Nurse practitioner model of care for the initiation of pre-exposure prophylaxis: A case series study.

AIM: The purpose of this study was to create and implement a nurse practitioner model of care in the initiation of a pre-exposure prophylaxis (PrEP) protocol with African American men who have sex with men (MSM). DESIGN: A case series design was used to implement the protocol for a nurse practitioner PrEP-based model of care. METHODS: The participatory, evidence-based, patient-focus process (PEPPA) framework and the American Association of Colleges of Nursing (AACN) Doctoral Essentials for Advanced Practice were aligned to guide the development, implementation, and evaluation of this advanced practice role in an urban medical clinic. RESULTS: Seven African American HIV-negative MSM who received treatment under the nurse practitioner PrEP-based model of care had increased PrEP knowledge and medication adherence and did not contract a sexually transmitted infection. CONCLUSIONS: New models of care can be created to meet the Getting to Zero HIV initiative of reducing rates of HIV infections with MSM.

A Comparison of the Process and Content of Sexual Communications Among African American Adolescent Children Living in Parent and Grandparent Headed Families.

INTRODUCTION: The process of parental sexual communication has been shown to delay the sexual debut of adolescents; however, few studies have focused on extended family members such as grandparents. The purpose of this study was to compare the process and content of sexual communications among African-American adolescent children living in parent or grandparent headed families. METHODS: A secondary analysis of two de-identified datasets from 80 African-American adolescents was conducted. RESULTS: Findings indicated that there were no significant differences in the sexual communication process in relation to facilitators p= 0.38 and barriers p =0.23 with the discussions. There were however significant differences with adolescents' attitudes (p = 0.04) and feelings regarding sexual abstinence (p =0.01), HIV prevention (p= 0.002) and teen pregnancy (p= 0.010). DISCUSSION: Researchers can use the results of this study as a beginning point in examining the sexual communication process in grandparent-headed families.

Mobile phone, social media usage, and perceptions of delivering a social media safer sex intervention for adolescents: results from two countries.

Purpose: Rates of sexually transmitted infections among adolescents remain high in the United States and Botswana. Mobile phone density rates in Botswana exceed those of the United States. Yet, in both countries, safer sex information continues to be delivered primarily via face-to-face curricula such as Becoming a Responsible Teen and Living as a Safe Teen. While social media shows promise as a medium for delivering risk-reduction information to youth, few studies have been conducted in either country to assess its effectiveness. This study examines adolescents in both countries, their mobile phone and social media usage, and their perceptions of safer sex interventions delivered via social media. Design and methods: Three focus groups were conducted with 28 adolescents 13-18 years of age who lived in the United States (n=14) and Botswana (n=14). Data analysis was ongoing, which informed the data collection process. After the first group, no additional revisions were made to the focus group protocol. An abridged method of analyzing the data was employed. Results: Adolescents in all groups discussed peer pressure and connectedness with mobile phones and social media and had general knowledge of STIs and HIV. The adolescents agreed that adaptation of risk reduction interventions for mobile phone and social media delivery was warranted, and they shared ideas for adaptation. Practice implications: Our findings provide a starting point for researchers interested in developing a social media intervention with global implications for sexual health promotion.

Self-care management strategies used by Black women who self-report consistent adherence to antihypertensive medication.

BACKGROUND: Black women in the USA have the highest prevalence rate of hypertension (HTN) contributing to a higher risk of organ damage and death. Research has focused primarily on poorly controlled HTN, negative belief systems, and nonadherence factors that hinder blood pressure control. No known research studies underscore predominantly Black women who report consistent adherence to their antihypertensive medication-taking. The purpose of this study was to describe self-care management strategies used by Black women who self-report consistent adherence to their antihypertensive medication and to determine the existence of further participation in lifestyle modifications, such as eating a healthy diet and increasing physical activity. METHODS: Using a qualitative descriptive design, four focus groups with a total of 20 Black women aged 25-71 years were audio-taped. Transcripts were analyzed using qualitative content analysis. Participants were included in the study if they scored perfect adherence on the medication subscale of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. RESULTS: Medication adherence was predicated on three themes: HTN experience, involvement with treatment regimen, and a strong motivated mentality. Black women would benefit from treatment approaches that are sensitive to 1) diverse emotional responses, knowledge levels, and life experiences; 2) two-way communication and trusting, collaborative relationships with active involvement in the treatment regimen; 3) lifestyle modifications that focus on health benefits and individual preferences; and 4) spiritual/religious influences on adherence. CONCLUSION: The use of self-care management strategies to enhance antihypertensive medication adherence is key to adequate blood pressure control and the reduction of cardiovascular events. This study provides preliminary insight for future research to develop interventions to aid those Black women who struggle with medication adherence and are disproportionately impacted by HTN.

Examination of Lesbian, Gay, Bisexual, and Transgender Health Care Content in North Carolina Schools of Nursing.

BACKGROUND: Nursing students require academic and clinical training in preparation for the increased demand for culturally competent care. One group that is in need of culturally knowledgeable health care providers is lesbian, gay, bisexual, and transgender (LGBT) individuals. The purpose of this study was to examine how LGBT health care content is integrated into North Carolina schools of nursing curricula and to examine the existence of specific LGBT policies. METHOD: A survey was mailed to 70 deans and directors of RN programs in North Carolina. RESULTS: Over 90% of the schools indicated that LGBT health care issues were taught in the curricula. The majority of the content was taught as an "other" course (37%). More than two thirds of the schools devoted less than 5 hours teaching LGBT content. CONCLUSION: LGBT health care content is being taught, yet the presence of specific LGBT practice policies is basically nonexistent. [J Nurs Educ. 2017;56(4):223-226.].

African American Transgender Women's Individual, Family, and Organizational Relationships: Implications for Nurses.

Guided by the relational cultural theory, we conducted a qualitative study to examine the relationship experiences of African American transgender women living in North Carolina. A convenience sample of 15 transgender women participated in the study. Semi-structured interviews, guided by an investigator-developed interview guide, were used to explore the personal experiences of transgender women on individual, family, and organizational levels. The findings provide a scheme for understanding the process through which transgender women's relationships hinder or enhance their ability to connect with individuals, family, and organizations. Nurses can use these findings to better understand the connectedness that occurs or does not occur in transgender women's relationships and provide culturally competent care to empower them to become resilient.

Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic.

OBJECTIVES: The purpose was to pilot the feasibility and impact of a 4-week transition-to-care program on quality of life for heart failure patients. BACKGROUND: The transition from the acute care to the outpatient setting has been shown to be a critical time with heart failure patients. METHODS: A pre- and post-test design was used. Quality of Life, measured by the Minnesota Living with Heart Failure Questionnaire, and hospital readmissions were the outcomes. A convenience sample of 50 persons was recruited into a multidisciplinary transition-to-care program for heart failure patients following hospitalization. Thirty-six (72%) completed the study. RESULTS: There was a significant improvement in quality of life. Men reported greater improvement in physical symptoms and less emotional distress when compared to women. Only 2 participants were readmitted within 30 days. CONCLUSIONS: Study findings support improved quality of life and decreased readmission rates following a multidisciplinary transition-to care program for heart failure patients.

Using mobile technology to promote safe sex and sexual health in adolescents: current practices and future recommendations.

Youth and young adults (19-24 years of age) shoulder the burden of sexually transmitted infections accounting for nearly half of all new infections annually. Mobile technology is one way that we have reached this population with safer sex information but challenges exist with the delivery process. The literature between 2010 and 2015 was reviewed for data on safe sex and sexual health information delivered using mobile cell phone devices. A search for relevant databases revealed that 17 articles met our inclusion criteria. Findings suggest that mobile cell phone interventions are an effective mode for delivering safe sex and sexual health information to youth; those at the highest risk may not be able to access cell phones based on availability and cost of the text messages or data plans.

Generational differences in the sexual communication process of African American grandparent and parent caregivers of adolescents.

PURPOSE: This study assessed generational differences in the sexual communication process between 40 African American parent and 40 grandparent caregivers of adolescent children. DESIGN AND METHODS: The study reports findings from a secondary analysis of data from two databases. The HIV Risk Reduction Survey was used to examine the sexual communication process. RESULTS: Grandparents wanted to talk about sex and had open sexual communications, while parents valued sexual abstinence and had limited communications. PRACTICE IMPLICATIONS: Based on the findings, healthcare providers and programs need to recognize that differences do exist between parents and grandparents with sexual communications.

Text-messaging-enhanced HIV intervention for African American adolescents: a feasibility study.

We examined the feasibility and acceptability of an HIV prevention intervention for African American adolescents delivered via mobile cell phones and looked at intervention-related changes in beliefs and sexual behaviors. We used a longitudinal one-group comparison design with data collected at three points. Forty adolescents, 13-18 years old, participated in the Becoming a Responsible Teen intervention followed by the delivery of daily multimedia messages for 3 months. The mobile-cell-phone enhanced intervention was feasible and acceptable to the participants. Greater HIV knowledge, improved attitudes toward condoms, and increased perceived HIV risk scores were observed with older adolescents (16-18 years old). Behavior trends showed a decrease in the number of times participants reported engaging in unprotected sexual intercourse over the previous 2 months. Mobile-cell-phone multimedia-text-messaging boosters tested in this study provided preliminary evidence of efficacy of the enhanced HIV prevention intervention for African American youth.

Adolescents' perceptions of a mobile cell phone text messaging-enhanced intervention and development of a mobile cell phone-based HIV prevention intervention.

PURPOSE: This study examined African American adolescents' perceptions of a mobile cell phone (MCP)-enhanced intervention and development of an MCP-based HIV prevention intervention. DESIGN AND METHODS: One focus group was conducted with 11 adolescents who participated in the Becoming a Responsible Teen Text Messaging project. RESULTS: Adolescents said they benefited from the MCP-enhanced approach and were receptive to the idea of developing an MCP-based intervention. PRACTICE IMPLICATIONS: Nurses can use the findings of this report as a starting point in examining the development of MCP-based sexuality education with parents and adolescents.

Receptivity of African American adolescents to an HIV-prevention curriculum enhanced by text messaging.

PURPOSE: This study assessed African American adolescents' receptivity to an HIV-prevention curriculum enhanced by text messaging. DESIGN AND METHODS: Two focus groups were conducted with 14 African American adolescents regarding how an HIV-prevention curriculum could be enhanced for text messaging delivery. RESULTS: The adolescents were receptive to the idea of text messaging HIV-prevention information but wanted to receive a maximum of three messages per day during the hours of 4:00-6:00 p.m. PRACTICE IMPLICATIONS: By taking the findings of this study, nurses, other healthcare providers, and community-based organizations can adapt evidence-based interventions for text messaging delivery to individuals at high risk for HIV infection.

African American grandfamilies' attitudes and feelings about sexual communication: focus group results.

Little attention has been given to the responsibilities that African American grandparent caregivers face when they assume the role of raising their grandchildren. One particularly challenging task of grandparent caregivers is communicating with their grandchildren about sexuality issues. This study therefore examined the sexual communications and attitudes and feelings toward these communications between African American grandparent caregivers and their adolescent grandchildren (11-13 years of age). Focus group methodology was used to generate data about the grandparent/grandchild sexuality communication process and attitudes and feelings toward that process. The sample included 40 dyads of African American grandparents/grandchildren, for a total of 80 participants. Grandparents as well as their adolescent grandchildren desired open communication about sexuality issues, said that societal pressure makes sexual encounters hard to resist, and felt that they needed assistance with the sexuality communication process. Nurses can build upon the study's results to assist African American grandparents and their adolescent grandchildren with sexual communication.

Adaptation of an HIV prevention curriculum for use with older African American women.

Although African American women over 50 years of age represent the fastest growing group with HIV infection, little attention has been given to their HIV risk reduction needs. This study adapted an HIV risk reduction curriculum for use with older African American women based on input from a sample of women from the target population. Four focus group interviews were conducted with 30 African American women from three churches regarding adaptation of the Sisters Informing Sisters on Topics about AIDS (SISTA) curriculum for older women and the feasibility of implementing the curriculum in a church setting. From these focus group interviews, the authors identified modifications that could be used to adapt the curriculum for older women. After examination of the curriculum, the women expressed increased knowledge of HIV, a sense of bonding with other participants, and willingness to use churches as venues for HIV prevention. Nurses can build upon the study's recommendations to ensure successful implementation of church-based sexuality programs for individuals of all ages.