Evidence-Based Education on Care of LGBTQ Patients: Improving Knowledge and Attitudes Among Pediatric Nurses.

BACKGROUND: Due to stigma and mistreatment, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients and their families often face barriers to accessing and receiving equitable health care. Pediatric settings are not immune to this health inequity, yet there is limited literature to address it with pediatric nurses. METHOD: An evidence-based education program on the care of LGBTQ patients was delivered electronically to pediatric nurses. Using a pre- and posttest design, knowledge and attitudes regarding care of LGBTQ patients were collected via online questionnaires. RESULTS: Knowledge significantly increased from pre- to posttest (p = .02). Attitudes related to LGBTQ concepts either remained consistently positive or shifted in the positive direction. CONCLUSION: Providing education regarding LGBTQ patients to pediatric nurses can improve related knowledge and attitudes. Expansion of evidence-based LGBTQ education to pediatric nurses is likely to contribute to lessening the health care barriers and inequities faced by these patients and their families. [J Contin Educ Nurs. 2024;55(4):181-186.].

A study of Reiki therapy on unpleasant symptoms in children with cerebral palsy.

Children with Cerebral Palsy (CP) commonly experience unpleasant symptoms such as pain, anger, and sadness. The purpose of this quasi-experimental study, guided by the Theory of Unpleasant Symptoms (TOUS), was to examine the practicality and impact of delivering Reiki Therapy (RT) in homes over an 8-week intervention phase to children with CP. Thirteen pediatric participants were recruited, ranging in age from 5 to 16 years. Reiki Therapy was administered by a Level 3 Reiki Therapist in the home for 8 consecutive weeks. Parents completed on-line questionnaires addressing their children's unpleasant symptoms. Hair cortisol was measured as an indicator of stress. Nearly all study procedures were completed by the participants, indicating that the methods are feasible for a larger study. Reiki Therapy significantly decreased pain while lying down (3.09 vs. 2.00; p = .002) but not while sitting (2.55 vs. 2.09; p = .40). Anger symptoms showed a trend towards improvement in the participants. These preliminary findings demonstrate that Reiki is a therapeutic modality worthy of further investigation in the CP pediatric population.

Assessing Competence With a Task Trainer: Validity Evidence for Novel Tracheostomy Care Skills Assessment Tool.

INTRODUCTION: The purpose of this study was to develop a caregiver and healthcare provider assessment tool to evaluate essential tracheostomy skills using a simulated task trainer. METHODS: Three tracheostomy skill checklists were developed: closed suctioning, open suctioning, and tracheostomy change. Checklist items were developed based on institutional guidelines and a literature review. Items were revised based on iterative expert review and pilot testing. A total of 64 intensive care staff and 24 caregivers were evaluated using the checklists, of which 29 staff members and 4 caregivers were rated simultaneously by 2 raters to estimate interrater reliability. The relationships between checklist performance and staff demographics (experience and discipline) were calculated. A survey examining the selection of automatic fail items and minimum passing score was sent to 660 multidisciplinary staff members. RESULTS: Intraclass correlations were 0.93 for closed suctioning, 0.93 for open suctioning, and 0.76 for tracheostomy change. Staff performance only correlated with experience for the tracheostomy change checklist and was inconsistently associated with discipline (respiratory therapy vs nursing). A large, multidisciplinary survey with 132 of 660 respondents confirmed the selection of automatic fail items and minimum passing score. A total of 92.9% of the survey respondents agreed with a minimum passing score of 80%. CONCLUSIONS: We developed 3 essential tracheostomy skill checklists with multiple sources of validity evidence to support their use in a simulation-based assessment of tracheostomy skills.

Capturing At-Home Health and Care Information for Children With Medical Complexity Using Voice Interactive Technologies: Multi-Stakeholder Viewpoint.

Digital health tools and technologies are transforming health care and making significant impacts on how health and care information are collected, used, and shared to achieve best outcomes. As most of the efforts are still focused on clinical settings, the wealth of health information generated outside of clinical settings is not being fully tapped. This is especially true for children with medical complexity (CMC) and their families, as they frequently spend significant hours providing hands-on medical care within the home setting and coordinating activities among multiple providers and other caregivers. In this paper, a multidisciplinary team of stakeholders discusses the value of health information generated at home, how technology can enhance care coordination, and challenges of technology adoption from a patient-centered perspective. Voice interactive technology has been identified to have the potential to transform care coordination for CMC. This paper shares opinions on the promises, limitations, recommended approaches, and challenges of adopting voice technology in health care, especially for the targeted patient population of CMC.

Staff Nurses' Perspectives of Resources Needed During Floating.

OBJECTIVE: The aim of this study was to examine nurses' perceptions regarding the resources needed during floating. BACKGROUND: Most studies report on patterns of floating and the characteristics of float pool nurses. No studies exist regarding staff nurses' views of the types of resources needed to support floating. METHODS: Staff nurses in a pediatric hospital (N = 220) completed an electronic survey of both open- and close-ended questions. Close-ended data were analyzed with frequencies and percentages. Open-ended data were content-analyzed and then frequencies and percentages of categories of responses were performed. χ Analyses were used to examine relationships between the variables. RESULTS: There were no significant relationships between resources and years at the institution and number of times floated in past year. The top 3 categories of resources needed to float by nurse participants included having an assigned a resource/buddy, mini-orientation, and electronic updates about the units they are floating to. CONCLUSIONS: These findings underscore common frustrations nurses experience during floating and ways that nurse executives can create a more satisfactory floating environment and increase nursing satisfaction.

A systematic review of pediatric self-report symptom measures: Congruence with the theory of unpleasant symptoms.

PURPOSE: Many children and adolescents experience unpleasant symptoms due to acute and chronic illnesses. Several symptom measures specific to children and adolescents are available to assess unpleasant symptoms. What is unclear is how well these measures assess all dimensions of the symptom experience. Using the Theory of Unpleasant Symptoms (TOUS) as a guide, the purpose of this systematic review of self-report symptom measures was to examine the comprehensiveness of current symptom measures designed to assess children's and adolescents' symptom experiences. CONCLUSIONS: The TOUS did not guide the development of any of the measures studied; hence, exact parallels were not expected. Currently, no pediatric self-report symptom measures were found that assessed all dimensions of the symptom experience. Four measures captured three dimensions: intensity, timing, and distress. Only two measures assessed quality. PRACTICE IMPLICATIONS: Practitioners need to be aware of the dimensions reflected in commonly used symptom measures. Augmentation of these measures is needed in order to assess the entire symptom experience in children and adolescents.

Nurses' Responses and Reactions to an Emergent Pediatric Simulation Exercise.

Pediatric nurses' responses and reactions in emergent simulations are understudied. Using authority gradient theory as a guide, the purpose of this study was to examine nurses' reactions during an emergency simulation exercise when directed to give an incorrect medication dose. Ten groups of noncritical care nurses were videotaped from the beginning of the simulation through debriefing. Although errors were made during the simulation event, all groups responded correctly during debriefing, indicating that authority gradient may play a role in clinical decision-making.

A systematic review of reviews of behavioral interventions to promote condom use.

BACKGROUND: Sexually transmitted infections (STIs) are a major public health problem. Realistically, condom use is still the primary means to prevent STIs. Because many behavioral intervention studies have been performed to increase condom use across multiple populations and many reviews have been done, a review of all these reviews is warranted. AIMS: The purpose of this paper is to examine Level I evidence of behavioral intervention studies to promote condom use. The purpose of this evidence-based practice (EBP) review is to examine the evidence and determine: (a) if behavioral interventions are effective; and (b) if they are, what are the common characteristics of successful interventions that need to be implemented in practice. METHODS: A systematic search for literature was conducted in the following databases: Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, and Psychological and Behavioral Sciences Collection. The following parameters were used for the search: (a) a meta-analysis or level 1 synthesis of literature containing only intervention (randomized control trials or quasi-experimental) studies; (b) peer-reviewed journals; (c) published in the past 10 years (2002-2012); (d) had adolescents or adults as the sample (13-44 years of age); and (e) were published in English. RESULTS: Behavioral interventions were effective in promoting condom use and other safer sexual practices and reducing STIs. They were not effective in promoting abstinence. Tailoring to certain characteristics of the population and including skills building exercises were primary characteristics in the successful interventions IMPLICATIONS: There is a preponderance of evidence that behavioral interventions do promote condom use and reduce STIs across diverse groups of individuals. Clinicians can use these interventions with confidence in practice.

Temperament, Context and Sexual Risk among College Students.

Much is known about predictors of risky sexual behaviors in young adults. Little is known; however, about the contribution of temperament and how temperament interacts with context to influence sexual risk intentions and actual behaviors. Since intentions are closely linked to behavior, knowing how temperament influences these decisions is important in planning interventions. The purpose of this quasiexperimental study was to examine the effect of gender, temperament, and context on sexual risk intentions and behaviors among college students (N = 145). Although individual components of temperament were associated with sexual risk intentions, temperament did not predict sexual risk intentions in a safer or risky context or actual behaviors. There were also no differences by gender. In this study, temperament did not interact with context to influence sexual risk intentions or behaviors. According to these results, interventions promoting safer sexual behaviors may not have to be tailored to individuals with different temperament styles.

Army women's evaluations of a self-administered intervention to prevent sexually transmitted diseases during travel.

BACKGROUND: Military personnel experience seven times the sexually transmitted infections of civilians. Military women are especially vulnerable. No self-administered interventions to promote safer sexual behaviors are available for use by military personnel while on duty in austere locations. The purpose of this study was to ascertain Army women's evaluations of a new theory-based, self-administered, and portable intervention designed to promote safer sexual practices during duty abroad. METHOD: Two focus groups were conducted at a large military installation in the Pacific Northwest. Army women (N=20) ages 18-49 years participated in the groups. Women first examined the intervention and then their reactions to the intervention were elicited with open-ended questions. The qualitative data then were content analyzed. RESULTS: All participants would either recommend or personally use the intervention. Positive features of the intervention included the type of information, a user-friendly and self-explanatory format, and that it was an aid to decision making about safer sex. Concerns included a tendency toward too much information and fears of non-acceptance by peers or sexual partners. CONCLUSION: Minor changes have been made based upon these results. The intervention will be reviewed again and proceed to clinical trials with female military personnel and other travelers.

Preventing women's sexual risk behaviors during travel.

Sexually transmitted infections (STIs) are a global concern. Although several countries have tracked the incidence of STIs acquired during travel to foreign countries, the United States lags behind in this practice. Nevertheless, there is evidence from the US and several countries that women engage in sexual risk behaviors during travel whether domestic or foreign, thereby placing themselves at risk for contracting STIs. Guidelines for assessment, prevention, and travel-related supplies and resources are discussed.

Army women's reasons for condom use and nonuse.

PURPOSE: The purpose of this study was to examine Army women's condom use patterns, reasons for condom use and nonuse, and what is liked about and problems associated with condom use. METHODS: Army women (n = 131) from military posts around the country were recruited. The women ranged in age from 18 to 68 years (M = 30.5, SD = 10.5). The sample was of mixed ethnicity. Questionnaires were distributed by the units and returned directly to the principal investigator. Participants completed a series of anonymous open- and closed-ended questions regarding their experiences with condoms. Closed-ended questions were analyzed with descriptive statistics and open-ended responses were content analyzed (McLaughlin & Marascuilo, 1990). CONCLUSIONS: Regular condom use was low in this sample. The most often cited responses as to why women liked using condoms included peace of mind, protection, or ease of use. The most cited problems and subsequent disuse included irritation/inflammation, breakage, improper fit, or ruining the moment. Results differed by consistency of condom use. Regular users of condoms reported a lower percentage of problems using condoms.

Army women's sexual health information needs.

OBJECTIVE: To ascertain Army women's specific sexual health information needs prior to developing a theoretically based, self-administered intervention to promote safer sexual practices during deployment. DESIGN: An exploratory design was employed to address the research questions. PARTICIPANTS: Participants (N= 131) were Army women recruited from Army posts around the United States. The women ranged in age from 18 to 68 years (M= 30.8, SD= 10.5), were of varied ethnicity, and had an average time in service of 8.0 years (SD= 6.6). MAIN OUTCOME MEASURES: Desire for knowledge about sexual health and safer sexual practices were measured with forced-choice responses based upon DiIorio's Safer Sex Questionnaire (DiIorio, Parsons, Lehr, Adame, & Carlone, 1992) and open-ended questions to assess past information received, quality of that information, and information desired. RESULTS: Participants had moderate levels of sexual risk behaviors. Forced-choice responses yielded little desire for information regarding safer sexual practices. Women identified different sexual health and safer sexual information needs based upon whether they were at a normal duty station or during deployment. CONCLUSIONS: Participants did not identify many information needs; however, their sexual behaviors indicate the need for interventions.

The need for sexual health information: perceptions and desires of young adults.

PURPOSE: To ascertain young adults perceptions of previously received sexual health information and describe what types of information they would like to receive. STUDY DESIGN AND METHODS: In individual interviews, 55 young adults were asked questions regarding their perceptions of previously received sexual health information as well as their interests in receiving future information. Content analysis was used to categorize responses and identify categories. RESULTS: The majority of participants remember receiving information about sexually transmitted infections (STIs) primarily from classes in middle and high school. Less than half remembered receiving information about contraception or how to prevent STIs. The majority of participants did not feel that (or were uncertain about whether) past information influenced their current sexual practices. Of those who felt past education influenced them in changing sexual practices, an increase in awareness of their risk was the category most often cited. One-third of the participants responded that a culture of abstinence in the US explained why current educational programs failed. When asked to describe an ideal sexual health program, the most common answers were wanting a comfortable, "not scared" person to teach them more "nitty-gritty" information about STIs with "more details," what they could do to protect themselves, "how to get birth control," and "how the reproductive system works." CLINICAL IMPLICATIONS: Young adults have specific needs and interests when it comes to sexual health information. Research is necessary to see if development of specific interventions requested by young adults would result in higher levels of recall and ability to avoid dangerous sexual practices.

Emotions involved in college students' sexual encounters.

The number of sexually transmitted infections continues to rise among late adolescents and young adults. One possible explanation is that an important variable, emotion, is missing from theories and programs promoting safer practices. This study performed a thorough examination of emotions involved during and after sexual encounters and how these related to risk and planning of the sexual encounter. Eighty-two college students were given recall instructions and a questionnaire designed to elicit detailed information about their recent or most memorable sexual encounter. Using content analysis, open-ended questions concerning emotions and thoughts about the sexual partner, the participant in the situation, the place of the encounter, and feelings after the encounter were analyzed. Major findings included individuals who experienced negative or mixed emotions expected certain sexual behaviors less than those who had positive emotions. Unlike previous studies, there were no differences in emotions and planning of the sexual encounter, type of partner, and sexual risk.

Restorative activities of community-dwelling elders.

This study was conducted to identify the restorative activities of community-dwelling elders. Exposure to restorative activities, such as observing nature, is associated with improved concentration, more effective cognitive functioning, and feelings of greater mental energy, peacefulness, and refreshment. Little literature exists regarding the types and benefits of restorative activities engaged in by elders, a group in need of means to promote optimal daily functioning. A qualitative descriptive design was used. Thirty (28 women, 2 men) community-dwelling elders (ages 65 to 92 years) were interviewed using open-ended questions to ascertain their perceptions of restorative activities. A content analysis of themes produced 12 categories of restorative activities: creative outlets, altruism, nature, social connections, cognitive challenges, physical activity, reading, family connections, spirituality and reflection, cultural activities, travel, and other activities. Additional studies with larger, culturally diverse samples and more men are warranted before implementing restorative interventions with elders in the hopes of promoting optimal functioning and well-being.

Situational factors involved in college students' safer and risky sexual encounters.

OBJECTIVE: To ascertain the differences between the situational factors of risky and safer sexual encounters in college students. DESIGN: Descriptive. SETTING: Community-dwelling college students from a large Midwestern university. PARTICIPANTS: Participants were 84 college students ages 18 to 20 years. Fifty-five were female (67.5%), the majority (95.2%) were White, and all reported being heterosexual. MAIN OUTCOME MEASURE: Use of safer or risky practices in last or most memorable sexual encounter. RESULTS: Important situational characteristics of safer encounters were negative ambiance of the place, type of partner, unattractive qualities of the partner, communication with the partner, and having the encounter because of feeling desire. Important situational characteristics of risky encounters were a cozy ambiance, partner's attractiveness inducing desire, asking directly for the encounter, and encounters occurring after celebration or partying. CONCLUSIONS: Many characteristics were similar for both risk groups. However, practitioners can tailor interventions to make clients aware of factors that were more prevalent in risky sexual encounters, such as having the encounter with a boyfriend or girlfriend and having an encounter after drinking alcohol and partying.

College students' perceptions and practices of sexual activities in sexual encounters.

PURPOSE: To examine college students' understanding of safer sexual encounters, including expectation for sexual activities, planning for sexual encounters, and ideas about what constitutes "safe" sex. DESIGN: Exploratory design of college students' perceptions of and actual sexual activities that occurred in their last or most memorable sexual encounter. METHODS: Participants in one U.S. university completed three open- and closed-ended questions about their activities, as part of a larger questionnaire concerning contextual factors in their sexual encounters. A content analysis was conducted on data from open-ended questions. Encounters were categorized by risk for further analysis. FINDINGS: No significant differences were found in expectations regarding sexual activities between participants who had risky and safer encounters, except that participants who had safer encounters expected touching through clothing significantly less than did those who had risky encounters. Frequencies of sexual activities varied greatly between the two risk groups. No differences were found between the two groups concerning whether the encounter was planned or in expectation of sexual activities by planning of the encounter. The majority erroneously thought they had "safer" sex. The most reported reasons for believing a risky encounter was safer included the use of a hormone-based birth control method, use of a condom during vaginal sex only, and believing no sex had occurred in the case of oral sex. CONCLUSIONS: For these participants, planning of the encounter was not related to safer sexual activities and safer sexual activities were generally misunderstood.