Behavioral Economics: A New Lens for Understanding Genomic Decision Making.

PURPOSE: This article seeks to take the next step in examining the insights that nurses and other healthcare providers can derive from applying behavioral economic concepts to support genomic decision making. As genomic science continues to permeate clinical practice, nurses must continue to adapt practice to meet new challenges. Decisions associated with genomics are often not simple and dichotomous in nature. They can be complex and challenging for all involved. DESIGN: This article offers an introduction to behavioral economics as a possible tool to help support patients', families', and caregivers' decision making related to genomics. METHODS: Using current writings from nursing, ethics, behavioral economic, and other healthcare scholars, we review key concepts of behavioral economics and discuss their relevance to supporting genomic decision making. FINDINGS: Behavioral economic concepts-particularly relativity, deliberation, and choice architecture-are specifically examined as new ways to view the complexities of genomic decision making. Each concept is explored through patient decision making and clinical practice examples. This article also discusses next steps and practice implications for further development of the behavioral economic lens in nursing. CONCLUSIONS: Behavioral economics provides valuable insight into the unique nature of genetic decision-making practices. CLINICAL RELEVANCE: Nurses are often a source of information and support for patients during clinical decision making. This article seeks to offer behavioral economic concepts as a framework for understanding and examining the unique nature of genomic decision making. As genetic and genomic testing become more common in practice, it will continue to grow in importance for nurses to be able to support the autonomous decision making of patients, their families, and caregivers.

Cues to Cervical Cancer Screening Among U.S. Hispanic Women.

INTRODUCTION: Hispanic women's cervical cancer rates are disproportionately high. Cues to cervical cancer screening (Cues to Action) are strategies to activate the decision-making process to get screened for cervical cancer. This study used the health belief model to examine which cues prompt Hispanic women to undergo cervical cancer screening and how perceptions could be potentiated by cues to cervical cancer screening. METHOD: A cross-sectional survey was conducted among Hispanic women 18 to 65 years old ( n = 220). Generalized linear modeling was used. RESULTS: Spanish media and reminders by mother and doctors were relevant cues. Generalized linear modeling showed cues to action modified significantly the predictive effect of Perceived Threats (i.e., Susceptibility, Severity), benefits, barriers, and self-efficacy on Hispanic women's cervical cancer screening behavior. "Mother told me" and Spanish media messages were significant covariates. CONCLUSION: Cues to Action influenced Hispanic's women participation in cervical cancer screening. Cues to Action increased the strength of the health belief model as an explanatory model, and must be considered in designing culturally appropriate cervical cancer screening interventions.

Breastfeeding and Growth of Children in the Peri/postnatal Epigenetic Twins Study (PETS): Theoretical Epigenetic Mechanisms.

BACKGROUND: The prevalence of overweight infants and toddlers has increased by 60% in the past 30 years and is a significant contributor to diabetes, cardiovascular disease, and early morbidity and mortality. The World Health Organization's updated meta-analysis in 2013 observed an association between breastfeeding and a lower prevalence of obesity later in life. The purpose of this study was to assess the growth of children in a cohort of Australian twins to examine associations between duration of breastfeeding and growth at 18 months of age. Our hypothesis is that the anthropometric measurements of the participants will be greater with shorter duration of breastfeeding. METHODS: Methods include using cross-sectional data from a cohort at the 18-month visit (n = 179) in the Peri/postnatal Epigenetics Twins Study (PETS) to assess the relationship between duration of breastfeeding and infant size at 18 months of age. Inclusion criteria were birth weight of more than 2000 grams and breastfed for less than 1 month, 1 to 3 months, or 4 to 6 months. RESULTS: The analysis suggested that infants breastfed for 1 to 3 months were significantly larger than infants breastfed for 4 to 6 months in terms of mean body mass index (BMI) (0.61 kg/m(2); P = .02; 95% confidence interval [CI], 0.17-1.05), arm circumference (0.66 cm; P = .006; 95% CI, 0.26-1.06), and abdominal circumference (1.16 cm; P = .03; 95% CI, 0.26-2.06). The analysis also suggested that infants breastfed for less than 1 month were significantly larger than infants breastfed for 4 to 6 months in terms of mean arm circumference (0.72 cm; P = .009; 95% CI, 0.26-1.17). CONCLUSION: Results suggest that supplementing with non-breast milk before 4 months of age was associated with an increased BMI, arm circumference, and abdominal circumference at 18 months of age. The mean BMI decreased from 85% to 65% when infants were breastfeeding for 4 to 6 months as compared to breastfeeding for 1 to 3 months. Breastfeeding for 4 to 6 months appeared to protect against the risk of obesity for the children in the PETS.

Exploring mHealth as a new route to bridging the nursing theory-practice gap.

The purpose of this article is to evaluate mHealth as a tool for research and development of nursing theories. Mobile health (mHealth) is one of the most promising new advances in health care technology. mHealth is defined as the use of mobile technology in the provision of health care delivery or health promotion (Qiang, Yamamichi, Hausman, & Altman, 2011). The need for innovative and effective interventions for the prevention and management of chronic illness is evident. The use of mHealth interventions in the treatment and monitoring of chronic illness is still young but shows great promise. Currently, the public health and psychological sciences are using their theories to guide interventional studies by operationalizing concepts through mHealth's multifaceted capabilities for patient interaction. Outcomes measures from chronic illness-mHealth studies are thematically evaluated by using theoretical nursing outcome-related concepts of Meleis's transitions theory and Mishel's uncertainty in illness theory. Despite a small sample of articles, there are strong themes of activation and engagement within this literature review. The application of nursing theory in mHealth offers a new method to operationalize theoretical concepts, test theory-based interventions, and gain new contextual insight into the health-illness patient experience.

Factors Affecting Hispanic Women's Participation in Screening for Cervical Cancer.

Hispanic women's cervical cancer rates are disproportionately high. The Health Belief Model (HBM) was used as a theoretical framework to explore beliefs, attitudes, socio-economic, and cultural factors influencing Hispanic women's decisions about cervical cancer screening. A cross-sectional survey was conducted among Hispanic women 18-65 years old (n = 205) in the Upstate of South Carolina. Generalized Linear Modeling was used. Across all models, perceived threats (susceptibility and severity), self-efficacy, and the interaction of benefits and barriers were significant predictors. Significant covariates included age, marital status, income, regular medical care, and familism. A modified HBM was a useful model for examining cervical cancer screening in this sample of Hispanic women. The inclusion of external, or social factors increased the strength of the HBM as an explanatory model. The HBM can be used as a framework to design culturally appropriate cervical cancer screening interventions.

Evidence-based nursing: the role of the advanced practice registered nurse in the management of heart failure patients in the outpatient setting.

Heart failure (HF) is a chronic debilitating illness that affects millions of Americans each year. Patients with HF are faced with chronic physical symptoms, emotional strain, and significant socioeconomic burden. Goals in the management of HF are to slow the disease progression, decrease symptom acuity, and prevent exacerbations that lead to hospital readmission. Management of HF remains a challenge for healthcare providers. There is a fine balance between optimizing patient functioning and minimizing healthcare expenditures. With the incidence of HF increasing annually, it is important to have effective disease management strategies in place. In any disease management program, it is important to follow those guidelines outlined by evidence-based practice. The purpose of this systematic review was to evaluate current evidence-based practice and determine what benefit exists of having an advanced practice registered nurse assist in the management of patients with HF.

Community life, public health, and children's safety.

As the US Advisory Board on Child Abuse and Neglect recognized in the early 1990s, the challenges posed by (a) the ongoing crisis in the child protection system and (b) the generational decline in social capital are intertwined. This issue of Family and Community Health, 31.2, discusses the conceptualization, implementation, and effects of Strong Communities for Children, the first large-scale application of the board's vision for a neighborhood-based child protection system. Having already demonstrated effectiveness in mobilizing large numbers of volunteers and organizations in diverse communities, Strong Communities has potential usefulness not only in promoting child safety but also in meeting other important goals for community health.

Rapid response teams: do they make a difference?

Hundreds of lives are now being saved in hospitals across the country with the use of rapid response teams. These teams are composed of clinicians who bring critical care expertise to the patient bedside. The purpose of these teams is to assess and stabilize the patient, assist with communication among the interdisciplinary care providers, educate and support the staff caring for the patient, and assist with transfer of the patient if necessary. Research has shown that, with successful implementation of a rapid response team, the percent of codes and mortality rates decrease. The purpose of this study was to evaluate the effectiveness of implementing a rapid response team at 1 medical center. The results from the study demonstrated a decrease in the percent of codes outside the critical care units. However, it did not show a decrease in overall mortality rates for the patients. Data review will continue as we strive to improve our overall mortality rates while maintaining a decrease in the amount of codes.

Assent of school-age bilingual children.

This article discusses the issue of assent of school-age bilingual children to participate in a research study. The article reviews cognitive, cultural, and linguistic factors influencing verbal and nonverbal concept formation in bilingual children. At the applied level, the focus of the article is on methodological considerations in using this information to obtain assent from a child who is bilingual and speaks English as a second language. Recommendations for the assessment of the child's language dominance, language proficiency, and the development of the assent form are provided. Language diversity and its potential effects on the assent process need to be formally acknowledged and appropriately addressed.

Clinical research and the development of new drugs: issues for nurses.

Critical care nurses are frequently exposed to clinical trials for either new medications, equipment, or procedures. This article discusses the FDA regulatory requirements as well as the guidelines for conducting human research involving investigational new drugs. The role of the critical care nurse caring for patients enrolled in clinical trials is also discussed.