Symptom frequency and exposure to a cyanobacteria bloom in Florida.

This investigation was undertaken to characterize health effects associated with a major bloom of blue-green algae due to the proliferation Microcystis aeruginosa that occurred in Florida in 2018. Cyanobacteria produce multiple toxins, including the potent hepatotoxic microcystins (MCs), that have been reported to cause illness in exposed persons worldwide. Widespread exposure to toxins released by blue-green algae during the 2018 bloom was shown by the presence of MCs in the nasal passages of 95 percent of the individuals studied previously in south Florida (Schaefer et al., 2020). The current analyses were conducted to determine whether self-reported symptoms were associated with activity patterns, direct contact with water, residential, recreational, and occupational exposure. The 125 persons who participated in the initial study reported an average of 4.94 (± 4.87) symptoms. Those reported most commonly included rhinorrhea, sneezing, headache, sore throat and dry cough. Respiratory symptoms were reported by 74%, ocular symptoms by 62%, and gastrointestinal symptoms by 35% of respondents. Residential and recreational exposures were associated with increased risks of respiratory, gastrointestinal, or ocular symptoms in univariate and adjusted multivariable analyses. Residential exposure was significantly associated with increased reporting of dry cough (p = 0.03), dyspnea (p < 0.01) and wheezy respirations (p = 0.04). Among persons reporting gastrointestinal symptoms, nausea (p = 0.02) and abdominal pain (p < 0.01) were significantly associated with residential exposure. Recreational exposure was significantly associated with sore throat and eye irritation. The findings add to the evidence that exposure to cyanobacteria at concentrations encountered during an algal bloom is associated with a diverse array of symptoms and that inhalation of aerosols constitutes an important exposure pathway.

Measurement of Microcystin Activity in Human Plasma Using Immunocapture and Protein Phosphatase Inhibition Assay.

Microcystins are toxic chemicals generated by certain freshwater cyanobacteria. These chemicals can accumulate to dangerous levels during harmful algal blooms. When exposed to microcystins, humans are at risk of hepatic injury, including liver failure. Here, we describe a method to detect microcystins in human plasma by using immunocapture followed by a protein phosphatase inhibition assay. At least 279 microcystins have been identified, and most of these compounds share a common amino acid, the Adda side chain. We targeted this Adda side chain using a commercial antibody and extracted microcystins from human samples for screening and analysis. To quantitate the extracted microcystins, we fortified plasma with microcystin-LR, one of the most well-studied, commonly detected, and toxic microcystin congeners. The quantitation range for the detection of microcystin in human plasma using this method is 0.030-0.50 ng/mL microcystin-LR equivalents. This method detects unconjugated and conjugated forms (cysteine and glutathione) of microcystins. Quality control sample accuracies varied between 98.9% and 114%, with a precision of 7.18-15.8%. Finally, we evaluated plasma samples from a community health surveillance project of Florida residents living or working near harmful algae blooms.

Perceptions of Breastfeeding for Women with Perinatal Depression: A Descriptive Phenomenological Study.

Women with perinatal depression have an increased risk for breastfeeding cessation, yet few studies have explored their lived experience. In this qualitative study, semistructured interviews were conducted with a purposeful sample of women (N = 10) who self-reported perinatal depression. Using Giorgi's descriptive phenomenological method of data analysis, five components were found to embody their lived experience of breastfeeding: (a) choosing selflessness, (b) harboring inadequacy, (c) deliberate persevering, (d) discerning meaning, and (e) cherishing intimacy. Findings contribute to understanding the experience of breastfeeding for this population and could provide guidance to improve lactation management and perinatal mental health education for nurses.

The Invisibility of Spiritual Nursing Care in Clinical Practice.

Background and Purpose: Spirituality has been identified as the essence of being human and is recognized, by many health care professionals, as a central component in health and healing. Scholars have identified spiritual nursing care as essential to nursing practice and include caring for the human spirit through the development of relationships and interconnectedness between the nurse and the patient. However, despite the recognition of spiritual practices as important to health, little attention has been given to spirituality in nursing practice and education in the literature. The purpose of this article is to explore factors contributing to the invisibility of spiritual nursing care practices (SNCP), recognition and offer strategies to enhance the visibility of SNCP. Two major factors that reduce visibility of SNCP are conceptual confusion differentiating between spirituality and religion and limited education in the area of spirituality including nursing curricula and organizations. Strategies to enhance visibility of SNCP include educational approaches in nursing curricula and health care organizations. to influence nurses' perceptions about spirituality and creation of a culture of spiritual care. Conclusion: Holistic nursing includes assessing and responding to the spiritual needs of patients. Changes in nursing education and health care systems are needed to increase the visibility of SNCP.

Narratives of older persons' frailty and physical activity in relation to environmental landscapes and time.

AIMS AND OBJECTIVES: The objective of this study was to explore the influence of the environmental landscape on the physical activity of older persons experiencing frailty. BACKGROUND: This manuscript describes the second phase of an unpublished larger study in the northern province of Lampang, Thailand. Phase One revealed that 14% of 1,788 older persons surveyed were found to have experienced frailty according to Fried's frailty phenotypes, and low physical activity was associated with frailty. In the light of frailty, how older persons experience physical activity in their day-to-day living environments warrants in-depth exploration. DESIGN: This was a qualitative study guided by narrative inquiry. METHODS: In-depth interviews and observations were conducted with 13 older persons living with frailty. The method of analysis was thematic and performance analysis. RESULTS: Two broad themes relating to the environmental landscapes were as follows: (a) limiting environmental landscapes and (b) engaging environmental landscapes. These landscapes, which change across time, refer to physical and social spaces, and beliefs of older persons and their family that have either positive or negative impacts on physical activity of frail older persons. CONCLUSION: Complex interactions between physical and social spaces and beliefs of older persons and family influence the physical activity behaviours of older persons living with frailty. IMPLICATIONS FOR PRACTICE: This study warrants education and policy aiming at creating optimal environmental landscapes to promote physical activity in frail older persons.

NASN Special Interest Groups: Their Growth and Development Through the Years.

Over the past 25 years, the roles of school nurses have been both expanding and specializing in public and non-public school settings. To help meet the ever-changing and demanding challenges that specialized school nurses encounter in their unique settings, NASN embraced the idea that school nurses need a way to connect with colleagues working in similar practices. Thus, special interest groups (SIGs) were established, and the SIGs have become an integral part of NASN.

Town & Gown.

Innovative approaches for building "town and gown" relationships between practicing school nurses, community partners, and universities/colleges are presented through exemplars relating to research, education, policy, and practice. The exemplars demonstrate the critical factors of successful partnerships as validated by their outcomes.

End of Life in a Haitian American, Faith-Based Community: Caring for Family and Communal Unity.

This article presents two models resulting from a grounded theory study of the end-of-life decision-making process for Haitian Americans. Successful access to this vulnerable population was achieved through the faith-based community. The first model describes this faith-based community of Haitian Americans. The second model describes the process used by families in this community who must make end-of-life healthcare decisions. Implications for nursing practice and caring science include a need to improve the congruence between the nursing care provided at this vulnerable time and the cultural values of a population.

Social Media Use by Transplant Recipients for Support and Healing.

Transplant recipients use a diverse support network that now includes transplant-related social media support groups. The purpose of this study is to explore the use of social media sites by transplant recipients as a potential source of support and healing and the usefulness of Internet postings as a source of rich qualitative data. A qualitative descriptive design was used for the study. A total of 126 retrospective postings from 58 participants were analyzed as they existed on this open publically available Web site over a 20-month period from the selected discussion threads. Two major themes emerged from the data: sharing overwhelming gratitude and finding sanctuary. Sharing overwhelming gratitude was expressed in emotional postings about feelings and letters to donor families. Finding sanctuary described the recipients' perception of the online community as a safe and nonjudgmental environment to discuss sensitive issues and feelings. This study adds to what is known about the unique psychological and emotional needs of transplant recipients. Transplant-related support Web sites offer the opportunity to learn what matters most to transplant recipients and identify gaps in care related to calls for nursing.

On Virtual Presence.

Advances in health care and communication technology have expanded nursing practice to nontraditional environments that preclude the physical presence of the nurse for a caring encounter. An increasing number of nurses are creating and maintaining nurse-patient relationships and practicing in a diverse range of specialties in virtual/distance environments. Can nursing presence as a caring modality be "real" in a virtual/distance environment? A new ontology of nursing presence is offered that transcends people, place, space, and time.

Clarifying a vision for health literacy: a holistic school-based community approach.

Health literacy has come to the forefront as an emerging health issue. Processes are needed to incorporate health literacy across community-wide settings. The purpose of this article is to describe the process used to assist community partners in a school health program in clarifying their vision of health literacy from which a more holistic approach to the care of school-aged children and the community was co-created.

Psychometric testing of the Gordon Facial Muscle Weakness Assessment Tool.

School nurses may be the first health professionals to assess the onset of facial paralysis/muscle weakness in school-age children. The purpose of this study was to test the psychometric properties of the Gordon Facial Muscle Weakness Assessment Tool (GFMWT) developed by Gordon. Data were collected in two phases. In Phase 1, 4 content experts independently rated each of the 22 items on the GFMWT for content relevance. The ratings were used to generate Item and Scale Content Validity Index (CVI) scores. In Phase 2, school nurses (N = 74) attending a state conference independently rated referral urgency on a set of 10 clinical scenarios using the GFMWT. The GFMWT had an item and scale CVI of 1.0. Overall, the interrater reliability was .602 (p < .001). When used by school nurses, the GFMWT was shown to be both a reliable and a valid tool to assess facial muscle weakness in school-age children.

Delegation guided by school nursing values: comprehensive knowledge, trust, and empowerment.

As health care institutions in the United States respond to shrinking budgets and nursing shortages by increasing the use of unlicensed assistive personnel (UAP), school nursing practice is changing from providing direct care to supervising activities delegated to UAP. Therefore, delegation is a critical area of concern for school nurses. The purpose of this qualitative research study was to explore values guiding the delegation of health care tasks to UAP in school settings from the perspective of the school nurse. An inquiry focus group was conducted with 64 Florida school nurses. Values guiding delegation were comprehensive knowledge, trust, and empowerment. These values provided a framework for guiding the delegation process.

Bell's palsy in children: role of the school nurse in early recognition and referral.

Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle weakness in children. Because facial palsy and muscle weakness may be an indicator of a serious or life threatening condition, the school nurse plays a critical role in early recognition and referral. The Gordon Facial Muscle Weakness Assessment Form is presented as a tool designed to assist school nurses in recognizing children with facial muscle weakness and in determining whether a primary health care provider referral should be considered immediate or urgent.

Shared vulnerability: a theory of caring for children with persistent head lice.

Head lice infestation is a worldwide phenomenon that affects persons of all ages. For reasons that are not entirely clear, a number of children experience persistent head lice infestations lasting weeks, months, or years. Little is known about the impact of caring for children with persistent head lice on parents/caregivers. The purpose of this grounded theory study is to explore how parents and caregivers manage caring for children with persistent head lice. Data were obtained through participant observation and in-depth interviews with a purposive sample of 20 parents/caregivers of school-age children with persistent head lice. The researcher identified a 4-stage process of shared vulnerability used by parents/caregivers to manage caregiver strain associated with caring for children with persistent head lice. The four stages included (a) being ostracized, (b) losing integrity of the self, (c) struggling with persistence, and (d) managing strain.

The usefulness of the community nursing practice model in grounding practice and research: narratives from the United States and Africa.

A community nursing practice (CNP) model is presented as the synthesis of a decade of experience of caring for persons and communities. Values form the basis of the model and provide the grounding for practice. Transcendent values of respect, caring, and wholeness are explicated in the actualizing values of primary health care: access, essentiality, empowerment, intersectoral collaboration, and community participation. Usefulness of the CNPM in providing a framework for community nursing practice at school-based community wellness centers in both the United States and Africa is described. Narratives of practice and research presented in the unique voice of three faculty members illuminate the model's values and paradigmatic view of person, nursing, community, and environment. These narratives provide insight into how the CNPM has served as a heuristic in the design of creative responses to calls for nursing in community nursing practice, education, and research.

Development of a school nursing research agenda in Florida: a Delphi study.

Research is important to the image, visibility, and viability of school nursing. Each state school nursing association should evaluate member commitment to school nursing research based on their unique set of financial, educational, and organizational resources. A 3-round Delphi study was conducted in which Florida school nurses identified research priorities. The 10 priority research topics were (a) obesity/nutrition, (b) role of the school nurse, (c) legal/ethical issues, (d) emergencies, (e) health education, (f) absenteeism/attendance, (g) diabetes and insulin, (h) injuries, (i) health services, and (j) asthma. These topics form the state research agenda and will be used to guide the development of multisite school nursing studies.