Moving Beyond the LGBTQIA+ Acronym: Toward Patient-Centered Care.

PURPOSE: The LGBTQIA+ communities experience distinct health disparities and inequities in health outcomes. Healthcare providers must be conscious of factors to facilitate optimal, person-centered care. This narrative briefly covers health disparities in the LGBTQIA+ community and posits strategies to promote inclusive care. METHODS: Current literature and clinical best practices from several authoritative sources on LGBTQIA+-specific issues and gender-affirming care were reviewed. Sources included several LGBTQIA+-specific healthcare organizations, national healthcare provider organizations, and federal agency policy statements. Inclusive terminology and healthcare practices were included. RESULTS: Healthcare providers must educate themselves on caring for gender- and sexual orientation-diverse populations to optimize the health status of these communities. It is essential that providers examine their own potential biases and maintain an openness to learning about LGBTQIA+ communities. CONCLUSIONS: Healthcare providers have a responsibility to not only understand issues specific to LGBTQIA+ individuals but also advocate for these groups. As nurses, we must continue to support public health policies that seek to end disparities and ensure health equity for all. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses are caring for more diverse populations than ever before and must understand how to provide compassionate, individualized care. Although this article focuses on the LGBTQIA+ community, the principles discussed are applicable across all populations.

Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association.

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates From the National Health and Nutrition Examination Survey (NHANES), 2013 Through 2018.

BACKGROUND: The American Heart Association recently published an updated algorithm for quantifying cardiovascular health (CVH)-the Life's Essential 8 score. We quantified US levels of CVH using the new score. METHODS: We included individuals ages 2 through 79 years (not pregnant or institutionalized) who were free of cardiovascular disease from the National Health and Nutrition Examination Surveys in 2013 through 2018. For all participants, we calculated the overall CVH score (range, 0 [lowest] to 100 [highest]), as well as the score for each component of diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure, using published American Heart Association definitions. Sample weights and design were incorporated in calculating prevalence estimates and standard errors using standard survey procedures. CVH scores were assessed across strata of age, sex, race and ethnicity, family income, and depression. RESULTS: There were 23 409 participants, representing 201 728 000 adults and 74 435 000 children. The overall mean CVH score was 64.7 (95% CI, 63.9-65.6) among adults using all 8 metrics and 65.5 (95% CI, 64.4-66.6) for the 3 metrics available (diet, physical activity, and body mass index) among children and adolescents ages 2 through 19 years. For adults, there were significant differences in mean overall CVH scores by sex (women, 67.0; men, 62.5), age (range of mean values, 62.2-68.7), and racial and ethnic group (range, 59.7-68.5). Mean scores were lowest for diet, physical activity, and body mass index metrics. There were large differences in mean scores across demographic groups for diet (range, 23.8-47.7), nicotine exposure (range, 63.1-85.0), blood glucose (range, 65.7-88.1), and blood pressure (range, 49.5-84.0). In children, diet scores were low (mean 40.6) and were progressively lower in higher age groups (from 61.1 at ages 2 through 5 to 28.5 at ages 12 through 19); large differences were also noted in mean physical activity (range, 63.1-88.3) and body mass index (range, 74.4-89.4) scores by sociodemographic group. CONCLUSIONS: The new Life's Essential 8 score helps identify large group and individual differences in CVH. Overall CVH in the US population remains well below optimal levels and there are both broad and targeted opportunities to monitor, preserve, and improve CVH across the life course in individuals and the population.

Nurse Author: Who Me? Yes, You!

BACKGROUND AND PURPOSE: Potential nurse authors may find writing a challenge, including managing the publication process from getting started through submission to revision of the work and its acceptance. This special article presents strategies to help inexperienced writers develop and hone skills for journal publication. POTENTIAL PUBLICATION STRATEGIES: Tips discussed here that may lead to manuscript acceptance include selecting a topic of interest, using motivational self-talk approaches and structuring time to write, choosing coauthors, targeting a journal for submission, writing strong sentences in active voice, developing a structured abstract, using correct citation and reference formats, understanding reviews and resubmitting the manuscript, and keeping momentum to produce continued writing results. Practical writing hints are also suggested for inexperienced writers. RELEVANCE AND CONCLUSION: These strategies can help guide nurse writers in planning, navigating the system, and finding success as a published author.

Modifications of the FIM instrument under the inpatient rehabilitation facility prospective payment system.

OBJECTIVES: To describe the modifications made to the FIM instrument when it was incorporated into the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and to compare FIM data collected before and after the IRF prospective payment system (IRF-PPS) was implemented in 2002 for patients with stroke. DESIGN: Year-by-year comparison of data of Medicare patients with stroke discharged in 1998-2003 from 411 IRFs that submitted data to the Uniform Data System for Medical Rehabilitation for each of those years. RESULTS: In the pre-PPS period, admission motor FIM ratings decreased slightly, and discharge motor, admission cognitive, and discharge cognitive ratings remained stable. Between 2001 and 2003, all four ratings decreased: admission motor by 1.8 FIM units, discharge motor by 3.3 FIM units, and admission and discharge cognitive each by 1.0 FIM unit. The lower admission FIM ratings led to an increase in the mean case-mix index from 1.39 to 1.49. CONCLUSIONS: The decrease in FIM ratings in the IRF-PAI/PPS years may reflect alterations in coding practices as a result of changed rules for rating the FIM instrument, "downcoding" leading to assignment into higher-paying categories, changes in the IRF patient population, and/or changes in IRF patient outcomes. Coding changes should be considered when comparing pre-PPS and PPS FIM data.

Nurse staffing and patient outcomes in inpatient rehabilitation settings.

In rehabilitation nursing, the patient classification systems or acuity models and nurse-staffing ratios are not supported by empirical evidence. Moreover there are no studies published characterizing nursing hours per patient day, proportion of RN staff and impact of agency nurses in inpatient rehabilitation settings. The purpose of this prospective observational study was to describe rehabilitation nurse staffing patterns, to validate the impact of rehabilitation nursing on patient outcomes, and to test whether existing patient measures on severity and outcomes in rehabilitation could be used as a proxy for burden of care to predict rehabilitation nurse staffing ceilings and daily nurse staffing requirements. A total of 54 rehabilitation facilities in the United States, stratified by geography, were randomly selected to participate in the study.

Preliminary results for the PAR-PRO: a measure of home and community participation.

OBJECTIVE: To develop a measure of home and community participation related to the World Health Organization's International Classification of Functioning, Disability and Health. DESIGN: Cross-sectional analysis of survey data. SETTING: Nine medical inpatient rehabilitation facilities from 6 states. PARTICIPANTS: A total of 594 patients of mixed impairment type admitted for inpatient rehabilitation in 2002. Mean age was 74.0 years and 61.4% were women. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reliability and validity of the participation instrument. RESULTS: A 20-item instrument of home and community participation was developed (PAR-PRO). The instrument showed good internal consistency and good Rasch person and item fit statistics. Four subfactors were identified beyond the unidimensional construct of participation including domestic management, socialization, physical vigor, and generative activities. The PAR-PRO total participation score correlated inversely with age (r=-.31, P<.001) but did not differ by sex. CONCLUSIONS: The 20-item PAR-PRO instrument of home and community participation displayed good psychometric characteristics. The instrument shows promise as a broad measure of home and community involvement for persons with disabilities. Further work is needed to support its application for people without disability.