Church Leaders Share and Implement Solution-Focused Health Strategies During the COVID-19 Pandemic in Rural Alabama.

Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.

Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities.

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.

Community Perspectives and Environmental Justice Issues in an Unincorporated Black Township.

Through each era, the southeastern United States was and continues to be an epicenter for industrial companies to establish factories and plants. Though this development attracts economic gain for the companies and surrounding areas, low-income and predominantly Black communities bear the brunt of the environmental consequences while frequently remaining stagnant economically. This qualitative, community-based participatory research study grew out of a larger study designed to recruit lay community advisors from communities labeled as hard to reach in research. We focus on Holt, Alabama, an unincorporated community in the southeastern United States region. The primary goal of this research inquiry is to thematically analyze community interviews stemming from a topic of research, practice, and policy interest to community members: the effects of industrial pollution on Holt citizens' daily lives. Content analysis of focus-group transcripts revealed four emergent themes, including: (1) how the pollution affects their water, soil, and air quality; (2) illness related to pollution; (3) community engagement and empowerment; and (4) suggestions regarding what government officials could do to address this area of need. Building upon the prior research regarding environmental justice, human flourishing, and the definition of nurturing environments, suggestions are made regarding the creation, implementation, and maintenance of project advisory councils focused on issues of environmental justice. Community advocacy and empowerment as well as community and scientific partnerships are imperative to alleviate problems associated with environmental justice.

Are Physical Activity and Sedentary Behavior Associated With Cancer-Related Symptoms in Real Time?: A Daily Diary Study.

BACKGROUND: Few studies have examined the real-time and dynamic relationship between lifestyle behaviors and treatment-related symptoms. OBJECTIVE: The aim of this study was to examine the associations of daily physical activity and sedentary behavior with symptom burden, pain interference, and fatigue among patients who were undergoing active cancer treatment. METHODS: A total of 22 (mean age = 57 years; 73% women; 55% Black) cancer patients were recruited from a local hospital and reported a daily diary of physical activity, sedentary behavior, symptom burden, pain interference, and fatigue over 10 days. Adjusted mixed-effects models were used to examine all associations. RESULTS: Body mass index moderated the relationship between physical activity and symptom burden (γ = 0.06, P < .01) and physical activity and fatigue (γ = 0.09, P < .05). On days where physical activity was higher than average, symptom burden and fatigue scores were lower among patients who had lower body mass index values. Also, age moderated the relationship between sedentary behavior and symptom burden (γ = -0.04, P < .05); on days where patients sat more, symptom burden was lower among patients who were younger than the average age. CONCLUSIONS: Overall, these data indicate that treatment-related symptoms vary daily within cancer patients and that physical activity may alleviate treatment-related symptoms for leaner patients. Larger samples and objective assessments of physical activity and sedentary behavior are needed to validate our results. IMPLICATIONS FOR PRACTICE: Oncology nurses may be in the best position to promote physical activity during treatment as a strategy to manage symptom burden.

Implementing a Protocol to Address Risk for Burnout Among Mental Health Professionals.

BACKGROUND: The magnitude for potential burnout is enormous. The Centers for Disease Control and Prevention, Center for Addiction and Mental Health, and Substance Abuse and Mental Health Services Administration reported diagnoses of psychiatric and substance use disorders are at an all-time high for physicians, psychiatrists, nurses, social workers, and psychologists. OBJECTIVE: Reduce the potential for burnout among outpatient mental health clinicians and staff. METHOD: Develop an agency wellness protocol utilizing evidence-based interventions to reduce the potential for clinician and staff burnout. RESULTS: Survey data indicated low to moderate levels of burnout and depersonalization. Staff and clinician recommendations provided during feedback sessions were incorporated with evidence-based interventions to establish a wellness protocol. CONCLUSION: Implementing evidence-based interventions in a wellness protocol may reduce the potential for clinician and staff burnout.

Evaluating the Use of High-Reliability Principles to Increase Error Event Reporting: A Retrospective Review.

OBJECTIVE: Assess the relationship between educating caregivers about high-reliability principles and reporting of potential adverse safety events. BACKGROUND: Persuading caregivers to report potential safety events is challenging. Learning high-reliability principles may help caregivers identify and report potential safety problems. METHODS: Event reports submitted by caregivers 6 months before and after high-reliability training were examined for event types, event significance, and shift when events occurred. χ Tests assessed relationships between variables. RESULTS: The number and type of caregiver event reports before and after training were not significantly different; however, clinical process error reports significantly decreased (χ = 9.251, P = .003). There was a significant difference in reports submitted by day and night shifts (χ = 5.942, P = .02). CONCLUSIONS: Trends suggest staff report actual, rather than potential, events regardless of training. Further research is needed to determine what motivates caregivers to report safety concerns.

Evaluation of the Pronouncement of Death Policy Implementation and Outcomes: Implications for Advanced Practice Nursing.

In 2011, the Veterans Health Administration mandated that Veterans Affairs (VA) Medical Centers develop and implement a policy that allowed registered nurses (RNs) and advanced practice registered nurses (APRNs) to pronounce the death of residents who die in Veterans Affairs community living centers, previously known as nursing homes, provided that there is a written do-not-resuscitate order in their medical record. The purpose of this quality improvement project was to determine the extent to which the implementation of the RN/APRN death pronouncement policy affected death pronouncement time for residents who die after 5 PM and before 7:30 AM, on weekends and holidays. This project is significant because the previous physician-only death pronouncement policy was found to cause unnecessary delays in death pronouncement. A chart review of the medical records of all veterans' deaths pronounced by physicians 3 years before the implementation of the policy and 4 years after the RN/APRN policy was reviewed and implemented. The data analysis was conducted using descriptive analysis. A significant difference was found in the results (P < .05). The maximum for prepolicy deaths was 125 minutes. The maximum for postpolicy deaths was 7 minutes. The results supported the assumption that RN/APRN pronounced death without delay.

Clinician accountability in a primary care clinic time-interval blood pressure measurements study: Practice implications.

BACKGROUND: Accurate blood pressure measurements (BPM) are important, as clinicians are tasked daily with using such measurements to make clinical diagnoses and patient care judgments. Research studies and controlled trials hold such measurements to a higher standard than everyday clinical practice. OBJECTIVE: The aim of this study was to evaluate difference in BPM outcomes of individuals in a clinic setting when clinicians collect BPM as usual vs BPM after 5- (USPSTF recommendation) and 10- minute (study unique intervention) timed rest interval. METHODS: A repeated-measures design was used to examine individual BPMs at the intervals of baseline, after a 5-minute rest interval post-baseline, and after a 10-minute rest interval post-baseline. Results Pairwise comparisons indicated that baseline SBP was the highest when compared to SBP measured at both 5- and 10-minutes post-baseline. SBP measured at 5-minutes was also significantly higher compared to SBP collected at 10-minutes post-baseline (ps < .05). For DBP, the repeated-measures ANOVA indicated that there was no significant difference across BPMs, F(2,198) = 1.25, p = .29. CONCLUSIONS: Results from this study revealed that implementing a 5-minute rest interval before BPMs are taken in a clinic setting produces a "clinically observable" reduction in the overall mean systolic BPs as seen at both 5- and 10-minute BPM intervals. It is important for all healthcare clinicians to recognize the importance of accurate BPM and the need to encourage better regulated BPM standard in everyday practice.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity.

BACKGROUND AND OBJECTIVES: This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. RESEARCH DESIGN AND METHODS: Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). RESULTS: Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). DISCUSSION AND IMPLICATIONS: PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

A pilot study of prostate cancer knowledge among African American men and their health care advocates: implications for screening decisions.

PURPOSE: Prostate cancer (PCa) is the second leading cause of cancer death in U.S. men [American Cancer Society (ACS)], most often affecting men age 50 and older. The study provides information about factors that influence rural AA men in their decision to undergo screening for PCa with a specific focus on PCa knowledge among AA men and their health care advocates. METHODS: A longitudinal quantitative study included AA males and their health care advocates. Participants were from three Alabama rural counties. Measures included demographics, PCa knowledge, decisional conflict, and health literacy scales. RESULTS: Thirty-three men with a mean age of 54.61 and 35 health care advocates were included in the study. PROCASE Knowledge Index measure results indicate a lack of PCa knowledge among both male primary participants and their advocates. The knowledge of AA men in the study was somewhat low, with individuals correctly answering approximately six questions out of ten at multiple time points (baseline total M = 6.42, SD = 1.52). Decisional conflict responses at 12 months (38.64) were lower than at baseline (M = 62.88) and at 6 months (M = 58.33), p < .005. CONCLUSION: Health care advocates of the 33 male participants were usually women, spouses, or significant others, supporting the vital role women play in men's health specifically in rural underserved communities. Low overall PCa knowledge, including their risk for PCa, among these participants indicates a need for PCa and screening educational interventions and dialogue that include males and their significant others.

A Qualitative Study to Determine Barriers for Prostate Cancer Screening in Rural African-American Men.

INTRODUCTION: African-American men have higher rates of prostate cancer and more advanced cancer when diagnosed than men of other ethnicities. PURPOSE: To explore the perspectives and shared experiences of rural African-American men when it comes to interactions with healthcare providers, shared decision-making, and information on prostate cancer and screening. METHODS: A convenience sample of African-American men in four rural counties in the southeastern United States agreed to participate. Semi-structured interviews of 43 men were conducted in patients' homes, classrooms, offices, and local churches. Lincoln and Guba's (1985) naturalistic approach was used. RESULTS: Analysis of the rich, in-depth narratives gleaned from these African-American men revealed three themes: 1) limitations in knowledge of prostate cancer, 2) poor patient/provider communication, and 3) deficient health literacy skills. CONCLUSIONS: Participants' perspectives about limited knowledge regarding PCa, variation in provider-patient communication and the finding of low health literacy skills expand knowledge, inform clinical practice, and provide evidence for further investigation to better provider communication and patient education concerning PCa and decision making in this population.

Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting.

IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association's Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail clinic setting. Use of the DRT or similar risk assessment tools in the retail clinic setting can aid in the identification of people at risk for type 2 diabetes.

Differences in Colorectal Cancer Risk Knowledge Among Alabamians: Screening Implications.

PURPOSE/OBJECTIVES: To explore differences in cancer risk knowledge and colorectal cancer (CRC) knowledge among adults in Alabama. 
. RESEARCH APPROACH: Telephone interviews were conducted using an 80-item questionnaire that included 14 demographic questions and 26 general questions regarding healthcare quality, sources of health-related information, and cancer fears and risk factors. Also included were 40 questions dealing with CRC perceptions and experiences (asked only of respondents aged 50 years or older).
. SETTING: A standard random-digit-dialed statewide telephone survey, targeting adult residents of Alabama. Interviews were conducted during about seven weeks in 2012. 
. PARTICIPANTS: 1,024 participants, including 615 who were aged 50 years or older. Most of the participants identified as Caucasian.
. METHODOLOGIC APPROACH: A secondary data analysis using data from a CRC screening survey of Alabama residents conducted in 2012 by the University of South Alabama polling group via telephone.
. FINDINGS: Knowledge of general cancer risk factors predicted disagreement with the statement, "There is nothing you can do to avoid getting cancer," and disagreement with the statement, "Only people with signs or symptoms should be screened for CRC." Binary logistic regression showed that those higher in CRC risk knowledge were more likely to have been screened for CRC. 
. CONCLUSIONS: Knowledge of general cancer risk factors may increase self-efficacy. In addition, individuals with increased knowledge of colorectal cancer risk factors were more likely to participate in CRC screening. 
. INTERPRETATION: Nurses play an instrumental role in addressing CRC, a preventable and treatable cancer. An opportunity exists for nurses and other healthcare providers to develop culturally appropriate educational interventions to increase knowledge related to CRC, risk factors, and screening, particularly among those who are at increased risk. This education needs to occur in clinical practice and within the community.

PROMOTING CANCER SCREENING AMONG RURAL AFRICAN AMERICANS: A SOCIAL NETWORK APPROACH.

Obstacles that prevent rural African Americans (AAs) from regularly engaging in cancer screening were explored, and a theoretical approach was formulated utilizing social networks as a culturally sensitive form of health promotion. Disparities in cancer morbidity and mortality continue to exist between AAs and Caucasians in the United States. Often rural dwellers are further disadvantaged because of a potential lack of medical and financial resources and low health literacy. Social networks provide an existing framework where health concerns are discussed and health interventions in cancer screening can strengthen or encourage relevant health behaviors in rural AAs and other disadvantaged populations.

An Evidence-Based Protocol for Protecting Newborns From Pertussis.

Pertussis, also known as whooping cough, is a vaccine-preventable disease most commonly affecting infants and young children. This article describes a project to develop an evidence-based protocol for implementing prenatal vaccination and cocooning in a major medical center in Georgia.

A Clinical Protocol for the Assessment of Obesity: Addressing an Epidemic.

The purpose of this article is to discuss the importance of addressing obesity, a national epidemic. Furthermore, the paper focuses on the utilization of a clinical practice protocol for identifying patients who are obese or at risk for obesity in the primary care setting. The practice protocol includes guidelines for assessment, documentation, and a consistent educational intervention for the identified priority population. The rapidly increasing incidence of obesity in our primary care practices supports the need for evidence-based approaches to ensure consistent assessment and documentation, thereby increasing the potential for weight management and obesity reduction.

Memory and cancer: a review of the literature.

The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.

The emerging Doctor of Education (EdD) in instructional leadership for nurse educators.

The nursing faculty shortage is directly related to the ongoing shortage of nurses. As a result of many nursing faculty retiring, the discipline of nursing is losing its most experienced educators. The need is great for programs that will increase access and prepare nurse educators. Doctorate degrees for nurses have evolved in myriad ways. Discussions over the nature of doctoral education for the preparation of nurse educators are at the forefront of debates in nursing education. In response to National League for Nursing (2007; Core competencies of nurse educators, http://www.nln.org/profdev/corecompletter.htm) and Institute of Medicine (2010; The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press, http://thefutureofnursing.org/IOM-Report) calls to increase the number of nursing faculty, the colleges of nursing and education at a major university have combined to establish a collaborative doctoral program. This article describes the historical evolution of the nursing doctorate degrees and the development and implementation of the EdD in Instructional Leadership for Nurse Educators.

Gender differences in colon cancer treatment.

UNLABELLED: Abstract Background: Despite women suffering a disproportionate burden of colon cancer mortality, few studies have examined gender differences in evidence-based treatment, especially in poorer states like Alabama. OBJECTIVE: To describe colon cancer treatment in older patients diagnosed in Alabama by gender. METHODS: Colon cancer patients 65 years and older diagnosed in 2000-2002 were identified from the Alabama Statewide Cancer Registry (N=1785). Treatment was identified from Medicare claims for 1999-2003. Outcomes were (1) receipt of surgery and adjuvant 5-fluorouracil chemotherapy (5FU) and (2) 5FU treatment duration (0-4, 5-7, and >7 months). Generalized Estimating Equation (GEE) models were used to determine significant gender differences, adjusting for clustering at the reporting hospital level, and controlling for race, age, stage, comorbid conditions, census tract-level socioeconomic variables, and adverse chemotherapy effects (when analyzing 5FU duration). RESULTS: Overall, 93.9% of the patients received surgery. Of stage II-III patients undergoing surgery, 60.4% stage III and 25.6% stage II patients received 5FU. Compared with men, women were more likely to have surgery (95.5% vs. 92.2%, p=0.003), less likely to have 5FU (38.6% vs. 45.2%, p=0.02), and more likely to have 0-4 months of 5FU (32.9% vs. 24.9%, p=0.05). Gender differences were significant for having chemotherapy (adjusted odds ratio [aOR] 0.78, confidence interval [CI] 0.61-1.00, p=0.049), but not for having 0-4 months of 5FU when adjusting for adverse effects (aOR 1.36, CI 0.95-1.94, p=0.09). CONCLUSIONS: In Alabama, some gender differences in stage-specific colon cancer treatment are worth further scrutiny.