Sexually Transmitted Infection Prevention Perspectives in Black Men Who Have Sex With Men Taking Preexposure Prophylaxis in New Orleans.

INTRODUCTION: Profound sexual health disparities exist for Black men who have sex with men (MSM) in the US South, including a high prevalence of sexually transmitted infections (STIs). Sexually transmitted infection prevention strategies beyond condoms are needed for Black MSM taking preexposure prophylaxis (PrEP). METHODS: We conducted in-depth interviews with Black MSM taking PrEP in New Orleans, Louisiana. Informed by the Health Belief Model, we asked about participants' perceived susceptibility, severity, and concerns regarding STIs, and perceived benefits of STI prevention. We also asked about willingness to use various STI prevention strategies, including antibiotic prophylaxis. Interviews were audio-recorded and analyzed using applied thematic analysis. RESULTS: We interviewed 24 Black MSM aged 18 to 36 years; half had a recent STI diagnosis. Most participants were concerned about receiving an STI diagnosis, noting shame or disappointment; physical effects were concerning but infrequently considered. Participants described being less likely to use condoms with routine partners or those taking PrEP. Most reported being willing to engage in each of the 6 prevention strategies discussed. CONCLUSIONS: Black MSM taking PrEP voiced concern about STIs, and many noted that they infrequently use condoms. They were willing to engage in methods focused on preventing STIs on an individual or population level.

Facilitation as a component of evidence implementation: a multinational perspective.

BACKGROUND: Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM: This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS: To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS: The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION: The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.

Reduction of aggressive and violent behavior toward behavioral health unit staff and other patients: a best practice implementation project.

OBJECTIVES: The current project aimed to implement evidence-based recommendations for the management of inpatient aggressive and violent behaviors in four behavioral health units (BHUs) in a mental healthcare area within an academic medical center. INTRODUCTION: Patient violence against healthcare workers is a global concern, particularly in mental health care. All employees who work in inpatient psychiatric environments are at higher risk for targeted violence than are other healthcare workers. For healthcare organizations and staff, violent episodes involving patients can bring about medical expenses, potential legal expenditure, sick leave and a high turnover rate. The hospital at which this project was implemented had been experiencing a steady increase in violence and aggressive behavior. METHODS: The project used the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting practice change in four BHUs. A baseline retrospective audit of 10 electronic health records from four BHUs assessed compliance with best practice regarding violent episodes. The Getting Research into Practice tool was used to identify barriers and develop an evidence-based educational strategy for 70 BHU staff aimed to improve compliance with best practice for managing aggression and violence. Staff education compliance was assessed via hospital education department records. A pre and postimplementation staff satisfaction survey assessed perceptions about education, confidence and unit safety. RESULTS: The baseline audit indicated that one of the three criteria had 0% compliance. Following implementation of an educational strategy using mock codes for BHU staff, there was 96% improvement in compliance for the BHU staff education audit criterion. Staff de-escalated patients in 83% of the episodes postimplementation. There was a slight decrease (9.1%) in the rate of violence across all four inpatient BHUs. Staff satisfaction survey findings did not show a statistically significant difference. CONCLUSION: Enhanced evidence-based education and mock codes resulted in BHU staff competence and confidence in managing aggressive and/or violent patients. Early signs of a decrease in the violence rate and improvement in the efficient use of de-escalation will be sustained with on-going yearly education, quarterly mock codes and future audits. This project was limited by its small size and short timeframe (21 weeks), making results not generalizable.

Evaluation of the JBI scoping reviews methodology by current users.

BACKGROUND: In 2014, JBI Database of Systematic Reviews and Implementation Reports published a comprehensive methodology for the conduct and reporting of scoping reviews based on previous frameworks and guidance. Further work on scoping review methodology and particularly reporting is needed. To assist with refinements to the methodology, this survey was undertaken to evaluate users' experiences of following the process methodology. An electronic survey was generated to explore authors' experiences with the methodology and to seek feedback on the stages of scoping review development. METHOD: An online survey administered using Qualtrics - a secure survey platform - was distributed through invitations to a total of 51 registered users in the Joanna Briggs Database of Systematic reviews and Implementation reports. We analysed the questionnaire data using descriptive statistics. The qualitative data were grouped together, and free text comments were inductively themed and coded by the authors. RESULTS: Thirty-one participants completed the survey (response rate of 61%). The majority of the participants identified themselves as researchers (55%) followed by educators (25%). Most participants were university employees (77%) and only 10% were based in hospitals. Forty-two percent of the participants reported that the scoping review they had been involved with had taken between 6 and 12 months, and 32% of participants spent over a year completing their reviews. Eighty-seven percent of participants stated that their scoping reviews led to further work such as developing a systematic review, a basis for a grant application, formation of a part of students' doctoral studies, and informing further work in a research project. Some of the limitations listed by the participants were the lack of examples in each section of the methodology, especially in the inclusion criteria, and presentation of the results sections. CONCLUSION: The overall evaluation by the participants of the JBI scoping review methodology highlighted the need for additional detailed guidance for inclusion criteria and presentation of the results. Provision of clear examples for each step was also requested for future improvement.

Effectiveness of corneal abrasion prevention interventions for adults undergoing general anesthesia for more than one hour: a systematic review protocol.

REVIEW QUESTION: The question of this review is: what is the effectiveness of eye lubrication, tape and/or a combination of these interventions in preventing corneal abrasions in adult patients aged 18 and over undergoing general anesthesia for more than one hour?

A Pilot Randomized Controlled Trial of the Feasibility of a Multicomponent Delirium Prevention Intervention Versus Usual Care in Acute Stroke.

BACKGROUND: Delirium after acute stroke is a serious complication. Numerous studies support a benefit of multicomponent interventions in minimizing delirium-related complications in at-risk patients, but this has not been reported in acute stroke patients. The purpose of this study was to explore the feasibility of conducting a randomized (delirium care) versus usual standardized stroke care (usual care) in reducing delirium in acute stroke. OBJECTIVE: This pilot study assessed the feasibility of (1) enrollment within the 48-hour window when delirium risk is greatest, (2) measuring cognitive function using the Montreal Cognitive Assessment, (3) delivering interventions 7 days per week, and (4) determining delirium incidence in stroke-related cognitive dysfunction. METHODS: A 2-group randomized controlled trial was conducted. Patients admitted with ischemic and hemorrhagic strokes and 50 years or older, English speaking, and without delirium on admit were recruited, consented, and randomized to usual care or delirium care groups. RESULTS: Data from 125 subjects (delirium care, n = 59; usual care, n = 66) were analyzed. All Montreal Cognitive Assessment subscales were completed by 86% of subjects (delirium care, mean [SD], 18.14 [6.03]; usual care, mean [SD], 17.61 [6.29]). Subjects in the delirium care group received a mean of 6.10 therapeutic activities (range, 2-23) and daily medication review by a clinical pharmacist using anticholinergic drug calculations. Delirium incidence was 8% (10/125), 3 in the delirium care group and 7 in the usual care group. CONCLUSION: Findings support the feasibility of delivering a multicomponent delirium prevention intervention in acute stroke and warrants testing intervention effects on delirium outcomes and anticholinergic medication administration.

Effectiveness of ketamine as an adjuvant to opioid-based therapy in decreasing pain associated with opioid tolerance in adults undergoing orthopedic surgery: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to examine the best available evidence on the clinical effectiveness of ketamine as an adjuvant to opioid-based therapy versus opioid-based therapy alone in decreasing perioperative pain associated with opioid tolerance in adult patients, aged 18-70 years, undergoing orthopedic surgical procedures.The following question guides the systematic review: does the administration of ketamine as an adjuvant to opioid-based therapy, compared to opioid-based therapy alone, improve perioperative pain relief in opioid-tolerant adult patients undergoing orthopedic surgical procedures?

Educating nurses to provide culturally competent care during disasters.

Health disparities are exacerbated during times of disasters. To decrease health disparities, it is essential that health care providers understand the specific needs, culture, and norms of individuals, groups, and populations in a disaster. Survivors respond and recover from disaster events within the context of their culture and beliefs; therefore, implementing cultural competent interventions for disaster victims is central to providing services and care. This article describes the development, implementation, and evaluation of a continuing education program and academic courses for nurses and nursing students.

Mixed-methods approach to understanding nurses' clinical reasoning in recognizing delirium in hospitalized older adults.

A mixed-methods study was conducted to enhance understanding of nurses' clinical reasoning in recognizing delirium in the hospitalized older adult. Paired nurse and researcher ratings of the confusion assessment method in 103 medical-surgical patients were analyzed to determine the rate of agreement in detecting delirium and to identify a purposive sample of nurses to be interviewed about the patients with delirium who were under their care. Nurses' clinical reasoning in recognizing and underrecognizing delirium was investigated using semistructured interviews. The incidence of delirium was 13%, with poor agreement (95% CI [0.05, 0.64], p < 0.05) between the researchers and the nurses in detecting delirium. Sixteen nurses were interviewed and transcripts were analyzed with grounded theory. Confusion was the primary causal factor for recognizing symptoms of delirium. The findings explicated a framework that forms the basis for generating testable assumptions to improve nurses' recognition of delirium.

Using second life to facilitate peer storytelling for grieving oncology nurses.

BACKGROUND: Oncology nurses often experience intense emotional reactions to patient deaths but may be forced to ignore or hide their feelings because of work-related responsibilities. The complexity of nurses' work and personal lives creates obstacles for participating in traditional support groups where grieving nurses can bond and share. We hypothesized that using a web-based, three-dimensional (3-D) virtual world technology (Second Life) may provide a venue to facilitate peer storytelling to support nurses dealing with grief. METHODS: We used a mixed-methods approach involving focus groups and surveys to explore the use of peer storytelling for grieving oncology nurses. Nine acute and ambulatory oncology nurses in groups of 3 participated using avatars in 5 group moderator-guided sessions lasting 1 hour each in a private 3-D outdoor virtual meeting space within Second Life. Baseline information was collected using a 12-item demographic and professional loss survey. At the end of the study, a 20-item survey was administered to measure professional losses during the study, exchange of support during sessions, and meaning-making and to evaluate peer storytelling using Second Life. RESULTS: Overall, nurses reported peer storytelling sessions in Second Life were helpful in making sense of and in identifying a benefit of their grief experience. They felt supported by both the group moderator and group members and were able to personally support group members during storytelling. Although nurses reported Second Life was helpful in facilitating storytelling sessions and expressed overall satisfaction with using Second Life, open-ended comments registered difficulties encountered, mostly with technology. Three central themes emerged in sessions, representing a dynamic relationship between mental, spiritual, and emotional-behavioral responses to grief: cognitive readiness to learn about death, death really takes death experience, and emotional resilience. CONCLUSION: This study suggests a potential benefit in using peer storytelling sessions in Second Life to facilitate oncology nurses' grief resolution. In particular, Second Life provides a nonthreatening venue for participating nurses to share their innermost feelings and accrue their own inventory of stories. Through these stories, each nurse's relational experience in expressing and coping with grief is realized.

Providing culturally competent care during disasters: strategies for nurses.

Planning for and responding to disasters involves more than traditional emergency management; members of vulnerable populations should be included in the disaster response cycle. Nurses are key to employing culturally competent strategies with vulnerable populations during disasters, enhancing the access of these populations to care and reducing their health disparities.

Using a multiuser virtual environment to facilitate nursing journal clubs: a mixed-methods study.

PURPOSE: The purpose of this mixed-methods pilot study was to explore the feasibility of using Second Life to conduct research and to describe nurses' experiences in using Second Life to facilitate nursing journal clubs. METHODS: A QUAN→qual sequential design using survey and qualitative methods was used to guide scientific inquiry. Survey data were analyzed using descriptive statistics, and t, Mann-Whitney U, and χ tests were used to test for presurvey and postsurvey group differences. Journal club screencast recordings were thematically analyzed. SETTING: This study was conducted in an Internet-accessible, 3-dimensional multiuser virtual environment. SAMPLE: A convenience sample of registered nurses from 7 facilities consented to participate. Completed data from 29 presurveys and 20 postsurveys were included in data analyses. FINDINGS: Overall, nurses reported a benefit in using Second Life to facilitate journal clubs. The Mann-Whitney U test identified (P < .05) improvement in 7 of 8 critical appraisal competencies after journal club activities: determining design, determining population, interpreting statistics, linking findings/conclusions, identifying limitations, identifying implications, and interpreting qualitative findings. Qualitative analyses of screencastings validated reports of improved critical appraisal competencies and identified 3 inworld themes: presence, learning strategies, and learning outcomes. CONCLUSIONS: Registered nurse study participants reported a benefit of using Second Life for nursing journal clubs. Participants perceived and demonstrated improvement in critical appraisal competencies. IMPLICATIONS: Further research is warranted on outcomes associated with nurses' appraisal of evidence for application to practice using a multiuser virtual environment.

Shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina.

The purpose of this focused ethnography was to describe the shared experiences of certified registered nurse anesthetists (CRNAs) who were on duty in New Orleans, Louisiana, during Hurricane Katrina as well as to elucidate the psychosocial impact the storm had on them. Ten CRNAs participated in 1 of 3 focus groups that were audio recorded. The audio recordings were transcribed and analyzed using qualitative data analysis computer software (NVivo 8, QSR International, Melbourne, Australia). Six major themes emerged from the study: caught off guard; sense of duty; uncertainty/powerlessness/frustration; group identity and cohesiveness; anger; and life-changing event. The themes represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted mainly in short-term sleep disturbances and increased drinking. Only 2 CRNAs expressed long-term psychosocial effects from the storm. The results of this study should be used to guide policies regarding disaster activation of CRNAs, to educate CRNAs on preparing for disaster duty, and to provide a framework for future disaster studies regarding CRNAs.

Disrupted by disaster: shared experiences of student registered nurse anesthetists affected by hurricane Katrina.

The purpose of this focused ethnography was to describe the shared experiences of student registered nurse anesthetists (SRNAs) whose senior year of education and training was disrupted by Hurricane Katrina, as well as to determine the storm's psychosocial impact on them. A convenience sample of 10 former SRNAs participated in focus groups that were audiorecorded, transcribed, and qualitatively analyzed. Three major themes emerged from the study: Seriousness of Urgency, Managing Uncertainty, and Stability Equaled Relief. The themes represented how the SRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the SRNAs resulted mainly in temporary increased alcohol consumption and short-term anxiety. One person started smoking. The results of this study should serve as a guide to formulate policies regarding the education of SRNAs during and immediately after a disaster and to provide a framework for future disaster studies regarding SRNAs.

Nurses' recognition of delirium in the hospitalized older adult.

BACKGROUND: Delirium is the most frequent complication associated with hospitalization of older adults, responsible for 17.5 million additional hospital days in the United States each year; yet, nurses fail to recognize it more than 30% of the time. OBJECTIVES: The specific aim of the study was to measure staff nurses' recognition of delirium in hospitalized older adults by comparing nurse and expert diagnostician ratings for delirium using the Confusion Assessment Method (CAM). METHOD: This study investigated the rate of agreement/disagreement between researchers and a convenience sample of 167 nurses caring for 170 medical surgical patients (>65 years) in detecting delirium. Paired (nurse vs researcher) CAM ratings were completed at least every other day until either discharge or delirium was detected by the researcher. RESULTS: The researcher detected delirium in 7% (12/170) of patients. Nurses failed to recognize delirium 75% (9/12) of the time, with poor agreement between nurse/researcher for all observations (κ = 0.34). A generalized estimating equation logistic regression model identified independent predictors of nurses' underrecognition of delirium that included increasing age and length of stay, dementia, and hypoactive delirium. DISCUSSION: Findings provide further support for the significance of nurses' underrecognition of delirium in the hospitalized older adult when using the CAM. Additional research is warranted regarding the clinical decision-making processes that nurses use in assessing acute cognitive changes and in identifying strategies to improve delirium recognition.

Spiritual development of nursing students: developing competence to provide spiritual care to patients at the end of life.

Nurses spend more time with their patients than do other health care workers. Therefore, the spiritual needs of patients must be recognized as a domain of nursing care. Holism cannot exist without consideration of the spiritual aspects that create individuality and give meaning to people's lives. The purpose of this article is to provide nursing faculty with tools that may be used to develop spiritually knowledgeable nursing students who can overcome barriers to providing spiritual care to end-of-life patients. Our students were required to complete care maps to ensure they are prepared for patient care at the end of life. In this article, we present tools that faculty and students may use to complete the spiritual concept in care mapping. The literature on spirituality is reviewed, use of care mapping in nursing curricula is described, and our teaching approach to develop nursing students who are skilled at providing spiritual care is explained. Three case studies and care maps created by former students are also presented to demonstrate examples of spiritual competence.

The BRK tyrosine kinase is expressed in high-grade serous carcinoma of the ovary.

BACKGROUND: We identified the BRK tyrosine kinase in a PCR-based screen of tyrosine kinases expressed by ovarian tumors. BRK expression is restricted to normal differentiating epithelial cells and its overexpression may play a role in processes related to tumor development and growth. Its expression in normal ovary and ovarian tumors has not previously been described, and is the focus of this study. METHODS: BRK expression levels were determined in 14 normal ovaries and 138 high-grade, late stage serous carcinomas of the ovary by immunohistochemical analysis, and in 19 ovarian cancer cell lines and immortalized ovarian surface epithelium by Western blot analysis. Furthermore, BRK/PTK6 gene copy number was determined in seven primary serous carcinomas by fluorescence in situ hybridization. RESULTS: Immunohistochemical studies indicate that BRK is highly expressed in 97/138 (70%) of high-grade, serous carcinomas of the ovary, but is absent in normal ovarian surface epithelia. BRK is also expressed by 9/19 of ovarian cancer cell lines, but is undetectable in immortalized ovarian surface epithelium. Interestingly, the BRK gene has been mapped to chromosome 20q13.3, a site frequently amplified in ovarian cancers, and associated with poor prognosis. We have determined by fluorescence in situ hybridization (FISH) that BRK is specifically amplified at low levels in 6/7 primary ovarian carcinomas. CONCLUSIONS: The amplification of the BRK gene and overexpression of BRK protein in the majority of high-grade serous carcinomas and ovarian cancer cell lines suggest that BRK may play a role in the development and growth of ovarian tumors.