Health Impact of Racism-Based Experiences Among Black African Immigrant Adults in the United States: An Integrative Review.

Racism-based experiences among Black African immigrants in the United States are a growing concern due to the prevalence of these events and risk for negative health (mental, behavioral, and physical) outcomes. This integrative review appraised published studies (2012-2023) addressing the relationship between racism-based experiences and adverse health for Black African immigrants. Articles were identified using structured search terms in several databases (APA PsycINFO, CINAHL, PubMed, Web of Science), Google Scholar, and citation mining. A total of fourteen studies met the inclusion criteria. Studies found a significant positive association between racism-based experiences and adverse mental (n = 9), behavioral (n = 3), and physical (n = 2) health outcomes. Racism-based experiences appear to have mental, behavioral, and physical health consequences for Black African immigrant adults. Given the growing population of Black African immigrants in the United States, more work is needed to elucidate the relationship between racism-based experiences and negative health outcomes.

Creating Space: A Resilience Room for Nursing Students.

ABSTRACT: Employer-based wellness interventions for health care providers are popular within acute care settings. A new intervention is a resilience room or serenity room, a specialized breakroom designed to promote relaxation. This article describes the implementation of a resilience room in an undergraduate, prelicensure nursing program.

One-week radiology boot camp for pre-clerkship medical students: A novel format improving image interpretation and confidence.

RATIONALE AND OBJECTIVES: To measure change in radiology knowledge, confidence in radiology skills, and perceptions pertaining to radiology following a one-week boot camp elective for undergraduate medical students. MATERIALS AND METHODS: A five-day comprehensive radiology boot camp was developed including sessions on image interpretation, procedural skills, and appropriate image ordering. A multiple-choice quiz was administered before and after the elective, utilizing radiology questions from the validated AMSER STARS database. Additionally, a pre- and post-elective survey was administered assessing radiology career interest, confidence in radiology-based skills, and the potential ability of radiology-based skills to increase confidence in specialties other than radiology. Responses from the assessments were analysed using paired t-tests. RESULTS: 15 students enrolled in the course and 14 completed all assessments. The average score on the quiz increased from 50.1% to 66.0% (p<0.001). On the post-elective survey, the average student confidence score increased by more than one point on a six-point Likert scale in each of radiographic interpretation (p=0.004), ultrasound interpretation (p=0.0002), CT/MRI interpretation (p=0.02), general radiology knowledge including procedural skills (p=0.0001), and appropriate image ordering (p=0.004). Average student satisfaction with the elective was 8.1 out of 10. CONCLUSION: A one-week radiology boot camp for pre-clerkship medical students improved radiology knowledge and confidence in radiology skills, showing potential for this format to meet the demand for increased radiology content in undergraduate training. Students indicated that confidence in radiology knowledge would increase confidence on non-radiology clerkship rotations, highlighting the importance of how a one-week radiology bootcamp can impact both future radiology and non-radiology clerkship experiences.

A Multisite Study of a Quality Improvement Teaching Strategy to Build Competency.

BACKGROUND: Quality improvement (QI) is an essential part of nursing education. Although there are robust examples of teaching strategies for QI, there is a distinct lack of research on effective strategies for teaching QI in nursing education. METHOD: This multisite study included students from six nursing programs. A treatment fidelity plan was developed and followed to ensure consistency for implementation of the study and data collection. A quasiexperimental, nonpaired, pre- and posttest study design was used to examine changes in student perspectives of QI after participating in a QI teaching strategy. Pre- and posttest questions were mapped to the American Association of Colleges of Nursing's Essentials subcompetency statements for QI. RESULTS: A total of 254 pre- and 116 posttest responses were included for analysis. Significance (p = .05) was found at the beginning level within three questions. CONCLUSION: Findings from this study indicate beginning-level students can benefit from a competency-based QI learning activity. [J Nurs Educ. 2024;63(1):38-42.].

Modifiable factors contributing to belongingness of undergraduate nursing students in the clinical learning environment: An exploratory study.

BACKGROUND: Belongingness has been tied to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment, but there is limited literature on specific factors that promote these important feelings of acceptance and value alignment. OBJECTIVES: This study aimed to assess demographic characteristics, program/clinical structure factors, and modifiable clinical setting factors that may impact feelings of belongingness in U.S. undergraduate nursing students in the clinical learning environment. DESIGN: A cross-sectional survey design was used to assess the relationship between demographics, program/clinical structure factors, and modifiable clinical setting factors and levels of belongingness using the U.S. version of the Belongingness Scale - Clinical Placement Experience. SETTING: A national study was conducted via the National Student Nurses Association database from December 2022 to January 2023. PARTICIPANTS: 759 volunteer undergraduate nursing students in the U.S. who had completed at least one clinical course. METHODS: An online survey was disseminated to assess demographic factors, program/clinical structure factors, students' perceptions on the frequency of occurrence and perceived value of modifiable clinical setting factors (including clinical format, clinical site, relationship and interpersonal, and miscellaneous factors), and to measure levels of belongingness experienced. RESULTS: Bivariate analyses revealed one statistically significant program/clinical structure factor (p <.001) and 10 statistically significant modifiable clinical setting factors (p <.001) that contribute to belongingness. The findings also support the use of the U.S. version of the BES-CPE as a reliable and valid instrument. CONCLUSIONS: Results demonstrate the importance of fostering belongingness in undergraduate nursing students in the clinical learning environment and, for the first time, extrapolate qualitative findings from the literature into the identification of factors that contribute to these critical feelings of inclusion. There are immediate implications for nursing educators and a rich foundation for future intervention research is proposed.

Just Culture: Nursing Students Transition to Practice-a Longitudinal Study.

BACKGROUND: Although just culture is reportedly integrated across education and practice, little is known about how perceptions may change across time as students transition from prelicensure education to registered nurse in the practice setting. PURPOSE: The purpose of this study was to describe and compare just culture perceptions of registered nurses at 2 time points: (1) as prelicensure students and (2) as new graduate nurses with a minimum of 6 months of experience. METHODS: Utilizing the Just Culture Assessment Tool for Nursing Education (JCAT-NE) and the Just Culture Assessment Tool (JCAT), this within-subject, longitudinal study measured just culture perceptions across time. RESULTS: Although there was no statistically significant change in total scores across time, 8 individual items demonstrated statistically significant change. CONCLUSIONS: Students use the knowledge, skills, and attitudes about just culture taught in prelicensure education as new graduate nurses. However, findings reveal areas where the practice environment has altered perceptions of just culture.

Physical and Mental Health Outcomes of Black Emerging Adults with Community Violence Exposure: An Integrative Review.

Community violence exposure (CVE) and its health impact is a public health crisis. Violent crime has steadily increased over recent years and has disproportionately affected Black communities. Emerging adulthood (18-29 years old) is a vulnerable period of development and Black emerging adults may be at increased risk for negative physical and mental health consequences from CVE. This integrative review was conducted to evaluate available evidence on health outcomes in Black emerging adults exposed to CVE. This review appraised published studies (2012-2022) addressing physical and mental health outcomes of Black emerging adults with CVE. Articles were identified using structured search terms in several databases (CINAHL, PubMed, PsycInfo, and Web of Science), a gray literature search, and citation mining. A total of 177 studies were identified for screening and 19 studies met inclusion criteria and were included in the review. The majority of studies found a significant positive association between CVE and adverse mental (n = 12) and physical (n = 7) health outcomes. CVE appears to have both mental and physical health consequences for Black emerging adults. Given that violent crime disproportionately increased in Black communities and Black people are more likely to develop chronic health conditions at younger ages, more work is needed to elucidate the relationship between CVE and health outcomes.

Centralized Triage of Suspected Coronary Artery Disease Using Coronary Computed Tomographic Angiography to Optimize the Diagnostic Yield of Invasive Angiography.

Background: Coronary computed tomographic angiography (CCTA) is preferable to invasive coronary angiography (ICA) for coronary artery disease (CAD) diagnosis in elective patients without known CAD. Methods: We conducted a nonrandomized interventional study involving 2 tertiary care centres in Ontario. From July 2018 to February 2020, outpatients referred for elective ICA were identified through a centralized triage process and were recommended to undergo CCTA first instead of ICA. Patients with borderline or obstructive CAD on CCTA were recommended to undergo subsequent ICA. Intervention acceptability, fidelity, and effectiveness were assessed. Results: A total of 226 patients were screened, with 186 confirmed to be eligible, of whom 166 had patient and physician approval to proceed with CCTA (89% acceptability). Among consenting patients, 156 (94%) underwent CCTA first; 43 (28%) had borderline/obstructive CAD on CCTA, and only 1 with normal/nonobstructive CAD on CCTA was referred for subsequent ICA against protocol (99% fidelity). Overall, 119 of 156 CCTA-first patients did not have ICA within the following 90 days (i.e., 76% potentially avoided ICA, due to the intervention). Among the 36 who underwent ICA post-CCTA per protocol, 24 had obstructive CAD (66.7% diagnostic yield). If all patients who were referred for and underwent ICA at either centre between July 2016 and February 2020 (n = 694 pre-implementation; n = 333 post-implementation) had had CCTA first, an additional 42 patients per 100 would have had an obstructive CAD finding on their ICA (95% confidence interval = 26-59). Conclusion: A centralized triage process, in which elective outpatients referred for ICA are instead referred for CCTA first, appears to be acceptable and effective in diagnosing obstructive CAD and improving efficiencies in our healthcare system.

Contexte: La coronarographie par tomodensitométrie (coro-TDM) est préférable à la coronarographie invasive chez les patients sans coronaropathie connue chez qui le diagnostic d'une coronaropathie n'est pas urgent. Méthodologie: Nous avons réalisé une étude interventionnelle non randomisée dans deux centres de soins tertiaires en Ontario. Les patients ambulatoires pour qui une coronarographie invasive non urgente a été demandée entre juillet 2018 et février 2020 ont été recensés par un processus centralisé de triage et se sont fait recommander de subir d'abord une coro-TDM. Les patients qui présentaient une co-ronaropathie obstructive ou dont les résultats se trouvaient tout juste à la limite de ce diagnostic lors de la coro-TDM se faisaient recommander une coronarographie invasive subséquente. L'acceptabilité de l'intervention, sa fidélité et son efficacité ont été évaluées. Résultats: Au total, 226 patients ont été sélectionnés et 186 ont été jugés admissibles. Parmi ces derniers, 166 ont accepté de subir la coro-TDM recommandée par le médecin (acceptabilité de 89 %). Parmi les patients ayant donné leur consentement, 156 (94 %) se sont d'abord soumis à une coro-TDM, et 43 (28 %) présentaient une coronaropathie obstructive ou des résultats limites selon cet examen. Seulement un patient ne présentant pas de coronaropathie ou présentant une coronaropathie non obstructive à la coro-TDM a été orienté vers une coronarographie invasive subséquente, contrairement au protocole (fidélité de 99 %). En tout, 119 des 156 patients s'étant d'abord soumis à une coro-TDM n'ont pas eu à subir une coronarographie invasive dans les 90 jours suivants (76 % d'entre eux ont potentiellement évité une coronarographie invasive grâce à cette première intervention). Parmi les 36 patients qui ont subi une coronarographie invasive après la coro-TDM, comme le recommandait le protocole, 24 présentaient une coronaropathie obstructive (rendement diagnostique de 66,7 %). Si tous les patients qui ont été orientés vers une coronarographie invasive et qui se sont soumis à cet examen dans l'un ou l'autre des centres entre juillet 2016 et février 2020 (n = 694 avant l'instauration; n = 333 après l'instauration) avaient d'abord passé une coro-TDM, une coronaropathie obstructive aurait été décelée lors de la coronarographie invasive chez 42 patients de plus par tranche de 100 patients (intervalle de confiance à 95 % : 26 à 59). Conclusion: Le recours à un processus de triage centralisé permettant de faire d'abord passer une coro-TDM aux patients ambulatoires dans une situation non urgente qui doivent subir une coronarographie invasive semble être un moyen acceptable et efficace de diagnostiquer la coronaropathie obstructive et d'améliorer l'efficacité dans notre système de santé.

Impact of School Shootings on Adolescent School Safety, 2009-2019.

Objectives. To examine the impact of school shootings on indicators of adolescent school safety in the United States. Methods. We linked 2009-2019 Youth Risk Behavior Survey data on 211 236 adolescents aged 14 to 18 years from 24 school districts with data on high school shootings from the Center for Homeland Defense and Security. We conducted 2-way fixed-effects logistic regression models to assess the impact of shootings on self-report of 3 indicators of school safety: avoiding school because of feeling unsafe, carrying a weapon at school, and being threatened or injured with a weapon at school. Results. High school shootings were associated with adolescents having 20% greater odds of avoiding school because of feeling unsafe (adjusted odd ratio [AOR] = 1.20; 95% confidence interval [CI] = 1.11, 1.29) than those who had not. Findings were slightly attenuated in sensitivity analyses that tested exposure to shootings at any school in the district or state. High school shootings were associated with a statistically nonsignificant (P = .08) elevated risk of carrying a weapon at school (AOR = 1.11; 95% CI = 0.99, 1.25). Conclusions. The negative ramifications of school shootings extend far beyond the event itself to adolescents' concerns about school safety. (Am J Public Health. 2023;113(4):438-441. https://doi.org/10.2105/AJPH.2022.307206).

A Psychometric Analysis of the Health Literate Health Care Organization-10 Item Questionnaire.

The concept of a Health Literate Healthcare Organization (HLHO) is a relatively new approach to health literacy that moves the focus from the individual patient to the overarching health care system. The HLHO-10 questionnaire was developed internationally to assess the 10 Attributes of HLHOs as described by participants of the Institute of Medicine Roundtable on Health Literacy. The purpose of this study was to establish reliability and validity of the HLHO-10 among a sample of United States hospitals. Reliability and validity were established through assessing the factor structure for the HLHO-10 and psychometric evaluation. The HLHO-10 was found to be reliable with a Cronbach's alpha of .855 and a two-factor structure was revealed through exploratory factor analysis. Additional research is needed to further validate use of the HLHO-10 in the U.S., but initial findings of this emerging tool are promising and timely as the issue of health literacy comes to the forefront of U.S. health care systems and associated regulatory agencies. [HLRP: Health Literacy Research and Practice. 2022;6(2):e137-e141.].

Leadership, Teamwork, and Collaboration: The Lived Experience of Conducting Multisite Research Focused on Quality and Safety Education for Nurses Competencies in Academia.

AIM: The aim of this study was to explore facilitators and barriers to conducting a multisite national study in nursing academia unsupported by grant funding. BACKGROUND: Scholarship focused on the Quality and Safety Education for Nurses (QSEN) competencies stimulates opportunities for research and collaboration among nurse educators and clinicians. Twelve members of the QSEN Academic Task Force collaborated on a multisite study of the effectiveness of a QSEN teaching strategy and published the findings. METHOD: A descriptive phenomenological reflective approach using Kim's critical reflective inquiry model was used to explore the lived experiences of the original study investigators. Data were analyzed using Colaizzi's phenomenological reduction. RESULTS: Findings revealed seven facilitators and one overarching barrier to conducting academic research projects of this scope. CONCLUSION: Participants found that strong leadership, a commitment to teamwork and collaboration, and a shared interest were critical to conducting a successful national study across academic settings.

Exploratory factor analysis of the Just Culture Assessment Tool for nursing education.

BACKGROUND: Just culture has been identified as a vital component of safety culture by national and international organisations. In a just culture, emphasis is not placed on blaming individuals for errors but rather on examining personal and system processes that can best support safety and prevent reoccurrence. Although those in the practice arena have worked to implement the concepts of just culture, the same is not true in nursing education, leaving nursing students lacking the pre-requisite knowledge, skills and attitudes to implement just culture in practice on graduation. AIMS: Assessment of this phenomena is the essential first step to align nursing education with practice in promoting just culture as a mechanism for patient safety. The purpose of this paper is to further refine the Just Culture Assessment Tool-Nursing Education through exploratory factor analysis. METHODS: The Just Culture Assessment Tool-Nursing Education was adapted from the Just Culture Assessment Tool, an instrument created for the practice setting. Validity and reliability were established for the Just Culture Assessment Tool-Nursing Education in a study of 800 nursing students to assess their perceptions and understanding of just culture with their nursing programmes. Using the previously conducted data, an exploratory factor analysis was conducted. RESULTS: Factor analysis supports six subscales, similar to that of the Just Culture Assessment Tool. However, individual items were loaded into different subscales. All subscales demonstrated good reliability. Factor analysis supported further refinement of two items to improve the instrument's ability to capture data. CONCLUSIONS: Perceptions of just culture differ between experienced providers and nursing students; nursing students have less experience with reporting errors. Factor analysis of Just Culture Assessment Tool-Nursing Education items demonstrated these differences, supporting modification of items by the instrument developers. An 'if' statement for students to consider their possible actions rather than experience was added to two items to better capture data from nursing students when completing the assessment.

Nursing Students' Perceptions of Just Culture in Nursing Programs: A Multisite Study.

BACKGROUND: While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education. PURPOSE: The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia. METHODS: Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs. RESULTS: The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ[2] = 25.09, P < .001). CONCLUSIONS: The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

Development and Validation of the Just Culture Assessment Tool for Nursing Education.

BACKGROUND: Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance. PURPOSE: The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings. METHODS: A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students. RESULTS: The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75). CONCLUSIONS: The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.

Validation and in-field testing of a new on-site qPCR system for quantification of Legionella pneumophila according to ISO/TS 12869:2012 in HVAC cooling towers.

Legionella pneumophila, found in engineered water systems such as HVAC cooling towers, poses a significant public health risk. Culture, though routinely used to quantify L. pneumophila, has several disadvantages including long turnaround time, low sensitivity, and inter-laboratory variability. In this study, we validated the performance of an on-site quantitative polymerase chain reaction (qPCR) detection system for L. pneumophila in accordance with International Standards Organization Technical Specification 12869:2012. We evaluated specificity, limit of detection and quantification, and calibration curve linearity. Additionally, we evaluated whole system recovery and robustness using samples taken from taps and evaporative cooling towers. We then compared the system's performance against laboratory culture and laboratory qPCR across 53 cooling towers in a 12-week in-field study. We found that concordance between on-site qPCR and culture was both laboratory- and site/sample-dependent. Comparison of laboratory qPCR with on-site qPCR revealed that laboratory results were highly variable and showed little concordance. Some discordance may be explained by time delay between sample collection and testing ('shipping effect') which may lead to inaccurate reporting. Overall, our study highlights the value of on-site qPCR detection of L. pneumophila, demonstrates that laboratories are prone to misreporting results due to shipping effects, and reveals significant discordance between laboratory qPCR and culture.

The HLKES-2: Revision and Evaluation of the Health Literacy Knowledge and Experiences Survey.

BACKGROUND: Low health literacy impacts individual health and the health care system. The Health Literacy Knowledge and Experience Survey (HLKES) was created to evaluate preparedness of nurses to provide health literate care. However, the instrument was developed a decade ago and needs revision. The purpose of this study was to update and shorten the HLKES into a feasible, valid, and reliable instrument. METHOD: The HLKES was refined into a 14-item instrument (10 knowledge questions and four experience questions). Expert review was obtained. Face validity was assessed, and pilot and field testing with students was conducted. RESULTS: Scale content validity index was 0.95, and individual questions demonstrated appropriate item difficulty and discrimination. Cronbach's alpha coefficient was .565 for the 10 multiple choice questions and .843 for the four Likert-type questions, indicating good reliability. CONCLUSION: A reliable and valid HLKES-2 was developed to evaluate health literacy knowledge and experiences in a contemporary setting. [J Nurs Educ. 2019;58(2):86-92.].

Pharmacogenomics and Psychiatric Nursing.

The treatment of mental illness is often done on a trial-and-error basis and achieving therapeutic benefits from a medication is not always guaranteed. Pharmacogenomics explores the role of gene-gene interactions and interindividual responses to a drug and may be promising in the guidance of pharmacotherapeutic options. In the present study, the impact of pharmacogenomic testing in management of mental health medication was investigated. Participants were identified at a local outpatient mental health facility through convenience sampling. Retrospective chart review included medication history, adverse drug reactions, pharmacogenomic history, and demographic data including insurance coverage. Chart review focused on six months pre- and post-pharmacogenomic for a comparison with the patient serving as their own control. Results indicate a high incidence of alterations in two specific cytochrome enzymes, CYP2D6 and CYP2C19. In total, 82% of the sample had variations with CYP2D6, while 64% of individuals had variations with CYP2C19. In total, 91% of patients tested received Medicaid or Medicare. Post-pharmacogenomic testing, all patient drug regimens were modified, and all reported less adverse side effects. Moreover, advanced practice nurse providers educated patients about the availability of genetic testing, initiated testing and provided care based on findings. These results demonstrate the utility of genetic testing in the realm of mental health. Future directions involve further exploring the benefits of pharmacogenomic testing in this vulnerable population.

Constructive Feedback Teaching Strategy: A Multisite Study of Its Effectiveness.

AIM: The study purpose was to describe students' perceptions of feedback after participating in a teaching strategy designed to foster a view of feedback as an opportunity for improvement. BACKGROUND: Although delivering and receiving constructive feedback are essential to the role of the professional nurse, feedback has been identified as a trigger for incivility in academia and practice. METHOD: Twelve nurse educators from the Quality and Safety Education for Nurses Academic Task Force, located at nine schools of nursing across the nation, implemented a presentation about giving and receiving constructive feedback in junior and senior courses. RESULTS: Five hundred twenty-three students submitted a total of 985 posts or essays in response to viewing the presentation; seven themes were identified. CONCLUSION: Viewing this teaching strategy enabled nursing students to develop an awareness of the opportunity that constructive feedback presents for professional development, self-improvement, teamwork and collaboration, and patient safety.

Combination of IAP Antagonists and TNF-α-Armed Oncolytic Viruses Induce Tumor Vascular Shutdown and Tumor Regression.

Smac mimetic compounds (SMCs) are anti-cancer drugs that antagonize Inhibitor of Apoptosis proteins, which consequently sensitize cancer cells to death in the presence of proinflammatory ligands such as tumor necrosis factor alpha (TNF-α). SMCs synergize with the attenuated oncolytic vesicular stomatitis virus (VSVΔ51) by eliciting an innate immune response, which is dependent on the endogenous production of TNF-α and type I interferon. To improve on this SMC-mediated synergistic response, we generated TNF-α-armed VSVΔ51 to produce elevated levels of this death ligand. Due to ectopic expression of TNF-α from infected cells, a lower viral dose of TNF-α-armed VSVΔ51 combined with treatment of the SMC LCL161 was sufficient to improve the survival rate compared to LCL161 and unarmed VSVΔ51 co-therapy. This improved response is attributed to a bystander effect whereby the spread of TNF-α from infected cells leads to the death of uninfected cells in the presence of LCL161. In addition, the treatments induced vascular collapse in solid tumors with a concomitant increase of tumor cell death, revealing another mechanism by which cytokine-armed VSVΔ51 in combination with LCL161 can kill tumor cells. Our studies demonstrate the potential for cytokine-engineered oncolytic virus and SMCs as a new combination immunotherapy for cancer treatment.