Vaccine Hesitancy: Developing Competency in Nursing Students Through Simulation.

BACKGROUND: Many Americans are undecided about or have barriers to receiving vaccines. Complacency, confidence, convenience, misinformation, and disinformation impact vaccine hesitancy (VH). PROBLEM: During the COVID-19 pandemic, rates for flu and routine childhood vaccinations declined globally. As vaccination rates decline, the risk of disease outbreaks increases. Nursing students need to be prepared to address VH in the clinical setting. APPROACH: Four simulation experiences were developed to build confidence and competency in the provision of vaccinations and addressing VH. Nursing students practiced communication skills critical to motivational interviewing, health education, health promotion, and goal setting. OUTCOME: There were statistically significant increases in student confidence and perceived competence in vaccine administration and addressing VH through motivational interviewing. CONCLUSIONS: High-fidelity simulation combined with a virtual simulation was effective in developing confidence among nursing students. Students demonstrated skill in addressing VH and motivational interviewing.

Associations of Psychological Distress and Alcohol Use Patterns Among Older Adults of Sexual Minority Status and Heterosexual Peers.

BACKGROUND: There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use. OBJECTIVE: The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns. METHODS: This study was a secondary analysis of data from the 2017-2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption. RESULTS: Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use. CONCLUSION: Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse.

Impact of preparing nursing students to deliver a parent-based sexual health intervention on attitudes and intentions for sexual health education and parent communication counseling: a mixed methods study.

BACKGROUND: Nurses are well positioned to promote sexual health but are not adequately prepared in their nursing programs to engage families on this topic and often lack the knowledge and confidence necessary to counsel families about sexual health communication. The purpose of this study was to determine how facilitating a parent-based sexual health intervention would impact nursing students' attitudes and intentions about sexual health education and parent communication counseling. METHODS: Using an embedded mixed-methods design, which integrated a quasi-experimental framework, we examined the impact of participation in a parent-based sexual health intervention among 126 baccalaureate nursing students enrolled in a community/public health nursing clinical course. Independent t-tests, chi-squared tests, and the Mann-Whitney U test were used to compare intervention and control groups at baseline. Multiple linear regression was used to compare the groups for pre-post changes. Qualitative content analysis was used to analyze exit interview transcripts. RESULTS: We found statistically significant differences in nursing students' confidence to teach sexual health (p = < 0.001), satisfaction with skills as a sexual health educator (p = < 0.001), beliefs about the efficacy of parent-adolescent communication for reducing negative sexual outcomes among adolescents (p = < 0.001), and intentions to counsel parents on sexual health (p = < 0.001), with greater improvements in the intervention group than in the control group. Furthermore, we found statistically significant differences in nursing students' intentions to counsel parents about the HPV vaccine (p = < 0.01) and to endorse the HPV vaccine (p = < 0.05), with greater improvements in the intervention group than in the control group. Across all survey categories, qualitative findings confirmed improvements seen on the pre-post survey. CONCLUSION: Providing evidence-based adolescent sexual health training, including sexual health education content and discussion strategies, can prepare nursing students to strongly endorse sexual health communication and HPV vaccination uptake and to counsel parents on initiating and navigating these conversations with their youth. Our project exemplifies how a nursing program could organize an immersive experience, or elective within a specialty area, that aligns with the competency-based approach endorsed by the American Association of Colleges of Nursing. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (NCT02600884) on 09/01/2015; the first participant was recruited on 09/29/2015.

New nurses' quality and safety education: An analysis of the 2018 National Sample Survey of Registered Nurses.

BACKGROUND: The integration of the Nursing Quality and Safety Education (QSEN) competencies into American Association of College of Nursing - The Essentials: Core Competencies for Professional Nursing Education warrants continued assessment of the new nurses' QSEN competencies preparedness. PURPOSE: The purpose of this study was to analyze quality and safety education needs of nurses who graduated in 2016, 2017, and 2018 and have responded to the most recent National Sample Survey of Registered Nurses. METHODS: This is a retrospective correlational design study using analysis of publicly available data from the 2018 National Sample Survey of Registered Nurses. A logistic regression model was used to assess correlations between 21 quality and safety education variables and nursing degree type. RESULTS: When adjusting for differences in demographic and work characteristics, there were no significant differences in quality and safety training needs by the nursing degree type. New nurses, regardless of the nursing degree type reported additional training needs in patient-centered care (50%), evidence-based practice and team-based care (40%), quality improvement (30%). CONCLUSIONS: This study provides new, national data on new nurses' quality and safety education preparedness and provides evidence for the need for continued investment and integration of QSEN competencies in all nursing degree programs.

A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study.

BACKGROUND: Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide. OBJECTIVE: The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program. METHODS: The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. RESULTS: Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). CONCLUSIONS: This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.

Influences of race/ethnicity in periodontal treatment response and bacterial distribution, a cohort pilot study.

Objectives: Periodontitis disproportionately affects different racial and ethnic populations. We have previously reported the higher levels of Porphyromonas gingivalis and lower ratios of Streptococcus cristatus to P. gingivalis may contribute to periodontal health disparities. This prospective cohort study was designed to investigate if ethnic/racial groups responded differently to non-surgical periodontal treatment and if the treatment outcomes correlated to the bacterial distribution in patients with periodontitis before treatment. Methods: This prospective cohort pilot study was carried out in an academic setting, at the School of Dentistry, University of Texas Health Science Center at Houston. Dental plaque was collected from a total of 75 African Americans, Caucasians and Hispanics periodontitis patients in a 3-year period. Quantitation of P. gingivalis and S. cristatus was carried out using qPCR. Clinical parameters including probing depths and clinical attachment levels were determined before and after nonsurgical treatment. Data were analyzed using one-way ANOVA, the Kruskal-Wallis test, the paired samples t-test and the chi-square test. Results: The gains in clinical attachment levels after treatment significantly differed amongst the 3 groups-Caucasians responded most favorably, followed by African-Americans, lastly Hispanics, while numbers of P. gingivalis were highest in Hispanics, followed by African-Americans, and lowest in Caucasians (p = 0.015). However, no statistical differences were found in the numbers of S. cristatus amongst the 3 groups. Conclusion: Differential response to nonsurgical periodontal treatment and distribution of P. gingivalis are present in different ethnic/racial groups with periodontitis.

Feasibility of a meditation intervention for stroke survivors and informal caregivers: a randomized controlled trial.

BACKGROUND: Depressive symptoms are a significant psychological complication of stroke, impacting both survivors and informal caregivers of survivors. Randomized controlled trials are needed to determine optimal non-pharmacological strategies to prevent or ameliorate depressive symptoms in stroke survivors and their informal caregivers. METHODS: A prospective, randomized, parallel-group, single-center, feasibility study. Participants were assigned to a 4-week meditation intervention or expressive writing control group. The intervention comprised four facilitator-led group meditation sessions, one session per week and building upon prior session(s). Descriptive statistics were used to examine the proportion of eligible individuals who enrolled, retention and adherence rates, and the proportion of questionnaires completed. Data were collected at baseline, immediately after the 4-week intervention period, and 4 and 8 weeks after the intervention period. Secondary analysis tested for changes in symptoms of depression (Center for Epidemiologic Studies-Depression [CES-D]), anxiety [State-Trait Anxiety Inventory for Adults (STAI)], and pain (Brief Pain Inventory-Short Form) in the intervention group via paired t tests. Linear mixed models were used to compare longitudinal changes in the measures between the groups. Intervention and trial design acceptability were preliminary explored. RESULTS: Seventy-one (77%) individuals enrolled and 26 (37%) completed the study (baseline and 8-week post-intervention visits completed). Forty-two (66%) participants completed baseline and immediate post-intervention visits. Mean questionnaire completion rate was 95%. The median meditation group session attendance rate for the intervention group was 75.0%, and the mean attendance rate was 55%. Non-significant reductions in CES-D scores were found. Paired t tests for stroke survivors indicated a significant reduction from baseline through week 8 in BPI-sf severity scores (p = 0.0270). Repeated measures analysis with linear mixed models for informal caregivers indicated a significant reduction in in STAI-Trait scores (F [3,16.2] = 3.28, p = 0.0479) and paired t test showed a significant reduction from baseline to week 4 in STAI-Trait scores (mean = - 9.1250, 95% CI [- 16.8060 to 1.4440], p = 0.0262). No between-group differences were found. CONCLUSIONS: Future trials will require strategies to optimize retention and adherence before definitive efficacy testing of the meditation intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03239132. Registration date: 03/08/2017.

Parent and Child Anxiety Evaluated During an Early Period of the COVID-19 Pandemic: A Mixed-Methods Study.

Purpose: The objective of this study was to explore parent and child anxiety during the pandemic. Unlike previous pandemics, measures implemented to prevent the transmission of the SARS-CoV-2 virus have been much more limiting. Methods: An explanatory convergent mixed-methods design was used to describe anxiety of children 9-17 years of age and their parents during August-October 2020. Adult and child versions of State-Trait Anxiety Inventory (STAI) were used to examine levels as measured on STAI's state-anxiety subscale. Web-based interviews with a subset of patients were conducted qualitatively to analyze anxiety-related themes. Results: A total of 188 parents and 140 children responded to the questionnaires. Mean overall anxiety scores for parents (49.17 [standard deviation: 12.247]) and children (35.43 [standard deviation: 7.894]) were higher than published norms. Parent and child anxiety were positively correlated (r=0.36; P=0.01). From interviews with 11 parents and 11 children; 4 major themes and 10 subthemes describing physical and emotional outcomes resulting from limited social contact, work and family role strain, and uncertainty about COVID-19 were identified. Conclusions: Parents and children reported elevated anxiety levels during the COVID-19 pandemic. Findings of this study can guide the development of strategies that mitigate the negative impact of isolation, role strain, and uncertainty related to future public health crises.

Relationship Between Maternal COVID-19 Infection and In-Hospital Exclusive Breastfeeding for Term Newborns.

OBJECTIVE: To evaluate the relationship between maternal COVID-19 infection and the odds of in-hospital exclusive breastfeeding for term newborns. DESIGN: Retrospective descriptive quantitative. SETTING: A large, urban hospital with more than 6,000 births annually. SAMPLE: Term newborns born between March 1, 2020, and March 31, 2021 (N = 6,151). METHODS: We retrospectively extracted data from electronic health records to evaluate the relationship of maternal COVID-19 infection with the odds of in-hospital exclusive breastfeeding using univariate analysis and logistic regression models. The covariates included insurance type, race/ethnicity, glucose gel administration, length of stay, newborn gestational age, newborn birth weight, and maternal COVID-19 infection. RESULTS: Maternal COVID-19 infection was not significantly related to the odds of in-hospital exclusive breastfeeding (p = .138) after adjustment for covariates in the logistic regression model. However, when newborns who received pasteurized donor human milk supplementation were excluded from the logistic regression model, maternal COVID-19 infection significantly decreased the odds of in-hospital exclusive breastfeeding (p = .043). CONCLUSION: Maternal COVID-19 infection was not significantly related to the odds of in-hospital exclusive breastfeeding when newborns received donor human milk supplementation. Access to donor human milk for supplementation for term newborns may protect the odds of in-hospital exclusive breastfeeding.

Comparative effects of disability education on attitudes, knowledge and skills of baccalaureate nursing students.

AIM: This study aimed to examine if participation in a required clinical course or elective fellowship pertaining to care of people with disabilities (PWD) had an impact on attitudes, knowledge and skills of nursing when compared with those with no clinical exposure to PWD. BACKGROUND: Worldwide, over 1 billion people live with a disability, 93 million are children and an estimated 1-3% have an intellectual disability; 6.9 billion live with 'impairment producing health condition'. (WHO, 2011; Maulik et al., 2011; Roscigno, 2013 p.21). Barriers that contribute to health disparities in PWD are numerous; repeated themes of inadequate education of nursing students and faculty, deficient communication skills and negative attitudes are pervasive in the literature (Alshammari et al., 2018; Anyinam et al., 2019; Cervasio et al., 2010; Ilkhani et al., 2015; Lyon & Houser, 2018; Polikandrioti et al., 2020; Temple & Murdoch, 2012; Werner & Grayzman, 2011; WHO, 2011). STUDY DESIGN: A singular institution descriptive quantitative design using a purposive sample of student volunteers explored differences among pre-licensure senior nursing students which examined perceptions prior to and following a clinical experience specific to the care of PWD. METHODS: Analyses of the change in scale scores by student type and experience working with PWD were evaluated using one-way ANOVA. Spearman correlations were used to test for an association between the change in scale scores and birth year. RESULTS: There was no statistical evidence of differences between the elective fellowship (n = 9), clinical (n = 13), or control (n = 24) groups for change in attitudes (p = 0.1383), scenario 1 (p = 0.1996), or knowledge scores (p = 0.2854) (Table 3). Mean pre- and post-test scores for attitudes within the fellowship (69.78, 75.11) and clinical (67.62, 74) group increased more than the control (66.92, 68.29). There was evidence of a difference detected in the attitude questions, scenario 2 scores, with the fellowship and clinical groups showing a larger increase in scores compared with the control group (p < 0.0001) (Table 3). Also, the clinical group experienced a larger increase in skill scores compared with the control group (p = 0.0154). CONCLUSIONS: Results from pre-post surveys exemplify the need for disability specific undergraduate education. Students will experience confidence and competence in their transition to practice because at anytime, anywhere, they will encounter someone with a disability. Further research is needed to determine the amount and type of education that translates to quality care of PWD.

Disability Attitudes of Nursing Students: A Curriculum Intervention.

ABSTRACT: People with disabilities (PWD) have reported that health care workers' negative attitudes are among the most significant barriers to accessing health care services. PWD constitute one quarter of the population, yet the curriculum for PWD is inconsistent. This study describes a curriculum intervention allowing student interaction with a panel of PWD to change nursing student attitudes. Surveys were administered before and after the intervention. Our pilot study did not reveal a significant change in attitudes, which suggests that more exposure to PWD and education may be needed.

Collaborative Interprofessional Health Science Student Led Realistic Mass Casualty Incident Simulation.

In collaboration, a health science university and a fire department offered a mass casualty incident (MCI) simulation. The purpose of this study was to evaluate a cross-section of student health care providers to determine their working knowledge of an MCI. Students were given a pretest using the Emergency Preparedness Information Questionnaire (EPIQ) and the Simple Triage and Rapid Transport (START) Quiz. The EPIQ instrument related to knowledge of triage, first aid, bio-agent detection, critical reporting, incident command, isolation/quarantine/decontamination, psychological issues, epidemiology, and communications. The START Quiz gave 10 scenarios. Didactic online content was given followed by the simulation a few weeks later. A posttest with the same instruments was given after the simulation. Participants were majority female (81.7%), aged between 25-34 (41.7%), and 61.7% (n = 74) had undergraduate or post-graduate degrees. The overall pretest mean was 2.92 and posttest mean was 3.64. The START Quiz found participants struggled to correctly assign triage levels. Students also experienced challenges correctly assigning patients to specific triage categories. Findings will assist educators to understand knowledge gaps, so revisions can be made to enhance learning in disaster management. Concentration in proper field triage is also a needed focus.

Caregiver Burden and Associated Factors Among Informal Caregivers of Stroke Survivors.

BACKGROUND: Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors. METHODS: A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden. RESULTS: Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P < .001). CONCLUSION: Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.

The Effects of Meditation, Race, and Anxiety on Stroke Survivor Resilience.

BACKGROUND: Significant gaps exist in the identification and management of psychological effects of stroke on survivors. Interventions to enhance resilience, the ability to rebound from stress or adversity, could positively impact stroke recovery. The purpose of this study was to test the effect of meditation on resilience of community-dwelling stroke survivors and to identify resilience predictor variables in these survivors. METHODS: This was a substudy with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression. The effect of meditation on stroke survivor resilience in the intervention group (n = 20) was evaluated with a paired samples t test, with measures at baseline and immediately after the 4-week intervention. Baseline resilience predictor variables for all stroke survivors (n = 35) were evaluated with univariable analysis and multiple linear regression modeling. RESULTS: The increase in stroke survivor resilience scores from baseline (mean [SD], 3.46 [0.81]) to intervention completion (mean [SD], 3.58 [1.02]) was not statistically significant (t = 0.60, df = 19, P = .56). One-way analysis of variance with Tukey post hoc analysis revealed that baseline resilience was significantly lower (P = .02) for non-Hispanic black participants than for non-Hispanic white participants. Multiple linear regression with resilience as the dependent variable, race as a fixed factor, and trait anxiety as a covariate was significant (F3,33 = 6.32, P = .002) and accounted for nearly 33% of the variance in baseline resilience. CONCLUSION: The effects of meditation on stroke survivor resilience should be tested in larger clinical trials that would explore the influence of social determinants of health, perceived stress, race-related stress, and anxiety subtypes on resilience.

Establishing a Regional Trauma Preventable/Potentially Preventable Death Rate.

OBJECTIVE: To establish a trauma preventable/potentially preventable death rate (PPPDR) within a heavily populated county in Texas. SUMMARY: The National Academies of Sciences estimated the trauma preventable death rate in the United States to be 20%, issued a call for zero preventable deaths, while acknowledging that an accurate preventable death rate was lacking. In this absence, effective strategies to improve quality of care across trauma systems will remain difficult. METHODS: A retrospective review of death-related records that occurred during 2014 in Harris County, TX, a diverse population of 4.4 million. Patient demographics, mechanism of injury, cause, timing, and location of deaths were assessed. Deaths were categorized using uniform criteria and recorded as preventable, potentially preventable or nonpreventable. RESULTS: Of 1848 deaths, 85% had an autopsy and 99.7% were assigned a level of preventability, resulting in a trauma PPPDR of 36.2%. Sex, age, and race/ethnicity varied across preventability categories (P < 0.01). Of 847 prehospital deaths, 758 (89.5%) were nonpreventable. Among 89 prehospital preventable/potentially preventable (P/PP) deaths, hemorrhage accounted for 55.1%. Of the 657 initial acute care setting deaths, 292 (44.4%) were P/PP; of these, hemorrhage, sepsis, and traumatic brain injury accounted for 73.3%. Of 339 deaths occurring after initial hospitalization, 287 (84.7%) were P/PP, of these 117 resulted from sepsis and 31 from pulmonary thromboembolism, accounted for 51.6%. CONCLUSIONS: The trauma PPPDR was almost double that estimated by the National Academies of Sciences. Data regarding P/PP deaths offers opportunity to target research, prevention, intervention, and treatment corresponding to all phases of the trauma system.

Development and Testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE): Nonverbal Pain Behaviors in African American and Caucasian Nursing Home Residents with Dementia.

BACKGROUND: People with dementia experience a decline in language skills required to self-report pain; researchers thus recommend the use of nonverbal behaviors to assess pain. Although multiple instruments exist for assessing nonverbal pain behaviors, psychometric data are lacking for African American nursing home residents with dementia. AIMS AND DESIGN: The purpose of this methodological study was to describe the development and testing of the Pain Assessment Tool in Cognitively Impaired Elders (PATCIE) in African American and Caucasian nursing home residents with dementia. SETTINGS/PARTICIPANTS: The convenience sample included 56 African American and 69 Caucasian residents with dementia in multiple nursing homes from three states. The research staff completed the pain assessments when the nursing home staff transferred the residents. RESULTS/CONCLUSIONS: Initially, 15 nonverbal pain behaviors were evaluated. Based on the alpha scores and additional literature review, the 15 nonverbal pain behaviors were expanded to 28 behaviors. The PATCIE had a Cronbach's alpha of .73 during movement. Construct validity for the pain behaviors was demonstrated because higher scores were noted during movement, and scores before movement were significantly higher than those obtained after movement. For movement over time, there was a significant difference in the PATCIE score, regardless of ethnicity or time (p < .0001). There were no significant differences found between ethnic groups, either overall or in change over time between movements or between the categories of cognitive function. African Americans were more likely to display frowning, and Caucasians to display irritability. The PATCIE demonstrates preliminary reliability and validity in assessing pain in African American and Caucasian nursing home residents with dementia.

Effects of Gender-Specific Differences, Inflammatory Response, and Genetic Variation on the Associations Among Depressive Symptoms and the Risk of Major Adverse Coronary Events in Patients With Acute Coronary Syndrome.

Depressive symptoms independently contribute to major adverse coronary events (MACEs), with the biological immune response to depression being a likely mediator of this relationship. To determine whether genetic- and/or gender-specific phenotypic differences contribute to associations among depressive symptoms, inflammatory response, and risk of MACE in patients with acute coronary syndrome (ACS), we conducted a prospective study of 1,117 ACS patients to test a gender-specific model in which depressive symptoms (Beck Depression Inventory-II [BDI-II]) are associated with risk of MACE. Cox proportional hazards models were used to model time to incident MACE and determine whether single-nucleotide polymorphisms (SNPs) in specific inflammatory protein-coding genes and depressive symptoms interact to influence levels of inflammatory proteins or risk of MACE. Females had significantly higher high-sensitivity C-reactive protein and monocyte chemoattractant protein-1 levels. Depression status differed by gender (29.9% of females and 21.1% of males had BDI-II scores indicative of depression [ p = .0014]). Depressive symptoms were associated with MACE; however, the interaction between these symptoms and gender was not significant. SNPs and depressive symptoms did not interact to influence inflammation or MACE. More females than males had BDI-II scores indicative of depression, yet the association between positive depressive symptom status and MACE did not vary by gender. Nor did the SNPs interact with depressive symptoms to influence inflammation or MACE. It remains of interest to identify a high-risk subgroup of ACS patients with genetic polymorphisms that result in immunoinflammatory dysregulation in the presence of depressive symptoms.

Preparing Nursing Students to Work With Patients With Alcohol or Drug-Related Problems.

Stigma and insufficient training for addressing alcohol or drug problems in clinical settings are two significant barriers to earlier identification and access to care for patients with alcohol or drug (AOD)-related problems. Nurses are crucial players in this strategy, yet nurses often report poor motivation and insufficient training for working with AOD-affected patients. This article describes and reports preliminary evaluation results of an educational experience that integrated AOD curriculum into a community/public health nursing clinical practicum. The purpose of the intervention was to meet the required objectives for our university's community/public health nursing clinical course, improve students' attitudes and therapeutic commitment for working with AOD-affected patients, and prepare students for providing high-quality nursing care for individuals with AOD-related problems.