Genetic counseling graduate training to address religion and spirituality in clinical practice: A qualitative exploration of programs in North America.

Patients receiving clinical genetics services often navigate emotionally difficult situations and may utilize their faith as a source of support, an aid in decision-making, or a core coping strategy. Although patients have expressed interest in discussing their religious or spiritual (R/S) beliefs with their genetic counselor (GC), GCs may avoid such conversations because they feel they do not have the necessary skills to discuss R/S beliefs (Reis, Baumiller, Scrivener, Yager, & Warren, 2007). This qualitative study explored how GC programs in North America currently prepare their students to discuss R/S matters with their patients. The aims of this study were to identify (1) the R/S topics genetic counseling programs currently cover in the curriculum, (2) how genetic counseling programs evaluate their students within the R/S topics and activities that are included in the curriculum, and (3) the value or importance placed on R/S training by genetic counseling program directors. Leaders of 12 (36%) of the 33 eligible GC programs at the time of the study participated in a semi-structured phone interview. Their responses were coded using open and axial coding techniques and analyzed using grounded theory. Results revealed that R/S issues are often covered during the psychosocial portions of the curriculum through writing assignments, in class exercises, and role plays. Almost all participating programs include information on pastoral care services, but have little to no training about specific R/S beliefs or the use of spiritual surveys. While participating program directors emphasized that it is critical for students to be prepared to hold conversations about patients' R/S beliefs, the strategies used to prepare students are inconsistent and often not evaluated. We provide suggestions for enriching the R/S training in genetic counseling graduate programs in order to prepare students to facilitate discussions around patients' religion and/or spirituality in genetic counseling sessions.

Teaching Critical Care Nursing Online for RNs.

Registered nurses are choosing to further their educational careers by seeking a bachelor's of science degree online (RN-to-BSN). The impetus for choosing the online delivery method is related to the ability to sign into a Learning Management System during times that are advantageous to their hospital work schedules, family, and daily living activities. The RN-to-BSN online option degree requires a Critical Care/Advanced Health Care Course as part of their curriculum plan; therefore, the article presents an overall view of the critical care course, the theoretical underpinnings for progression to the online delivery method, and examples of a module required by the critical care course.

Artificial Differences in Clostridium difficile Infection Rates Associated with Disparity in Testing.

In 2015, Clostridium difficile testing rates among 30 US community, multispecialty, and cancer hospitals were 14.0, 16.3, and 33.9/1,000 patient-days, respectively. Pooled hospital onset rates were 0.56, 0.84, and 1.57/1,000 patient-days, respectively. Higher testing rates may artificially inflate reported rates of C. difficile infection. C. difficile surveillance should consider testing frequency.

Social Skills Training for Adolescents With Autism Spectrum Disorder Using Facebook (Project Rex Connect): A Survey Study.

BACKGROUND: Adolescents with autism spectrum disorder (ASD) spend more time using electronic screen media than neurotypical peers; preliminary evidence suggests that computer-assisted or Web-based interventions may be beneficial for social skills acquisition. The current generation of adolescents accesses the Internet through computers or phones almost daily, and Facebook is the most frequently used social media platform among teenagers. This is the first research study to explore the use of Facebook as a therapeutic tool for adolescents with ASD. OBJECTIVE: To study the feasibility and clinical impact of using a Web-based social platform in combination with social skills training for adolescents with ASD. METHODS: This pilot study enrolled 6 participants (all males; mean age 14.1 years) in an online social skills training group using Facebook. Data was collected on the participants' social and behavioral functioning at the start and conclusion of the intervention. Outcome measures included the Social Responsiveness Scale-2, the Social Skills Improvement System Rating Scale, and the Project Rex Parent Survey. Participants were surveyed at the conclusion of the intervention regarding their experience. RESULTS: No statistically significant differences in measurable outcomes were observed. However, the online addition of Facebook was well received by participants and their parents. The Facebook intervention was able to be executed with a careful privacy protocol in place and at minimal safety risk to participants. CONCLUSIONS: The utilization of Facebook to facilitate delivery of social skills training for adolescents with ASD appears to be feasible, although the clinical impact of such an addition is still unclear. It is important to note that social difficulties of participants persisted with the addition of the online platform and participants still required assistance to engage with peers in an online environment. A Web-based intervention such as the one utilized in this study has the potential to reach a mass number of patients with ASD and could address disparities in access to in-person treatment services. However, the complexity and evolving nature of Facebook's website and privacy settings leads to a number of unique online safety concerns that may limit its clinical utility. Issues encountered in our study support the development of an alternative and closed Web-based social platform designed specifically for the target audience with ASD; this platform could be a safer and more easily moderated setting for aiding in social skills development. Despite a small sample size with no statistically significant improvements of target symptoms, the use of electronic screen media as a therapeutic tool for adolescents with ASD is still a promising area of research warranting further investigation. Our study helps inform future obstacles regarding feasibility and safety.

Meeting the needs of family members of ICU patients.

Health care professionals have begun to view family members as an integral part of the healing process and the well-being of patients in the intensive care unit. The needs of family members may be varied, and nurses must become attuned to the family members' needs and acquire skills to direct interventions toward identifying and meeting those needs. The aim of the research study was to explore and identify the perceptions of family members' needs and to ascertain if those needs were perceived as met or unmet by the family members of patients housed in the intensive care units. The hypothesis proposed that a gap exists between identified needs of family members visiting intensive care patients and their perceptions of needs as being met or unmet. Data analysis included quantitative and qualitative methods.

Concept analysis: compassion fatigue and effects upon critical care nurses.

Walker and Avant's method of concept analysis was used to delve into the initial understanding of compassion fatigue, a relatively new concept being explored with critical care nurses and other health care professionals. The term was originally used in 1992 involving research exploring burnout experienced by critical care nurses when a trend emerged where nurses appeared to have lost their "ability to nurture." The term has since been used synonymously with secondary traumatic stress disorder. Two important goals exist for this article: First, theoretically to conduct a concept analysis of compassion fatigue, thereby providing information for critical care nurses to understand the concept as a universal human experience. Second, from a caring perspective, identifying the effects related to critical care nurses provides an opportunity to address physical and somatic consequences of compassion fatigue that will ultimately become important to nursing practice, education, and research.

Involving patient and family advisors in the patient and family-centered care model.

Health care facilities that utilize patient and family advisors are experiencing improved outcomes in decreased length of stay, and improved reimbursements and patient satisfaction. Patient and family advisors can be strong allies in ongoing performance improvement efforts. Perhaps even more importantly, involving advisors in health care systems encourages treatment of the whole patient as he or she would want to be treated

Supporting the integration of HIV testing into primary care settings.

OBJECTIVES: We examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings. METHODS: We used quantitative process data from 8 regional AETCs for July 1, 2008, to June 30, 2009, and qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of early diagnosis and treatment. RESULTS: Compared with other AETC training, HIV testing training was longer and used a broader variety of strategies to educate more providers per training. During education, providers were able to understand their primary care responsibility to address public health concerns through HIV testing. CONCLUSIONS: AETC efforts illustrate how integration of the principles of primary care and public health can be promoted through professional training.

Introduction to the special issue: toward diversity and cultural competence in genetic counseling.

This introduction provides an overview of the professional issues and original research papers in this special issue. The articles address workforce challenges and/or cross-cultural education and communication with culturally and religiously diverse clients. Additional suggestions are made for moving the profession of genetic counseling toward diversity and cultural competence.

Enriching the genetic counseling recruitment pipeline: a national cross-sectional study of public high school counselors.

Early awareness of careers is helpful in recruiting students into a career pipeline. School counselors are among the top resources that students turn to when seeking advice about choosing their career. Studies show that high school is the ideal time to generate interest in the genetic counseling career, especially for minorities. This novel study of 291 high school counselors working in ethnically diverse public school districts in the United States examined to what extent members of this important group discuss genetic counseling as a career option with their students. The findings indicate that the majority of school counselors in this study (83%) did not discuss genetic counseling with their students, citing a lack of resources and lack of student interest as the major barriers. Suggestions of ways to increase high school counselors' awareness of the genetic counseling career in order to enhance the goal of enriching recruitment of ethnic minorities into the genetic counseling pipeline are presented.

Basic personnel tools to help ensure a future public health and environmental laboratory workforce.

Competition is growing in the United States for a shrinking national pool of qualified laboratory scientists. Public health and environmental laboratories (PHELs) must address this problem using a range of strategies and tools to ensure that a highly technical workforce of PHEL scientists is available in the future. One of these tools is the use of common personnel standards involving job titles and definitions, job classifications and minimum qualifications, and multi-step career paths. This article explains in detail the need for structure and use of common, basic personnel standards in developing and retaining a national workforce of PHEL scientists.

Familial risk for chronic disease and intent to share family history with a health care provider among urban Appalachian women, southwestern Ohio, 2007.

INTRODUCTION: Family history of certain chronic diseases is a risk factor for those diseases. We assessed demographic characteristics associated with familial risk for common diseases and whether familial risk was associated with intent to share family history with a health care provider among urban Appalachian women. METHODS: Urban Appalachian women (N = 88) with less than a college education participated in education sessions about family history in health promotion in southwest Ohio. Participants used My Family Health Portrait, electronically or on paper, to document their level of familial risk. Evaluations completed after each session gauged intent to share family history with a health care provider. RESULTS: Participants who used the paper version of My Family Health Portrait had lower odds of high familial risk for diabetes, heart disease, and stroke. Most participants (n = 62, 77%) reported that they intended to share their family history with a health care provider. Factors associated with intent to share family history included younger age, use of the electronic family history tool, and high familial risk of heart disease. CONCLUSION: The large proportion of women who intended to share family history with a health care provider may reflect the success of the educational component. Since familial risk for chronic disease is high among these urban Appalachian women, the need to share family history should continue to be promoted.

A discussion of family-centered care within the pediatric intensive care unit.

Every year, thousands of children are admitted to pediatric intensive care for treatment. Many of these admissions are for acute injuries, but children with chronic illnesses requiring repeated hospitalization are also on the rise. Hospitalization of a child is extremely stressful for both the patient and family. Historically, intensive care units had restrictive visitation hours and did not allow for sibling visitation or multiple family members. Parents and family members were not encouraged to participate in care when at the bedside. As the shift toward family-centered care continues, many hospitals are now changing visitation policies to allow for active family involvement in patient care. Parents are now encouraged to participate in care. Intensive care units are modifying layouts of the unit to facilitate visitors and provide sleeping spaces for parents when available. Families are considered part of the team instead of visitors, and are included in the decision making process. The purpose of this article is to promote discussion of family-centered care in the pediatric intensive care unit.

A cross sectional study exploring factors impacting recruitment of African American college students into the genetic counseling profession.

African Americans account for about 12.7% of the United States population, but only 1% of the National Society of Genetic Counselors' membership identifies as African American. Since individuals often seek health care from providers sharing similar backgrounds, training genetic counselors from diverse backgrounds is critical. Psychology and biology students (N=552) at four universities completed a self-administered online survey assessing the influence of genetic counseling awareness, demographics, and career decisions on students' interest in pursuing genetic counseling as a career. More African Americans (83%) than Caucasians (62%) reported having chosen a career (p< or = .001). Of the 65% of students who indicated interest in the career description of genetic counseling, fewer African Americans (50%) than Caucasians (74%) had heard of genetic counseling (p< or = .001). Specific strategies to overcome recruiting barriers such as early career selection and lack of awareness of the genetic counseling career among African Americans are suggested.

High school biology/life science teachers' presentation of genetic counseling and health care career options in their classrooms.

Studies show teachers play an influential role in the career decision-making process of students and early knowledge of genetic counseling (GC) increases the likelihood students will consider this career option. This quantitative study is the first to explore the presentation of GC and other health care career options by high school (HS) biology/life science (B/LS) teachers in their classrooms. Our findings indicate most B/LS teachers present GC as a career option to HS students, agree it complements classroom activities, and perceive students as interested in learning about the profession. However, teachers note many barriers to spending class time presenting GC careers. Consequently, a substantial number of teachers spent a minimal amount of time presenting health care careers in general. We discuss ways genetic counselors can enhance career resources, reduce barriers, and foster student interest in pursuing a career in GC by developing partnerships with HS B/LS teachers.

Perceived met and unmet needs of family members of patients in the pediatric intensive care unit.

Extensive research has been conducted over the years with a general focus on the family members of adult patients in the critical care setting. The resulting recognition of the profound impact that the family has on the patients' outcomes has led to greater focus on the direct assessment and identification of perceived met and unmet needs of family members. In contrast to the adult patients needs, this descriptive, exploratory pilot study consisted of 20 family members who had pediatric patients in the pediatric intensive care unit. Families completed a 2-part instrument: the Demographic Data Questionnaire and the Needs Met Inventory. Data were analyzed and reported the top 10 always met/usually met needs and the top 10 never met/sometimes met needs in order of importance during the first 24 to 36 hours after admission of the pediatric patient. The overall items under the subscale assurance ranked the highest as perceived needs always met/usually met. The overall items under the subscale support ranked the lowest as perceived needs never met/sometimes met.

Factors influencing treatment delays for acute myocardial infarction.

Previous studies have supported the fact that delaying medical attention when suffering an acute myocardial infarction may lead to complications such as cardiac dysrhythmias, congestive heart failure, pericarditis, and rupture of heart structures. Gender and culture are often associated with delayed treatment times, with socioeconomic status as a silent interwoven barrier in seeking treatment. Delaying treatment times for clients suffering an acute myocardial infarction potentially poses a disadvantage for receiving occlusion-eliminating therapies. The purpose of this article is to begin discussion of the effects of delayed treatment outcomes regarding gender, culture, and occlusion-eliminating therapies.

A family history demonstration project among women in an urban Appalachian community.

BACKGROUND: Family health history (FHH) is promoted to consumers by the Surgeon General as a tool to improve health and prevent disease. However, few FHH resources exist for medically underserved populations such as the urban Appalachian community in Southwest Ohio. OBJECTIVES: To engage and educate urban Appalachian women about the importance and collection of their own FHH. METHODS: Researchers partnered with six community organizations to develop a model Family History Demonstration Project. Focus groups were held with urban Appalachian women to determine how they would like to learn about their FHH. Resources and an educational intervention were developed based on focus group findings with input from the academic and community partners. Participants in the project recorded their family history and evaluated the education sessions and materials. RESULTS: Eleven fact sheets and four educational presentations were developed based on feedback from the target community. One hundred women participated in two family history education sessions. Learning objectives for both education sessions were met. All participants recorded their family history electronically or on paper and 91% of participants found the first education session (ES1) very helpful at teaching the importance of FHH. CONCLUSIONS: Community organizations and university researchers partnered to develop a model Family History Demonstration Project with input from community members. Evaluations of the project were positive. Future efforts should focus on sustainable dissemination of the educational programs and resulting health outcomes.