Exploring Experiences of Pain Management Among Family Caregivers of Community-Dwelling Older Adults With Dementia.

BACKGROUND: Pain is often underreported and under-treated in older adults with dementia. The role of family caregivers (FCGs) in managing pain for their loved ones with dementia living in community has been significantly burdensome. Surprisingly, research has not delved into the experiences of FCGs' concerning pain management in this context. METHODS: A qualitative descriptive study was conducted to gain a deep understanding of FCGs' experiences in managing pain for their loved ones. Family caregivers participated in semi-structured face-to-face or telephone interviews. Inclusion criterion included being an adult providing care to community-dwelling older adults with dementia. Recruitment stopped upon reaching thematic saturation. Basic demographic characteristics was also collected. Constant comparison analytic method was employed. RESULTS: The study included 25 FCGs in central Virginia, spanning ages from 29 to 95. Participants were predominantly white, female, married, and had a minimum high school education. Most of them were adult children (52%) or the spouses (28%) of the care recipients. Four thematic categories emerged around exploring FCGs' pain management experiences: (1) Values; (2) Barriers; (3) Support; and (4) Adaptation. Each theme included sub-themes. CONCLUSION: Family caregivers follow their values to make decisions in pain management. Barriers existed for effective pain management. Adaptation and support from professional or formal caregivers greatly improved FCGs' perception of their competence in pain management. The finding underscores the need for further research and the development of interventions aimed at enhancing FCGs' perception of self-efficacy in this crucial aspect of caregiving.

Sedentary behavior and physical activity of young adult university students.

Movement and non-movement behaviors include sleep, sedentary behavior (SB) and physical activity (PA). While young adults are generally perceived as healthy, the level and relationship of SB and PA in college-age students has not been greatly explored. The purpose of this study was to objectively measure the levels of SB and PA in 18-20 year-old university students, record their self-reported extracurricular activities, and explore the relationship of all these with body mass index (BMI) and waist circumference (WC). Male (n = 48) and female (n = 46) students participated in this cross-sectional study. Hierarchical multiple regression analyses were used to examine time spent in SB, moderate to vigorous physical activity (MVPA), number of self-reported sedentary extracurricular activities, and their relation to the dependent variables of BMI and WC. In correlation analyses, SB (p < .001) and MVPA (p = .017) both were negatively associated with BMI, and "other" race or ethnicity (African American, Hispanic, mixed; p = .013) and number of self-reported sedentary extracurricular activities (p = .006) were positively associated with BMI. In the WC regression model, SB (p = .018) was negatively associated and number of self-reported sedentary extracurricular activities (p = .006) was positively associated with WC. University students may be both highly active and highly sedentary. Future researchers should consider targeting interventions to reduce SB in addition to improving PA.

Adolescent Smoking Prevention: Feasibility and Effect of Participatory Video Production.

PURPOSE: This study tested whether a youth participatory video production program for smoking prevention is feasible and effective. DESIGN AND METHODS: A participatory video production program was implemented in eight twice-weekly sessions at a youth summer camp in a community center in a low-income neighborhood. Twenty-three youths participated. Descriptive statistics and a qualitative analysis were conducted to test the feasibility of the program by assessing attendance rates, the time and resources required, reasons for participation, and program satisfaction using checklists and interviews. Smoking intention was measured via pre- and post-intervention surveys and a quantitative analysis utilizing a Wilcoxon Signed Rank test to detect differences in intention for non-smoking. RESULTS: Participants worked in groups to produce four video clips containing anti-smoking messages. Three main themes (active engagement, participation for community health, and personal growth and healthy development) emerged from the qualitative interview data. >75% of the participants considered the program excellent and stated that it met their expectations. Significant positive changes were also found from baseline to post-intervention in intention not to smoke. CONCLUSIONS: This study demonstrated the effect of a participatory digital media production approach and confirmed its feasibility for youth health promotion and health education. Participants' active involvement in producing anti-smoking videos for a community health-promotion campaign decreased their intention to smoke and empowered them as advocates for a non-smoking community. PRACTICE IMPLICATIONS: These findings confirm the feasibility and utility of digital media use and interactive technology for actively engaging young people in health promotion.

South Korean Adolescents' Intention to Smoke.

OBJECTIVES: The purpose of this study was to examine associations between intention to smoke, and 3 constructs of the Theory of Planed Behavior, including attitude, subjective norm, and perceived behavioral control related to smoking among adolescents in South Korea. METHODS: We used a cross-sectional correlational design. The survey was conducted on 13- to 15-year-old adolescents (N = 740) in Seoul, South Korea. Multilevel modeling was conducted to analyze the data. RESULTS: After adjusting for socio-demographic and economic factors, attitude toward smoking, subjective norm about smoking, and perceived behavioral control about smoking were independent statistically significant predictors of in tention to smoke. When all 3 were considered together, attitude toward smoking and perceived behavioral control remained statistically significant, but subjective norm about smoking did not. The number of licensed tobacco retailers also predicted intention to smoke. CONCLUSIONS: Attitude, perceived behavioral control, and tobacco retailers around schools need to be considered when developing tobacco prevention and control programs and policies for adolescents.

Density and Proximity of Licensed Tobacco Retailers and Adolescent Smoking.

Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on tobacco retailer density and proximity in relation to adolescent smoking, published in peer-reviewed journals between 2004 and 2014. The tobacco retailer density and proximity were correlated with adolescent lifetime smoking, past 12-month smoking, past 30-day smoking, and susceptibility to smoking. School nurses or other school health professionals may need to include the density and proximity of tobacco retailer factors around schools in school-based tobacco-use prevention programs. Health policy makers may need to consider zoning or licensing restrictions of tobacco retailers around schools for adolescent smoking prevention.

Validation of Accelerometer Thresholds and Inclinometry for Measurement of Sedentary Behavior in Young Adult University Students.

Sedentary behavior (SB) is a major contributor to obesity and significant morbidity and mortality in adolescence and adulthood, yet measurement of SB is still evolving. The purpose of this study was to assess the degree of construct validity of the inclinometer function and single-axis and vector magnitude accelerometry metrics of the ActiGraph GT3X+ in objectively measuring SB and physical activity in 28 young adult university students who performed nine semi-structured activities, each for five minutes: lying, sitting, reading, seated video gaming, video watching, seated conversation, standing, stationary biking, and treadmill walking. Inclinometry and four output metrics from the ActiGraph were analyzed in comparison to direct observation by a researcher recorded each minute. For overall accuracy in measuring both SB and physical activity, all four accelerometer metrics (94.7-97.8%) outperformed the inclinometer function (70.9%). Vector magnitude accelerometry with a threshold of 150 counts per minute as the cut point for sedentary behavior was superior to other methods. While accelerometry was more accurate overall at detecting the behaviors tested, inclinometry had some advantages over accelerometry methods at detecting walking, biking, and standing. The findings support use of accelerometry as a valid objective measure of body movement, while use of inclinometry as a sole measure is not recommended. Additional research would be beneficial to improve the calibration of the inclinometer and explore ways of combining this with accelerometer data for objectively measuring SB and physical activity.

Evaluating a Quality Improvement Program for Cervical Cancer Screening at an Urban Safety Net Clinic.

This article evaluates a quality improvement program for improving guideline-consistent cervical cancer screening practices in an urban safety net clinic. Quality improvement initiatives that combine policy with practice are particularly timely in light of the alignment of cervical cancer screening guidelines released in 2012 by the most influential national organizations. A descriptive comparison design was employed using the Healthy People 2020 target of 93% screened according to guidelines. Provider-, patient-, and workflow-based strategies included (1) addition of a clinical decision support system, (2) provider educational outreach, (3) patient reminder letters, and (4) development of a clinic procedure manual. Through the application of an established quality measurement tool, three quality indicators were measured: screened according to evidence-based guidelines, not screened, and screened more frequently than recommended. Data from the sample (N = 1,032) were collected at baseline and 12 months postimplementation. Each quality indicator category was significant at follow-up. Patients screened according to guidelines nearly doubled while the number of underscreened patients was reduced by nearly half. Similarly, there was a threefold decrease in patients screened more frequently than recommended. Clinical administrators, quality improvement specialists, and health care providers in primary care settings can use the strategies implemented in this study as a starting point for continuous quality improvement initiatives for cervical cancer screening.

Cornerstone Documents, Milestones, and Policies: Shaping the Direction of Public Health Nursing 1890-1950.

The interplay of policy, milestone events, and cornerstone documents was critical in the evolution of the specialty of public health nursing (PHN) from 1890-1950. Using our contemporary lens, this article examines PHN development from an historical perspective, including events and milestones driving growth in the early 20th century. Some of the challenges faced by our founding public health nursing leadership are not unlike challenges we face today. In 1950, Ruth Hubbard, a former leader in the National Organization of Public Health Nurses and Director of the Visiting Nurse Society of Philadelphia, spoke of the value of examining the past to forge a new future. This article calls for contemporary public health nurses to act upon the lessons learned from the past, to strengthen the renewed focus on prevention, to develop policies that impact population health, and to foster a vision that will guide us into the future.

Youths as partners in a community participatory project for substance use prevention.

This community-based participatory research project aimed to develop strategies to prevent youth substance use in a rural county. This article (1) describes the project phases, (2) examines unique contributions and considerations of youth involvement, and (3) explores the youths' perspective. Twelve youths, aged 16 to 18 years, joined parents, community leaders, and research specialists on the community-based participatory research team. The youths were integrally involved in all phases including the community assessment, community leader interviews, selection of a substance use prevention program, and program implementation. Youths reported sustained enthusiasm, experiences of authentic leadership, development of research skills, and greater awareness of their community.

"Something must be done!": public health nursing education in the United States from 1900 to 1950.

This article examines public health nursing (PHN) education in the United States from 1900 to 1950. Following establishment of district nursing and the Henry Street Settlement in the late 1800s, nurses worked with families and communities in schools, homes, and with immigrant populations in tenements of industrialized cities. By the early 1900s, PHN leaders recognized that graduates needed broader education than provided by hospital training schools to prepare nurses to address social conditions and promote health and hygiene for populations. Current themes in professional nursing, such as social determinants of health, have their roots in early discourse about PHN education.

Changing health outcomes of vulnerable populations through nursing's influence on neighborhood built environment: a framework for nursing research.

PURPOSE: The purpose of this article is to present a framework for nurses to study the impact of built environment on health, particularly in vulnerable populations. ORGANIZING CONSTRUCT: The framework is adapted from Social Determinants of Health and Environmental Health Promotion, a framework describing how physical and social environments interact to influence individual and population health and health disparities via macro, community-level, and interpersonal factors. METHODS: The original framework was modified for public health nursing using nursing research evaluating built environment and health, and supplemented with Nightingale's theory of nursing and health. FINDINGS: The built environment affects health through regional-, neighborhood-, and individual-level factors. Nursing can affect the health of patients by evaluating the neighborhood built environment where patients reside, and by advocating for changes to the built environment. CONCLUSIONS: Through development of built environment research, nurses can provide valuable insight into the pathways linking built environment to health of vulnerable populations, providing evidence for public health nurses to advocate for these changes on a neighborhood, state, and federal level. CLINICAL RELEVANCE: This framework can be used by public health clinicians to understand the pathways by which the built environment may be affecting the health of their patients, and by researchers to investigate the pathways, and to design and test community interventions.

Evolving public health nursing roles: focus on community participatory health promotion and prevention.

Public health nursing (PHN) practice is population-focused and requires unique knowledge, competencies, and skills. Early public health nursing roles extended beyond sick care to encompass advocacy, community organizing, health education, and political and social reform. Likewise, contemporary public health nurses practice in collaboration with agencies and community members. The purpose of this article is to examine evolving PHN roles that address complex, multi-causal, community problems. A brief background and history of this role introduces an explanation of the community participation health promotion model. A community-based participatory research project, Youth Substance Use Prevention in a Rural County provides an exemplar for description of evolving PHN roles focused on community health promotion and prevention. Also included is discussion about specific competencies for PHNs in community participatory health promoting roles and the contemporary PHN role.

International experiences in nursing education: a review of the literature.

Service learning and study abroad opportunities have become increasingly popular in nursing education in the past decade. The purpose of this systematic review was to explore existing literature concerning global health experiences in nursing education. Twenty-three empirical articles from 2003 to 2010 were reviewed, building upon existing reviews of international nursing education literature. Research on two-way exchange experiences and models for best practice were found to be lacking. While an array of countries were represented as the visiting or hosting side of the experience, few co-authors from host countries were found, particularly in literature originating from the U.S. The authors recommend that two-way exchange programs be evaluated to identify successful strategies and barriers to success. Ongoing evaluation of exchanges is necessary to ensure continued sustainable partnership and exchange in immersion experiences for nursing students.

Beliefs and norms associated with smoking tobacco using a waterpipe among college students.

This web-based, cross-sectional survey guided by the Theory of Reasoned Action (TRA), examined behavioral beliefs and normative beliefs associated with smoking tobacco using a waterpipe in a sample of 223 undergraduate college students. Beliefs and norms associated with waterpipe smoking intention were captured using the investigator-developed TRA Waterpipe Questionnaire. Significant behavioral beliefs that contributed to the prediction of smoking intentions included smoking tobacco with a waterpipe "will taste pleasant" and "will allow me to have a good time with my friends." Significant norms that emerged were perceived approval of waterpipe smoking from friends and significant others. Current smoking status, both waterpipe and cigarette, also contributed to the prediction of smoking intention. The variables of the TRA represent prime targets for intervention and provide useful information that can be used to tailor waterpipe prevention messages.

Nursing science and public health: contributions to the discipline of nursing.

This column highlights the unique relationship of nursing science and public health in the broader context of the discipline of nursing and healthcare. An integrated framework is used to illustrate that nursing knowledge is the product of interaction and interdependence of four domains -the discipline and science of nursing, the philosophy of nursing, the nursing profession, and nursing practice. In the context of the integrated framework, knowledge specific to public health nursing is shown to inform the discipline of nursing and other health disciplines. Ongoing challenges related to clarifying and describing unique contributions to nursing and public health are explored. In addition, under utilization of theoretical and conceptual nursing knowledge from public health nursing for the advancement nursing science in education, practice, and research is addressed.

New tobacco trends: waterpipe (hookah) smoking and implications for healthcare providers.

PURPOSE: To inform healthcare providers about waterpipe smoking, a new trend in tobacco use that is gaining popularity among adolescents and young adults. DATA SOURCES: American Lung Association Tobacco Policy Alert on Waterpipe Smoking, World Health Organization Tobacco Regulation Advisory Note on Waterpipe Smoking, and pertinent publications available in the literature. CONCLUSIONS: Waterpipe smoking is a new trend in tobacco use that is associated with multiple health problems, including addiction. Healthcare providers should be aware of new tobacco trends that may affect patients, such as waterpipe smoking, that are potential gateways to nicotine addiction. IMPLICATIONS FOR PRACTICE: Tobacco comes in many forms, all of which are addicting. Healthcare providers must be knowledgeable about new forms of tobacco to address all types of tobacco use with patients. Healthcare providers also have a responsibility to educate patients about the health risks inherent in these products to help prevent the long-lasting problem of nicotine addiction.