Sharing Perspectives in African American Communities to Reduce Stroke Risk Through Community Listening Circles.

PURPOSE: To build trust and explore community perception on stroke disparities as well as barriers and strengths to stroke prevention. DESIGN: Mixed methods study. METHODS: A convenience sample (n = 54) of African Americans responded to questionnaires and participated in focus groups. FINDINGS: Although a majority of participants had some knowledge of stroke warning signs and risk factors, there were misconceptions identified through the Community Listening Circles (CLCs). Misconceptions about stroke were identified. Six key themes emerged. CONCLUSIONS: Focus groups provided a better understanding of stroke perception. CLINICAL EVIDENCE: Community health nurses may be able to use this information to provide care appropriately.

Toward a Better Understanding of Sex- and Gender-Related Differences in Endovascular Stroke Treatment: A Scientific Statement From the American Heart Association/American Stroke Association.

There are many unknowns when it comes to the role of sex in the pathophysiology and management of acute ischemic stroke. This is particularly true for endovascular treatment (EVT). It has only recently been established as standard of care; therefore, data are even more scarce and conflicting compared with other areas of acute stroke. Assessing the role of sex and gender as isolated variables is challenging because they are closely intertwined with each other, as well as with patients' cultural, ethnic, and social backgrounds. Nevertheless, a better understanding of sex- and gender-related differences in EVT is important to develop strategies that can ultimately improve individualized outcome for both men and women. Disregarding patient sex and gender and pursuing a one-size-fits-all strategy may lead to suboptimal or even harmful treatment practices. This scientific statement is meant to outline knowledge gaps and unmet needs for future research on the role of sex and gender in EVT for acute ischemic stroke. It also provides a pragmatic road map for researchers who aim to investigate sex- and gender-related differences in EVT and for clinicians who wish to improve clinical care of their patients undergoing EVT by accounting for sex- and gender-specific factors. Although most EVT studies, including those that form the basis of this scientific statement, report patient sex rather than gender, open questions on gender-specific EVT differences are also discussed.

Peer Group Support Intervention to Reduce Cardiovascular Disease Risk for African American Men According to Life's Simple 7 in Faith-Based Communities.

BACKGROUND AND PURPOSE: Adverse cardiovascular health disparities persist for African American men. Although changing health behaviors is perhaps one of the most effective methods to prevent cardiovascular disease (CVD)-related deaths, previous behavior change programs targeting single or multiple CVD risk factors in target groups have had mixed success. The purpose of this pilot study was to determine whether a multi-faceted peer group intervention model based on American Heart Association's Life's Simple 7 was feasible, safe, acceptable, and efficacious in producing meaningful risk reduction for African American men. METHODS: A convenience sample of 24 African American men with at least one CVD risk factor participated quasi-experimental study having peer intervention vs. nonequivalent comparison groups, with pretest-posttests at two church sites in Minneapolis, MN (MPLS) and Washington, D.C. (DC). Feasibility, safety, acceptability, and potential efficacy were assessed by examining completion of peer group sessions, adverse events, attendance, attrition, within and between-group changes in measures using nonparametric statistics. RESULTS: All twenty-four men completed the study with no study-related adverse symptoms and medical events. The peer groups had moderate to high attendance, and the peer program evaluation was highly positive among participants. Between baseline and 6-months, there were significant differences between the intervention and the comparison group in cholesterol levels and weights (p = .041, p = .034, respectively) at one site (DC). There were no significant between-group changes at the other site (MPLS). IMPLICATION FOR PRACTICE: The multi-faceted peer support intervention was feasible, acceptable, and shown to have potential efficacy to reduce CVD risk for highly motivated African American men. Future studies with a larger sample size are needed to test the effectiveness of this intervention model to reduce CVD risk among African American men.

End-Of-Life Care Communication in Long-Term Care Among Nurses, Residents, and Families: A Critical Review of Qualitative Research.

RNs in long-term care (LTC) are a critical nexus for end-of-life (EOL) care communication with older adult residents and their families. A critical review of 17 qualitative research studies examined nurses' experience with EOL care in LTC. Findings indicate that time, preparation, advocacy, organizational resources, and a continuous, relational approach support EOL care communication. Regulatory burdens, understaffing, workflow demands, family and organizational dysfunction, anxiety, and depression impede EOL care communication. The current review revealed a gap in the literature describing LTC RNs' unique perspectives and knowledge regarding EOL care communication with residents and families. There is a current, pressing need to understand the facilitators LTC RNs use to overcome obstacles to effective EOL care communication. Future research could inform clinical practice guidelines and EOL care nursing education, enhancing LTC nurses' capacity to develop trust-based relationships and improving the efficacy of current EOL care communication interventions in LTC. [Journal of Gerontological Nursing, 47(7), 43-49.].

Association between Family History of Stroke and Stroke Risk: A Community Survey.

Approximately 20% of the annual 795,000 stroke occurrences in the United States are fatal, and survivors face high-risk of long-term disability. The purpose of this secondary analysis of a cross-sectional survey data was to explore the association between individuals' family history of stroke and their stroke risk among Minnesota adults attending the State Fair. The primary study sample (n=207) completed a nine-part survey addressing medical history, stroke risk factor knowledge, and the American Stroke Association stroke risk score. Analysis used descriptive summaries and McNemar's Chi-square test. McNemar's test indicated a significant association between family history of stroke and an individual's stroke risk score (χ2=38.09, p<.001, (n=194)). Of those with and without family history of stroke, 87.1% and 95.5% correctly identified at least one stroke risk factor, respectively. Implications of this secondary data analysis is for nurses to target high-risk populations using primary prevention strategies to reduce stroke occurrence.

Challenges and Lessons Learned Tailoring a Behavioral Intervention for Stroke Survivor-Care Partner Dyads.

INTRODUCTION: Research is increasingly exploring interventions for patient-care-partner dyads, but little has been reported regarding challenges of implementing dyad-focused interventions. This article reports the lessons learned in a pilot feasibility study of problem-solving therapy versus stroke education in stroke survivor-care partner dyads. CHALLENGES AND LESSONS LEARNED: Challenges arose in numerous aspects of intervention delivery. These ranged from personalizing the intervention to meet individual needs and balancing participation between dyad members to maintaining focus, managing conflict, and addressing ethical concerns, all of which required attention from the nurse researcher. These anticipated and unanticipated challenges were addressed using a variety of solutions, including engagement, active listening, redirection, and structured adaptation. IMPLICATIONS FOR PRACTICE: The knowledge gained and lessons learned in this study may be applied to other patient-care-partner dyads and other behavioral therapies. Nurses may also identify opportunities to increase inclusion of care partners in other interventions. Awareness of these challenges may lead to greater success in working with dyads. CONCLUSIONS: Dyad-focused behavioral interventions hold promise for use with stroke survivors and their care partners. They also present unique implementation challenges compared with survivor-only interventions.

Generating Evidence of Critical Care Nurses' Perceptions, Knowledge, Beliefs, and Use of Music Therapy, Aromatherapy, and Guided Imagery.

BACKGROUND: Critical care settings are known to be fast-paced and technologically advanced. To optimize humanistic care, integration of evidence-based complementary and alternative therapies holds promise. However, evidence of critical care nurses' use of complementary and alternative therapies in clinical practice has not been evaluated recently. OBJECTIVES: This study sought to determine critical care nurses' perspectives of music therapy, aromatherapy, and guided imagery (GI) including perceptions of legitimacy, self-reported knowledge, interest in gaining knowledge, beliefs of harm/benefits, professional use, personal use, recommendations for use in critical care practice, and requests for these therapies by critical care patients or families. METHODS: A descriptive cross-sectional design with repeated measures was conducted with critical care nurses (N = 53) practicing in 3 intensive care units at a Midwestern academic-affiliated medical center. The nurses' current perceptions, knowledge, beliefs, and use of music therapy, aromatherapy, and GI were assessed. In addition, an evaluation of the consistency of participants' responses using the Critical Care Nurses' Use of Complementary Therapies survey was performed on a subset of the sample (n = 15) at 2 time points 4 to 6 weeks apart. RESULTS: Most nurses (66%-83%) endorsed the legitimacy of these therapies for use with their patients. Nurses had the most knowledge of aromatherapy, followed by music therapy and GI; they showed interest in gaining further knowledge of the therapies even when reporting "some" to "a lot" of knowledge. Nurses showed a positive response regarding their beliefs about the benefits of each therapy. Professional use was highest for aromatherapy (85%), followed by music therapy (75%), corresponding with greater self-reported knowledge and personal use. A majority recommended aromatherapy (79%) and music therapy in practice (64%) and reported that these therapies were requested by patients or families. Responses on the survey items at 2 time points of administration showed consistency. DISCUSSION: On the basis of the overall survey responses, developing a robust scientific base and addressing educational needs through expanding resources and continuing education programs may promote use of these therapies to benefit patients in critical care.

Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review.

BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning.

Associations between characteristics of stroke survivors and caregiver depressive symptoms: a critical review.

Background: Poststroke depression is common in stroke survivors. Evidence suggests that caregivers of stroke survivors also experience depression, at rates similar to survivors (30-40%). While much research has focused on developing better understanding of poststroke depression in stroke survivors, stroke caregiver depression has received less attention. Available research suggests that characteristics of the survivor such as age, gender, relation to caregiver, mental health, and physical or cognitive deficits correlate with and may be contributing factors for caregiver depression. Knowledge of risk factors for stroke caregiver depression could translate to better screening, management, and prevention, but further investigation is needed. Objectives: To examine the existing literature and synthesize evidence surrounding survivor characteristics and their association with poststroke depressive symptoms in caregivers. Methods: Medline, PsychInfo, and CINAHL databases were searched with variations of keywords: "stroke," "caregiver" and "depression." Studies analyzing associations between at least one stroke survivor characteristic and caregiver depressive symptoms were included. Results: Seventeen studies met eligibility criteria. They analyzed a wide range of survivor characteristics. Many survivor characteristics lacked convincing evidence of an association with caregiver depressive symptoms. However, a trend emerged supporting an association between survivor depressive symptoms and caregiver depressive symptoms. Conclusions: Health-care providers should be aware that depressive symptoms in one member of a stroke survivor-caregiver dyad may indicate risk for depressive symptoms in the other. Screening both individuals may lead to earlier detection and provide information to guide interventions. Knowing risk factors for stroke caregiver depression may improve prevention/management, but further investigation is needed.

Correction to: Power of Peer Support to Change Health Behavior to Reduce Risks for Heart Disease and Stroke for African American Men in a Faith-Based Community.

An error in Fig. 1 in this article as originally published ("Theme 6: feelings of belonging and being care for" was missing the numeral "6") has been corrected. The original article has been corrected.

Power of Peer Support to Change Health Behavior to Reduce Risks for Heart Disease and Stroke for African American Men in a Faith-Based Community.

INTRODUCTION: Peer support has powerful potential to improve outcomes in a program of health behavior change; yet, how peer support is perceived by participants, its role, and how it contributes to intervention efficacy is not known, especially among African Americans. The purpose of this study was to identify the subjectively perceived experience and potential contributions of peer support to the outcomes of a peer group behavioral intervention designed to change health behavior to reduce risks for heart disease and stroke in African American men in a faith-based community. METHODS: A peer support group intervention was implemented to increase health knowledge and to improve health behaviors in line with the American Heart Association's Life Simple 7 domains (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking). Fourteen peer group sessions and eight follow-up interviews with program participants were recorded, transcribed, and analyzed. RESULTS: Seven key themes emerged, including (1) enhancing access to health behavior information and resources, (2) practicing and applying problem-solving skills with group feedback and support, (3) discussing health behavior challenges and barriers, (4) sharing health behavior changes, (5) sharing perceived health outcome improvements and benefits, (6) feelings of belonging and being cared for, and (7) addressing health of family and community. CONCLUSION: Qualitative findings revealed a positive perception of peer support and greater understanding of potential reasons why it may be an effective strategy for African American men.

Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis.

BACKGROUND: Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making. OBJECTIVE: The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process. METHODS: MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes. RESULTS: Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process. CONCLUSIONS: Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.

Part II: The Effects of Aromatherapy and Guided Imagery for the Symptom Management of Anxiety, Pain, and Insomnia in Critically Ill Patients: An Integrative Review of Current Literature.

This review is part II of a 2-part series that presents evidence on the effectiveness of aromatherapy and guided imagery for the symptom management of anxiety, pain, and insomnia in adult critically ill patients. Evidence from this review supports the use of aromatherapy for management of pain, insomnia, and anxiety in critically ill patients. Evidence also supports the use of guided imagery for managing these symptoms in critical care; however, the evidence is sparse, mixed, and weak. More studies with larger samples and stronger designs are needed to further establish efficacy of guided imagery for the management of anxiety, pain, and insomnia of critically ill patients; to accomplish this, standardized evidence-based intervention protocols to ensure comparability and to establish optimal effectiveness are needed. Discussion and recommendations related to the use of these therapies in practice and needs for future research in these areas were generated.

Part I: The Effects of Music for the Symptom Management of Anxiety, Pain, and Insomnia in Critically Ill Patients: An Integrative Review of Current Literature.

Critical care environments are known for provoking anxiety, pain, and sleeplessness. Often, these symptoms are attributed to patients' underlying physiological conditions; life-sustaining or life-prolonging treatments such as ventilators, invasive procedures, tubes, and monitoring lines; and noise and the fast-paced technological nature of the critical care environment. This, in turn, possibly increases length of stay and morbidity and challenges the recovery and healing of critically ill patients. Complementary therapies can be used as adjunctive therapies alongside pharmacological interventions and modalities. One complementary therapy with promise in critical care for improving symptoms of anxiety, pain, and sleeplessness is music. A review of current literature from Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and PubMed was conducted to examine the evidence for the use of this complementary therapy in critical care settings. This review presents the evidence on effectiveness of music for the symptom management of anxiety, pain, and insomnia in critically ill adult patients. The evidence from this review supports music in symptom management of pain, insomnia, and anxiety in critically ill patients. This review provides practice recommendations, generates dialog, and promotes future research. This review is part I of a 2-part series that focuses on evidence for use of music, aromatherapy and guided imagery for improving anxiety, pain, and sleeplessness of patients in critically ill patients.

Nonpharmacological Treatments for Post-Stroke Depression: An Integrative Review of the Literature.

Stroke is the fifth leading cause of death and the number one cause of long-term disability. Seventy-five percent of annual stroke victims are older than 65. Post-stroke depression (PSD) is a common consequence of stroke, with the estimated prevalence ranging from 25% to 79%. Although several studies have investigated the impact of pharmacological interventions on PSD, there is a significant gap in knowledge regarding the efficacy of nonpharmacological measures for treatment of PSD. The purpose of the current integrative literature review was to synthesize the state of knowledge on selected nonpharmacological treatments for PSD and present findings regarding the efficacy of investigated treatments. Twenty-one studies published from 1992-2016 were identified and synthesized. Results indicated that studies demonstrating improvement in depressive symptoms included ecosystem-focused therapy, life review therapy, problem solving therapy, meridian acupressure, repetitive transcranial magnetic stimulation, music therapy, exercise, light therapy, motivational interviewing, and robotic-assisted neurorehabilitation. [Res Gerontol Nurs. 2017; 10(4):182-195.].

Feasibility of a Pilot Study of Problem-Solving Therapy for Stroke Survivors.

PURPOSE: The purpose of this pilot study was to assess the feasibility and potential effectiveness of problem-solving therapy (PST) on stroke survivors' depressive symptoms and function in the rehabilitation stage of recovery. DESIGN: This study employed a repeated measures experimental design. METHODS: We recruited a convenience sample of 22 ischemic stroke survivors and randomized to treatment group receiving PST and control group receiving standard care. FINDINGS: Our recruitment and retention rates were 54% and 81%, respectively. Results for depression scores in the treatment group as compared to the control group indicated clinical significance but not statistical significance (p>.05). Function was not statistically significant. CONCLUSION: Problem-solving therapy is potentially therapeutic for stroke survivors. CLINICAL RELEVANCE: Rehabilitation nurses could be educated on the use of PST as a potential intervention for stroke survivors.

Functional magnetic resonance imaging as experienced by stroke survivors.

Functional magnetic resonance imaging (fMRI), a noninvasive technique that measures brain activation, has been increasingly used in the past decade, particularly among older adults. Use of fMRI in research with stroke survivors in recent years has substantially contributed to researchers' understanding of the pathophysiology of stroke sequelae. However, despite the increasing popularity and use of fMRI, little is known about the patient experience of fMRI under research circumstances. The current research brief reports the findings of a pilot study undertaken to understand stroke survivors' experiences with fMRI under research circumstances. Nine ischemic stroke patients underwent two MRI sessions, each of which lasted 1.5 hours and included several fMRI tasks. Patients were asked about their experiences and to share any advice. All participants reported that they did not feel claustrophobic; in addition, the importance of educating participants about fMRI was a universal theme that emerged. Knowledge of participant experiences may help with enrollment strategies for fMRI studies and improve research outcomes related to the fMRI experience.

A pilot study of the trajectory of functional outcomes in stroke survivors: implications for home healthcare.

This longitudinal, prospective pilot study (N = 23) explored patterns of functional recovery using the functional independence measure (FIM) at 2 weeks, 1 month, and 3 months poststroke. Results showed that the subcategory of self-care had the most observable improvement, whereas communication had the least improvement. Study results have implications for clinicians, as they are instrumental in assessment, and in determination of treatments and level of care required to promote optimal rehabilitation and recovery of function across all dimensions.

Lighting the fire with mentoring relationships.

Mentoring provides fuel to advance nursing science and ensure a growing cadre of career nurse scientists. With the demand for well-prepared nursing faculty in the area of academic geriatrics, mentoring by expert faculty provides an optimal opportunity for retention and growth of junior faculty. Reflecting on 2 years of a mentoring relationship in the Hartford Building Academic Geriatric Nursing Capacity (BAGNC) postdoctoral scholar program, the BAGNC Claire M. Fagin Fellowship, the authors describe the desired attributes of mentoring relationships that were beneficial to the career of the mentored junior faculty member and were satisfying to the mentors. From the perspective of mentors and mentee, the authors describe the stages of a mentoring relationship and the ingredients of this transforming experience, as well as barriers, challenges, rewards, and lessons learned.

Developing grant writing skills to translate practice dreams into reality.

In an era of health care reform and limited financial support, good ideas for changes in clinical practice may await the available time, resources, and attention that are required to test and implement them. Developing grant writing skills is a way to attract resources to explore the feasibility and potential efficacy of changes to improve patient outcomes or efficiencies of care. This article describes the purpose of grant writing by advanced practice nurses (APNs), discusses the needs for and benefits of grant writing, identifies types and sources of available grants, describes potential roles of APNs in grant writing, describes ways to overcome barriers to grant writing, and presents strategies for writing winning grants to develop and improve practice in acute and critical care settings. These strategies will help APNs get started and provide a guide to follow in writing their first grant or will refresh their existing grant writing skills.