Adolescent Workers' Experiences of and Training for Workplace Violence.

Adolescent workers may not be aware that violence is a safety concern in the workplace. As part of a larger mixed-methods pilot study, investigators used a self-administered survey and individual interviews with 30 adolescent workers from a chain of food service stores in a Midwestern metropolitan area to explore experiences of workplace violence (WPV) and ways of learning WPV-specific information. Participants reported experiencing verbal and sexual harassment and robberies. Most participants reported awareness of WPV-specific policies and procedures at their workplace; the ways participants reported learning WPV-specific information varied. Findings support the need for occupational safety training to assist adolescent workers prevent and mitigate potential WPV.

Teaching differential diagnosis to nurse practitioner students in a distance program.

An interactive case study (ICS) is a novel way to enhance the teaching of differential diagnosis to distance learning nurse practitioner students. Distance education renders the use of many teaching strategies commonly used with face-to-face students difficult, if not impossible. To meet this new pedagogical dilemma and to provide excellence in education, the ICS was developed. Kolb's theory of experiential learning supported efforts to follow the utilization of the ICS. This study sought to determine whether learning outcomes for the distance learning students were equivalent to those of on-campus students who engaged in a live-patient encounter. Accuracy of differential diagnosis lists generated by onsite and online students was compared. Equivalency testing assessed clinical, rather than only statistical, significance in data from 291 students. The ICS responses from the distance learning and onsite students differed by 4.9%, which was within the a priori equivalence estimate of 10%. Narrative data supported the findings.

Genetic and genomic testing in clinical practice: what you need to know.

The clinical applications of genetic testing are growing rapidly and they now account for a significant percentage of total laboratory testing procedures. Many clinicians are uncomfortable with the types and applications of genetic tests and the dependable resources that are available for self-education. Furthermore, Direct to Consumer genetic testing has presented several challenges to healthcare providers as consumers now have an access to tests that they may not fully understand and results they may act upon inappropriately. This article presents some of the issues and resources to help nurses navigate this changing landscape.

Adolescents' experience with workplace aggression: school health implications.

Aggression exposure is a critical health issue facing adolescents in the United States. Exposure occurs in various settings including home, school, and the community. An emerging context for aggression exposure is in the workplace. Thirty adolescent employees age 16-18 participated in a qualitative study exploring proposed responses to future workplace aggression. Semistructured interviews were used to gather participants' proposed responses to a series of hypothetical aggressive incidents in the workplace. Conventional content analysis identified patterns and themes among the participants' responses. Results indicated adolescent employees' proposed responses to workplace aggression are similar to other forms of aggression such as peer-bullying and teen dating violence. Education and training are needed within the school setting to promote appropriate responses to various forms of aggression encountered by adolescents. Implications for school health professionals' involvement in addressing responses to such aggression and further research opportunities are explored.

The impact of learning space on teaching behaviors.

In traditional classrooms the teacher stands at the front of the room and rows of students face forward. Many academic institutions have chosen to renovate traditional classrooms and turn them into spaces more conducive to collaboration. Few data exist supporting the notion that changing physical space affects teaching behaviors. We used a mixed method design to evaluate teaching behaviors in traditional and collaborative classrooms. Expert teachers viewed classroom videos and described behaviors observed. After qualitative analysis, we identified the frequency of themes and found no significant differences in teaching behaviors in traditional versus collaborative classrooms.

Measuring sports participation decisional conflict in youth with cardiac pacemakers and/or ICDs.

AIMS: We examined the Decisional Conflict Scale to determine if it would be useful to measure conflict around sports participation decision-making in youth with cardiac pacemakers and/or implantable cardioverter defibrillators. BACKGROUND: Sports participation decisions made by parents and youth with implanted cardiac devices can have profound implications. Contact sports can result in damage to the device and leads, but the value of exercise is well documented and restriction from a cherished activity can increase resistance and distress in the young. The extent of this problem is unknown. METHODS: An explanatory mixed methods design was used with a convenience sample (N=35) of youth aged 12-21 (Mean=16.5; sd=3) years awaiting services at an electrophysiology clinic. Data were collected between 2007 and 2008. The Decisional Conflict Scale is a self-report measure, used worldwide in adult populations. Analyses and interviews determined the properties of the measure and whether the instrument captured conflict. RESULTS: The scale showed strong internal consistency (Cronbach alpha=0.87). Overall scores were low (Mean=17.31; SD=10.99; range=0-37). There was no statistically significant difference (P>0.05) in total scores between boys (n=25) and girls (n=10) using independent t-tests. Qualitative analysis documented conflict and non-adherence to clinician recommendation despite low scores. CONCLUSIONS: Analyses indicate that youth aged 12-21 years understand and can effectively complete the Decisional Conflict Scale, but this instrument alone did not capture all conflict. These results can guide study of the extent of this problem and eventual development of an intervention to support sports participation decision-making.

Genetic characterization of familial CPVT after 30 years.

INTRODUCTION: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a stress-related, bidirectional ventricular tachycardia and atrial tachyarrhythmia in the absence of either structural heart disease or prolonged QT interval. Autosomal dominant and recessive forms of CPVT because of mutations in the cardiac ryanodine receptor (RyR2) or calsequestrin 2 (CASQ2) have been reported. The objective of this study was the clinical and genetic characterization of the family of an individual initially diagnosed as a child in 1978. METHOD: We collected family medical history and recorded a four-generation pedigree. We performed mutation analysis of RyR2 "critical regions'' in the N-terminus, FKBP12.6 binding domain, Ca2+ binding domain, and transmembrane domains of the C-terminus by direct sequencing. RESULTS: CPVT was diagnosed in two of the nine family members evaluated. Pedigree analysis suggested autosomal dominant disease transmission. There were no additional reports of seizures, pregnancy loss, neonatal death, or sudden cardiac death in family members. A novel RyR2 gene variant (W4645R) was found in four family members including two without symptoms. RyR2-W4645R segregates with disease in this family with incomplete penetrance. The W4645 residue is evolutionarily conserved in the transmembrane region adjacent to previously reported disease-causing mutations. Based on sorting intolerant from tolerant analysis of protein structure, RyR2-W4645R is predicted to be deleterious. CONCLUSIONS: All current evidence supports RyR2-W4645R as a disease-causing variant, which was silent in persons for two generations before causing symptoms in persons for the next two generations, beginning in 1978.

Genetics in critical care: a toolbox.

Becoming comfortable with the onslaught of genetic information requires a familiarity with genetics terminology and basic molecular genetics. Caring for the genetic health of our patients requires an additional appreciation of genetic testing and screening issues and new areas of study with strange-sounding names, such as proteomics, nutrigenomics, and epigenetics. This article provides an overview of basic genetic principles and terminology with applications to critical care patients. It lays a foundation to support understanding of the other articles in this issue. An appreciation of genetics (the study of heredity) and genomics (the study of the interaction of genes within an organism) has an important place in the knowledge base of every critical care clinician.

Pharmacogenetics in critical care: atrial fibrillation as an exemplar.

Pharmacogenetic testing is currently not routine in critical care settings but recent changes in the warfarin label are likely to lead to critical care nurses encountering physician or nurse practitioner orders for such testing. Although the science for pharmacogenetics is complex, the components of patient teaching are not beyond that which nurses already provide about other laboratory, disease, and treatment-based information. It is reasonable to expect that as the science of pharmacogenetics and pharmacogenomics expands and discoveries are translated in clinical settings, the additional information from pharmacogenetic test results will help prescribers select or adjust medication doses to reduce the risk for adverse drug reactions and improve the chances of achieving therapeutic targets in a timely fashion.

Self-reported adjustment to implanted cardiac devices.

BACKGROUND AND RESEARCH OBJECTIVE: Although implantations of devices to support cardiovascular function are increasing, little is known about the factors involved in adjusting psychologically to having an implanted device. This study provides factor analysis of the Implanted Device Adjustment Scale (IDAS) and self-reported data on quality of life, mood states, and global adjustment. SUBJECTS AND METHODS: This cross-sectional correlational design study included 174 subjects (46 women and 128 men). A convenience sample was recruited from electrophysiology practices in 2 large Midwestern cities. Subjects completed the IDAS, the SF-36 quality-of-life measure, the Profile of Mood States, and a device adjustment visual analog scale. RESULTS AND CONCLUSIONS: The factor analysis produced 4 subscales for the IDAS: fear/anxiety, attitude, preparation, and body awareness. Perceived adjustment was "good" for 89% of persons and was unrelated to age, sex, type of device, and whether a shock was received. All 4 subscales of the IDAS correlated negatively with adjustment (higher IDAS score means poorer adjustment). The overall IDAS was internally consistent with a Cronbach alpha = .89. Adjustment, as measured by the overall IDAS, had a weak but significant relationship with measures of quality of life including the mental component summary scale of the SF-36 (r = 0.19), but not the physical component summary scale of the SF-36. All the Profile of Mood States subscales correlated positively with the IDAS subscale anxiety/fear with the exception of vigor/activity which had a negative correlation. No sex differences in total adjustment were seen in this group of patients, although there were differences in body awareness, physical functioning, and fatigue. Although patients with implanted cardioverter defibrillator were more fearful/anxious than patients with pacemaker only, no differences in total adjustment were seen between the 2 groups. A better understanding of the experience of adjusting to an implanted device is foundational to the development of appropriate interventions.

Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders.

Although clinical genetic testing is available for over 1,000 inherited disorders, consequences of predictive genetic testing have been most extensively examined for hereditary breast and ovarian cancer (HBOC), hereditary colon cancer, and Huntington disease (HD). These focus primarily on psychological, ethical, legal, and social aspects of genetic testing. Genetic testing may also provide information that can lead to behaviors that promote health and reduce risk for disease, reflecting options available for the disorder for which the person is at risk. However, regardless of condition, people completing a genetic test may inform relatives about the results of the test and implications for their risk to develop the condition. Literature on risk reduction behaviors and communication focuses on families with HBOC or colorectal cancer. Few reports document behaviors for other conditions. This paper presents a systematic review of the research literature on risk reduction and health promotion behaviors following clinical genetic testing for adult onset conditions, primarily HBOC, familial colon cancers, and HD. Insights gleaned from this review are discussed as a basis for planning monitoring of health promotion and risk-reduction behaviors for genetic testing for present and future use.

Neonatal long QT syndrome due to a de novo dominant negative hERG mutation.

A 4-day-old girl with ventricular tachyarrhythmias, sinus bradycardia, and 2:1 atrioventricular block had prolongation of the QT interval. She was symptomatic with arching, gasping, and cyanosis presumably due to a life-threatening ventricular tachyarrhythmia such as torsades de pointes. Molecular genetic studies indicated a heterozygous, de novo, dominant negative mutation in hERG, a gene that encodes a protein in a potassium ion channel. The parents do not have the mutation. The patient's clinical scenario was produced by the convergence of 3 events: a de novo mutation occurred in hERG, the mutation was dominant negative, and the action of the mutation resulted in neonatal long QT syndrome. The child was treated aggressively and is doing well at age 6 years.

Experiences of college-age youths in families with a recessive genetic condition.

Growing up in a family with a recessive genetic condition can trigger questions about progeny effect. This study explored perceptions of family hardiness and information sharing by 18- to 21-year-olds about genetic risk. Semistructured interviews, the Family Hardiness Index (FHI), and a Family Information Sharing Analog Scale (FISAS) were used. Participants included 11 youths who had relatives with hemophilia and 4 with sickle cell anemia. Findings revealed seven themes: assimilating premature knowledge; caring for others, denying self; cautioning during development; experiencing continual sickness; feeling less than; magnifying transition experiences; and sustaining by faith. There was no significant correlation between total FHI and FISAS. However, there was a statistically significant difference in FISAS between genetic condition variance. Specifically, higher hardiness was found and information sharing correlated among college youths in families with hemophilia. Additional research can lead to nursing interventions to provide genetic information to youths in families for illness variance.

Development of the implanted devices adjustment scale.

Advances in microelectronics have resulted in exponential growth in the number of implanted medical devices. Most people do well adjusting to their devices, but others show signs of depression and/or anxiety. The Implanted Device Adjustment Scale (IDAS) was developed to measure how well a person is adjusting to an implanted device. First, a pool of items was generated and reviewed by 2 panels of clinicians and psychometricians for content validity. The revised version was then administered to a small sample that provided information about problematic items. Finally, a convenience sample of 45 persons (66% males) with implanted devices (18 pacemakers only, 37 cardioverter/defibrillators) completed the revised IDAS twice. After deleting weak items, the Cronbach alpha was 0.90. No age, gender, or device differences were found. Test-retest reliability was 0.92. The IDAS may be useful to evaluate how well a person is adjusting to her/his device. This may lead to more timely and appropriate interventions to improve outcomes.

Genetic practice, education, and research: an overview for advanced practice nurses.

PURPOSE/OBJECTIVES: The purpose of this article is to describe how the new genomic era will affect advanced practice registered nurses (APRNs) patient care, education, and research. BACKGROUND/RATIONALE: Given the exponential growth of genetic information and that 9 of the top 10 leading causes of mortality have genetic components (www.cdc.gov), it is imperative to educate advanced practice nurses about this salient topic. DESCRIPTION OF THE PROCESS: Because few APRNs in practice or academia have had formal education on genetics, the first step of nursings' own gene discovery is recognizing that there is an ongoing need to understand state of the science genetic information to gain clinical and educational utility. OUTCOMES: By recognizing APRNs need to know genetics, APRNs will clamor within their workplace for continuing education about this dynamic information. It is critical knowledge for APRNs to classify risk based on family history, target individualized patient prevention and education, modify pharmacologic interventions, and refer when genetic testing is necessary. INTERPRETATION/CONCLUSION: This article stresses the timely relevance of applying genetics and genomics to practice, teaching, and research. IMPLICATIONS FOR NURSING PRACTICE: APRNs need to maintain a place at the genetic table with all healthcare providers by developing strategies to expand this nursing knowledge to their practice, teaching, and research. Nurses need to be cognizant of the keen genetic value of family histories, how risk classification will individualize prevention recommendations, and the exciting role of pharmacogenetics, given many APRNs' prescriptive authority. Our core professional belief that each human is highly unique has probably never been more accurate than with the future in genetic and genomic nursing.