Psychometric properties of the Diabetes Empowerment Scale Modified Version-Spanish, tested in an at-risk Latino immigrant population.

BACKGROUND: Latino populations are at high risk of developing diabetes; however, few scales measure self-efficacy to change health behaviours in at-risk Latino individuals. The Diabetes Empowerment Scale was translated into Spanish, and its psychometric properties were tested. METHODS: This descriptive investigation was conducted with adults in a predominately Latino Midwest community. Participants (N = 141) completed a modified version of the Diabetes Empowerment Scale, which measures self-efficacy in exercising and healthy eating. Factor analysis was performed on completed surveys. Recruitment in Latino cultural centres and parishes took place from June 2016 to May 2017. RESULTS: Three factors emerged: self-efficacy to exercise, emotional eating and social eating. Three scale questions had low scores during analysis; however, overall, the tool demonstrated adequate validity. CONCLUSIONS: The Diabetes Empowerment Scale Modified Version-Spanish demonstrated adequate reliability and validity. Healthy dietary preferences and physical activity in populations at-risk for diabetes should be assessed by nurses to ascertain level of self-efficacy in individuals by assessing confidence to engage in specific healthy behaviours.

Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics.

OBJECTIVE: This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS: This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS: The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each. CONCLUSION: This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.

Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection and hospitalization rates.

BACKGROUND: The focus of nursing home infection control procedures has been on decreasing transmission between healthcare workers and residents. Less evidence is available regarding whether decontamination of high-touch environmental surfaces impacts infection rates or resident outcomes. The purpose of this study was to examine if ultraviolet disinfection is associated with changes in: 1) microbial counts and adenosine triphosphate counts on high-touch surfaces; and 2) facility wide nursing home acquired infection rates, and infection-related hospitalization. METHODS: The study was conducted in one 160-bed long-term care facility. Following discharge of each resident, their room was cleaned and then disinfected using a newly acquired ultraviolet light disinfection device. Shared living spaces received weekly ultraviolet light disinfection. Thirty-six months of pretest infection and hospitalization data were compared with 12 months of posttest data. Pre and posttest cultures were taken from high-touch surfaces, and luminometer readings of adenosine triphosphate were done. Nursing home acquired infection rates were analyzed relative to hospital acquired infection rates using analysis of variance procedures. Wilcoxon signed rank tests, The Cochran's Q, and Chi Square were also used. RESULTS: There were statistically significant decreases in adenosine triphosphate readings on all high-touch surfaces after cleaning and disinfection. Culture results were positive for gram-positive cocci or rods on 33% (n = 30) of the 90 surfaces swabbed at baseline. After disinfectant cleaning, 6 of 90 samples (7.1%) tested positive for a gram-positive bacilli, and after ultraviolet disinfection 4 of the 90 samples (4.4%) were positive. There were significant decreases in nursing home acquired relative to hospital-acquired infection rates for the total infections (p = .004), urinary tract infection rates (p = .014), respiratory system infection rates (p = .017) and for rates of infection of the skin and soft tissues (p = .014). Hospitalizations for infection decreased significantly, with a notable decrease in hospitalization for pneumonia (p = .006). CONCLUSIONS: This study provides evidence that the pulsed-xenon ultraviolet disinfection device is superior to manual cleaning alone for decreasing microbes on environmental surfaces, as well as decreasing infection rates, and the rates of hospitalization for infection. Results suggest that placing a stronger emphasis on environmental surface disinfection in long-term care facilities may decrease nursing home acquired infections.

Embracing an "African Ethos" to facilitate African immigrants participation in medical genetics and genomics research.

BACKGROUND: Limited published research exists on perceptions and potentials for black African immigrants' participation in medical genetics and genomics research. PURPOSE: This study explores the inclination and disinclination of African immigrants to be involved in genetics and genomics research. METHODS: In-depth qualitative interviews were employed in which a sample of black African immigrants 18 years and older (n = 34) were interviewed. DISCUSSION: Barriers included contrary beliefs and customs about disease and the human body that differs from Western conceptions, and lack of genuine connection to the health care system. Facilitators included promotion of an "African ethos," wherein Africans unite with one another in a communal extension of self and robust community involvement across the life span of genetic studies. CONCLUSION: It is important for researchers and genetic counselors to understand the sociocultural underpinnings of African immigrants about genetics and genomics research as an initial step to encouraging their participation.

Effective Weight Loss for Children: A Meta-analysis of Intervention Studies 2002-2015.

BACKGROUND: Investigators have implemented a variety of strategies for managing and treating childhood overweight and obesity over the past decade, yet the high prevalence of childhood overweight or obesity remains. The aim of this meta-analysis was to examine the effectiveness of childhood overweight or obesity interventions addressing weight loss from 2002-September 2015. METHODS: The population focused on in this review were children who were overweight. The treatment group interventions focused on weight loss for overweight children, and included dietary, physical activity, life style changes, or a combination of treatments. Control groups received no treatment other than what they would usually receive in their normal daily lives including standard healthcare assessments. Outcomes for the studies were focused on whether the overweight children in the treatment groups lost weight. RESULTS: The criteria for the meta-analysis were met by 16 intervention studies, with a total of 19 outcomes reported within those studies. Two thousand, three hundred and seventeen participants ranged from 6 to 15 years of age with a mean age of 12 years or less. The majority of the 16 studies were conducted outside the United States (n = 13), with half reporting data on the cost of running the programming (n = 8) and were overwhelmingly conducted by interdisciplinary teams without nurses as members of the team (n = 13). The M effect was g = .732, p < .001 with a 95% confidence interval of 0.351 to 1.113, with quality scores ranging from 20 to 29 out of a possible 41. The heterogeneity analyses overall Q score was 378, an I-squared of 95, with a fail-safe N of 415. LINKING EVIDENCE TO ACTION: Diverse interventions included in this meta-analysis had a significant positive effect on weight loss in overweight children. Future research needs to focus on the role of the nurse in ensuring development and translation of the effective interventions in real world settings, at a scale that would move beyond small segments of the affected populations of overweight children.

The Ebola epidemic in West Africa: challenges, opportunities, and policy priority areas.

The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in particular the inadequacies of health care systems in sub-Saharan African countries for appropriately managing and containing infectious diseases. The purpose of this article is to examine the sociopolitical and economic conditions that created the environment for the Ebola epidemic to occur, identify challenges to and opportunities for the prevention and control of Ebola and future outbreaks, and discuss policy recommendations and priority areas for addressing the Ebola epidemic and future outbreaks in West Africa. Articles in peer-reviewed journals on health system reforms in developing countries and periodicals of international organizations were used to gather the overview reported in this article. We identify individual, structural, and community challenges that must be addressed in an effort to reduce the spread of Ebola in West Africa. The Ebola epidemic in West Africa underscores the need for the overhaul and transformation of African health care systems to build the capacity in these countries to address infectious diseases. Public-private partnerships for investment in developing countries' health care systems that involve the international community are critical in addressing the current Ebola epidemic and future outbreaks.

Exploratory Study of Breast Cancer Screening Practices of Urban Women: A Closer Look at Who Is and Is Not Getting Screened.

Several initiatives have been embarked upon over the past decade to encourage breast cancer screening and follow-up among women who reside in urban communities. With these efforts, data revealed that many women do not receive the recommended breast cancer screening. Studies have been published in scientific literature that explored barriers faced by women relative to breast cancer screening. But, only a few reports have been published of efforts initiated to define the limits of characteristics of women who have and women who have not been screened. This cross-sectional exploratory study was designed to examine the breast cancer screening practices of women 40-74 years of age and older who reside in a densely populated metropolitan community of S.E. Wisconsin, and to identify and compare the characteristics of women who report breast cancer screening and with characteristics of women who report no breast cancer screening. The organizing framework for this study was derived from the United States Department of Health and Human Services Determinants of Health Model. An investigator-designed instrument was used to assess the influence of age, family history of breast cancer insurance status, characteristics of residential neighborhood and local access to breast care on breast cancer screening. While the majority of the women surveyed reported breast cancer screening, less than half of the women reported screening that was consistent with recommended breast cancer screening guidelines (i.e. annual mammography and annual clinical breast examination). Deficits in breast cancer screening were noted most among women who were uninsured, with no knownfamily history of breast cancer, who resided in low income neighborhoods, inner-city neighborhoods and neighborhoods without facilities for primary breast care. The results of this study demonstrate the needfor clinicians, health care administrators and advocates committed to breast cancer detection and control within targeted communities. They must carefully assess the impact of individual, social and structural factors on breast cancer screening, and the need to design initiatives specifically targeted to women who have received less than optimal or no breast cancer screening.

Black African immigrant community leaders' views on participation in genomics research and DNA biobanking.

BACKGROUND: The emergence of DNA biobanks and the power they lend to genomics research promise substantial advances in disease prevention and treatment. Greater participation of racial/ethnic minority populations is necessary to assure a future of personalized medicine for all. PURPOSE: The purpose of this study was to explore perspectives on genomics research and DNA biobanking among black African immigrants, an often overlooked US subpopulation. METHODS: As part of a larger staged study using community-based participatory research (CBPR) methods, we conducted four focus groups with 27 leaders in the black African immigrant community, exploring perceptions about genomics, barriers, and facilitators to participation in DNA biobanks and ethical ways to engage communities. FINDINGS/DISCUSSION: Prominent in their views on genomics research was the legacy of colonial mistreatment and exploitation by Western researchers in their home countries in sub-Saharan Africa. The central dilemma for participants was balancing responsibilities to protect their people from harm and to find solutions for African generations to come. They insisted that nothing short of a transformation of research practice would elicit the full and sustained participation of African immigrants in the genomics enterprise. CONCLUSION: To better align practice and policy in the field of genomics research and DNA biobanking with values expressed by African immigrant leaders, it is recommended that the field adopt a CBPR model for research and a benefit-sharing model for policy.

Promoting breast health among urban African-American women: evidence supporting the need for a purposeful pursuit of the promise.

While several reports of studies undertaken to examine the influence of individual factors and access to quality care on the breast cancer outcomes of African-American women have been published, few studies have been reported that examined the interaction of these factors with variables associated with the social and physical environment. This report presents a summary of outcomes of a study undertaken to explore the impact of individual factors, social factors, environmental factors, and access to quality breast care on breast awareness and breast cancer screening practices among a targeted group of African-American urban women. The findings revealed that awareness and screening were significantly influenced by the participant's age, insurance status, characteristics of their social environment, and their breast awareness. The findings emphasize the need for targeted programming and services in low-income communities and inner-city neighborhoods where women may be less inclined to "venture out" and where clinicians, educators, researchers, and representatives of institutions dedicated to breast cancer control have been less inclined to "venture in."

Reflections and perspectives of African-American community leaders regarding genetics and genomics research: sentiment and wisdom of Sankofa.

Advances in genetic and genomic research are shifting the typical disease timeline. For those afflicted by disease and for population groups known to experience excess disease-related morbidity and mortality, the ability to use genetics and genomics to predict an individuals' predisposition for developing a disease and/or to anticipate an individual's response to treatments holds tremendous promise. Over the past two decades several public and private institutions within the United States have been established for the purpose of collecting and storing biological specimens for the purpose of conducting genetic/genomic research. Multiple reports indicate that the involvement of racial/ethnic minority participants in these bio-repositories is limited. Little is known about the willingness of African-Americans, one of the largest and most vulnerable racial/ethnic population groups, to participate in genetic research, genomic research, and to contribute biological specimens to bio-repositories. An exploratory study was undertaken using principles of community engagement and community-based participatory research to examine the perspectives of leaders within the African-American community about participation in genetics research, genomics research, and bio-banking. Semi-structured focus groups with twenty-one African-American community leaders were the primary means of gathering the study data. Reflections and commentary of the community leaders were interspersed with sentiments of "Sankofa." The emergent themes, health-related disparities, historical injustices in medical research, the promise of genetic and genomic research, and genetics/genomic research engagement, implicated the importance of conducting genetics/genomics research in the context of the community interdependent with efforts to address determinants of health and health disparities.

TANF over time: the tale of three studies.

We compare the experiences of women from three studies who were in different stages of participation in the U.S. welfare program, Temporary Assistance for Needy Families (TANF). The setting for the studies was a large Midwest urban county, targeted chain referral sampling was used, and the combined sample of the three studies was 106 women. The instruments were a semistructured interview guide, the HANES General Well-Being Schedule and a demographic data form. Quantitative data are augmented with qualitative interview data. The findings suggest barriers to self-sustaining employment include health challenges, limited education, socio-economic marginalization, and the welfare policy itself. Nurses are well positioned to advocate for women in poverty and mitigate the health challenges they face. The findings add to the limited evidence base on which the TANF policy is based and can be used to modify the policy to increase the success of the women who participate in it.

Exploring Factors Associated with Physical Activity in Latino Immigrants.

Latinos are at increased risk for developing chronic conditions. Regular physical activity (PA) assists in protecting adults from developing type 2 diabetes, excess weight, and heart disease, making PA important for health promotion. This cross-sectional, descriptive investigation was conducted with adults 18 years of age and older in a predominately Latino community. Perceptions of factors which influenced PA were examined. Descriptive statistics and multiple regression analysis were performed. Immigrant Latino males engaged in PA significantly more often than female participants. In Latino participants, those who engaged in walking activities were more likely to engage in both vigorous (r = .341, p<.005) and moderate PA (r = .317, p <.001). Self-efficacy and acculturation were significant predictors of PA. Acculturation was associated with physical activity, even after adjusting for perceived stress. Findings highlight the continued importance of self-efficacy to foster health promotion in Latino communities.

Relationship of symptoms, perceived health, and stigma with quality of life among urban HIV-infected African American men.

OBJECTIVES: To explore the relationship of symptom prevalence and intensity, perceptions of health, and stigma on quality of life (QOL) among HIV-infected African American men. DESIGN: Cross-sectional correlational descriptive study. SAMPLES: The sample consisted of HIV-infected African American men (N=55), all urban, age range 23-66 years (M=48.84, SD=7.67), average length of time since HIV diagnosis 10.79 years (SD=6.4). MEASUREMENTS: A questionnaire consisting of 5 instruments was used: (a) sociodemographic characteristics, (b) Holzemer Signs and Symptom Checklist for HIV, (c) perceptions of health, (d) Berger HIV Stigma Scale, and (e) Holmes HIV/AIDS-Targeted Quality of Life Scale. RESULTS: Prevalent symptoms were fatigue (98%), fear (92.7%), shortness of breath (92.7%), gastrointestinal upset (85.5%), numbness (80.0%), and headache (76.4%). Symptoms with the highest intensity were gastrointestinal upset, body changes, fear, and fatigue. Symptom intensity was significantly associated with the measures of stigma and QOL. CONCLUSIONS: The results underscore the importance of incorporating a holistic view of the relationship of symptoms with QOL for HIV-infected African American men. Without efforts to ameliorate stigmatizing effects, however, nurses may be falling short in helping individual African American men with HIV infection achieve a better QOL.

Grief and personal growth experience of spouses and adult-child caregivers of individuals with Alzheimer's disease and related dementias.

PURPOSE: The purpose of this study was to describe the grief and personal growth experience of spouses and adult children of individuals with Alzheimer's disease and related dementias and the factors contributing to these experiences. DESIGN AND METHODS: We used a modification of the Marwit-Meuser-Sanders Caregiver Grief model to examine the factors that contribute to grief and personal growth. We used chi-square tests, t tests, multivariate analyses of variance, correlations, and hierarchical regression analyses in a cross-sectional analysis of 201 spouses and adult children caregivers at various stages of the disease trajectory. RESULTS: Grief increased as the severity of the disease increased. When the spouse with Alzheimer's disease lived out of the home, spouse caregivers experienced more sadness and longing, worry and isolation, and personal sacrifice burden than did adult children caregivers. Different factors influence grief and personal growth for caregivers of individuals with Alzheimer's disease. The majority of caregivers experienced personal growth, with more growth experienced by adult children. IMPLICATIONS: Health care providers should consider using the Marwit and Meuser Caregiver Grief Inventory to screen for high levels of grief in caregivers of individuals with Alzheimer's disease. Supportive services targeted for those with high levels of grief are suggested.

Behaviors of nursing home residents with dementia: examining nurse responses.

It is challenging for nurses to understand and respond to behaviors expressed by individuals with dementia. Nurses in this study responded to behaviors in 4 discrete ways--with no treatment, treatment without assessment, repetitive use of ineffective treatments, and with comprehensive assessment followed by treatment. Using ineffective treatments and treating without assessing were associated with recurrence of behaviors. This study suggests there is a need for more assessment and critical thinking when addressing behavior change in individuals with dementia.

Nurses' Own Birth Experiences Influence Labor Support Attitudes and Behaviors.

OBJECTIVE: To describe the attitudes of intrapartum nurses about the importance of and intent to provide professional labor support (PLS); barriers to PLS, such as perceived subjective norms and perceived behavioral control; and relationships among attitudes, behaviors, and nurse and site characteristics. DESIGN: A cross-sectional, mixed-methods, descriptive design was guided by the Theory of Planned Behavior. SETTING: Three hospital sites in one region of a single Midwestern state. PARTICIPANTS: Sixty intrapartum nurses participated. METHODS: The Labor Support Questionnaire and demographic questionnaire were administered online. The Labor Support Questionnaire is used to measure attitudes about the importance of and intended behaviors associated with labor support. RESULTS: Nurse Caring Behaviors was the highest rated PLS dimension. Participants' own personal birth experiences and length of current intrapartum experience were positively correlated with attitudes about and intent to provide PLS. Barriers to PLS included staffing, documentation, physicians, use of epidural analgesia, doulas, and birth plans. CONCLUSION: Personal birth and work experience influenced attitudes about and intent to provide PLS and demonstrated the relationships described in the Theory of Planned Behavior. Intrapartum nurses may benefit from an examination of their personal experiences to see how they might influence attitudes about PLS. Enhanced training and expanded labor and birth experience for novice nurses or students may improve attitudes and intended behavior with regard to PLS. Further investigations of the factors that affect integration of PLS into care are important to promote healthy birth outcomes.

Quiet time for mechanically ventilated patients in the medical intensive care unit.

OBJECTIVE: Sleep disruption occurs frequently in critically ill patients. The primary aim of this study was to examine the effect of quiet time (QT) on patient sedation frequency, sedation and delirium scores; and to determine if consecutive QTs influenced physiologic measures (heart rate, mean arterial blood pressure and respiratory rate). METHOD: A prospective study of a quiet time protocol was conducted with 72 adult patients on mechanical ventilation. SETTING: A Medical Intensive Care Unit (MICU) in the Midwest region of the United States. RESULTS: Sedation was given less frequently after QT (p=0.045). Those who were agitated prior to QT were more likely to be at goal sedation after QT (p<0.001). Although not statistically significant, the majority of patients who were negative on the Confusion Assessment Method (CAM-ICU) prior to QT remained delirium free after QT. Repeated measures analysis of variance (ANOVA) for three consecutive QTs showed a significant difference for respiratory rate (p=0.035). CONCLUSION: QT may influence sedation administration and promote patient rest. Future studies are required to further understand the influence of QT on mechanically ventilated patients in the intensive care unit.

Predictors of grief in bereaved family caregivers of person's with Alzheimer's disease: a prospective study.

The purpose of this prospective study was to identify factors in 66 spouses and adult child caregivers of person's with Alzheimer's disease prior to the death that predicted higher levels of grief in bereavement. A hierarchical regression model was tested. Predeath grief, dysfunctional coping, depression, social support, and decreased positive states of mind explained 54.7% of the variance in postdeath grief. Factors that contributed significantly to postdeath grief included predeath grief and depression. Results from this study indicate that risk factors for postdeath grief can be predicted prior to the death.

Implementation of the Bedside Paediatric Early Warning System (BedsidePEWS) for nurse identification of deteriorating patients.

PURPOSE: The purpose was to explore nurses' and physicians' recognition of signs of deterioration and management of symptoms. DESIGN AND METHODS: This descriptive, cross-sectional study used an electronic survey with 35 nurses and 17 physicians. RESULTS: Nurses using the Bedside Paediatric Early Warning System (BedsidePEWS) were significantly more likely to recognize risk for deterioration and respond with appropriate interventions. Physicians incorporating BedsidePEWS were more likely to choose reliable indicators of deterioration and reported significantly more effective communication from nurses to identify deterioration. PRACTICE IMPLICATIONS: BedsidePEWS may improve nurses' and physicians' abilities to recognize early signs of patient deterioration, communicate findings to providers, and plan interventions.

Exploring future nurses' attitudes and beliefs related to childhood overweight.

Millions of American children enjoy good health due to public health interventions addressing childhood-related diseases; however, such gains are being compromised due to the increasing proportion of overweight or obese children. Nurses are positioned to play a pivotal role in addressing the overweight and obesity epidemic among children. This cross-sectional study examined the attitudes and beliefs of undergraduate prenursing students and students in the clinical nursing major about children who are overweight or obese. A secondary aim was to examine whether there are differences or similarities in attitudes and beliefs about children who are overweight or obese between prenursing students and students in the clinical nursing major. Findings indicated that undergraduate prenursing students and students in the clinical nursing major have negative perceptions of overweight children. However, negative perspectives varied between the prenursing and clinical nursing major students on overweight children in relation to perceptions of causative factors for children being overweight and their subsequent quality of life.