Do We Make a Difference? The Effect of a Doctor of Physical Therapy Program Curriculum on Student Cultural Competence.

INTRODUCTION: Doctor of Physical Therapy (DPT) education programs have been charged with developing a culturally competent health care workforce to better meet the needs of diverse communities and reduce health inequities. The purpose of this longitudinal, quasi-experimental educational intervention study was to examine the effects of an integrated DPT program curriculum on student cultural competence at a public, midsize, midwestern university. REVIEW OF LITERATURE: There is an abundance of research on conceptual models and frameworks for the development of cultural competence within health care education with many studies relying on self-perception to measure outcomes. Using the Model of Interculturalization as a theoretical framework, this study explored the development of cultural competence among DPT students using the Intercultural Development Inventory (IDI). SUBJECTS: A purposeful convenience sample of DPT students ( n = 177) was used. METHODS: The IDI was administered to 3 student cohorts. One cohort had data at 4 different time points, including upon entry into the program (baseline) and at the end of the first, second, and third year. Two cohorts had data for 2 time points. IDI Developmental Orientation (DO) and Orientation Gap (OG) scores were used to measure cultural competence and accuracy of self-perception of cultural competence. Data analysis was performed using descriptive statistics, independent and dependent sample t -tests, and analysis of variances. RESULTS: There were no differences between the cohorts. There were statistically significant improvements in both cultural competence (DO scores) and accuracy of self-perception of cultural competence (OG scores) for 2 cohorts. However, significant change only occurred during year 1. No other differences across time for any of the cohorts were significant. DISCUSSION AND CONCLUSION: Findings can be leveraged and incorporated into recommendations for curricular revision and program reform targeting cultural competence development among DPT students.

A review of the risks and relationships between oral health and chronic diseases.

Advances in medical science and in preventive dentistry have changed the context of oral health. The American population is living longer with numerous complex chronic diseases. This paper is to raise awareness about the impact of multiple chronic diseases and their associations with oral diseases. Comorbidities can worsen the course of dental treatment. Inflammation has been the connecting factor in the bidirectional pattern of oral and systemic diseases. High occurrences of chronic diseases generally occur in aging as well as disadvantaged populations. Serious infections, slow healing, prolonged bleeding, and hospitalizations can escalate in patients with uncontrolled chronic diseases. A multidisciplinary team-based approach to patient management can minimize complications and unexpected challenges.

Sickle cell disease: Contributing factors and radiological assessments.

Sickle Cell Disease (SCD) is genetically described as an autosomal blood disorder resulting from the presence of a mutated form of hemoglobin. Morbidity, frequency of crisis, degree of anemia, and organ systems involved vary considerably per patient. Dental health professionals and other specialists commonly request comprehensive medical consultations prior to performing complex periodontal, endodontic, and surgical procedures. In order to have successful dental outcomes and minimize posttreatment dental complications, relevant disease indicators are noted. This review is to raise awareness of the impact of oral diseases in patients with sickle cell disease and to emphasize the importance of full medical disclosure, radiographic interpretation, and a well-documented medical history, and a well-written consultation which can guide treatment planning and greatly improve the course of dental treatment.

Exploring nurses' perceptions of nurse managers' communicative relationships that encourage nurses' decisions to buy-in to initiatives that enhance patients' experiences with care.

AIM: To explore nurses' perceptions of nurse managers' (NMs') communicative relationships that encourage nurses' decisions to buy-in to organisational initiatives to enhance patients' experiences with care (PEC). BACKGROUND: The role of the nurse to patient experience is well established, yet little is known about how the communicative relationship between manager and nurse relates to nurse buy-in to PEC initiatives. METHOD: An exploratory qualitative descriptive study was conducted with 15 nurses from two inpatient medical-surgical units in a large acute care hospital using semi-structured interviews. RESULTS: Three themes were identified. The communicative relationship was developed and strengthened through the manager's: (a) multimodal approach to communicating and influencing, (b) engaging and supporting staff and (c) promoting staff-led decision-making. CONCLUSIONS: Nurses in our study who reported having a strong communicative relationship with their NM perceived that this relationship encouraged their buy-in and engagement in PEC initiatives. IMPLICATIONS FOR NURSING MANAGEMENT: An assessment of the communication between the frontline NM and his or her team is important for understanding why initiatives to support PEC are or are not yielding desired results.

Leading Change: A Case Study of the First Independent Critical-Access Hospital to Achieve Magnet® Designation.

OBJECTIVE: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®. BACKGROUND: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources. METHODS: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed. RESULTS: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged. CONCLUSIONS: The journey to Magnet leads to improved nurse, patient, and organization outcomes.

Leading change: a concept analysis.

AIM: To report an analysis of the concept of leading change. BACKGROUND: Nurses have been called to lead change to advance the health of individuals, populations, and systems. Conceptual clarity about leading change in the context of nursing and healthcare systems provides an empirical direction for future research and theory development that can advance the science of leadership studies in nursing. DESIGN: Concept analysis. DATA SOURCES: CINAHL, PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, Health Business Elite and Business Source Premier databases were searched using the terms: leading change, transformation, reform, leadership and change. Literature published in English from 2001 - 2015 in the fields of nursing, medicine, organizational studies, business, education, psychology or sociology were included. METHODS: Walker and Avant's method was used to identify descriptions, antecedents, consequences and empirical referents of the concept. Model, related and contrary cases were developed. RESULTS: Five defining attributes of leading change were identified: (a) individual and collective leadership; (b) operational support; (c) fostering relationships; (d) organizational learning; and (e) balance. Antecedents were external or internal driving forces and organizational readiness. The consequences of leading change included improved organizational performance and outcomes and new organizational culture and values. CONCLUSION: A theoretical definition and conceptual model of leading change were developed. Future studies that use and test the model may contribute to the refinement of a middle-range theory to advance nursing leadership research and education. From this, empirically derived interventions that prepare and enable nurses to lead change to advance health may be realized.

Exploring leadership roles, goals, and barriers among Kansas registered nurses: a descriptive cross-sectional study.

OBJECTIVES: The Institute of Medicine's Future of Nursing report advocates for full nurse leader representation across multiple settings to address current challenges in our health care system. The purpose of this study was to examine nursing leadership development needs among Kansas registered nurses (RNs). METHODS: Data were collected through an online survey and analyzed using quantitative and qualitative methods. RESULTS: Nearly 1,000 Kansas RNs participated. Most reported holding one or more leadership positions. Prevalent leadership goals were health care organization volunteer administrative roles. The most frequently identified barrier to developing leadership roles was time constraints. Many wanted to develop skills to serve on a board, 20% were interested in personal leadership development, and 19% in policy development. CONCLUSIONS: Based on the findings, the Kansas Action Coalition leadership team is developing programs to address the leadership needs of Kansas RNs. By building capacity in advanced leadership roles, RNs will be better prepared serve as full partners and lead efforts to promote the health of Kansans.

Effect of continuing education: do attendees implement the tools that are taught?

BACKGROUND: Educators are being challenged to show how participants implement in practice the objectives and outcomes of what they learn in professional development activities. Continuing education (CE) departments are being called on to document that the offerings are making a difference in practice. Participants described efforts to implement mindfulness processes after a CE workshop on managing the unexpected. METHODS: A mixed-methods approach was used. Qualitative and quantitative data were used to assess whether participants implemented mindfulness practices that they learned during a CE workshop. This pilot study used an e-mail survey and focused interviews. RESULTS: Participants self-assessed the use of practices taught at a CE workshop and identified barriers and aids to implementing practice change. Focused interviews elicited examples and provided more information about the barriers and facilitators of change that can assist with future program planning. CONCLUSION: CE can change practice in health care organizations. Additional research is needed to document best practices in CE to effect change in practice.

Mutation of HERC2 causes developmental delay with Angelman-like features.

BACKGROUND: Deregulation of the activity of the ubiquitin ligase E6AP (UBE3A) is well recognised to contribute to the development of Angelman syndrome (AS). The ubiquitin ligase HERC2, encoded by the HERC2 gene is thought to be a key regulator of E6AP. METHODS AND RESULTS: Using a combination of autozygosity mapping and linkage analysis, we studied an autosomal-recessive neurodevelopmental disorder with some phenotypic similarities to AS, found among the Old Order Amish. Our molecular investigation identified a mutation in HERC2 associated with the disease phenotype. We establish that the encoded mutant HERC2 protein has a reduced half-life compared with its wild-type counterpart, which is associated with a significant reduction in HERC2 levels in affected individuals. CONCLUSIONS: Our data implicate a model in which disruption of HERC2 function relates to a reduction in E6AP activity resulting in neurodevelopmental delay, suggesting a previously unrecognised role of HERC2 in the pathogenesis of AS.

Scheduled out-patient endoscopy and lack of compliance in a minority serving tertiary institution.

INTRODUCTION: Lack of adherence to appointments wastes resources and portends a poorer outcome for patients. The authors sought to determine whether the type of scheduled endoscopic procedures affect compliance. METHODS: The authors reviewed the final endoscopy schedule from January 2010 to August 2010 in an inner city teaching hospital that serves a predominantly African American population. The final schedule only includes patients who did not cancel, reschedule or notify the facility of their inability to adhere to their care plan up to 24 hours before their procedures. All patients had face to face consultation with gastroenterologists or surgeons before scheduling. The authors identified patients who did not show up for their procedures. They used Poisson regression models to calculate relative risks (RR) and 95% confidence intervals (CI). RESULTS: Of 2183 patients who were scheduled for outpatient endoscopy, 400 (18.3%) patients were scheduled for Esophago-gastro-duodenoscopy (EGD), 1,335 (61.2%) for colonoscopy and 448 (20.5%) for both EGD and colonoscopy. The rate of noncompliance was 17.5%, 22.8% and 22.1%, respectively. When compared with those scheduled for only EGD, patients scheduled for colonoscopy alone (RR = 1.47; 95% CI: 1.13-1.92) and patients scheduled for both EGD and colonoscopy (RR = 1.36; 95% CI: 1.01-1.84) were less likely to show up for their procedures. CONCLUSIONS: This study suggests a high rate of noncompliance with scheduled out-patient endoscopy, particularly for colonoscopy. Because this may be a contributing factor to colorectal cancer disparities, increased community outreach on colorectal cancer education is needed and may help to reduce noncompliance.

The number of lymph nodes examined debate in colon cancer: how much is enough?

BACKGROUND: Much debate exists over the significance of the number of lymph nodes (LN) examined after colon resection. MATERIALS AND METHODS: The Surveillance, Epidemiology and End Results (SEER) database was queried for patients who presented with colonic adenocarcinoma. Multiple Cox proportional hazard regressions were run using successive LN cut-offs (6-26), first controlling for and then stratifying by T-stage. This was repeated in subsets of patients delineated by LN status. Additional variables controlled for in every regression were age, gender, ethnicity, marital status, number of positive LN, grade, metastases, and extent of surgery. After each regression, a Harrell's C statistic and an Akaike's information criterion (AIC) were performed to test the predictive capacity and fit of the model, respectively. RESULTS: 128,071 patients met selection criteria. The highest Harrell's C statistics among all patients were the cutoffs at 14 LN and 15 LN. Between those, the AIC shows that the cutoff at 15 LN fit the data more closely than the 14 LN cutoff. The models with the best predictive ability and best fit by T-stage were T1, 14 LN; T2, 10 LN; T3, 10 LN; T4, 12 LN. CONCLUSIONS: Using a population-based dataset, we show the optimal number of LN examined is dependent upon the patient's tumor stage. Across all T-stages, the highest optimal number of LN resected was 15. Since it is possible to estimate but not perfectly predict the stage of a patient's tumor preoperatively, we believe the recommendation should be based on the most conservative measure.

Lost in translation: unfolding medical students' misconceptions of how to perform a clinical digital rectal examination.

BACKGROUND: Digital rectal examination (DRE) skills are difficult to teach and assess. This study sought to assess the construct validity of newly developed DRE simulators, which were then used to evaluate DRE palpation techniques and accuracy based on experience. METHODS: Medical students (n = 30), residents (n = 24), and experienced clinicians (n = 24) performed clinical DREs on the simulators and documented their findings. During the examinations, computer-generated quantitative performance data were collected. RESULTS: Students focused more on pronating and supinating their examining finger in the rectum. In addition, students were less accurate when assessing the prostate gland compared with experienced clinicians and residents (students = 33%, residents = 64%, and clinicians = 76%; P <.05. CONCLUSIONS: The DRE simulators were useful in defining specific differences in clinical DRE palpation techniques based on experience. We believe the observed differences are largely caused by students' misconceptions about how to perform the DRE.

Cognitive flexibility as a mediator of family communication environments and young adults' well-being.

In this study, cognitive flexibility was tested as a mediator of family communication environments (i.e., family expressiveness, structural traditionalism, and avoidance of conflict) and young adults' well-being (i.e., self-esteem, mental health, and physical health). Participants included 395 young adults from first-marriage and postdivorce families. Using structural equation modeling, the results revealed that family expressiveness positively predicted young adults' cognitive flexibility, whereas avoidance of conflict emerged as a negative predictor. Cognitive flexibility, in turn, fully mediated the influence of both expressiveness and avoidance of conflict on well-being. Although structural traditionalism did not predict cognitive flexibility, it did have a direct, inverse effect on young adults' well-being. Among the more important implications of this study is the finding that structural traditionalism and avoidance of conflict, 2 aspects of a conformity orientation in families, generate different effects (i.e., direct vs. indirect) on young adult's well-being.