is a promising digital therapeutic for depressive symptoms. Feasibility can be strengthened through "on the go" access via mobile devices and Internet delivery.

Assessing and managing spider and scorpion envenomation.

Envenomation by spiders or scorpions is a public health problem in many parts of the world and is not isolated to the tropics and subtropics. Spiders and scorpions can be unintentionally transported globally, and keeping them as pets is becoming more popular, so envenomation can occur anywhere. Emergency nurses should be prepared to assess and treat patients who present with a bite or sting. This article gives an overview of the signs, symptoms and treatment of envenomation by species of arachnids that are clinically significant to humans.

CREATING A SERIOUS GAME FOR HEALTH.

The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health.

WAIT, WON'T! WANT: BARRIERS TO HEALTH CARE AS PERCEIVED BY MEDICALLY AND SOCIALLY DISENFRANCHISED COMMUNITIES.

OBJECTIVES: We explored barriers to healthcare as perceived by members of medically and socially disenfranchised communities. METHODS: We conducted focus groups with 28 women and 32 men from Northeast Ohio who identified themselves as African-American, Hispanic/Latino, lesbian/gay/bisexual/transgendered, and/or Russian immigrant. RESULTS: Participants described their experiences of waiting, things they won't tolerate, when they won't participate, and what they want from providers. They described behaviors, actions and relationship characteristics that they want from their providers and characteristics that they prefer in health systems. CONCLUSIONS: The themes of Wait, Won't, and Want have healthcare practice and policy implications. Patient-provider interactions are known to be significant determinants of healthcare outcomes and these exploratory findings suggest that they might also affect patient self-management strategies. Future efforts should focus on developing and testing patient-centered strategies that address the themes identified to increase engagement to increase self-management of health.