Covid-19 presented tremendous challenges to healthcare systems throughout the world. In particular, the presence of comorbid conditions became a significant factor due to the greatly increased risk of hospitalization and death in people living with diseases such as Congestive Heart Failure. While the literature has long indicated relationships between psychological challenges (depression and anxiety), the pandemic represented a particular challenge due to the way that it limited individual’s ability to engage in activities outside of the home. While all activities were limited, exercise presented a particular challenge as it is so essential to Congestive Heart Failure self-management. The current study used a quantitative descriptive design to examine the relationship between psychological variables and heart failure self-management. The study indicated relatively mild alterations in depression and anxiety. However, the results indicated a significant relationship between physical activity during the pandemic and having engaged in Cardiac Rehabilitation prior to the lockdowns (p < .05). Further, the results indicated that self-efficacy related to self-management was higher in patients who engaged in higher activity levels (p < .001). The study supported the importance of cardiac rehabilitation and subsequent exercise in establishing self-efficacy and beneficial outcomes in patients living with Congestive Heart Failure.

Objective: Nurses engaged in practice make split-second decisions based on stimuli perceived in the clinical environment. There has been limited research in nursing on stimuli perception and limited research aimed specifically at directly measuring nurses’ gaze and the subsequent quality of their decisions.Methods: This study used an observational descriptive design to examine nurses’ gaze behaviors as they cared for a simulated patient in three different clinical scenarios. Participants were fitted with eye-tracking goggles that facilitated the recording on video of the focal point of their gaze. The recorded videos were coded to quantify the participants’ areas of focus. For each scenario, visual focus data were compared between participants who successfully resolved the scenarios and those who did not. Results: The results revealed statistically significant differences in areas of focus between successful and unsuccessful participants. While successful participants focused on the patient, unsuccessful participants focused on task-irrelevant environmental cues.Conclusions: The results demonstrate a need for nurse educators to focus their students on the patient, while guiding them to avoid becoming mired in task irrelevant foci and actions.

Stigmatizing behaviors engaged by care providers in clinical settings represent a significant barrier to care seeking on the part of persons living with HIV. The majority of studies addressing stigma by healthcare workers has been reported in the developing world. The current study sought to determine the presence of stigmatizing thoughts and behaviors in Ryan White Care Act funded clinics across the United States. The study used a quantitative descriptive design, and included all such sights in the US and its territories. The results indicated that paraprofessional personnel were more likely to engage in thoughts and behaviors that reflect stigma. This finding is significant since these individuals are the first people who patients contact when seeking care, establishing a significant barrier to retention in care. The study reflects a need to engage education and training designed to minimize these behaviors in paraprofessionals.

Mentoring and coaching are effective and sometimes necessary strategies to foster the development of expertise. However, these learning enhancement methods are multifactorial and often ambiguously characterized. The goal of this chapter is to unpack this complex interactional relationship to more fully describe what it means to be an effective coach/mentor, and to better understand their role in developing expertise. Specifically, this chapter provides: (1) a detailed description of the different components and functions of mentoring, coaching, and preceptorship; (2) a summary of the meta-analytic evidence supporting the effectiveness of developmental support roles on a range of outcome measures (e.g., job performance); (3) a review of the empirical evidence supporting the development of expertise in mentoring-type roles; and (4) concluding remarks summarizing some of the major issues, and suggestions for how to advance this area of research.

Objective: We examined which demographic and psychosocial factors were associated with healthcare empowerment (HCE) and decisional self-efficacy (DSE) among African-American (AA) men. Methods: African-American men (N = 76), who never received a prostate cancer screening or it was over one year since their last screening, completed in-person questionnaires about HCE, DSE, and prostate cancer screening. Results: Multiple regression models predicted that the frequency of social and emotional support was a statistically significant predictor of HCE. There were no significant results for DSE. Conclusions: Social and emotional support may be influential on the AA male's sense of HCE. The results provide a foundation for the development of interventions for AA men to increase utilization of the healthcare system.

BACKGROUND:Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions.OBJECTIVE:Describe the arrival time distribution of HF patients presenting to the ED.METHOD:The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools.RESULTS:HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas.CONCLUSIONS:The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED.

Purpose: The purpose of this research was to examine intrapersonal and community factors associated with prostate cancer screening (PCS) among African-American (AA) males of >= 40 years from a nationally representative data set in the US. The theory of planned behavior was utilized as the theoretical framework.Patients and methods: A cross-sectional secondary analysis employed data from the National Health and Nutrition Examination Survey in the US. The sample consisted of 377 AA males. The primary outcome variables were two PCS tests, the digital rectal exam (DRE) and the prostate-specific antigen test. Logistic regression models were developed to test for associations between the PCS tests and the factors of interest.Results: The factors of age, education, and access to a health care facility were associated with AA males receiving the DRE. The age group of 40-49 years was least likely to receive the DRE when compared to the age group of >= 70 years. Similarly AA males without a college degree were also least likely to receive the DRE when compared to AA males with a college degree. AA males with access to health care were more likely than those without access to receive the DRE. Age <70 years along with church attendance was associated with AA males receiving the prostate-specific antigen test.Conclusion: Differences were present for significant associations among intrapersonal and community variables and the two PCS exams. A culturally sensitive approach is necessary for understanding factors associated with PCS among AA males, which is central to designing and appropriately targeting public health interventions to decrease the health disparity of prostate cancer among this high-risk population.

Background/Objective : Use of in-room sitters to prevent patient’s fall or injury is widespread in hospitals. This practice, however, is expensive, seldom reimbursed, controversial in the literature, and not supported by a strong body of evidence.  The objective of this study was to determine the prevalence of patient falls and self-harm using in-room sitters and video monitoring and associated costs. Methods : In-room sitters and video monitoring was studied in two adult, medical surgical units, using an evaluative research design, with quasi-experimental approach. Descriptive statistics and independent samples t tests were performed for analysis. Results : The study identified no statistically significant difference in the prevalence of falls or self-harm events when video monitoring was used to provide constant observation. There was statistically significant lower cost per patient day with video monitoring. Conclusions : Video monitoring is less expensive than sitters and does not impose a patient safety risk for falls or self-harm.

OBJECTIVE:To examine demographic, social support, and community factors from a national dataset that influence African-American (AA) and White men to receive prostate cancer screening (PCS) via the Digital Rectal Exam (DRE) or Prostate Specific Antigen Test (PSA).DESIGN AND SAMPLE:A cross-sectional secondary analysis from the National Health and Nutrition Examination Survey (NHANES) provided the sample of AA (N = 377) and White (N = 971) men over the age of 40 years. Regression analysis with confidence intervals was utilized to examine the factors associated with AA and White men receiving PCS. The Social Ecological Model provided the theoretical framework.MEASURES:Questionnaires from the NHANES dataset provided data for this study.RESULTS:Age, education, and access to health care was associated with AA and White men receiving the DRE. Income and church attendance was only associated with White men receiving the DRE. Only White men had an association of income with receiving the PSA test and only AA men had an association of marital status with receiving the PSA test.CONCLUSIONS:Cultural evaluations of PCS behaviors among AA men are necessary to decrease the health disparity of prostate cancer among the AA population.

There are a dearth of studies that quantitatively measure nurses' appreciation of stimuli and the subsequent generation of options in practice environments. The purpose of this paper was to provide an examination of nurses' ability to solve problems while quantifying the stimuli upon which they focus during patient care activities. The study used a quantitative descriptive method that gathered performance data from a simulated task environment using multi-angle video and audio. These videos were coded and transcripts of all of the actions that occurred in the scenario and the verbal reports of the participants were compiled. The results revealed a pattern of superiority of the experienced exemplar group. Novice actions were characterized by difficulty in following common protocols, inconsistencies in their evaluative approaches, and a pattern of omissions of key actions. The study provides support for the deliberate practice-based programs designed to facilitate higher-level performance in novices.

Background: Students in accelerated second-degree programs are reported to be highly motivated, older, competitive, maintain higher grade point averages than their traditional counterparts, and score higher on standardized nursing achievement tests. However, studies that directly measure clinical performance parameters of students in accelerated second-degree programs in direct side-by-side comparison with traditional students under similarly controlled conditions have not been reported. Aim: The purpose of this study was to compare traditional and second-degree baccalaureate nursing students’ performance of key assessments and interventions in the management of deteriorating patients in a simulated task environment. Methods: A convenience sample of 20 traditional and 20 accelerated undergraduate baccalaureate-nursing students participated. The four high-fidelity simulation exercises required the participants to detect early signs of patient deterioration and initiate treatment-based interventions. Two research personnel independently coded audio and videotaped data. The coders recorded the first time in which an assessment or intervention was performed. An independent samples t -test was performed to determine differences in nursing students’ performance of key assessments and interventions. Results: Second-degree accelerated nursing students were in general more likely to recognize and respond to indicators of patient deterioration more promptly than their traditional counterparts. Conclusions: Second-degree students appear to possess attributes that increase the likelihood that they will appreciate stimuli in the clinical environment, which is a precursor to effective intervention. Further research is required to substantiate the factors that account for performance differences between these traditional and second-degree baccalaureate nursing students.

We examined whether relationship status, relationship ideation, and sexual agreements affected HIV/sexually transmitted disease (STD) prevention strategies and high-risk behaviors in young men who have sex with men (MSM). Using an online survey, we found that partnered MSM more commonly used condoms with casual partners and knew the reported HIV status of all their partners, compared to single MSM (p < .05). Men scoring high in relationship exclusivity reported higher condom use with casual partners compared to men scoring lower (p < .05). Of partnered MSM, 58% reported a sexual agreement. MSM reporting restricted sexual agreements more commonly used condoms during oral and anal intercourse with their main partners and casual partners compared to MSM reporting unrestricted sexual agreements. The data suggest that relationship status should be considered by health care providers when counseling MSM and that behavioral interventions should target sexual agreements as a mechanism to reduce HIV/STD transmission.

Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrant's efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health-related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim. The purpose of this paper is to examine the basic social processes that characterize efforts to gain access to health services among HIV positive undocumented African migrants to the UK. The most recent estimates indicate that there are a total of 618,000 migrants who lack legal status within the UK. Other studies have placed the number of undocumented migrants within the UK in the range of 525,000-950,000. More than 442,000 are thought to dwell in the London metropolitan area. Even in cases where African migrants enter the UK legally, they often face considerable difficulty in their quest to gain legal employment due to barriers inherent to the system that grants work permits. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority.

Objective: The study examined the clinical performance differences of novices before and after a critical care internship and compare their performance attributes to a reference group comprised of experienced critical care nurses. The extant research regarding clinical internship programs has focused on retention in practice, workforce issues and competence. While studies have shown a pattern of improved retention in practice settings, they have failed to objectively measure actual clinical performance. Methods: The study design was based on pre-post comparisons of novice nurses and a reference group comprised of experienced nurses who served as a benchmark. The novice group was required to respond to patient needs in high-fidelity clinical scenarios before and after an internship. The experienced nurses attended a single testing session. Results: Findings revealed statistically significant improvement in the performance of the novice group; however, they failed to perform at the level of the experienced nurses. Conclusions: The study is the first to detail the degree to which a structured internship can facilitate changes in selected aspects of clinical performance. The study establishes the effect associated with engagement in a structured internship. While novices improve significantly, they fail to achieve the level of clinical performance seen in experienced nurses. The paper will present background information related to the established effects of internship programs, and will then present the data related to the current study. The paper will then present similarities and differences between the results of the current study, and the literature.

Background: The purpose of this study was to establish the efficacy of a deliberate practice intervention designed to enhance levels of clinical performance in senior baccalaureate nursing students.Method: A randomized control design was used. Forty participants were randomly assigned to control and intervention groups.Results: The deliberate practice-based intervention resulted in statistically significant improvements to key aspects of participants' efforts in each of the four scenarios.Conclusions: The deliberate practice protocol prompted participants to reconsider and act on salient stimuli present in the simulated task environment, resulting in substantive performance improvement. (C) 2014 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

Background: Medication errors are costly in both human and financial loss. Interpretations of prescription instructions have been found to vary considerably, including discrepancies between patients and prescribing physicians. Objective: Identify discrepancies in interpretation of prescription instructions between healthcare consumers, nurses, and physicians Method: Research Design: Cross-sectional study; Setting: Large university, 2 hospitals and various clinics in Mississippi and Florida; Participants: 74 young healthcare consumers, 34 RNs, and 36 physicians; Measures: Questionnaires asking for interpretations (i.e., what times would/should you take the drug) for various prescription instructions were provided to healthcare consumers, nurses, and physicians. Results: There was considerable within-group variability in the interpretation of prescription instructions by all groups including physicians. Moreover, physicians, nurses, and healthcare consumers exhibited between group variability in their interpretation of prescription instructions. None of the instructions were uniformly interpreted and a fair number of consumer and nurse interpretations resulted in potentially unsafe schedules of drug administration. Some physicians and nurses also apparently lacked awareness of the potential for interpretation variability. Conclusions: Because two healthcare providers can have different intentions for identical instructions, an awareness and subsequent education of potential sources of misinterpretation is vital. The present results indicate a need to identify and explore within-group variability of intent among physicians and other healthcare providers.

Nurse practitioners are at the forefront of efforts to increase health within our communities and thus play a vital role in the prevention of head injuries among children and adolescents engaging in sports. In recent times, the media have increased public awareness regarding the long-term effects of concussive injuries in professional athletes in sports such as football and hockey, which are traditionally classified as contact sports. The purpose of this article is to highlight the risk of concussion among children and adolescents engaging in traditionally high contact sports and sports that are less often considered in the context of concussion.

BACKGROUND:The purposes of this study were to (1) identify school nurses' awareness of information and communication technology (ICT) use in students' health education and (2) explore the barriers or reasons for the adoption of ICT in school nursing practice, while (3) presenting strategies to speed ICT diffusion and dissemination into practice.METHODS:For data collection, 209 primary school nurses in K province of Korea were selected and e-mailed the questionnaires. Collected data were analyzed as frequency, percentages, and chi-square tests.RESULTS:The major reasons to adopt ICT were increasing school nurses' confidence in providing health education and improving teaching methods using diverse multimedia. The major barriers to utilization of ICT were lack of time for preparation of educational materials, lack of software availability, and lack of computer skills of school nurses and students. Several strategies were suggested to speed the diffusion of ICT into students' health education, such as integrating a health education course into regular curriculum.CONCLUSIONS:It is important to identify barriers and reasons for adoption of ICT in school nursing. In addition, strategies should be emphasized that result in more rapid diffusion of these technologies in school nursing practice.

The purpose of this study was to identify the core nursing sensitive outcomes according to the most frequently used five North American Nursing Diagnosis AssociationInternational for patients with cerebrovascular disease using the Nursing Outcomes Classification (NOC). A cross-sectional survey design was used. First, nursing problems were identified through 78 charts review, and then linkages between each of nursing problems and nursing sensitive outcomes were established and validated by an expert group for questionnaires. Second, 80 nurses working in the neurosurgical intensive care unit and neurosurgery departments of five Korean hospitals were asked to evaluate how important each outcome is and how often each outcome used to evaluate patient outcomes using 5-point Likert scale. Although there were some differences in the core outcomes identified for each of the nursing problem, consciousness, cognitive orientation, neurologic status and communication were considered the most critical nursing sensitive outcomes for patients suffering cerebrovascular disease. Core nursing sensitive outcomes of patients suffering cerebrovascular disease using NOC were identified to measure the effectiveness of nursing care.

Backgrounds: With the increasing use of simulation in nursing education and a growing acceptance of simulation as a component of student's clinical experiences, there is a need to provide evidence of a relationship between knowledge, performance in simulated task environments, and actual clinical performance.Methods: This study used a pre/post test design to examine the relationship between standardized test scores and performance in real-time and simulated critical care settings. Performance in a simulated task environment and scores on standardized tests were examined before and after a 4-week critical care experience in a group of senior nursing students.Results: Findings from the study demonstrate statistically significant relationships among the three variables.Conclusions: Findings from the study provide evidence for the effectiveness of simulated scenarios as a means to assess clinical performance and to differentiate between high-and low-performing students. (C) 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.