Association of Partner Support and Partner Communication with Provider Prescribed Contraceptive Method Use among Heterosexual Couples in Kisumu, Kenya.

We explored partner support and communication factors associated with provider prescribed contraceptive (PPC) use to inform contraception interventions among heterosexual couples in Kenya. From April 2014 through September 2016, 252 community recruited couples in Kisumu, Kenya, were enrolled. Men and women were surveyed separately and asked about communication regarding sexual/reproductive health and relationship characteristics. PPC use was defined as female reported use of pills, injection, implant, IUD, or tubal ligation. Multivariable Poisson regression with robust variance estimate was used to identify factors associated with PPC. In multivariable modeling, women who reported discussing the future of their relationship with their partner were 2.46 (95% CI: 1.13-5.36) times more likely, and men who reported discussing condom use were 0.83 (95% CI: 0.72-0.95) time less likely, to report PPC use. These findings call for greater attention to involving male partners, incorporating communication skills, and relationship characteristics into interventions in our and similar settings.

Utilizing an Integrated Learning Experience in a Senior Undergraduate Nursing Program.

Integration of nursing classroom didactics with clinical and simulation experiences is crucial to obtaining improved student learning outcomes and successful academic achievement. According to the Institute of Medicine (2010), to ensure the delivery of safe, patient-centered care across settings, the nursing education system must be improved. Patient needs have become more complicated, and nurses need to attain requisite competencies to deliver high-quality care. An important aim is to increase active learning behaviors and maintain student engagement, which will foster an effort to learn and meet the complex needs of patients today. The integration of clinical and simulation with theory concepts can contribute to successful student development, confidence, self-efficacy, and reenforced desire to learn which is the key to success and competence development. Teamwork and collaboration are valued in nursing educational objectives as well as in the workplace. Blending a shared vision and mutual expectations helps to meet goals.

Measuring Family Satisfaction With Care Delivered in the Intensive Care Unit.

BACKGROUND: In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families' needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families' satisfaction with care in this setting. OBJECTIVE: To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. METHOD: A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. RESULTS: Forty family members completed the survey. Overall, the mean score for families' satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families' satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient's condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families' experience. CONCLUSION: Although patients' family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients' families, and patients will be targeted for quality improvement initiatives.

Risk factors for breast cancer in a population with high incidence rates.

BACKGROUND: This report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates. METHODS: Eligible women who were residents of Marin County diagnosed with breast cancer in 1997-99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews. RESULTS: In multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990-94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over. CONCLUSIONS: Despite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis.

Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study.

Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low.Content analysis was used to identify themes of Role Conflict With Management/Rules, Death and Suffering, Dealing With Violence in the Intensive Care Unit, Dealing With Family, Powerlessness, Physical Distress, and Medical Versus Nursing Values. Additional themes identified were caring, helping families, long-time interdependent relationships of colleagues, and satisfaction in trauma nursing.As work engagement increased, compassion satisfaction significantly increased, and burnout significantly decreased. Results of this study support moral distress as a clinically meaningful issue for surgical intensive care unit nurses. Moral distress scales were elevated, whereas work engagement scales were low. This finding was congruent with Lawrence's study and may reflect ongoing need for greater supports for experienced intensive care unit nurses, from both education and management. Future recommendations for research include examining the interaction of these variables in larger samples to examine additional explanatory factors as well as strategies for self-care, motivation, and behavior change.

Use of simulation to practice multidisciplinary anaphylaxis management.

Multidisciplinary clinical simulation can be an essential part of nursing education strategies to improve and enhance patient safety and experience. Clinical simulation can be utilized to change practice, reinforce practices, and direct patient and family education needs for a safe discharge. Anaphylaxis is potentially fatal and is increasing in occurrence. A simulation scenario was designed by a multidisciplinary team to review anaphylaxis recognition and to provide simulated practice for emergency response. Clinical scenarios were developed based on evidence-based practices and included a prebriefing and postdebriefing. Bandura's self-efficacy theory was used as a framework to develop the project, as it supports behavior change strategies well suited for clinical simulation. Clinical simulations provide a nonthreatening environment for staff to learn, practice, and receive feedback to improve patient care and serve as a vehicle to role-play expected practices, enhance communication between disciplines, demonstrate progress, and evaluate competency.

Left ventricular assist devices as destination therapy.

Although an estimated 16,500 Americans annually could benefit from a heart transplant, in 1999 only 2184 heart transplants were performed in the United States. These statistics emphasize the severity of the shortage of available hearts for transplantation. Circulatory support provided by an implantable Left Ventricular Assist Device (LVAD) that meets Food and Drug Administration approval as destination therapy is a promising alternative that impacts patient survival. As medical technology creates smaller implantable battery-powered circulatory assist devices that allow patients to safely live independently in the community, nursing's role must change in response. Long-term LVAD patients require strategic, anticipatory planning for extended care and emergency preparedness for mechanical support. Therefore, practitioners must familiarize themselves with these devices as they care for larger numbers of patients with implanted LVADs who require assessment and treatment of noncardiac problems during their lengthened lifespan.