A phenomenological exploration of the mental health experiences of young women with diminished ovarian reserve.

Infertility is a reproductive disease affecting one in six individuals that renders an individual unable to conceive. One cause of infertility is diminished ovarian reserve (DOR), which reduces the quantity and/or quality of a female's oocyte pool. Although typically indicating normal ovarian aging during the late 30s and early 40s, DOR can also impact younger women, increasing their risk for psychological distress from an unexpected diagnosis of infertility. A phenomenological approach examined the mental health experiences and perceptions of infertility-related mental health care of young women with DOR. Women diagnosed with DOR by age 35 in the United States who experienced emotional distress during infertility were recruited from infertility-specific social media and via snowball sampling. Participants completed a demographic survey and semi-structured individual interview that was audio-recorded, transcribed verbatim, and analyzed using a phenomenological approach. Ten women ages 27-41 completed the study. On average, participants were 30 years of age at the time of DOR diagnosis (age range 25-35), primarily Caucasian (90%), and married (90%). Two main themes were found: (1) Young women with DOR feel like a "forgotten community" coping with an invisible disease; and (2) Not all fertility clinics are created equal. Participants perceived their diagnosis as devastating and hopeless and urged others to find a provider with ample experience treating patients with DOR. This study helped to understand how young women with DOR perceive their mental health and identified a significant need for advancing towards more holistic infertility healthcare that encompasses both physical and mental health.

Nurse practitioner curriculum puzzle: Connecting all of the documents.

ABSTRACT: Many organizations, foundational documents, and structures guide nurse practitioner (NP) educators. The number can be overwhelming for nurse practitioner faculty and administrators, but awareness and understanding are essential for developing high-quality NP programs. A set of five key questions is a starting place for NP faculty to identify documents that guide their NP program development and curricula. (1) Which states does your program meet state educational requirements for professional licensure or certification? (2) Which accreditor is your program accredited by? (3) Which certification examinations are your students prepared to take? (4) Which educational competencies/standards apply to your program? (5) Which professional or practice organizations might be influential to your program? The development of high-quality NP programs advances the protection of the public and upholds the reputation of the profession. Organizations, components of licensure, accreditation, certification, education, and practice (LACEP), and key documents from national organizations will be reviewed, including how each of these are complementary and different.

Academic Practice Partnerships: Improving Doctor of Nursing Practice Project Quality.

ABSTRACT: Doctor of nursing practice (DNP) projects with impactful health system outcomes can be a challenge for graduate students and graduate program faculty to develop. Rigorous DNP projects address patient and health system needs, meet programmatic requirements, and result in a portfolio of sustainable scholarship for DNP graduates. A strong academic-practice partnership may result in a greater likelihood of successful and impactful DNP projects. Our academic-practice partnership leaders developed a strategic approach to align health system priorities with DNP student project needs. This partnership has resulted in project innovation, increased clinical application, improved outcomes within the community, and enhanced project quality.

A review of the psychometric properties and implications for the use of the fertility quality of life tool.

OBJECTIVES: To analyze and synthesize the reported psychometric properties of the Fertility Quality of Life (FertiQoL) instrument and describe its implications for use in practice and research in men and women with infertility. METHODS: A systematic literature search was performed to identify all articles using the FertiQoL tool. PubMed, CINAHL, and PsycINFO were searched from September 2006 through May 2022. Studies were eligible for inclusion if they reported psychometric data on the original FertiQoL tool using a sample population of individuals with infertility. Sample size, country of origin, and psychometric data were documented for each study. RESULTS: The initial search revealed 153 articles that had utilized the FertiQoL. Following abstract, title, and full-text screenings, 53 articles reported psychometric data and met criteria for inclusion. The FertiQoL is a sound measurement with satisfactory reliability and validity. Studies indicated adequate reliability in the overall scale ([Formula: see text]), as well as the core Emotional, Mind/Body, Social, and Relational scales ([Formula: see text]) and two optional Tolerability and Environment fertility treatment subscales ([Formula: see text]). Although the Relational subscale exhibited slightly lower reliability in several studies, the internal consistency for the measurement as a whole was satisfactory. Results also indicate adequate: 1) face and content validity with extensive professional and patient feedback during development; 2) convergent validity with general quality of life, depression, and anxiety measurements; and 3) structural validity using both confirmatory and exploratory factor analyses. CONCLUSION: The FertiQoL tool is the most commonly used instrument to measure the impact of fertility issues on quality of life in men and women with infertility. Understanding the impact of infertility on quality of life provides valuable insight into the areas of infertility-related care that need to be prioritized, such as mental health or relational stressors. While the instrument has been used in different patient populations with infertility and available in multiple translations, it is necessary to understand the updated psychometric properties and the implications for its use. This review shows that the FertiQoL is reliable and valid for cross-cultural use among individuals with various etiologies of infertility.

Exploration of Social Proximity and Behavior in Captive Malayan Tigers and Their Cubs.

The survival of endangered felids is becoming increasingly dependent on the successful management and breeding of reserve populations in captivity. While most felid species are reported to be solitary in the wild, increasing evidence suggests that some big cats have greater social plasticity than is currently acknowledged. This social plasticity allows felids to be sometimes socially housed in environments such as zoos and rescue centers. While the effects of such shared enclosures remain in question, many reports provide evidence of several welfare benefits of maintaining these large carnivores in pairs or even groups. Since 2019, Le Parc des Félins has housed a breeding pair of Malaysian tigers (Panthera tigris jacksoni) alongside their offspring. The purpose of this study was to quantify the social affiliation between the male tiger and his cubs and to investigate the female's tolerance toward him. The data were collected using video recordings in the outdoor enclosure when social interactions were observed. The data were coded and categorized in the open-source software BORIS, from which behavioral activity budgets were calculated. Data were analyzed using the chi-squared test for association to determine differences in affiliative frequency, with directed and undirected sociograms created to visualize individual relationships. Overall, the male regularly engaged in affiliative behaviors with the cubs, with no significant difference found in the frequency of interactions with them compared to the female. No physical aggression was directed by the male toward the cubs. Although the female maintained a stronger bond with the cubs compared to the male, he displayed a greater range of affiliative behaviors toward them than male tigers are thought to exhibit. Both adults showed a high degree of tolerance toward their conspecifics, suggesting that maintaining breeding pairs with their offspring is a viable management strategy in zoological collections. This study could therefore improve husbandry and conservation practices by developing our understanding of felid sociality and the potential welfare benefits of social housing, allowing for evidence-based captive management decisions.

Summary of New Guidance on Selected Immunizations.

In 2022, the Centers for Disease Control and Prevention (CDC) updated its Adult Immunization Schedule Recommendations for Ages 19 Years or Older to provide the most current evidence-based recommendations following comprehensive reviews of data related to vaccines. In its report, the CDC highlighted the importance of health care professionals staying up to date on the latest evidence. During the novel coronavirus pandemic, the ability to provide routine vaccinations to the adult population was limited and even halted at times. As in-person health care visits continue to resume, it is imperative for nurses to refocus on and be familiar with the most up-to-date vaccine recommendations. Here, we summarize information on vaccine guidelines, safety, and special considerations for women, and we highlight changes to the 2022 adult immunization schedule. Keeping individuals free of vaccine-preventable diseases is one of the most effective and important public health interventions in health care.

Understanding Veteran Suicide Risk and Mitigation Strategies During the COVID-19 Pandemic.

U.S. Veterans experience a significantly higher risk for suicide compared to the general population. Understanding the challenges associated with coronavirus disease 2019 (COVID-19) enables providers to mitigate the risk of suicide among Veterans. Evidence supports access and utilization of U.S. Department of Veterans Affairs (VA) mental health services as they are a protective factor associated with lower suicide rates. During the ongoing COVID-19 pandemic, the VA has worked to further decrease deaths by suicide in the Veteran population by rapid expansion of current interventions and implementation of new evidence-based interventions. These interventions include mental health and coaching applications, consistent use of measurement-based care across multiple disciplines, and greater use of telehealth services. Through these efforts, despite increased risk for suicide due to additional stressors from COVID-19, suicide rates among Veterans are decreasing. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 25-29.].

A Distance Accessible Education Model: Teaching Skills to Nurse Practitioners.

INTRODUCTION: Health care providers in rural areas are often unable to attend continuing education trainings due to limited staffing coverage. The coronavirus pandemic has created a unique situation, requiring many health care providers to obtain continuing education through virtual offerings. METHODS: This study used a descriptive design with a team-developed presurvey for demographics, 2 posttraining instruments, and a team-developed competency validation checklist. RESULTS: The study sample included nurse practitioner (NP) students and practicing NPs. All participants met competency in the skills validation. DISCUSSION: The results indicate that continuing education and competency validation of procedures is feasible in a virtual format.

Competency-based education in transitioning nurse practitioner students from education into practice.

Competency-based education (CBE) provides a framework for nursing programs including those educating nurse practitioners (NPs). The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. The work done to date in developing competencies and progression indicators provides the critical basis to move toward a common language and clear expectations for the continuum of linear progression of proficiency. Entrustable professional activities (EPAs) are built on competencies and stated as measurable activities that providers can be expected to do, at varying levels of competence or trust or supervision, and allow the faculty member, preceptor, or supervisor to make decisions as to what teaching methods and level of supervision are needed. Numerous methods are used to measure competency in clinical skill knowledge, performance, and practice readiness including clinical preceptor feedback, objective structured clinical examination, and simulation, just to name a few. NP programs continue to struggle with the education practice gap between theory and the actual provision of care. The discussion about novel and reliable methods for measurement of competencies must address the strategic importance of a consensus about when, where, and how students can obtain the appropriate amount and type of experience and supervision required in the transition to independent practice. There is also a significant need for processes and standardized guidelines that can contribute to EPA development.

Meeting Health Care Needs in Rural Alabama: The Power of Partnerships.

Recruiting and retaining rural primary care providers is challenging. The Graduate Nursing Education Primary Care Scholars (GNEPCS) is a partnership between a philanthropic organization and a school of nursing to recruit, educate, train, and retain primary care advanced practice registered nurses (APRNs) for practice in rural Alabama with a focus on improving the state's health outcomes. In its initial four years, the GNEPCS partnership has been successful in identifying 60 registered nurses interested in becoming rural primary care APRNs. These students have received mentoring, individualized content on rural health, preceptorships with rural providers, and opportunities for professional and leadership development. Pilot philanthropic funding has allowed us to develop sustainable curricula, attract additional complementary federal funds, and create a critical mass of practice-ready APRNs who are improving primary care access for some of the state's most rural and underserved populations.

Diagnosis and Treatment of Genitourinary Syndrome of Menopause.

Genitourinary syndrome of menopause (GSM), formerly referred to as vulvovaginal atrophy or atrophic vaginitis, is a common chronic condition that requires a collaborative treatment plan between a health care provider and a woman to relieve symptoms and improve quality of life. Many women are not aware that symptoms can be controlled with treatment. Current treatment options approved for GSM include vaginal moisturizers, lubricants, and hormones. For women with GSM symptoms that are unresponsive to nonhormonal therapy, low-dose vaginal estrogen therapy is the preferred pharmacologic treatment. Clinicians should be trained to routinely ask appropriate questions during the history to elicit sufficient information to assess for GSM. Physical examination findings may further confirm suspicion of GSM.

Common Sexually Transmitted Infections in Women.

The spread of sexually transmitted infections (STIs) remains a significant public health issue in the United States. Social, economic, and behavioral implications affecting the spread of STIs have been identified. The most important social factor in the United States is the stigma associated with discussing sex and STI screening. In this article, specific recommendations for women are included regarding screening, diagnosing, and treating common vaginal and cervical infections. Screening women for infections of the vagina and cervix is essential because untreated infections may result in complications that have current and long-term health consequences and impact quality of life.

Highlights From the U.S. Selected Practice Recommendations for Contraceptive Use.

The U.S. Centers for Disease Control and Prevention recently updated the U.S. Selected Practice Recommendations for Contraceptive Use to foster a reduction in unplanned pregnancy rates and to provide clinicians an evidence-based guide for contraception management. Nurses play an important role in helping women and families with reproductive life planning. By bridging knowledge gaps and removing access barriers with regard to contraception, nurses can contribute to reducing rates of unintended pregnancy. Nurses and other clinicians are encouraged to use the U.S. Selected Practice Recommendations for Contraceptive Use when counseling women about safe and effective contraception management.

Prevention and Treatment of Injuries and Infections Related to Pubic Hair Removal.

The 21st century has witnessed an increasingly prevalent trend of women removing their pubic hair. Body hair removal norms have changed significantly over the past several decades. Regardless of the motivation or technique behind pubic hair grooming, this trend is presenting a unique challenge for health care professionals with regard to health education about safe removal and treatment for associated injuries and infections. To provide appropriate education to women, nurses and other clinicians should be familiar with cultural norms, motivations, expectations, methods, dangers, best practices, and treatment options. They should be comfortable discussing grooming practices with women and be prepared to provide guidance on best practices. Women should also be made aware that pubic hair removal may put them at increased risk for transmission of sexually transmitted infections.

How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening?

OBJECTIVE: Identify the determinants that influence the patient's decision-making process when deciding to accept or decline preimplantation genetic screening (PGS) in a given IVF cycle. DESIGN: Pilot, retrospective, cross-sectional study that used a questionnaire containing a combination of quantitative and qualitative items. SETTING: Private practice IVF clinic. PATIENT(S): Patients and partners initiating an IVF treatment cycle, both autologous and donor, between October 2012 and January 2015. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Identification of patient perceived determinants and the importance of each on the decision to accept or decline PGS. RESULT(S): Responses from the questionnaire (N = 117) were returned, and of these, 60% accepted PGS. The female response rate was 75% (N = 88) and the male response rate was 25% (N = 29). Ninety-eight percent were Christian (N = 112) and 88% college educated (N = 102) with 39% (N = 40) having some postgraduate education. Sixty-eight percent (N = 79) had no knowledge of PGS before the IVF cycle; however, after provider education, 92% (N = 108) correctly identified that PGS was elective and 93% (N = 109) reported sufficient knowledge to make an informed decision to accept or decline PGS. The additional cost of screening, the provider information and influence, and social support or acceptance from partner, family, and/or friends, were the three statistically significant variables affecting the decision. CONCLUSION(S): This is the first study, to the authors' knowledge, to identify and assess the determinants of the patient decision-making process when presented with the choice of PGS. Several factors contribute to the patient-perceived determinants when choosing to accept or decline PGS, including cost, religious and ethical beliefs and values, social and family support, provider influences, and the past reproductive experience of the patient.

Smoking Is a Women's Health Issue Across the Life Cycle.

Many women know about the risks of lung cancer and cardiovascular disease that stem from tobacco use, but many don't realize there are several other potential health consequences of smoking. Nurses should utilize every opportunity to educate women about the various health risks of smoking. Promotion of smoking cessation now may help women prevent numeroushealth problems later.

Current evidence supporting fertility and pregnancy among young survivors of breast cancer.

Approximately 6% of invasive breast cancer is diagnosed in women younger than age 40 of age childbearing potential. Cancer-directed therapies can cause hormonal and anatomical changes that negatively affect the reproductive potential of young survivors of breast cancer. Recent national guidelines on fertility preservation are widely available. However, gaps in care exist in the interdisciplinary evidence-based management of young survivors of breast cancer with fertility and parenting concerns after cancer treatment.