Improving CRNAs' Confidence and Perceived Knowledge of Endosurgical Patients Who Use Marijuana: A Quality Improvement Project.

Although some researchers have reported health-related benefits of marijuana, others have reported adverse side effects in nearly every organ system. Patterns of marijuana use are evolving, as is researchers' understanding of marijuana use for healthcare. Despite these findings and developments, nurse anesthetists are inadequately educated about marijuana's perioperative effects on endosurgical patients. As a result, many nurse anesthetists lack confidence in and knowledge of the perioperative care of endosurgical patients under the influence of marijuana. This lack of confidence and knowledge limits the ability of nurse anesthetists to provide optimal care, threatens patient safety, and potentially impairs surgical outcomes. To improve the confidence and perceived knowledge of certified registered nurse anesthetists (CRNAs) regarding perioperative care of endosurgical patients who use marijuana, a quality improvement project was conducted in a metropolitan endosurgical center in California. After the project, participating CRNAs (N = 15) reported increased confidence (z = -0.982; P = .325, > .05) and significantly improved perceived knowledge (z = -3.04; P = .002, < .05) regarding care of patients who use marijuana. For endosurgical patients who used marijuana prior to their procedure, knowledgeable and confident anesthesia care for the side effects of marijuana substantially improved the quality of care, communication, and reduced cancellations.

Improving Discharge Teaching for Adult Patients with an Ileostomy.

LOCAL PROBLEM: Discharge teaching is essential to the self-care and successful recovery of colorectal surgery patients, yet the trend toward shorter hospital stays for patients with new ileostomies limits opportunities for patient education. As a result, discharged patients at our institution are initiating calls to providers with questions that could have been addressed prior to discharge. PURPOSE: The aim of this quality improvement (QI) project was to decrease patient-initiated postdischarge inquiries using a frequently asked questions (FAQs) handout at discharge. METHODS: A retrospective chart review of inquiries to the outpatient clinic over the six-month period between July 2020 and January 2021 revealed common concerns, among them bowel movements, home health care, medications, wound care, stoma issues, pathology reports, diet, and activity-related issues. Based on these concerns, a FAQs handout was developed to review with patients prior to discharge. Data from three postdischarge time periods (0 to 72 hours, 72 hours to 21 days, and 0 to 21 days) in the three months from June to September 2021 were analyzed to determine the impact of the intervention on the frequency and content of the patient inquiries. RESULTS: Use of the FAQs handout led to a decrease in total patient-initiated postdischarge inquiries from 46 in the preintervention period to five in the postintervention period, and fewer topics of concern prompted patients' postintervention inquiries. There was also a pre-to-postintervention reduction in the proportion of patients who made calls to the outpatient clinic in each of the three postdischarge time periods, the greatest of which-from 49% to 15% of patients-was significant and occurred in the 72-hour-to-21-day period. CONCLUSION: This QI project demonstrated that a change in discharge teaching by adding a FAQs handout to the protocol could be effective.

The association between HIV disclosure, spousal testing and unprotected vaginal intercourse within marriage among HIV positive married MSM in China.

Disclosure of HIV status can encourage spouses of people diagnosed with HIV to prioritize HIV prevention. However, few studies have reported the HIV disclosure status of married men who have sex with men (MSM) and their female spouses. The purpose of this study was to describe the prevalence of HIV disclosure, and whether it was associated with spouses' HIV testing uptake and unprotected vaginal intercourse within marriage for MSM living with HIV (HIV + MSM) in China. A cross-sectional study was conducted in three Chinese cities. Of 309 participants, only 31.1% of men had disclosed their HIV status to spouses. About 80% of participants reported that their spouses had been tested for HIV. A small proportion of men (9.1%) had unprotected sex with their spouse after HIV diagnosis. Multivariate analyses indicated HIV disclosure was positively associated with HIV testing uptake of spouses, but there was no significant association between HIV disclosure and unprotected marital sexual behaviors for HIV + MSM. The findings indicated that HIV disclosure to spouses is uncommon among married HIV + MSM in China, and HIV disclosure is associated with increased uptake of HIV testing among spouses of MSM, but it does not decrease the unprotected sexual behaviors in marriage.

Traditional health-related practices of Russian-speaking immigrants.

The population of foreign-born residents continues to grow in the United States. One of the largest growing groups of immigrants is the population of Russian-speakers moving from the countries of the former Union of Soviet Socialistic Republics (Soviet Union/USSR). Like many other immigrants, Russian speakers present with various health concerns. Empirical literature indicates a gap in research that addresses culturally based beliefs and behaviors related to health in this group of immigrants. A qualitative ethnographic study that addresses the health-related practices of Russian-speaking immigrants was conducted on the East Coast of the United States. Twenty-eight participants, ages 36-86, were interviewed, along with participant observation and analysis of documents. Data analysis revealed three related categories: perception of health, perception of illness, and health-related practices. Perceptions of health were influenced by families and defined roles within the family. Perceptions of illness were outlined by approaches to disease management and remedies to illness. Subsequently, the health-related practices of Russian-speaking immigrants were molded by perceptions of health and illness. Further research is recommended to examine specific health-related practices of Russian-speaking immigrants in the United States and to explore more diverse groups within this aggregate.

Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project.

BACKGROUND: Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence. LOCAL PROBLEM: Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider's overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management. METHODS: This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine. INTERVENTIONS: Phase 2 of the project consisted of a pretest-posttest design pilot of the guideline via a "Lunch and Learn" educational session at a Federally Qualified Health Care Center located in the Northern California. RESULTS: The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice. CONCLUSIONS: Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.

Perceptions and Experiences of Women Participating in a Digital Technology-Based Physical Activity Intervention (the mPED Trial): Qualitative Study.

BACKGROUND: Despite the benefits of regular physical activity, women in every age group have lower activity levels than men, and few women meet the recommended levels of physical activity. Digital technologies have been useful in increasing physical activity during the course of an interventional study. However, sustaining that activity once the clinical trial was complete was a major challenge. OBJECTIVE: This study aimed to describe the experiences and perspectives of physically inactive women who completed the mobile phone-based physical activity education (mPED), a randomized controlled trial, at 12 months. METHODS: Of 210 women who were enrolled in the mPED trial, 203 completed a 12-month open-ended exit interview and survey through phone. The participants were asked about their physical activity levels; their digital technology use; what they learned from, liked, and would change about the trial; their motivations to keep active post-trial; and their advice for other women. Interviews were transcribed verbatim and thematically analyzed using the brief survey qualitative description. Descriptive statistics were used to describe the survey data with the significance level set at P<.05. RESULTS: In the 12-month survey, a greater proportion of the participants in the intervention group, compared with the control group, reported that they regularly wore a pedometer or physical activity tracker (49.3%, 66/143 vs 26.1%, 18/69; P=.002) and engaged in brisk walking (54.5%, 73/134 vs 30.4%, 21/69; P=.001). The experiences and perceptions of physical activity of physically inactive women over time were embedded in a complex interplay of internal and external factors. A total of 6 interactive themes emerged as critical in supporting continued engagement in physical activity postintervention: tracking, technology versus personal touch, accountability, resources and environment, motivation, and habit formation. Technology allowed for self-tracking, which supported internal accountability. However, tracking by another person (personal touch) was needed for external accountability. Resources and environment underpinned the relationship among the themes of tracking, technology versus personal touch, accountability, motivation, and habit formation. CONCLUSIONS: Future research is needed to identify the best ways to harness this dynamic process in promoting and sustaining physical activity among inactive women. Digital technology is evolving at an exponential rate and provides new opportunities to transform research into new approaches to promote physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1471-2485-11-933.

Applying Natural Language Processing to Understand Motivational Profiles for Maintaining Physical Activity After a Mobile App and Accelerometer-Based Intervention: The mPED Randomized Controlled Trial.

BACKGROUND: Regular physical activity is associated with reduced risk of chronic illnesses. Despite various types of successful physical activity interventions, maintenance of activity over the long term is extremely challenging. OBJECTIVE: The aims of this original paper are to 1) describe physical activity engagement post intervention, 2) identify motivational profiles using natural language processing (NLP) and clustering techniques in a sample of women who completed the physical activity intervention, and 3) compare sociodemographic and clinical data among these identified cluster groups. METHODS: In this cross-sectional analysis of 203 women completing a 12-month study exit (telephone) interview in the mobile phone-based physical activity education study were examined. The mobile phone-based physical activity education study was a randomized, controlled trial to test the efficacy of the app and accelerometer intervention and its sustainability over a 9-month period. All subjects returned the accelerometer and stopped accessing the app at the last 9-month research office visit. Physical engagement and motivational profiles were assessed by both closed and open-ended questions, such as "Since your 9-month study visit, has your physical activity been more, less, or about the same (compared to the first 9 months of the study)?" and, "What motivates you the most to be physically active?" NLP and cluster analysis were used to classify motivational profiles. Descriptive statistics were used to compare participants' baseline characteristics among identified groups. RESULTS: Approximately half of the 2 intervention groups (Regular and Plus) reported that they were still wearing an accelerometer and engaging in brisk walking as they were directed during the intervention phases. These numbers in the 2 intervention groups were much higher than the control group (overall P=.01 and P=.003, respectively). Three clusters were identified through NLP and named as the Weight Loss group (n=19), the Illness Prevention group (n=138), and the Health Promotion group (n=46). The Weight Loss group was significantly younger than the Illness Prevention and Health Promotion groups (overall P<.001). The Illness Prevention group had a larger number of Caucasians as compared to the Weight Loss group (P=.001), which was composed mostly of those who identified as African American, Hispanic, or mixed race. Additionally, the Health Promotion group tended to have lower BMI scores compared to the Illness Prevention group (overall P=.02). However, no difference was noted in the baseline moderate-to-vigorous intensity activity level among the 3 groups (overall P>.05). CONCLUSIONS: The findings could be relevant to tailoring a physical activity maintenance intervention. Furthermore, the findings from NLP and cluster analysis are useful methods to analyze short free text to differentiate motivational profiles. As more sophisticated NL tools are developed in the future, the potential of NLP application in behavioral research will broaden. TRIAL REGISTRATION: ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/70IkGagAJ).

Understanding Health Literacy for People Living With HIV: Locations of Learning.

Health literacy, including people's abilities to access, process, and comprehend health-related information, has become an important component in the management of complex and chronic diseases such as HIV infection. Clinical measures of health literacy that focus on patients' abilities to follow plans of care ignore the multidimensionality of health literacy. Our thematic analysis of 28 focus groups from a qualitative, multisite, multinational study exploring information practices of people living with HIV (PLWH) demonstrated the importance of location as a dimension of health literacy. Clinical care and conceptual/virtual locations (media/Internet and research studies) were used by PLWH to learn about HIV and how to live successfully with HIV. Nonclinical spaces where PLWH could safely discuss issues such as disclosure and life problems were noted. Expanding clinical perspectives of health literacy to include location, assessing the what and where of learning, and trusted purveyors of knowledge could help providers improve patient engagement in care.

A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV.

Globally, people living with HIV (PLWH) are at remarkably high risk for developing chronic comorbidities. While exercise and healthy eating reduce and mitigate chronic comorbidites, PLWH like many others, often fail to engage in recommended levels. We qualitatively examined the perspectives and contextual drivers of diet and exercise reported by PLWH and their health care providers. Two hundred and six participants across eight sites in the United States, Puerto Rico and Botswana described one overarching theme, Arranging Priorities, and four subthemes Defining Health, Perceived Importance of Diet and Exercise, Competing Needs, and Provider Influence. People living with HIV and their health care providers recognize the importance of eating a healthy diet and engaging in regular exercise. Yet there are HIV-specific factors limiting these behaviors that should be addressed. Health care providers have an important, and often underutilized opportunity to support PLWH to make improvements to their exercise and diet behavior.

Report From the Night Shift: How Administrative Supervisors Achieve Nurse and Patient Safety.

The administrative supervisor role (the nurse leader on the evening or night shift) has been present in hospitals for more than 100 years, but research is just commencing regarding how this leader achieves nurse and patient safety. This focused ethnographic study was conducted in 2 parts. The first part consisted of focus groups with night-shift staff nurses, held at 7 hospitals in the mid-Atlantic region of the United States, with the objective of obtaining the staff nurses' perception of the supervisors' role. The second part consisted of interviews with 30 administrative supervisors, recruited nationally from 20 different states, to explore the supervisors' perspective on practices used to enhance safety. The focus group and interview transcripts were thematically analyzed, using an iterative, comparative method to identify codes and sort for patterns. The findings reveal that administrative supervisors "make it (whatever needs to be done) work" and achieve nurse and patient safety by building trust with the staff, doing rounds, educating, and providing support to the front line team. These shift leaders foster a culture of safety with their relationship-oriented leadership style. By gaining further understanding about the administrative supervisor role, new workflow processes can be explored; specific continuing education programs can be developed; and additional research can be conducted.

Getting safely through the shift: a qualitative exploration of the administrative supervisor role.

AIM: The purpose of this qualitative study was to explore the administrative supervisors' perspective of their managerial practices and how these practices contribute to nurse and patient safety. BACKGROUND: The position of administrative supervisor, often referred to as house supervisor on the evening and night shifts, lacks empirical data supporting efficacy. METHOD: A focused ethnographic study was conducted with 30 administrative supervisors from acute care hospitals, using in-depth interviews and job descriptions. RESULTS: Regardless of the size, location or type of hospital, the interviews revealed the administrative supervisor as the hospital shift leader, who achieves nurse and patient safety when performing his/her role responsibilities, despite being disconnected from the nursing management team. CONCLUSIONS: To support patient care quality and safety, the administrative supervisor competencies need to be developed along with role-specific education programmes. Additionally, there is a need to recognise these off-shift leaders as a key stakeholder on the nursing leadership team. IMPLICATIONS FOR NURSING MANAGEMENT: Although nurse leaders in many countries may believe they understand this role, this is among the first empirical studies. These results can lead discussions on enhancing nurse and patient safety with additional support for administrative supervisors, along with the discussion of a best practice model for off-shift leadership.

Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members.

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Administrative Supervisors: A Qualitative Exploration of Their Perceived Role.

The administrative supervisor, who is the nurse manager present on the night and weekend shifts, can be found in hospitals throughout the United States. Yet, very little research has been published about this role on weekend and night shifts in acute care hospitals. The objective of this qualitative research study was to gain a better understanding of the administrative supervisor role. In-depth interviews with administrative supervisors were conducted at acute care hospitals in the mid-Atlantic region of the United States. Thematic analysis was used to reduce the data and identify codes and themes. Administrative supervisors experience and described their role within a "different" hospital world on weekends and at night. The administrative supervisors consistently stated that they oversee and are responsible for staffing and patient flow, crisis management, and management support for the staff. That administrative supervision is a challenging position for nurses is particularly evident as researchers seek to obtain a better understanding of how nurse leaders make a difference. This research delineates these different supervisor role responsibilities to provide a better understanding of management during the "off-shift." Nurse leaders can utilize this information to assist in justifying the need for this shift management role at their institutions.

Sources of Social Capital for Malawi People Living With HIV.

With one of the highest rates of poverty and HIV in the world, Malawi faith-based organizations (FBOs), non-governmental organizations (NGOs), and community-based organizations (CBOs) are expected to provide tangible and emotional support to people living with HIV (PLWH). Using Lin's social capital theoretical approach, we examine the perspective of PLWH regarding the adequacy of support responses. Forty-six rural Malawi HIV+ adults provided interviews that were recorded digitally, translated, and transcribed by Malawi research assistants. Atlas.ti was used to organize the data and to aid in the analytic process. Participants expressed disappointment in the lack of resources that could be accessed through the FBOs although their expectations may have been unrealistic. Outcomes from accessing and mobilizing the FBO network were negative in terms of stigmatization by FBO leaders and members, whereas outcomes related to CBOs and NGOs were generally positive in terms of empowerment through HIV information and attendance at support groups.

Nurse Manager Safety Practices in Outpatient Hemodialysis Units.

Little is known regarding the specific managerial activities or best practices that nurse managers in outpatient hemodialysis settings use to achieve positive safety outcomes. The purpose of this study was to identify and describe specific managerial practices used by nurse managers in outpatient hemodialysis units to enhance patient safety and quality of care. A descriptive qualitative design was used. Seventeen nurse managers in outpatient hemodialysis units comprised the study sample. Telephone interviews were conducted, and qualitative content analysis was used to encode the data. Nurse managers identified patients, staff, the dialysis unit environment, and the dialysis organization as sources of safety risks. Nurse manager safety practices illuminated from the data were complex and multifaceted, and were aimed at reducing patient, staff environmental, and organization risks. The findings from this study offer a description and a better understanding of the practices in which nurse managers in outpatient hemodialysis units engage to keep patients safe in their units, and they underscore the critical role of nurse managers in creating and maintaining patient safety within outpatient hemodialysis settings.

Perception and Sense of Control Over Eating Behaviors Among a Diverse Sample of Adults at Risk for Type 2 Diabetes.

PURPOSE: The purpose of the study was to explore and understand knowledge and attitudes about food, diet, and weight control, focusing on barriers and motivators to reduce risk of developing type 2 diabetes. METHODS: Six focus groups were conducted in May and June 2010. The groups were stratified by sex. A total of 35 ethnically diverse samples with a high risk for type 2 diabetes participated. The average age was 51 ± 10.6 years, and 57% of the sample represented women. RESULTS: Four themes emerged from the focus groups: (1) demonstrated knowledge and source of knowledge, including participants' basic understanding of "good" and "bad" food and what constitutes a "healthy diet" and trusted sources of information; (2) perceptions of food and diet, encompassing how participants expressed their perception of and interaction with food and diet; (3) sense of control over dietary intake, reflecting participants' discussion of their perceived ability to control their eating patterns and food choices; and (4) eating behaviors, describing participants' patterns of eating and perceived barriers to eating a healthy diet. CONCLUSIONS: Study findings demonstrate that eating healthy requires a complex interaction between individual perceptions of food and sense of control over eating patterns and sociopolitical and economic structural factors that restrict healthy eating options while promoting unhealthy ones. Programs for long-term eating behavioral change necessary to reduce type 2 diabetes and obesity need to incorporate strategies that address individual-level factors of perception of food and sense of control over eating patterns, as well as structural level factors such as poverty and food insecurity.

Evolution of a nursing education program delivered to baccalaureate-prepared Haitian nurses.

Haiti has high morbidity and mortality rates, a large proportion of people living in poverty, and a shortage of nurses and nursing faculty members. A partnership program between a US and Haitian university was formed to deliver a certificate program in nursing education. The authors describe their experiences developing, delivering, and evaluating the blended on-site and online program and their future goals.

A response to Edzi (AIDS): Malawi faith-based organizations' impact on HIV prevention and care.

African faith-based organization (FBO) leaders influence their members' HIV knowledge, beliefs, and practices, but their roles in HIV prevention and care are poorly understood. This article expands the work of Garner (2000) to test the impact of FBO influence on member risk and care behaviors, embedding it in the Theory of Planned Behavior. Qualitative interviews and quantitative surveys were collected from five FBOs (Christian and Muslim) in Malawi and analyzed using mixed methods. Contrary to Garner, we found that the level of power and influence of the FBO had no significant impact on the risk-taking behaviors of members; however, leaders' HIV knowledge predicted members' behaviors. Stigmatizing attitudes of leaders significantly decreased members' care behaviors, but FBO hierarchy tended to increase members' care behaviors. The power of local church and mosque leaders to influence behavior could be exploited more effectively by nurses by providing support, knowledge, and encouragement to churches and mosques.

Qualitative exploration of the acceptability of a mobile phone and pedometer-based physical activity program in a diverse sample of sedentary women.

OBJECTIVES: The objectives of this paper were to explore the acceptability of components of a mobile phone/pedometer-based physical activity program and to understand motivators and barriers to increase physical activity in a diverse sample of sedentary women. DESIGN AND SAMPLE: Face-to-face semi-structured interviews were conducted following a 3-week pilot mobile phone/pedometer-based physical activity intervention. Forty-one sedentary women participated in the study. MEASURES: Subjects were interviewed using a semi-structured interview guide. A qualitative description method was used to thematically analyze the interviews. Two investigators reviewed the transcripts independently and identified codes based on the main concerns in the interview questions. RESULTS: Three themes emerged from qualitative data shedding light on the perceived acceptability and usefulness of a mobile phone/pedometer-based intervention: (1) Monitor me: mobile phone/pedometer as self-monitoring tools, (2) Motivate me: cycle of feedback in goal setting and usefulness/uselessness of daily random messages, (3) Mobilize me: engaging and adapting physical activity to fit one's own lifestyle. CONCLUSION: Mobile phone and pedometer-based physical activity programs might be helpful in keeping sedentary women engaged and motivated to increase their physical activity. A randomized controlled trial of this intervention is warranted.