Nursing roles and responsibilities conducted by registered nurse/BSN student dyads across ambulatory clinical sites in medically underserved communities.

BACKGROUND: Increasingly, registered nurses (RNs) are incorporated into ambulatory care teams. Yet, limited research exists on the roles of RNs across these settings. PURPOSE: The purpose of this study was to examine the roles performed by RNs (and their senior BSN students) in primary care and public health settings. METHODS: Working with nine RN preceptors, 15 students tracked all patient visits during a 150-h immersion experience using the Typhon™ clinical-tracking software. RESULTS: The BSN student/RN dyads conducted 1218 patient visits completing 8536 RN roles in 15 distinct categories. Most patients were African American and female (n = 736; 60.1 %) with an average age of 38.4 (SD 22.12). Patient demographics varied by site. The most common roles performed by the RN/student dyad were health assessment, behavioral health screening, and telehealth. Roles of the RNs and the student level of independence were significantly different across sites (Fisher's Exact test [p < .001]). CONCLUSIONS: Our results argue that RNs are providing substantial value to these FQHC and public heath settings. An academic/practice partnership, including a shared curricular review, can provide a strategic advantage for educators to ensure that health systems realize the unique roles for RNs and educators provide 21st century education.

Strategies to Recruit Adults with Advanced Cancer and Dependent Children.

Strategies for identifying and recruiting parents with advanced cancer with dependent children, a population that faces unique challenges for cancer care receipt and research participating is lacking. We outline three challenges to recruit eligible adults with advanced cancer who are also parents to children and offer recommendations to guide future protocols and study procedures for this poorly-understood population. Nurse researchers can incorporate recommendations into study protocols and procedures to identify and address unmet needs of this population.

Understanding Dying Concerns in Parents With Advanced Cancer With Dependent Children for Their Coparent: A Phenomenological Study.

Parents with advanced cancer and their dependent children experience high psychological distress, decreased quality of life, and decreased family functioning due to cancer-related concerns. Dying concerns are defined as fluctuating thoughts or feelings that are conscious or unconscious about an anticipated and approaching death that is attributed to a palliative/terminal diagnosis. This study used Gadamer's phenomenological approach to gain a shared understanding of the perspectives of the parents with advanced cancer about dying concerns, family life before and after advanced cancer diagnosis, and family resources to manage the crisis of advanced cancer for the coparent. The sample consisted of 4 patients from a Midwestern cancer hospital. Data were collected through 2 virtual semistructured interviews and were qualitatively analyzed using the hermeneutic rule and the theoretical concepts from McCubbin and McCubbin's Family Resiliency Model. Four major themes emerged: "Uncertainty in End-of-Life Decisions," "Effectless Communication," "Parental Skepticism," and "Psychological Well-being." The results showed that parents with advanced cancer have concerns for their coparent outside their parental role. Understanding dying concerns from all family members may increase nurse-initiated communication to improve family outcomes.

A Qualitative Approach to the Dimensions of Segregation among Pregnant Black Women.

This study compares and contrasts residents' perceptions of segregation measures using qualitative and quantitative data. Most studies exploring racial residential segregation and health outcomes use large-scale, metropolitan-wide measures. As a result, we have limited understanding of racial residential segregation outside of Census data, particularly about the firsthand experiences of those living in segregated areas. The purpose of this study was to compare data from Census-based measures of racial residential segregation with qualitative descriptions of these same constructs by pregnant, Black women in two US cities. Using novel qualitative interview questions, we explored the dimensions of segregation and neighborhood racial distribution among a sample of 27 pregnant, Black women between April and November 2019. The participants included in this sample had perceptions about their neighborhood segregation and demographic composition that were often different from the data derived from existing residential US Census data. The differences between qualitative and quantitative measures and the possible reasons for the discordance suggest new approaches to measurement and new directions for the study of segregation and health.

Family Cohesiveness: A Dying Concern for the Coparent in Families With Parents With Advanced Cancer With Dependent Children: A Pilot Study.

BACKGROUND: Dying concerns are thoughts expressed by a person diagnosed with a terminal illness or by an individual coping with the impending death of a loved one. Little is known about the dying concerns of parents with advanced cancer (PWACs) with dependent children, and even less is known about the dying concerns of the coparent. Understanding the PWACs' dying concerns for the coparent can contribute to the overall health of the family when faced with the death of a loved one. OBJECTIVE: The aim of this pilot descriptive study was to explore the PWACs' perspective of their dying concerns for their coparent. METHODS: Four PWACs were recruited from 2 oncology inpatient units from an urban community hospital within the same hospital system. Semistructured interviews were conducted, audio-recorded, and transcribed with 4 participants. Data analysis used directed content analysis. RESULTS: Parents with advanced cancer expressed concern about the repercussions of advanced cancer on family cohesiveness. Three subthemes within this general structure were "My Weakest Link," "If I'm Not There, Where Do They Go?" and "Putting Up a Front." CONCLUSIONS: Parents with advanced cancer have concerns beyond their role as a parent could make a difference in the overall health of the PWACs, but also the family unit. The PWACs' concerns are present but may be covered over by use of protective mechanisms to maintain family cohesiveness. IMPLICATIONS FOR PRACTICE: Understanding dying concerns may enhance nurse-initiated communications between family members and healthcare providers to improve psychological distress and enhance family functioning.

Testing a Middle -Range Theory of Heart Failure Self-Care.

A middle-range theory of heart failure self-care, derived from the self-care deficit theory of nursing, was tested among 175 Arab American older adults with heart failure. The middle-range theory achieved good statistical fit, but not all hypothesized relationships were supported. Specifically, conceptualizing basic conditioning factors as a single latent variable was not supported. However, individual factors of depression, social support, and time living with heart failure had a direct effect on both self-care agency and quality of life. Understanding predictors and outcomes of self-care within a theoretical framework is essential in caring for patients with heart failure.

Developing a Middle-Range Theory of Heart Failure Self-Care.

Middle-range nursing theories provide a bridge between the more abstract grand nursing theories, research, and clinical practice. As such, middle-range nursing theories derived from extant nursing theories are critical for developing and advancing both nursing science and practice. This paper describes the strategy used in developing a middle-range theory of heart failure self-care. After integrating theoretical and empirical literature, a hypothetico-deductive approach was used to develop the middle-range theory of heart failure self-care from Orem's theory of self-care. Theoretical substruction was used to provide a graphic representation of the conceptual-theoretical-empirical structure demonstrating the congruence between the theoretical and operational systems.

Dying concerns in young parents with advanced cancer (PWAC): A scoping review.

BACKGROUND: Advanced cancer in young parents (PWAC) can increase dying concerns, the fluctuating thoughts, or feelings, conscious, or unconscious, about an approaching death by a person facing a terminal illness or a family member coping with the impending death of a loved one. However, limited research has been conducted to identify dying concerns in an ill parent as the research has focused on older adults. OBJECTIVE: Our goal was to identify dying concerns that PWAC are expressing and to understand how these concerns affect measurable outcomes. METHOD: CINHAL, MEDLINE, PsychARTICLES, PsycINFO, Social Work Abstracts, Health Source: Nursing/Academic Edition, and Psychology and Behavioral Sciences Collection were searched. Articles included were samples of PWAC, peer-reviewed, and published within the last 10 years. Elderly or pediatric populations, PWAC with adult children, and early-stage cancer were excluded. The initial search resulted in 1,526 articles, 18 were identified as potentially relevant. Fourteen articles were identified and reviewed. RESULTS: PWAC expressed concerns for their children (n = 11), concerns for their co-parent (n = 4), and personal concerns (n = 11). Additionally, PWAC have decreased quality of life, have significant emotional and psychological distress, and have increased family dysfunction in relation to their concerns. Samples limit the generalizability of the findings. Majority of the articles consisted of White, upper, middle-class (n = 8) women (n = 7) diagnosed with breast cancer (n = 11) within nuclear families (n = 11). SIGNIFICANCE OF RESULTS: Dying concerns are described in the literature from a fairly narrow sample of PWAC. Future research should focus on recruiting participants from diverse backgrounds, genders, diagnosis types, and non-nuclear families. Identifying concerns for the co-parent would also add to the understanding of dying concerns.

Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust.

Peer-reviewed articles (n = 124) examining associations between medical mistrust (MM) and health outcomes from four databases, between January 1998 and May 2018, were reviewed; 36 qualitative and 88 quantitative studies met the inclusion criteria. The Williams and Mohammed framework guided our narrative synthesis of the studies; it argues that basic causes (e.g., biased institutions) affect the social status of marginalized groups which in turn effects multiple proximal pathways leading to responses and poor health. Most studies were cross-sectional with US-based samples. The MM in qualitative studies were categorized as interpersonal (n = 30), systemic (n = 22), and/or vicarious (n = 18); 25% did not explicitly note the basic causes of MM and race/ethnicity was often confounded with socioeconomic status (SES). All but three studies discussed an association between MM and a behavior response; no study focused on an actual health outcome. Most quantitative studies used multivariate regression analyses; only 15 of the 88 utilized advanced modeling techniques (e.g., mediation). Most (75%) studies did not describe basic causes for MM and 43% utilized low income samples. MM was conceptualized as a predictor/proximal pathway (in 73 studies) associated with a variety of responses, most commonly behavioral (e.g., diminished adherence); 14 studies found an association between MM and a specific health measure. This review underscores the need for future qualitative studies to place MM central to their research questions as in-depth descriptions of MM were limited. Future quantitative studies should replicate findings using more advanced analytical strategies that examine the relationship between MM and health outcomes.

Acculturation and Postpartum Depression Among Immigrant Women of Arabic Descent.

Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale-EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.

Interprofessional education during an autism session.

Interprofessional education (IPE) gained a strong foothold in the beginning of the twenty-first century as an effort to improve care to patients through enhanced teamwork. The aim of this study was to compare attitudes and experiences of the learners, which included graduate students, physicians in training, and practicing healthcare professionals, before and after an interprofessional clinical practice (IPCP) six-h autism didactic and experiential training session. The training session consisted of a 1-h lecture on Autism Spectrum Disorder (ASD), a 2-h behavior review meeting consisting of four different case study discussions among the learners, a 1-h lunch, a 1-h therapy session with children diagnosed with ASD, and a 1-h discussion among the learners. The IPCP learners (n = 63) completed a pre- and post-learning questionnaire of the Readiness for Interprofessional Learning Scale (RIPLS) and 12 Statements instruments and both showed an overall significant improvement in the learners interprofessional education after completing the training session. This study was able to show that students, professional trainees, and practicing professionals from different backgrounds led by an expert in the field can exchange ideas and role perceptions in an interprofessional didactic and experiential session, and develop improved attitudes toward IPCP. Moving forward, interprofessional education research needs to focus more on professional trainees and practicing professionals working together in combined didactic and experiential environments for children diagnosed with ASD.

Acculturative stress and lack of social support predict postpartum depression among U.S. immigrant women of Arabic descent.

PURPOSE: To examine the relationships among acculturative stress, social support, and postpartum depression (PPD) symptoms among U.S. immigrant women of Arabic descent; and to examine if social support moderates the associations between acculturative stress and PPD symptoms. METHODS: Using a cross-sectional design, a sample of 115 U.S. immigrant women of Arabic descent, all between 1 and 12 months postpartum, were enrolled from clinics in Dearborn, MI. Data were analyzed using correlational and multiple linear regression. RESULTS: Women had a mean age of 29 ±â€¯5 years and were 5 ±â€¯4 months postpartum. Women had been in the U.S. for 7 ±â€¯6 years and had a mean education of 12 ±â€¯4 years. The majority had an annual household income of <$40,000 (88%), were unemployed (80%), and preferred Arabic language for interview (68%). Higher levels of acculturative stress, higher levels of education, antenatal anxiety, and lower levels of social support predicted PPD symptoms (all significant at p < .05). The moderating effect of social support on the association between acculturative stress and PPD symptoms was not supported. CONCLUSIONS: Acculturative stress, lack of social support, higher level of education, and antenatal anxiety predicted PPD symptoms. Future research is needed to examine acculturative stress among immigrant women in different U.S. SETTINGS: Longitudinal studies and utilizing diagnostic assessments of PPD is highly recommended. Nurses need to screen immigrant women of Arabic descent for anxiety and depression during antenatal visits and develop evidence-based interventions targeted to improve mental health during pregnancy and postpartum.

Understanding tuberculosis in an era of global travel.

With the resurgence of tuberculosis (TB), it is imperative that healthcare providers have the necessary skills to manage the specialized issues of prevention, recognition, and treatment of TB. The case study in this article illustrates these skills for NPs and other advanced practice providers.

Evaluation of the psychometric properties of the Korean version of the Cultural Competence Assessment.

AIM: The 25 item Cultural Competence Assessment assesses the cultural competence of multiple types of healthcare providers. This study aimed to examine the validity and reliability of the Korean version of the questionnaire (KCCA) and to determine the need for changes to improve its validity and reliability. METHODS: Data from 161 hospital nurses were used for the item analysis and to assess the reliability and construct validity of the KCCA before and after the deletion of nine items. RESULTS: The KCCA did not demonstrate acceptable construct validity and subscale internal reliability. Nine items with high interitem correlations, high modification indices, and relatively lower factor loadings were deleted. The 16 item Modified KCCA showed improved construct validity, convergent and discriminant validity, and reliability. CONCLUSION: While further psychometric evaluation of the Modified KCCA should be undertaken with larger samples and diverse professionals, the study's data provide evidence that the Modified KCCA might be a more suitable measure for use among Korean healthcare providers.

A Quality Improvement Project To Educate Nurses on Coudé Catheter Placement.

When only physicians are trained to insert Coudé catheters, there is an increased burden to both the patient and the providers. Training nurses for placement of Coudé catheters can improve care and allow for better use of health care resources.

Measuring African American women's trust in provider during pregnancy.

Significant racial disparities exist in pregnancy outcomes, but few researchers have examined the relationship between trust in providers and pregnancy outcomes. The Trust in Physician Scale (TPS), the most widely used tool, has not been tested in pregnancy. We assessed the psychometric properties of the TPS and identified correlates of trust in 189 pregnant African American women. Evidence supports internal consistency reliability (>.85) and internal structure of the TPS (CFI = .97; RMSEA = .05; χ(2) (42) = 65.93, p = .001), but TPS scores did not predict pregnancy outcomes. African American women reported a high level of trust in obstetric providers. Trust did not differ by provider type (physician or midwife) but was related to the women's history of perceived racism and strength of ethnic identity.

Comparison of nurse managed health centers with federally qualified health centers as safety net providers.

Nurse Managed Health Centers (NMHCs) provide a critical safety net function in their communities, yet they often remain invisible and challenged in terms of financial sustainability. This paper presents a comparison of demographics and financial status of NMHCs and Federally Qualified Health Centers (FQHCs). The comparison is based on four years of annual NMHC national survey data that includes 42 NMHCs overall and the 2008 FQHC data in the Uniform Data System. Findings indicate that NMHCs and FQHCs serve very similar diverse populations yet funding and revenue differences were significant. NMHCs tend to rely more on grants and donations from the private sector as well as contracts while FQHCs have access to considerable federal support that is cost based when serving the underserved. In addition, NMHCs are challenged by the array of state, federal and third party insurers' regulations that often disadvantage nurse practitioners as primary care providers.

Testing a multi-group model of culturally competent behaviors among underrepresented nurse practitioners.

Diversifying the health professional workforce and enhancing cultural competence are recommended for decreasing health disparities. We tested a structural equation model of the predictors of culturally competent behaviors in a mailed survey of three groups of underrepresented nurse practitioners (n = 474). Our model had good fit and accounted for 29% of the variance in culturally competent behaviors. Life experiences with diversity had direct effects on awareness/sensitivity and behaviors, and diversity training had a direct effect on behaviors. Cultural awareness/sensitivity mediated the relationship between life experiences with diversity and culturally competent behaviors; all paths remained after controlling for covariates. For unique experiences that contribute to workplace diversity, life experiences with diversity, and diversity training are important for culturally competent behaviors.

Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners.

PURPOSE: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary-care nurse practitioners using Cox's Interaction Model of Client Health Behaviors. DESIGN: A descriptive-correlational study was conducted with a convenience sample of 100 community-dwelling adults. METHODS: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data. ANALYSIS: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client-professional interaction, and outcome. FINDINGS AND CONCLUSIONS: Cox's model indicated a complex view of African American patients' perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse-practitioner (NP) providers explained 41% of variance in satisfaction. CLINICAL RELEVANCE: An African American patient's own attitudes about racial identity and the client-professional relationship have a significant effect on satisfaction with primary care.