To stay or leave: Public health nurse workforce retention in North Carolina.

States across the country have been experiencing a steady decline in public health nursing workforce, including North Carolina (NC). OBJECTIVES: To better understand retention in the NC Public Health Nurses (PHNs) workforce through an assessment of perceptions of the working environment, stress, intent to stay, and job satisfaction. DESIGN: A cross-sectional online survey using closed and open-ended questions. SAMPLE: The study population comprised of non-supervisory PHNs (n = 672) working at NC local health departments (LHD). MEASUREMENTS: Retention problem, working environment, and job satisfaction measures were adapted from the revised Casey-Fink Registered Nurse Retention Survey© (2009) to fit public health settings. RESULTS: Despite high levels of job satisfaction (79.76%, n = 473), 53% of respondents (n = 323) acknowledged a retention problem within their LHD; 35.32% (n = 203) planned to/considered leaving their position in the next 3 years for reasons other than retirement. ANOVAs and Kruskal Wallis Test results showed that those planning to leave had statistically lower scores on perceived working environment and job satisfaction and demonstrated higher negative stress levels. CONCLUSION: Like other states, NC is experiencing a PHN shortages predicted to worsen in coming years. To retain the current workforce, LHDs need to work to improve PHNs working environment, increase PHNs' pay, and alleviate stressors.

Access to Care as a Barrier to Mammography for Black Women.

Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.

#CRCFREE: Using Social Media to Reduce Colorectal Cancer Risk in Rural Adults.

Objectives: In this study, we pilot-tested #CRCFree, a Facebook-based intervention aimed at reducing colorectal cancer (CRC) risk in rural Appalachian adults at risk for CRC. Methods: Participants were 56 rural Appalachian adults aged > 50 years. Daily #CRCFree Facebook posts addressed diet, physical activity, and CRC screening. Participants' sociodemographics, diet, body mass index, physical activity, and CRC screening status were measured pre- and post-intervention. The Healthy Eating Index (HEI) and the Dietary Inflammatory Index (DII) assessed dietary patterns. Facebook engagement was measured throughout the intervention. A post-intervention focus group evaluated intervention acceptability. Results: Participants were Caucasian, aged 58 ± 6 years, and predominantly female (66%). Post-intervention, HEI scores increased (49.9 ± 9.9 vs 58.6 ± 12.1, p = <.001), and DII scores decreased from baseline (2.8 ± 1.1 vs 1.6 ± 1.7, p = .002). There was no change in physical activity, BMI, or CRC screening status. Focus group participants found the intervention to be educational and motivating. Conclusions: These results provide preliminary evidence to support using Facebook to address CRC risk in this population. Participants were responsive to this intervention, and Facebook is a novel and accessible modality for health promotion.

Use of Essential Oils by Health Care Professionals for Health Maintenance.

This study explores essential oils' use by health care professionals for health maintenance. A qualitative, descriptive design was employed, and a convenience sample of 10 participants was interviewed. Four themes were identified: an essential oils' community, essential oils' use, essential oils' acceptance, and essential oils' benefits and harms.

LGBT friendly healthcare providers' tobacco treatment practices and recommendations.

PURPOSE: This study aimed to describe lesbian, gay, bisexual, and transgender (LGBT) friendly providers' (1) smoking cessation recommendations to LGBT patients and (2) tobacco treatment practices for transgender patients. DESIGN AND METHODS: In-depth, semistructured phone interviews were conducted with 13 healthcare providers. FINDINGS: Four overarching themes emerged: (1) providing tobacco treatment services for LGBT patients; (2) barriers to LGBT smoking cessation; (3) prescribing practices for transgender individuals taking estrogen hormone therapy; (4) provider community outreach to promote LGBT smoking cessation. PRACTICE IMPLICATIONS: Holistic tobacco treatment services are needed to address LGBT-specific barriers to tobacco cessation, such as stress, identity-related factors, and inadequate healthcare access.

Evaluating Undergraduate Nursing Students' Attitudes Toward Health Care Teams in the Context of an Interprofessionally-Focused Nursing Course.

BACKGROUND: Nursing students' attitudes related to health care teams in the context of interprofessional education (IPE) and the impact of these attitudes on IPE and future practice are not fully understood. PURPOSE: The current study assesses baccalaureate nursing students' attitudes toward health care teams and evaluates if these attitudes have changed after completion of a nursing course focusing on health care systems from an interprofessional perspective. METHOD: A convenience sample of 116 undergraduate nursing students in a required interprofessionally-focused course was invited to participate. The Attitudes Toward Health Care Teams Scale Quality of Care subscale (ATHCT-QC) and Team Understanding Scale (TUS) were employed via a pretest-posttest design. Paired samples t-tests were conducted to compare mean scores. RESULTS: Ninety-five respondents (81.8%) voluntarily participated at the beginning and conclusion of the course. CONCLUSIONS: There were no significant differences between pretest-posttest attitudes toward interprofessional health care teams. Nurse educators must create and evaluate innovative IPE interventions to enhance students' preparedness to be effective interprofessional health care team members.

Primary Care Providers' Attitudes Related to LGBTQ People: A Narrative Literature Review.

The purpose of this article is to review the current literature describing primary care providers' (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs' actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies' purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs' attitudes toward LGBTQ people were positive, but a minority of each studies' participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.

College sorority members' knowledge and behaviors regarding human papillomavirus and cervical cancer.

The incidence of human papillomavirus (HPV) is higher in college students than in many other populations. HPV puts young women at risk for developing cervical cancer. The relationship between HPV and risky sexual behaviors has been well established. This study describes female college students' knowledge regarding HPV and cervical cancer, identifies sexual risk behaviors in this group, and assesses whether there is any relationship between knowledge of HPV and cervical cancer and the sexual risk behaviors in this population. Health care providers need to be aware of this health issue and actively promote appropriate prevention strategies.

The future of nurse practitioner practice: a world of opportunity.

Health care is transforming at a rapid pace. Nurses should be leading change and advancing health in this increasingly complex health system. The multiple systemic health care changes occurring secondary to the 2010 Patient Protection and Affordable Care Act make this an optimal time for full use of nurse practitioners (NPs). This article describes the evolution and future of the NP role, explores the practice in relation to regulation and policy; primary care; acute care; international, global, and cultural issues; and public image, and addresses how NPs must prepare for changing health care environments and consumer demands.