Rethinking the Order of the Learning Process: A New and Sustainable Path Designed for an RN-to-BSN Education Program.

ABSTRACT: The unpredictable and volatile economic context, ever-changing demography, explosion of technology, and rapid disruptive health delivery models are only a few of the factors characterizing the constant flux permeating the health care system. Current educational initiatives are corrective and reactive rather than reflective and proactive. Some renowned nurse educators and educational leaders pioneered the departure from a learning emphasis on what nurses do to what nurses become. To foster students' creative initiatives, faculty of an RN-to-BSN three-semester program thread five stages of a creativity process of exposure, inquiry, discovery, reflection, and evaluation into three interrelated courses in the program of study.

COVID-19 pandemic-related changes in wellness behavior among older Americans.

BACKGROUND: COVID-19 has taken its toll on citizens in all 50 states of the United States. The United States (U.S.) leads the world with 30,291,863 confirmed reported cases and 549,664 deaths as of March 29, 2021 compared to globally confirmed cases at 127,442,926 and 2,787,915 deaths as of March 29, 2021. The U.S. federal government primarily left the response to the virus to individual states, and each implemented varying measures designed to protect health of citizens and the state's economic well-being. Unintended consequences of the virus and measures to stop its spread may include decreased physical activity and exercise, shifting access and consumption of food, and lower quality-of-life. Therefore, our primary goal was to quantify the impact of COVID-19 on health and well-being by measuring changes in physical activity, mental health-quality of life, food security and nutrition in adults ages 40 and older. We believed shifts in health behaviors would be more prevalent in minorities, less educated, lower socio-economic status, older adults, and those with underlying health conditions, so a secondary goal was to determine the impact of COVID-19 on these sub-populations. METHODS: We conducted an online survey with 9969 adults 40 years and older between 9 August and 15 September 2020 in urban areas across the four U.S. census regions. The survey included questions about demographic variables, pre-existing health conditions, physical activity, access to food, quality-of-life, and nutritional food status and asked participants to respond with information from pre-pandemic and pandemic conditions. We used paired-sample t-tests to detect changes in variables after the start of the pandemic and Cohen's d to determine effect sizes. RESULTS: Our main findings showed a decrease in physical activity since the onset of COVID-19 for minorities and non-minorities. Food security also slightly increased for minorities during the pandemic, but we found no other changes in food security, quality-of-life indicators, or nutritional status of those who responded to this survey. CONCLUSIONS: It is concerning that physical activity declined. Such activity helps maintain physical and mental health, and it is also an important time to socialize for many older adults. In many ways, our data indicate that the older adult population in U.S. cities may be more resilient than expected during the pandemic. However, the pandemic could have negative impacts that we did not detect, either due to the survey instrument or the timing of our survey, so the health and well-being of older adults should continue to be monitored in order to mitigate potential negative impacts.

Dietary Shifts since COVID-19: A Study of Racial Differences.

BACKGROUND: The COVID-19 pandemic has fundamentally changed the quality and quantity of people's food consumption. OBJECTIVE: This study aimed to explore the dietary shifts among different racial groups resulting from the COVID-19 pandemic, focusing on changes in consumption across various food categories. METHODS: This cross-sectional study included a sample of 10,050 urban residents aged 40-100 years across the United States. Dietary patterns among African American, Asian, Hispanic, and White populations were assessed before and since the pandemic (retrospective condition) using the Dietary Screening Tool (DST). The DST investigates consumption trends in food groups aligned with the MyPlate guidelines, plus fat, sugar, and sweet (FSS) intake and processed meats. RESULTS: This study found significant shifts in food consumption patterns among racial groups since COVID-19. The data indicate that African American individuals largely reduced their consumption of several food groups compared to White individuals, with a 43% decrease in processed meats, 42% in dairy, 36% in lean protein, 21% in fruit, 17% in grains, and 15% in FSS, although their vegetable consumption did not significantly decrease. African American individuals also consumed 66% less processed meat, 57% less dairy, and 30% less lean protein in comparison to Asian individuals. Hispanic individuals also showed a tendency to reduce their consumption more than White individuals, with a 34% decrease in dairy, 28% in vegetables, and 24% in fruit. In contrast, Asian individuals consumed 37% less FSS and 34% less grains than White individuals. Additionally, when compared to Asian individuals, Hispanic individuals consumed 49% less dairy and 47% less processed meat. The findings also revealed that African American individuals were the most nutritionally vulnerable group since the pandemic. Specifically, they were 38% and 35% more likely to be considered at nutritional risk than Asians and White participants, respectively. CONCLUSIONS: These findings illuminate the considerable dietary shifts induced by the COVID-19 pandemic and emphasize the critical need to address the racial disparities in nutritional vulnerability and public health policy.

Effects of Lifestyle Factors on Cognition in Minority Population of Older Adults: A Review.

The onset of dementia and Alzheimer's disease (AD) is projected to expand over the next several decades in the United States as the population ages. However, the cognitive health burden is not equally distributed among the population, as Hispanics and African Americans are at higher risk of AD when compared with Non-Hispanic Whites. There is some evidence to indicate that cognitive decline may be associated with lifestyle factors and that interventions in these domains may prevent or delay this decline. These lifestyle factors include social engagement, physical activity, both aerobic and strength training, dietary intake, sleep and stress. This review summarizes, in general, what is known about the relationship between risk factors and cognition and, in particular what is known about this relationship in minority populations. The results show that the relationship between these risk factors and cognitive decline is stronger for some of the factors such as physical activity and dietary intake and weaker for the other factors depending on what is measured and in what populations. It does appear, however, that the studies in minority populations is limited and warrants more targeted research and interventions.

Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index.

PURPOSE: The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods. BACKGROUND: Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD. METHOD: Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures. RESULTS: Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184). CONCLUSIONS: A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.

Perceptions, Opinions, Beliefs, and Attitudes About Physical Activity and Exercise in Urban-Community-Residing Older Adults.

Background: This research study illustrates the perceptions, opinions, beliefs, and attitudes of older adults residing in an urban community as major factors to understanding barriers and motivators in older African Americans, Hispanics, and Asians adults within Washington, DC. Methods: Eight focus group sessions conducted with 58 older adults to determine their understanding of physical activity and exercise, as well as of barriers to, motivators for, and benefits of physical activity and exercise. Results: The results showed that dance was the preferred physical activity and exercise, fixed or limited income were the main barriers, and prolonged life, more energy, and a stronger body were the main benefits. Conclusion: The results will assist in recommendations to policy makers on programs for older adults that will increase physical activity and exercise for local citizens. These interventions are more likely to increase older adults' ability to remain in their communities and improve their overall health and well-being.

Peripheral arterial disease and the ankle-brachial index: what home healthcare clinicians need to know.

Registered nurses and physical therapists working in home healthcare are ideally situated to identify individuals with undiagnosed peripheral arterial disease (PAD). This article focuses on identifying PAD in the lower extremities. The purpose of this continuing education article is to assist the reader in recognizing the role of the home healthcare clinician in identifying and managing PAD. At completion of this module, participants will be able to identify key factors related to PAD, including use of the ankle-brachial index (ABI), and to identify individuals with the disease.