Evaluation of a Nurse-Initiated Routine HIV Testing Pilot on a Medical-Surgical Unit.

National guidelines recommending a shift from risk-based to routine HIV testing for persons ages 13-64 are described. The role of nurses, particularly medical-surgical nurses, in increasing the number of people screened is discussed.

Assessment of the public's knowledge of venous thromboembolism.

Venous thromboembolism (VTE) is a major public health problem impacting 600,000 people and causing 100,000 deaths annually. Nurses are in a unique position in all health care settings to educate patients and the public to prevent and provide early detection for this devastating complication. A dearth of information exists regarding the knowledge level of those affected. This manuscript presents a study that investigates and quantifies the general public's knowledge level of VTE through a 13-question survey of 325 participants. The results indicate that >70% of the general, nonmedical participants involved in the survey were not familiar with VTE. The findings suggest the need for nurses to consistently and systematically educate patients and the public about VTE to decrease morbidity and mortality.

Roles and strategies of diabetes support group facilitators: an exploratory study.

PURPOSE: The purpose of the study was to explore the roles and strategies implemented by diabetes support group facilitators. METHODS: A descriptive exploratory design that included 2 in-depth interviews and 1 group interview of 6 diabetes support group facilitators was implemented over a 2-month period. RESULTS: The participants described the role of facilitator as involving 4 major aspects: (1) a philosophy of shared authority and group ownership; (2) a conception of diabetes as a highly complex disease interconnected with all aspects of one's life; (3) a focus on quality of life; and (4) recognition of perfectionism as neither possible nor desirable in self-management. These role aspects formed the context for facilitator strategies in working with support groups. Four strategies were identified based on the individual and group interviews: (1) connecting, (2) exchanging information, (3) managing group dynamics, and (4) promoting problem solving. A facilitator support group model was developed from the study results. CONCLUSIONS: A clear need exists to develop and teach best practices for support group facilitation. Education in this area should occur systematically at the baccalaureate and master's levels as the role of health providers increasingly expands to include populations living with chronic diseases. Health care providers who are functioning in this role need continuing education to provide proficient care in this area of practice.

Implementation of routine HIV testing in an acute care hospital in Rhode Island: a nurse-initiated opt-out pilot project.

The Centers for Disease Control and Prevention (CDC) expanded HIV screening of adults ages 13-64 years in 2006 from risk based to routine. Early detection and treatment improve patient outcomes and prevent disease transmission. This article describes a pilot program in which nurses in an adult inpatient unit at an acute care hospital offer HIV testing to all patients ages 18-64 upon admission through standing orders. The pilot, Standing Orders for Routine Testing (SORT), is a response to changes in state law and regulations in the majority of states including Rhode Island, which have occurred following the CDC policy change. The SORT pilot involves collaboration with interdisciplinary partners and education of unit nurses.

Political astuteness of baccalaureate nursing students following an active learning experience in health policy.

OBJECTIVES: To describe changes in political astuteness after baccalaureate nursing student participation in a series of public policy learning activities. DESIGN AND SAMPLE: This one-group pretest/posttest design included 300 undergraduate nursing students enrolled in the public/community health nursing course. Data collection occurred each semester beginning spring 2008 and ending summer 2011. MEASURES: The Political Astuteness Inventory (PAI) was used to compare levels of political astuteness and to identify conceptual factors contributing to political involvement prior to and at the completion of the public policy learning activities. INTERVENTION: The public policy learning activities were a central clinical component of the senior level public/community health nursing course. These activities included information sessions at the State Department of Health and State House, a legislative assignment, and a public policy group project. RESULTS: After participating in the public policy learning activities, students' political astuteness mean scores significantly increased (p = .000). Participation in professional organizations and knowledge of the legislative and policy processes significantly predicted posttest political involvement (p = .000). CONCLUSION: The PAI was a useful outcome measure for the public policy activities. Active learning experiences in public policy can increase the knowledge and skills that future nurses need to influence public policy.

Recognition and management of hypertension by nurses: action in patients with diabetes is critical.

The Canadian Hypertension Education Program (CHEP), Canadian Hypertension Society, Blood Pressure Canada, Canadian Diabetes Association, College of Family Physicians of Canada, Canadian Pharmacists Association, Heart and Stroke Foundation of Canada, and the Canadian Council of Cardiovascular Nurses issued a recent call for all health care professionals in Canada to double their efforts to assist patients with diabetes in maintaining target blood pressures (Campbell et al., 2009b). Blood pressure (B/P) in diabetic individuals should be less than 130 mmHg systolic and less than 80 mmHg diastolic (CHEP 2009). Considering recognition and treatment of hypertension in people with diabetes can result in reductions in disability and death, control of hypertension must become an interdisciplinary priority. Maintaining B/P less than 130/80 mmHg requires lifestyle modification as the cornerstone to treatment and often two or more B/P medications (Campbell et al., 2009a). The cost of multiple drugs required for B/P control in diabetic individuals is one of the few treatments estimated to reduce overall health costs and related cardiovascular disease complications (Gillies, Abrams, & Lambert, 2007). Nurses are essential partners in assessing and assisting diabetic patients and all patients with hypertension to reduce overall cardiovascular risks. Nurses may also be key practitioners in assessing and monitoring patient difficulties with adherence to lifestyle or pharmacological interventions (Jayasinghe, 2009; McLean et al., 2008). Individualized lifestyle counselling and treatment modification are recommended to maintain target B/P and treat dysglycemia, dyslipidemia, smoking or any other cardiovascular risks in diabetic individuals.

2007 Hypertension Education Program (CHEP) recommendations: management of hypertension by nurses.

Recent data from the World Health Organization (WHO) indicate that nearly one billion people in the world are suffering from hypertension. Forecasts suggest that, with the aging of the population, this number could reach 1.5 billion by 2025 (Kearney, Whelton, & Reynolds, 2005). In developed countries, more than one in five adults have hypertension (Vasan, Beiser, Seshadri, Larson, Kannel, & D'Agostino, 2002). Statistics for Canada reveal that fewer than 15% of those diagnosed with hypertension are adequately controlled (Joffres, Hamet, MacLean, L'italien, & Fodor, 2001). Part of the effort to improve hypertension detection, assessment and treatment is an annual process to produce and update evidence-based recommendations for the management of hypertension and to implement the recommendations (Zarnke, Campbell, McAlister, & Levine, 2000; Campbell, Nagpal, & Drouin, 2001). The most up-to-date 2007 Canadian recommendations for the assessment and management of hypertension are presented. Contemporary nursing practice requires that nurses take responsibility and a role in the primary prevention, detection and treatment of hypertension.

What is the experience of men and women with congestive heart failure?

Congestive heart failure (CHF) is increasing in incidence and prevalence in both men and women in Canada. Research findings to date have been inconsistent with respect to whether gender differences influence quality of life, treatment and survival. There is a paucity of qualitative research describing the experience of patients with CHF This qualitative case study approach used semistructured interviews with women and men with New York Heart Association (NYHA) class three or four CHF who were referred to a CHF clinic. In addition to quality of life measures, data related to medical history, medical management and NYHA scores were collected to offer a thorough description of these clients' experiences. Three hypotheses were generated from 13 themes that emerged. First, the psychosocial impact of CHF outweighs the physical impact. Second, sex differences exist in relation to living with CHF with men being more accepting of CHF and more likely to experience social isolation and loss than women, while women are more likely to describe fear. Third, the experience of CHF is influenced by age with physical experiences and depression mentioned more frequently in younger age groups. Findings from this study have generated nursing implications and recommendations for further research.

An active learning experience in health policy for baccalaureate nursing students.

Nurses have the potential to promote the public's health through active involvement in shaping health and social policy. Preparing nursing students to influence public policy is a major component of the curriculum in public/community health nursing. A series of learning experiences was designed to engage students in this process. First, students participate in information sessions at the State Health Department and the State House. This provides them with opportunities to engage in dialogue with public health leaders as well as advocates from both professional organizations and community groups. Next, students identify the legislators who represent them in the community and write a narrative that describes the legislators' interest and commitment to health-related legislation. Lastly, students work in clinical groups to analyze a public health problem that can be addressed through public policy interventions. This has led to the students testifying at legislative hearings and working with community groups involved with the issue. The students present their findings to their peers and to the wider college community. Through these learning experiences, students gain practical experience in understanding the political process that leads to important policy change. This in turn prepares them for their roles as professional nurses and involved citizens.