Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department.

BACKGROUND: Emergency department (ED) health care workers experience high rates of workplace violence (WPV). LOCAL PROBLEM: Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits. METHODS: A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED. INTERVENTIONS: Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies. RESULTS: Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits. CONCLUSIONS: Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.

Daily motivational text messages impact on college students' nutritional awareness and physical activity levels.

Objective: To examine the effect of receiving daily motivational text messages on the change in college students' nutritional choices and levels of physical activity. Participants: Two hundred and one university students participated in an eight-week experimental/control group study. Methods: All participants received a brochure that contained nutritional and physical-activity information. The survey consisted of three parts: demographic information, health and diet, and physical activity. All participants completed a self-administered survey at the beginning and the end of the eight-week study. The experimental group participants received a daily motivational-text message. Results: There were significant interactions between group and time on most of the health and diet items, but there were no significant interactions on the physical activity items. Conclusions: It is crucial to monitor and promote college students' nutrition and physical activity behaviors. The study findings will be vital in designing interventions that enhance college students' general health.

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting.

BACKGROUND: Quality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support. METHODS: An advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening. CancerSupportSource (CSS), a validated web-based distress screening program developed by Cancer Support Community for use in community cancer settings, was employed to screen for distress, identify potential resources, and improve in-house and community referrals. For purposes of this quality improvement project, CSS was administered in interview format by staff. The Plan-Do-Study-Act (PDSA) quality improvement approach was used to implement CSS. RESULTS: To implement the practice of distress screening, 21 patient participants were initially screened and evaluated for distress, including risk for clinically significant levels of depression, using CSS. The tool identified participant concerns and flagged thirteen persons as at risk for depression. After implementation and evaluation of distress screening using PDSA, in a year, 51 participants were screened. Participants stated that distress screening allowed for discussion of intimate questions that may not have otherwise occurred in an intake interview. CONCLUSION: It was demonstrated that CSS identified psychosocial and practical needs, facilitating the referral process and identification of community resources. Application of the PDSA model was an effective quality improvement model that can be used for the implementation and sustainability of distress screening across settings.

Factors Affecting Health-Promoting Lifestyle Behaviors Among Arab American Women.

Introduction: An estimated 3.6 million Arab Americans live in the United States. Limited studies have addressed Arab American women's health needs. The purpose of this study was to explore the relationships between personal factors (sociodemographic factors, degree of acculturation, psychological stress), health self-efficacy, social support, and health-promoting lifestyle behaviors among Arab American women in California. Method: A cross-sectional, correlational survey study involved 267 women. The survey assessed women's personal factors, health self-efficacy, social support, and health promotion behaviors. Results: Age, education, orientation to American culture, psychological stress, health self-efficacy, and social support were strongly correlated with health promotion behaviors and explained 46% of its variance among participants, F(18, 248) = 10.657, p = .000, R2 = .46. Discussion: Participants scored low on both the physical activity and stress management of the health promotion subscales. Culturally sensitive interventions are needed to improve engagement in health promotion behaviors among these women.

Health implications of sex trading characteristics in Long Beach, California, USA.

This study examined the comparative health risk behaviors of women who (a) traded sex for money, (b) traded sex for drugs, (c) traded sex for both drugs and money, or (d) did not trade sex. Self-report data were collected from 2369 women who received services through HIV and sexually transmitted infection (STI) testing programs and a subset were tested for HIV, hepatitis B, hepatitis C, and syphilis. Results revealed those women who traded sex only for money used condoms, were tested for HIV, and received the HIV test results more often than the other women. Women who traded sex for both drugs and money reported a significantly higher prevalence of gonorrhea, hepatitis B, and syphilis; were more likely to test positive for hepatitis B, syphilis, and HIV; engaged more often in sex acts without condoms; and were incarcerated for significantly more days. Based on these findings, the targets with greatest potential for STI prevention interventions are female sex workers who trade sex for both drugs and money.

Orthorexia Nervosa: A Review of the Literature.

BACKGROUND: The phenomenon of orthorexia nervosa (ON) has been noted by clinicians since 1996 and described in the scientific literature, and yet there is no formal recognition of ON as a psychiatric diagnosis. OBJECTIVE: Review the latest available literature regarding diagnoses similarities, presentation uniqueness, assessment/assessment tools, and suggested treatments of ON. METHOD/DESIGN: A literature search of four databases focusing on articles published between 2000 and 2016 was conducted to evaluate the status of the literature on Orthorexia. RESULTS: Among the 15 articles selected for this review, similarities with other psychiatric disorders emerged, confusion about use of assessment tools existed, and the lack of evidence based treatments for ON was pronounced. CONCLUSION: More research is needed to determine the prevalence of pathologically unhealthy, obsessive, "self-defined healthy," eating behaviors, and to determine if ON is a unique eating disorder or just a subset of another disorder.

Failure to get into substance abuse treatment.

Among substance abusers in the US, the discrepancy in the number who access substance abuse treatment and the number who need treatment is sizable. This results in a major public health problem of access to treatment. The purpose of this study was to examine characteristics of Persons Who Use Drugs (PWUDs) that either hinder or facilitate access to treatment. 2646 participants were administered the Risk Behavior Assessment (RBA) and the Barratt Impulsiveness Scale. The RBA included the dependent variable which was responses to the question "During the last year, have you ever tried, but been unable, to get into a drug treatment or detox program?" In multivariate analysis, factors associated with being unable to access treatment included: Previously been in drug treatment (OR=4.51), number of days taken amphetamines in the last 30days (OR=1.18), traded sex for drugs (OR=1.53), homeless (OR=1.73), Nonplanning subscale of the Barratt Impulsiveness Scale (OR=1.19), age at interview (OR=0.91), and sexual orientation, with bisexual men and women significantly more likely than heterosexuals to have tried but been unable to get into treatment. The answers to the question on "why were you unable to get into treatment" included: No room, waiting list; not enough money, did not qualify, got appointment but no follow through, still using drugs, and went to jail before program start. As expected, findings suggest that limiting organizational and financial obstacles to treatment may go a long way in increasing drug abuse treatment accessibility to individuals in need. Additionally, our study points to the importance of developing approaches for increasing personal planning skills/reducing Nonplanning impulsivity among PWUDs when they are in treatment as a key strategy to ensure access to additional substance abuse treatment in the future.