State and national data on the Georgia nursing workforce.

BACKGROUND: The enduring absence of robust nursing workforce data creates gaps to support evidence-based workforce planning and policy development. PURPOSE: The purpose of this study was to examine Georgia nursing workforce data available through state and national agencies to determine if significance differences exist among data sources. METHODS: A cross-sectional, descriptive analysis of 2017 Georgia nursing workforce data was used to examine and compare workforce characteristics available from five data sources. The advantages and limitations of each data source were reviewed. FINDINGS: Significant differences were noted in the quality and quantity of data collected on the Georgia nursing workforce as reported by state and national agencies. None of the datasets include in our analysis had comprehensive and timely data on the Georgia nursing workforce. DISCUSSION: Nursing workforce stakeholders must work collaboratively to require and implement a comprehensive re-licensure survey. It is only though a standardized national minimum dataset that we can ensure an adequate nursing workforce.

Cost-effectiveness of a faith-based lifestyle intervention for diabetes prevention among African Americans: A within-trial analysis.

AIMS: We assessed costs and cost-effectiveness of implementing Fit Body and Soul (FBAS), a church-based 18-session lifestyle education intervention for African Americans. METHODS: We calculated incremental cost-effectiveness ratios (ICER) using data from a cluster randomized controlled trial comparing FBAS with health education (HE) among 604 overweight participants in 20 churches. The ICER was the adjusted difference in costs to deliver FBAS versus HE over the difference in weight change (kilograms [kg]) at one-year follow-up. Costs included those incurred for participant identification and program implementation. We fitted linear mixed-effects regression models, accounting for clustering of participants within churches and for age, sex, and educational attainment. We repeated these analyses for secondary outcomes (waist circumference [cm], physical activity [MET], glucose, blood pressure, and quality of life). RESULTS: Per-person intervention cost of FBAS was $50.39 more than HE ($442.22 vs. $391.83 per-person), and adjusted differences in weight change (1.9 kg [95% CI: 1.0 to 2.8]) and waist circumference (2.4 cm [95% CI: 1.3 to 3.4]) were both significant. FBAS did not result in statistically significant differences in physical activity, glucose, blood pressures, or quality of life. We estimated that compared to HE, FBAS costs an additional $26.52 per kg weight lost and $21.00 per cm reduction in waist circumference. CONCLUSIONS: For a modest increase in cost, FBAS led to greater weight and waist reductions among African Americans in a church setting. ClinicalTrials.gov Identifier NCT01730196.

The Role of the Nurse Educator in Sustaining Compassion in the Workplace: A Case Study From an Intensive Care Unit.

Intensive care unit (ICU) nurses are frequently exposed to emotional and stressful situations in the workplace, which has changed little over the decades. Compassion fatigue is caused by sustained exposure to situations that conflict with one's values and beliefs in the ICU, eroding clinical team relationships and ultimately the quality and safety of patient care. Continuing education in the intensive care setting is a priority, as ICU nurses need to remain abreast of the rapid developments in high-acuity care delivery; however, attention also needs to be directed to nurses' emotional well-being. Nurse educators are well positioned to create and sustain open dialogue that contributes to group cohesion and assists nurses' well-being. J Contin Educ Nurs. 2018;49(5):221-224.

Percent weight reduction required to achieve minimal clinically important improvements in health-related quality of life among African Americans: A secondary analysis of the fit body and soul study.

OBJECTIVE: To calculate the percent weight reduction required to achieve minimal clinically important improvement (MCII) in health-related quality of life (HRQOL). DESIGN: Secondary data analysis from the longitudinal cohort of a single-blinded, cluster-randomized community trial to test the efficacy of the faith-based adaptation of the Diabetes Prevention Program. SETTING: African-American churches. PARTICIPANTS: This study included 472 congregants with a body mass index of ≥25 and fasting plasma glucose<126mg/dl. MAIN OUTCOME MEASURE: Percent weight reduction required to achieve the MCII in HRQOL measured by two instruments, SF-12 and EQ-5D, one year following baseline. ANALYSIS: The percent weight reduction required to achieve established MCII in SF-12 Physical Component Summary (PCS), SF-12 Mental Component Summary (MCS), and EQ-5D Health Status (HS) at one-year follow-up were calculated using fitted linear regression models. In addition to models for the total sample, we generated models, stratified by baseline BMI, PCS, and HS, to calculate the percent weight reduction required to achieve MCII in HRQOL for those most in need of weight reduction and those in need of improved HRQOL. RESULTS: The percent weight reduction was a significant predictor of improvement in the SF-12PCS and the EQ-5DHS but not SF-12MCS. To achieve a MCII in SF-12PCS and EQ-5DHS, 18% and 30% weight reductions were required, respectively. A smaller percent weight reduction was required when the baseline BMI was ≥40. CONCLUSIONS AND IMPLICATIONS: Improvements in HRQOL among African-American congregants seeking weight reduction required more than the 3-5% weight reduction associated with improvements in physical health.

Community Trial of a Faith-Based Lifestyle Intervention to Prevent Diabetes Among African-Americans.

About 75% of African-Americans (AAs) ages 20 or older are overweight and nearly 50% are obese, but community-based programs to reduce diabetes risk in AAs are rare. Our objective was to reduce weight and fasting plasma glucose (FPG) and increase physical activity (PA) from baseline to week-12 and to month-12 among overweight AA parishioners through a faith-based adaptation of the Diabetes Prevention Program called Fit Body and Soul (FBAS). We conducted a single-blinded, cluster randomized, community trial in 20 AA churches enrolling 604 AAs, aged 20-64 years with BMI ≥ 25 kg/m(2) and without diabetes. The church (and their parishioners) was randomized to FBAS or health education (HE). FBAS participants had a significant difference in adjusted weight loss compared with those in HE (2.62 vs. 0.50 kg, p = 0.001) at 12-weeks and (2.39 vs. -0.465 kg, p = 0.005) at 12-months and were more likely (13%) than HE participants (3%) to achieve a 7% weight loss (p < 0.001) at 12-weeks and a 7% weight loss (19 vs. 8%, p < 0.001) at 12-months. There were no significant differences in FPG and PA between arms. Of the 15.2% of participants with baseline pre-diabetes, those in FBAS had, however, a significant decline in FPG (10.93 mg/dl) at 12-weeks compared with the 4.22 mg/dl increase in HE (p = 0.017), and these differences became larger at 12-months (FBAS, 12.38 mg/dl decrease; HE, 4.44 mg/dl increase) (p = 0.021). Our faith-based adaptation of the DPP led to a significant reduction in weight overall and in FPG among pre-diabetes participants. CLINICALTRIALS. GOV IDENTIFIER: NCT01730196.

Implementing the New ANA Standard 8: Culturally Congruent Practice

The American Nurses Association (ANA) is responsible for the contract between society and the nursing profession, including the nursing scope and standards of practice. In 2015, an ANA workgroup produced Nursing: Scope and Standards of Practice, 3rd Ed during a time of social change and an increase of culturally and ethnically diverse consumers. Subsequently, a subset of workgroup members and an invited transcultural nursing expert led to the creation of the new Standard 8: Culturally Congruent Practice, describing nursing care that is in agreement with the preferred values, beliefs, worldview, and practices of the healthcare consumer. This article records the history of the revised scope and standards and new Standard 8, the reasoning behind this standard and its impact on nursing practice, education, and research. The article also guides nurses in the application of Standard 8 to nursing practice and offers discussion about implementing culturally congruent practice through the nursing process. We also discuss cultural congruence for the graduate-prepared nurse; offer brief comments related to evaluation of culturally congruent practice using Standard 8 and future research; and conclude with a call to action.

Pathway to Weight Maintenance: A-Qualitative Study with Church Health Advisors to Assess Weight Loss Maintenance Program Needs Among African-Americans.

Nearly 50% of African-American adults are obese. Obesity is a known contributor to chronic diseases such as type 2 diabetes mellitus (type 2 DM). Short-term Diabetes Prevention Programs (DPPs) achieve short-term weight loss success, but weight regain is common. African-Americans, compared to Whites, are particularly challenged by weight maintenance. In collaboration with community health workers, translation scientists have delivered successful short-term DPPs in community settings, such as African-American churches. Evidence of the salient components of effective weight maintenance intervention is minimal, especially among African-Americans in churches, and there is no known research that specifically explores the insights of community health workers. We report findings from a qualitative study to identify the necessary components of a sustainable church-based weight maintenance program from the perspective of community health workers. Two main themes emerged: overemphasis of short-term goals and consistent support. These findings have relevancy for developing faith-based weight maintenance programs.

Characteristics influencing weight reduction among veterans in the MOVE!® Program.

Obesity is a common health problem for veterans. This study explored background and program characteristics associated with a 5% weight reduction for veterans enrolled in MOVE!(®), a weight management program. For data analysis, 404 veteran records were examined using logistic regression. Background characteristics included socio-demographic variables, comorbidity, body mass index, rurality, and Veterans Administration (VA) priority group. Program characteristics included the program type (group attendee or self-managed) as well as the number and type of provider contacts. Thirteen percent of participants achieved a 5% weight reduction. Age in years (odds ratio [OR] = 1.04) and the number of group visits (OR = 1.05) were significant predictors for achieving a 5% weight reduction. Given the importance of weight reduction, health professionals should consider these significant predictors when planning weight-reduction programs for veterans.

A framework for describing health care delivery organizations and systems.

Describing, evaluating, and conducting research on the questions raised by comparative effectiveness research and characterizing care delivery organizations of all kinds, from independent individual provider units to large integrated health systems, has become imperative. Recognizing this challenge, the Delivery Systems Committee, a subgroup of the Agency for Healthcare Research and Quality's Effective Health Care Stakeholders Group, which represents a wide diversity of perspectives on health care, created a draft framework with domains and elements that may be useful in characterizing various sizes and types of care delivery organizations and may contribute to key outcomes of interest. The framework may serve as the door to further studies in areas in which clear definitions and descriptions are lacking.

Design of a cluster-randomized controlled trial of a diabetes prevention program within African-American churches: The Fit Body and Soul study.

Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI≥25kg/m(2)) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination.

The U.S. Preventive Services Task Force: an evidence-based prevention resource for nurse practitioners.

PURPOSE: To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services. SOURCES: Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984. CONCLUSIONS: A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs. IMPLICATIONS FOR PRACTICE: NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services.

The Well Woman Program: a community-based randomized trial to prevent sexually transmitted infections in low-income African American women.

In this sexually transmitted infection (STI) prevention study, we compared the efficacy of the Well Woman Program (WWP), a nurse practitioner-directed, culturally specific, intensive intervention, to minimal intervention (MI), brief lecture, and referral to usual care, in a community-based randomized controlled trial. African American women having past STIs and residing in high-risk communities were randomly assigned to the two groups. STI outcome was measured at baseline and three later points. A random effects logistic longitudinal regression model showed that, at baseline, approximately 75% of participants tested positive for an STI, predominantly trichomoniasis. At month 15, the estimated probability of a WWP participant having an STI was 20% less than an MI participant. Better STI outcomes were due to the intensive individualized intervention.

USPSTF recommendations for STI screening.

Since 2000, the U.S. Preventive Services Task Force (USPSTF) has issued eight clinical recommendation statements on screening for sexually transmitted infections. This article, written on behalf of the USPSTF, is an overview of these recommendations. The USPSTF recommends that women at increased risk of infection be screened for chlamydia, gonorrhea, human immunodeficiency virus, and syphilis. Men at increased risk should be screened for human immunodeficiency virus and syphilis. All pregnant women should be screened for hepatitis B, human immunodeficiency virus, and syphilis; pregnant women at increased risk also should be screened for chlamydia and gonorrhea. Nonpregnant women and men not at increased risk do not require routine screening for sexually transmitted infections. Engaging in high-risk sexual behavior places persons at increased risk of sexually transmitted infections. The USPSTF recommends that all sexually active women younger than 25 years be considered at increased risk of chlamydia and gonorrhea. Because not all communities present equal risk of sexually transmitted infections, the USPSTF encourages physicians to consider expanding or limiting the routine sexually transmitted infection screening they provide based on the community and populations they serve.

Integrating evidence-based clinical and community strategies to improve health.

Multiple and diverse preventive strategies in clinical and community settings are necessary to improve health. This paper (1) introduces evidence-based recommendations from the U.S. Preventive Services Task Force sponsored by the Agency for Healthcare Research and Quality and the Community Task Force sponsored by the Centers for Disease Control and Prevention, (2) examines, using a social-ecologic model, the evidence-based strategies for use in clinical and community settings to address preventable health-related problems such as tobacco use and obesity, and (3) advocates for prioritization and integration of clinical and community preventive strategies in the planning of programs and policy development, calling for additional research to develop the strategies and systems needed to integrate them.

Integrated primary and mental health care: evaluating a nurse-managed center for clients with serious and persistent mental illness.

Nurse-managed centers have been at the forefront of providing ambulatory care alternatives for underserved populations lacking access to care. Following this model, the Center for Integrated Health Care of the College of Nursing at the University of Illinois in Chicago delivers primary and mental health care services to a population of people with serious and persistent mental illness. The authors' experience illustrates the many rewards and challenges that nurse-managed centers face. This article describes their center's model of integrated care, examines selected performance indicators, and discusses the implications, opportunities, and challenges ahead.

Moving forward together: the practice doctorate in nursing.

Societal drivers, as well as trends in education and health care, are advancing the practice doctorate in nursing. For nurse practitioner preparation, the current resurgence of interest in the practice doctorate could precipitate change that mimics the evolution from post-basic certificate to Master's level education. The National Organization of Nurse Practitioner Faculties (NONPF) is a resource for the study of the practice doctorate relative to quality nurse practitioner education. This article will offer some insights into the movement toward the practice doctorate by describing, from the NP perspective, the societal impetus for change, the historical perspective of NP and doctoral education, the 4 Ws (why, what, where, and when) of the movement, and some of the myths and realities about the practice doctorate.

The relationship of work stress and family stress to the self-rated health of women employed in the industrial sector in Korea.

OBJECTIVE: To identify the relationship of work stress and family stress to the health of women in Korea. DESIGN: Cross-sectional study. SAMPLE: Three hundred and thirty-one married women working in 14 manufacturing companies in Korea. METHODS: Subjects responded to a questionnaire that included items on work stress, family stress, social support, and general characteristics. Perceived health status (PHS) was assessed with the Short Form-36. RESULTS: There was a significant positive relationship between social support and PHS, but significant negative relationships were found between PHS and work stress as well as family stress. Hierarchical multiple regression analysis explained the health status of married working women by four categories: personal, work related, family related, and social support, and accounted for 45.4% of the variance. When family-related factors were added to the model, the power of explanation was increased by 17.9% compared with the explained variance. Family stress was a major variable not only for explaining the variance but also for correlating with health status. CONCLUSIONS: Both work stress and family stress should be considered together when addressing the health of working women in the industrial sector in Korea.

Profiles of self-rated health in midlife adults with chronic illnesses.

BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time. OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time. METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time. RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes. DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.

Dealing with death: an audit of family bereavement programs in Australian intensive care units.

Patient death in Intensive Care Units (ICU) can be sudden and unexpected, leading to emotionally charged situations and life changing circumstances for family members. Supporting families during and after this critical period is particularly challenging for ICU nurses who often feel dissatisfied with the way they deal with the situation. Bereavement programs in various areas of nursing have been reported to be beneficial in promoting normal grief patterns. There is, however, a lack of research in the area of evaluation of bereavement programs in adult ICUs. This paper presents the results of an Australia-wide audit on current practices in the area of bereavement programs within adult ICUs. Surveys were sent to 117 adult Australian ICUs; 99 surveys were returned completed (84.6% response rate). It was identified that most surveyed units offer minimal components of bereavement programs, such as viewing of the deceased and communicating with family members. Less than one third (n=26) provide additional follow-up services in the form of telephone calls and sympathy cards or referral to additional services. Ten units employ some form of program evaluation. Verbal feedback from staff and families is the primary assessment method. Over half of responding ICUs indicated they are considering or interested in providing a bereavement program in their unit. This study highlights the need for research-based data to support the introduction or deletion of strategies for bereavement programs using family-centred outcome measures. ICU nurses are interested in this area of clinical practice and require considerable support. It is recommended that this support can come via postgraduate and on-going education, hospital policies and procedures.

Center for Integrated Health Care: primary and mental health care for people with severe and persistent mental illnesses.

The Center for Integrated Health Care capitalizes on the abilities, drive, and autonomy of advanced practice nurses, resulting in an exciting, timely academic nursing center exemplar. People with severe and persistent mental illnesses receive care that is targeted specifically to a population with chronic mental illnesses and tailored to the unique individual by integrating primary and mental health care. This Center is a partnership between Thresholds, a psychosocial rehabilitation center, staff and University of Illinois at Chicago, College of Nursing faculty. The Center's goals are to provide quality care, support teaching and learning for nursing and other health professional learners, and generate new knowledge related to the integration of mental and physical health care. To achieve long-term sustainability, the Center must partner with a federally qualified health center.