Beyond Resettlement: Sociocultural Factors Influencing Breast and Colorectal Cancer Screening Among Afghan Refugee Women.

Immigrants and refugees have an increased risk for developing chronic health conditions, such as breast and colorectal cancer, the longer they reside in the USA. Moreover, refugees are less even likely to use preventive health services like mammography and colonoscopy screening when compared with US-born counterparts. Focused ethnography was employed to examine sociocultural factors that influenced cancer screening behaviors among aging Afghan refugee women. We conducted 19 semi-structured interviews with Afghan women 50 and older and their family member/caregivers. Interview transcripts were inductively coded using Atlas.ti, where focused codes were sorted and reduced into categories, and we extracted meaning around groups of categories. Findings of this study revealed factors like fear of cancer, pre-migration experiences, family involvement, provider recommendation, and provider gender concordance influenced women's cancer screening behaviors. This study also found that women who have had a recent mammogram or colonoscopy described empowerment factors that helped them withstand the stressful process of screening, through encouragement and reminders from providers, support from adult family members, and finding strength through duaas (prayers). As refugee women continue to age in the USA, clinicians should incorporate multi-level strategies, including family-centered and faith-based approaches to promote preventive screening behaviors in this population.

Seizing opportunity: Diverse early-entry nursing students' perceptions of seeking a PhD.

BACKGROUND: The aging and retirement of the current nursing professoriate and the increasing numbers of nurses pursuing practice doctorates has precipitated decreasing numbers of nurses, specifically diverse nurses pursuing a research doctorate, thus limiting the development of nursing science. PURPOSE: To describe factors influencing decisions about entering a PhD program from the perspectives of early-entry PhD nursing students. METHOD: A qualitative descriptive design using semistructured interviews to explore the perceptions of making the decision to pursue a PhD in nursing of the students who participated in two early-entry mentoring programs. FINDINGS: A model, entitled "Seizing Opportunity" was developed from the findings about the process of students deciding to pursue a PhD. DISCUSSION: Motivators and detractors that can help nursing educators understand how to successfully recruit diverse PhD students were uncovered. Providing knowledge and mentoring for early entry students can increase the numbers of diverse students pursuing a PhD in nursing.

Hydration Management.

Optimal hydration is essential to health, yet many common health problems of older adults are exacerbated by suboptimal hydration, including falls, adverse medication events, and urinary tract infections to name a few. Understanding dehydration in older adults is difficult, and causes for inadequate intake are multifocal. The current article provides important care guidelines on assessing risk and providing essential interventions to prevent dehydration. [Journal of Gerontological Nursing, 46(2), 19-30.].

Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people.

BACKGROUND: There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. OBJECTIVES: To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). SEARCH METHODS: Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. SELECTION CRITERIA: Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. DATA COLLECTION AND ANALYSIS: Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability. MAIN RESULTS: There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration. AUTHORS' CONCLUSIONS: There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.

Relationship management strategies for daughters in conflicted relationships with their ageing mothers.

AIMS: To study relationship management strategies of daughters in conflicted relationships with their mothers and how they promoted or prevented elder abuse. BACKGROUND: Daughters have enduring, unique relationships with their mothers that often carry over into caregiving. Pre-caregiving relationship quality is related to many caregiving outcomes, although it is unclear how. DESIGN: Qualitative study. METHODS: Grounded theory design, informed by feminism, with telephone interviews conducted between January 2013-July 2013. The sample (N = 13) was recruited through an online recruitment strategy, with advertisements posted on relevant websites asking 'Are you in an abusive relationship with your ageing mother?' RESULTS/FINDINGS: Daughters used coping strategies and self-protective strategies aimed at decreasing their exposure to aggression and emotional distress when interacting with their ageing mothers. Daughters also used spiteful aggression out of the desire for revenge. CONCLUSION: Although the daughters' strategies served their personal needs, they jeopardized the mothers' needs by creating an environment where neglect could occur. Daughters also readily and intentionally used aggression against their mothers. These were strategies daughters have found useful. These strategies may be potential areas for designing interventions to promote healthy family relationships and decrease the occurrence of elder abuse and neglect.

Adult Daughters' Descriptions of Their Mother-Daughter Relationship in the Context of Chronic Conflict.

The purpose of this article is to describe, from the perspective of the adult daughter, the mother-daughter relationship in the context of chronic conflict. Grounded theory methodology was used. An online recruitment strategy was used to identify a sample of adult daughters (N = 13) who self-identified as having an abusive relationship with their aging mother. Data collection was completed through semi-structured telephone interviews. Daughters framed their relationship around their perceptions of past childhood injustices. These injustices invoked strong negative emotions. Daughters had equally strong motivations for sustaining the relationship, driven by desire to reconcile their negative experience through seeking validation and futile-hoping as well as a sense of obligation to do due diligence. Together these factors created an environment of inevitable confrontation and a relationship defined by chronic conflict. Findings from the study provide theoretical insights to the conceptualization of aggression, power relationships, and the development of elder abuse and neglect.

Hypertension prevalence, awareness, and control in Arab countries: a systematic review.

One billion of the world's population has hypertension, resulting in four million deaths per year. Data on the prevalence of hypertension in the Arab world are very limited. This review summarizes existing knowledge regarding prevalence, awareness, and control of hypertension in Arab countries. The PubMed, Cochrane Library, Scopus, and CINAHL databases were searched for publications on HTN among Arab people from 1980 to January 2011. Only 13 studies were identified in the literature from 10 Arab countries. The overall estimated prevalence of hypertension was 29.5% (n = 45 379), which indicates a higher prevalence of hypertension among Arabs compared to people from the USA (28%) and sub-Saharan African (27.6%). Awareness of hypertension was reported for 46% of the studies and varied from 18% (Jordan) to 79.8% (Syria). The control rate varied from 56% (Tunisia) to 92% (Egypt and Syria). The prevalence of hypertension was found to increase with age, occurring more frequently in Arab women.

The nursing assistants' communication style and the behavioral symptoms of dementia in Korean-American nursing home residents.

Few studies examined the association between communication style and behavioral symptoms of dementia (BSD). The communication style of Nursing Assistants' (NAs), whose ethnic background is different from the residents, may contribute to BSD. The purpose of this study was to explore the relationship between non-Korean NAs' communication style and BSD in Korean-American (KA) nursing home residents with dementia. Twenty eight NAs and 20 KA residents were recruited from an ethno-specific nursing home. Research assistants observed and recorded NAs' communication style and residents' behavior simultaneously during routine care for 3 days. This study shows a trend that NAs' dementia and culturally appropriate communication style influenced the decreased behavioral symptoms. This finding suggests the need for training for NAs in dementia and culturally appropriate communication.

Using Facebook and participant information clips to recruit emergency nurses for research.

AIM: To examine the use of social networking sites in recruiting research participants. BACKGROUND: Workplace violence is an important issue for staff and patients. One workplace that reports the highest levels of violence is the emergency department. The ability to research issues such as workplace violence in real time is important in addressing them expeditiously, and social media can be used to advertise and recruit research subjects, implement studies and disseminate information. REVIEW METHODS: The experience of recruiting subjects through social networks, specifically Facebook, and the use of participant information clips (PICs) for advertising. DISCUSSION: A brief discussion of the history of advertising and communication using the internet is presented to provide an understanding of the trajectory of social media and implications for recruitment in general. The paper then focuses on the lead author's experience of recruiting subjects using Facebook, including its limitations and advantages, and her experience of using participant information clips. The low cost of advertising and recruiting participants this way, as well as the convenience provided to participants, resulted in almost half the study's total participants being obtained within 72 hours. CONCLUSION: Using Facebook to target a younger age range of nurses to participate in a study was successful and yielded a large number of completed responses in a short time period at little cost to the researcher. Recording the PIC was cheap, and posting it and a link to the site on pre-existing group pages was free, providing valuable viral marketing and snowball recruiting. IMPLICATIONS FOR RESEARCH/PRACTICE: Future researchers should not overlook using social network sites for recruitment if the demographics of the desired study population and subject matter permit it.

Prevalence, awareness, treatment, and control of hypertension among Arab Americans.

BACKGROUND: Hypertension (HTN) is a major risk factor for heart disease, which is the leading cause of death in the United States. Hypertension detection and blood pressure (BP) control are critically important for reducing the risk of myocardial infarction and strokes. Although there are more than 3.5 million Arab Americans in the United States, there are no national or regional data on HTN prevalence among Arab Americans. OBJECTIVE: This study aims to estimate the prevalence of HTN in a community sample of Arab Americans; assess levels of awareness, treatment, and control in hypertensive patients; and describe and compare lifestyle behaviors (eg, physical activity, nutrition, and weight control). METHODS: In this cross-sectional, descriptive study, 126 participants completed a self-administered questionnaire to measure physical activity, nutrition, and medical history. Height and weight were measured. Three BP measurements were obtained at 60-second intervals after resting for 5 minutes. Hypertension was defined as a mean systolic BP of 140 mm Hg or higher, or a diastolic BP 90 mm Hg or higher, and/or taking antihypertensive medications. RESULTS: Overall, 36.5% of participants had HTN and 39.7% had pre-HTN. Among hypertensive participants, only 67.4% were aware of their high BP, and 52.2% were taking antihypertensive medication. Among those taking medication, 46% had controlled BP. The prevalence of HTN was higher in men than in women (45.9% and 23.2%, respectively; P = .029) and increased with age (P = .01). Hypertensive participants also had higher body mass index (mean, 31.55 kg/m) compared with normotensive participants (mean, 28.37 kg/m; P = .01). CONCLUSION: Our results indicate that HTN and pre-HTN are highly prevalent in Arab Americans. Hypertension awareness and control rates were inadequate and low compared with national data. These results emphasize the urgent need to develop public health strategies to improve the prevention, detection, and treatment of HTN among Arab Americans.

Predictors and outcomes of early adherence to the use of a home telehealth device by older veterans with heart failure.

OBJECTIVES: The present study examined home telehealth (HT) adherence, and its potential predictors and outcomes, in older Veterans with heart failure (HF) using the Health Buddy (Bosch Healthcare, Palo Alto, CA) device. SUBJECTS AND METHODS: This was a retrospective study using secondary data from the Department of Veterans Affairs (VA) databases, describing adherence rates and patterns in the first 90 days after enrollment in 248 older Veterans with HF enrolled in the VA HT Programs using the Health Buddy at five medical centers in Southern California and Nevada, between June 1, 2006 and June 1, 2008. Adherence to the use of Health Buddy was defined as the number of days the patient completed an HT session over different time frames during the study period. RESULTS: Significant differences occurred between average adherence across all three 30-day time frame increments, with adherence decreasing over time. Despite the use of standardized VA HT protocols and equipment, the department in which the HT program was embedded was a consistent significant predictor of patient adherence in all time frames, with odds ratios of 2.2-4.0 for the department with the consistent best adherence versus that with the worse adherence (confidence intervals varying with the time frame, p<0.03). Increased co-morbidity burden was associated with decreased adherence only in the first 30 days after enrollment. In this short-term study, no relationship was found between adherence to the use of the Health Buddy and outcomes. CONCLUSIONS: Program and patient characteristics warrant further study as potential predictors of HT device adherence. Additional research is also needed to further examine the relationships between HT device adherence and various outcomes.

Social Media Use and Depression in Older Adults: A Systematic Review.

Social media has become an integral part of everyday life and revolutionized how older adults communicate and interact with others. The aim of the current review was to identify and synthesize quantitative studies addressing the potential relationship between social media use and depression in older adults. Medline, CINAHL, and PsycINFO databases were used to identify studies performed up to July 2020. Keywords identified were depression, social media use, and older adults. A nuanced relationship was revealed between social media use and depression in older adults. There were noted differences in the conceptualization of social media use. The reviewed studies lacked exploration of structural characteristics, examination of content, and quality of interactions in older adults' social media use. Health variables, social factors, and age cohort differences could influence the relationship between social media use and depression. Further studies are needed to enhance the understanding and explore the benefits and potential disadvantages of social media use in older adults. [Research in Gerontological Nursing, 16(2), 97-104.].

Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care.

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond.

OBJECTIVES: Poor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake. DESIGN: Qualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed. SETTING: Residential care. PARTICIPANTS: 27 invited researcher and provider experts. RESULTS: Challenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals). CONCLUSIONS: COVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.

Human patient simulation: state of the science in prelicensure nursing education.

Nurse educators strive to engage students in an active learning process. Human patient simulation (HPS) may provide an interactive learning experience for nursing students. However, the current literature and research published on HPS is restricted and lacks objective evidence supporting this educational method in prelicensure nursing education. Studies with large numbers of participants and clearly defined, objective, and validated data collection methods are rare. Despite the lack of empirical evidence for HPS, many are embracing a technology and form of education in which the efficacy is still in question. This article reviews the current research in the areas of HPS value perceptions and studies of HPS impact on knowledge and knowledge transfer among nurses.

Aging and living with HIV/AIDS.

With individuals either living longer with the disease or contracting it at a later stage in life, HIV/AIDS can no longer be regarded as just a young person's disease. In fact, people older than 50 will represent 50% of HIV/AIDS cases by 2015. The intersection of aging and HIV/AIDS is explored in this article through the use of an individual example highlighting typical age-related issues encountered in living with a chronic HIV infection and two of the more common comorbid conditions. Nursing implications for managing these conditions-depression and dyslipidemia-as well as other considerations for providing care to older adults with HIV/AIDS are addressed.

Benefits of physical activity for knee osteoarthritis: a brief review.

Osteoarthritis (OA) is the second most prevalent health condition in community-dwelling adults 65 and older, with 27 million older Americans affected. Approximately half of community-dwelling women (54%) and men (43%) older than 65 have OA, and the percentage with symptomatic knee OA rises to more than 60% among older adults who are overweight. This article examines major risk factors for knee OA and nursing interventions to help older adults with knee OA minimize disease symptoms. Significant health benefits of physical activity for the prevention of obesity, delay of onset of physical limitation, and importance to normal joint health for older adults with OA are emphasized. Nursing recommendations for physical activity in older adults with OA are detailed. Social and environmental barriers inhibiting older adults from achieving their weight loss and exercise goals are discussed. Resources supporting physical activity in older adults with OA are provided.

Violence against women: the phenomenon of workplace violence against nurses.

Registered nurses have been the recipients of an alarming increase in workplace violence (WPV). Emergency and psychiatric nurses have been found to be the most vulnerable and yet few solid reporting procedures exist to fully account for a true number of incidents. Further compounding the problem is the lack of a standard definition of violence to guide reporting procedures, interventions, legislation, and research. While there are certain risk factors that not only predispose the nurse and the patient to WPV, research continues to attempt to parse out which risk factors are the key determinants of WPV and also which interventions prove to be significant in reducing WPV. The nursing shortage is expected only to increase; recruitment and retention of qualified staff members may be deterred by WPV. This necessitates focused research on the phenomenon of workplace violence in health care.

Preventive Cancer Screening Among Resettled Refugee Women from Muslim-Majority Countries: A Systematic Review.

As refugee populations continue to age in the United States, there is a need to prioritize screening for chronic illnesses, including cancer, and to characterize how social and cultural contexts influence beliefs about cancer and screening behaviors. This study examines screening rates and socio-cultural factors influencing screening among resettled refugee women from Muslim-majority countries of origin. A systematic and integrative review approach was used to examine articles published from 1980 to 2019, using PubMed, CINAHL, and PsycINFO. A total of 20 articles met the inclusion criteria. Cancer screening rates among refugee women are lower when compared to US-born counterparts. Social and cultural factors include religious beliefs about cancer, stigma, modesty and gender roles within the family context. The findings of this review, suggest that resettled refugee women underutilize preventive services, specifically mammography, Pap test and colonoscopy screening, and whose perceptions and behaviors about cancer and screening are influenced by social and cultural factors.

Factors determining nurses' clinical judgments about hospitalized elderly patients with acute confusion.

Acute confusion(AC)/delirium is a common clinical phenomenon in hospitalized elders that is often overlooked or misdiagnosed by nurses of various cultural backgrounds. The aim of this study was to better understand factors affecting nurses' clinical judgments regarding the detection of AC in elderly Taiwanese patients. Nurses from two hospitals in Taiwan (n = 654, response rate = 71.3%) participated in the study. A two-level hierarchical linear model analysis was used to examine the data. The characteristics of patients explained the most variance of the model (86.2%), with characteristics of nurse participants and their health organizations accounting for 13.8% of the variance. Patient characteristics of age, infection, hydration, and hypoactive subtypes of AC, as well as a nurse's strong belief in traditional Chinese values, such as respect for elders, hard work, modesty, noncompetitiveness, and respect for tradition, were positively associated with difficulty detecting acute confusion. Findings of this study indicated that the accuracy of nurses' clinical judgments in detecting AC were most related to characteristics of patients.