Assessment of Screening, Brief Intervention, and Referral to Treatment Training to Interprofessional Health-Care Students.

Substance abuse and addiction are responsible for an assortment of health and financial concerns in the United States. Tools to identify and assist at-risk persons before they develop a substance use disorder are necessary. Screening, brief intervention, and referral to treatment (SBIRT) can be utilized by health-care professionals to identify those at risk to minimize health-related complications and the potential of developing a substance use disorder. The primary objective of this study was to provide educational training sessions on SBIRT to health-care students utilizing interprofessional education activities and assess perceptions of the training sessions and activities with regard to confidence to utilize SBIRT in at-risk patients and overall student satisfaction with SBIRT instruction. The research protocol enrolled students of pharmacy, nursing, medicine, behavioral health, and physician assistant studies who received interprofessional SBIRT training. Students completed an anonymous posttraining online survey, measuring student perceptions of knowledge gained and confidence to utilize training. A total of 303 students completed the SBIRT training. Approximately 70% of students were satisfied with the training materials, instruction, quality, and experience. After training, 78% were confident that they could perform screening for substance abuse, conduct a brief intervention (80%), and when to refer to treatment (71%). A total 73% of students reported that the asynchronous online-based activity was extremely effective in increasing knowledge of the roles and responsibilities of other disciplines and providing opportunities to interact with students from other health professions. Interprofessional education-trained students from multiple health-care disciplines feel comfortable performing SBIRT to identify persons at risk for substance misuse in practice.

Improving the Quality of Nasal Specimen Collection for Influenza A and B Screening.

CONTRIBUTION TO EMERGENCY NURSING PRACTICE: PROBLEM: Rapid diagnosis of seasonal influenza leads to optimized clinical care and reduces the spread of infection. The collection of adequate cellular material can be facilitated by the presence of moisture in the nares. The specific aim of this project was to determine if the installation of sterile saline into the nares prior to specimen collection would improve the quality of the specimen. METHODS: This quasi-experimental single group design tested an initial "dry swab" specimen against a second swab after instillation of sterile saline solution using a nasal atomizer, a "wet swab." RESULTS: A total of 80 paired specimens were collected and analyzed between December 7, 2015, and April 21, 2016, with an 11.25% infection rate in those tested. Of 9 positive tests, 6 subjects tested positive for influenza A or B for both the dry swab and the wet swab. Three subjects tested positive for influenza A or B for only the wet swab, and these subjects had experienced their symptoms longer than did subjects who tested positive for both methods (mean symptom onset of 72 hours vs 66 hours). We found an important inconsistency between manufacturers' recommendations and typical hospital practice. IMPLICATIONS FOR PRACTICE: The results appear somewhat equivocal. Because viral shedding declines after the first 48 to 72 hours in adults, the wet swab method may be clinically superior for detecting influenza in adults presenting later in the course of their illness. Hospital policy was revised for consistency in using the gel medium before sampling in accordance with manufacturer recommendations.

Early initiation of tobacco use in adolescent girls: key sociostructural influences.

BACKGROUND: An important developmental task during adolescence is ego development. Millions of adolescents choose to initiate cigarette smoking at a young age as a result of transitional conflicts during this phase of normal developmental progression. Unfortunately, the decision to use tobacco compromises both the short- and long-term health status of smokers as well as the health of those around them. OBJECTIVE: It was hypothesized that in early adolescence, girls choose to begin smoking cigarettes as a result of sociostructural influences, including media, peers, and family. The purpose of this study was to investigate what modifiable sociostructural variables will decrease the risk of initiating cigarette smoking before the age of 12 years among adolescent girls. The aim of the study was to develop a risk reduction model that increases the likelihood of healthy behavior choices in girls during early adolescence. METHOD: Data collected for the New Hampshire Teen Assessment Project survey were used for this secondary data analysis. The original study included a multicommunity sample of 7,648 students from eight school districts enrolled in New Hampshire schools between January 2000 and October 2001. This current analysis focused only on the health behavior of the adolescent girls enrolled in the larger study (n = 3,775). With the use of a socioecological theoretical framework as a guide, this secondary data analysis first identified correlates of the early initiation of tobacco use using Pearson's correlations. Then, the data were explored for variables that decreased the relative risk for the early initiation of cigarette smoking among adolescent girls. The dependent variable of interest (i.e., early initiation of tobacco use) referred to girls who reported having smoked their first cigarette at or before the age of 12 years. Twenty-eight percent of the sample had initiated tobacco use before they were 12 years old. Multiple logistic regression was used to predict the final risk reduction model. RESULTS: The first level of analysis confirmed previously reported evidence that there is a correlation between adolescent girls' initiation of smoking early (n = 1,047) and their engagement in other health risk behaviors such as daily use of alcohol (n = 859), daily use of marijuana (93%), and engaging in unprotected intercourse (15%). Next, logistic regression was used to predict a risk reduction model that demonstrated the importance of community, family, and school variables in decreasing the relative risk for the early initiation of tobacco use. Those sociostructural variables that decrease the relative risk for the initiation of tobacco use were noted in the following: (1) 71% of the girls who feel that it is important to contribute to their community (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.31-2.23) are less likely to initiate tobacco use and (2) 54% of the girls are more likely to feel that their community is a good place to live in (OR = 1.54, 95% CI = 1.20-1.97), are more than twice as likely to have parents who think smoking is wrong (OR = 2.09, 95% CI = 1.77-2.48), are 9% more likely to have parents whom they can talk to when they have personal problems (OR = 1.09, 95% CI = 1.02-1.17), and are 38% more likely to enjoy school. DISCUSSION: The findings of this study may be an important portal for prevention intervention in the area of early adolescent tobacco use. A risk reduction model is presented based on the theory that both the environment and modeling play an important role in the development of health behavior.

Understanding school-age obesity: through participatory action research.

PURPOSE: This study aimed to assess current levels of overweight (obesity) and fitness among school students using objective data. METHODS: School-based action research teams were recruited statewide by the New Hampshire Healthy Schools Coalition, the state team of the National Action for Healthy Kids Coalition. Action teams consisted of a physical education teacher, a school nurse, and a school administrator. Data were collected from 6,511 student participants aged 6 to 14 years, which was a representative cross-section from New Hampshire school districts. Key variables of interest in the study were body mass index, and ability to pass five fitness tests using FITNESSGRAM. Pearson's correlation was used to assess the relationships among body mass index, age, gender, and the percent of students that passed FITNESSGRAM tests. RESULTS: The ability of participants to pass the FITNESSGRAM tests declined markedly with age and differed between boys and girls, although the healthy fitness zones for any particular test was lower for girls. Body mass index was significantly negatively correlated with performance on all tests. Age was also statistically negatively correlated with performance on all tests; the relationship between gender and performance on the tests was less striking. CLINICAL IMPLICATIONS: Results reflected an increase in the prevalence of overweight school children, even in New Hampshire, which is purported to be one of the healthiest states in the nation. Results offered evidence that body mass index is a valid proxy measure for fitness levels and that fitness programs are necessary to effectively combat the obesity epidemic. Evidence-based changes need to be implemented to address obesity-related factors in schools, because children spend many of their waking hours in that setting. Physical activity during recess and physical education classes could help to increase energy expenditure and develop sound minds and bodies. Schools should consider the development of school-based wellness teams to advise and advocate improved school-based wellness policies. School nurses can take an active part in these initiatives.

The lived experiences of adolescent girls' relationship with tobacco.

PURPOSE: Despite increased efforts to educate youth about the dangers of cigarette smoking, the percentage of teenagers who smoke continues to rise. This study was designed to explore the lived experiences of 14 adolescent girls who enrolled in a tobacco cessation program. DESIGN: Phenomenology. METHODS: The experiences of fourteen adolescent girls were studied over a 10-week period while they were enrolled in a school-based tobacco cessation program. A combination of interviews, group discussions, and journaling were used to describe the experiences of these girls with tobacco use. Three common themes and two subthemes emerged that were supported by data. RESULTS: Tobacco use in the lives of these girls changed over time. The importance of listening to their stories and giving meaning to the behavior is clear. Nurses must continue to explore these methods as they support clients in tobacco cessation programs. While none of the girls in this study quit smoking, the need for nursing interventions to support tobacco users by understanding their physical and emotional relationship with tobacco is important for future success.

Guns and dolls: an exploration of violent behavior in girls.

As demonstrated by several studies, there is an increase in levels of female violence. This study attempts to more fully understand the increasing phenomenon of violence in girls by exploring motivations to engage in violent behavior. The hypothesis that a girl's perceived sense of competence is influenced by social and environmental variables that motivate her to engage in violent behavior is tested. Research studies of female adolescent violence have focused on the study of risk factors predisposing the individual to violent behavior. This study uses a health behavior framework (C.L. Cox, Advances in Nursing Science, October 1982, 41-56) to explore the links between perceived sense of competence and both the risk and protective factors that motivate girls to act violently.

The marginalization of chronically ill adolescents.

Chronic illness during adolescence adds a dimension to a developmental stage that already has the potential to be tumultuous. Consequences of marginalization that predispose well adolescents to risk behaviors such as low self-worth and feelings of isolation are compounded in the chronically ill. In the author's proposed model, it is essential that nurses promote strategies that empower chronically ill adolescents. Care should be community-based and have an integrated multidisciplinary approach involving nursing, medicine, allied health care providers, and, (very importantly) the social networks of the adolescent [38,39]. For optimal health outcomes, we must begin to empower the chronically ill to meet their developmental need both within their social and medical contexts.