Patient-Centered Care: Lifestyle Modifications Among Adult Participants With Dyslipidemia.

BACKGROUND: Dyslipidemia, a risk factor for coronary heart disease (CHD), is a burden due to morbidity, mortality, and CHD-related costs. Patient-centered clinical interventions improve adherence to lifestyle modifications among adults with dyslipidemia. OBJECTIVE: The study's objectives were to (a) promote participants' safety through increased knowledge on the risks and prevention of CHD, (b) help participants identify their own barriers to lifestyle modifications, and (c) develop strategies with participants on individualized plans to adhere to healthy living. METHODS: Seventeen participants with dyslipidemia enrolled in a quality improvement over 6 weeks. Participants were from one employee health clinic in Mississippi. Measures are Heart Disease Fact Questionnaire (HDFQ), Framingham Tool, pre- and poststudy lipid panels, and physiologic measurements. Interventions include motivational technique-led interviews as a tool for behavioral change. RESULTS: Pre- and post-HDFQ responses indicated an 18% increase in knowledge attainment because of the patient-centered care interventions. Postinterventions, mean plasma lipid panels were 29% lower, weight loss ranged from 0 to 10.1 pounds, and body mass indexes were 0.4 to 1.2 less. Blood pressures (BPs) preintervention ranged from 120/70 to 159/89. Postinterventions BP ranged from 107/82 to 146/70. CONCLUSIONS: Patient-centered clinical interventions improve management of dyslipidemia through increased knowledge on risks and prevention of CHD and also through finding own barriers to healthy living. IMPLICATIONS: Healthcare providers can make a difference in people's lives through exploring the unhealthy behaviors and discovering ways for better health outcomes.

Educational Intervention for Nutrition Education in Patients Attending an Outpatient Wound Care Clinic: A Feasibility Study.

PURPOSE: The purpose of this study was to determine whether nurses could use a structured intervention to educate patients with wounds about foods that promote healing and whether this educational intervention could be provided in a cost-effective manner. DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: The study was conducted at an outpatient wound care center located on a hospital campus in the Southern United States; 3 full-time nurses and 2 nurses employed on part-time status delivered the intervention. METHODS: A nutrition education intervention was developed through collaborative efforts of a registered dietitian and a nurse. A cross-sectional survey design was used to (1) evaluate nurses' perceptions of the intervention and (2) identify barriers to implementation of the intervention. Direct costs related to materials and nursing time required to deliver the intervention were calculated. RESULTS: Participants indicated they were competent to deliver the structured intervention, and all were willing to continue its use. Survey results indicated that nurses believed the intervention was beneficial to their patients and they indicated that patients were responsive to the intervention. The intervention was found to be low cost ($8.00 per teaching session); no barriers to implementation of the intervention were identified. CONCLUSION: The results of this exploratory study suggest that a structured nutrition education intervention can be provided by nurses in outpatient wound clinics at low cost. Further study is needed to determine the impact of this intervention on nutritional intake and wound healing.

Evaluating Community Health Advisor (CHA) Core Competencies: The CHA Core Competency Retrospective Pretest/Posttest (CCCRP).

Health care and academic systems are increasingly collaborating with community health advisors (CHAs) to provide culturally relevant health interventions that promote sustained community transformation. Little attention has been placed on CHA training evaluation, including core competency attainment. This study identified common CHA core competencies, generated a theoretically based measure of those competencies, and explored psychometric properties of that measure. A concept synthesis revealed five CHA core competencies (leadership, translation, guidance, advocacy, and caring). The CHA Core Competency Retrospective Pretest/Posttest (CCCRP) resulted from that synthesis, which was administered using multiple approaches to individuals who previously received CHA training (N= 142). Exploratory factor analyses revealed a two-factor structure underlying the posttraining data, and Cronbach's alpha indicated high internal consistency. This study suggested some CHA core competencies might be more interrelated than previously thought, and two major competencies exist rather than five and supported the CCCRP's use to evaluate core competency attainment resulting from training.

Integrating Leonardo da Vinci's principles of demonstration, uncertainty, and cultivation in contemporary nursing education.

Nurses today are facing an ever changing health care system. Stimulated by health care reform and limited resources, nursing education is being challenged to prepare nurses for this uncertain environment. Looking to the past can offer possible solutions to the issues nursing education is confronting. Seven principles of da Vincian thinking have been identified (Gelb, 2004). As a follow-up to an exploration of the curiosità principle (Butts & Story, 2013), this article will explore the three principles of dimostrazione, sfumato, and corporalita. Nursing faculty can set the stage for a meaningful educational experience through these principles of demonstration (dimostrazione), uncertainty (sfumato), and cultivation (corporalita). Preparing nurses not only to manage but also to flourish in the current health care environment that will enhance the nurse's and patient's experience.

Getting on Target with Community Health Advisors (GOTCHA): an innovative stroke prevention project.

Health disparities along with insufficient numbers of healthcare providers and resources have created a need for effective and efficient grassroots approaches to improve community health. Community-based participatory research (CBPR), more specifically the utilization of community health advisors (CHAs), is one such strategy. The Getting on Target with Community Health Advisors (GOTCHA) project convened an interdisciplinary team to answer the call from 10 counties in the rural Mississippi Delta area of 'The Stroke Belt' to meet the region's identified health needs, and to impact the health of a disparaged state. This article explores this CBPR project including the community involvement strategies, innovative CHA training curriculum, evaluation plan, and implications to healthcare professionals, particularly nurses.

Innovative strategies for nursing education program evaluation.

Nursing programs are mandated by accreditation bodies to report data significant to program quality and outcomes. The history at one school of nursing in the southern United States revealed the program evaluation committee experienced roadblocks in retrieving such information. Creative approaches were adopted to overcome some of the barriers to program evaluation, including the use of more technological-based approaches to engage alumni who embrace this technology as a way of life. Among the many advantages of these approaches were convenience, ease of administration and analysis, cost effectiveness, and more meaningful data. The advantages far outweighed the few disadvantages incurred, with the most prominent being potential sampling bias.

Compelling teaching with the four Cs: caring, comedy, creativity, and challenging.

The traditional classroom, particularly in nursing, often is stifling to students and teachers. A dynamic co-learning experience creates a potential to move students from merely obtaining knowledge to practice. This article presents an exemplar of the transformative learning process within the nursing education setting. The concepts forming this compelling teaching approach are caring, comedy, creativity, and challenging (the four Cs). Through this innovative teaching method, opportunities are created for authentic co-learning to occur.

The role of community health advisors in community-based participatory research.

Mistrust and fear of research often exist in minority communities because of assumptions, preconceived ideas, and historical abuse and racism that continue to influence research participation. The research establishment is full of well-meaning 'outsider' investigators who recognize discrimination, health disparities, and insufficient health care providers in minority communities, but struggle in breaking through this history of mistrust. This article provides ethical insights from one such 'insider-outsider', community-based participatory research project implemented via community health advisors in the Mississippi Delta. Both community-based participatory research and community health advisors provide opportunities to address the ethical issues of trust, non-maleficence, and justice in minority communities. Implications for ethics-driven nursing research are discussed.