Engaging Older Adults in a Depression Simulation Experience.

BACKGROUND: Clinical simulation has become integral to curriculum development in nursing programs. This innovative intervention was designed to explore the efficacy of high-fidelity standardized patient (SP) simulation to increase students' ability to recognize signs of depression and to improve therapeutic communication. METHOD: During a 12-month period, prelicensure nursing students (n = 136) in a midwestern nursing program participated in this simulation experience. Volunteer retirees residing in the college-affiliated retirement village played the roles of depressed patients. RESULTS: Students' self-evaluations indicated this experience was a positive learning experience. All of the students indicated the experience improved their knowledge about depression; 91% stated their confidence in interviewing improved, and 89.7% indicated improvement in their communication skills. CONCLUSION: Use of SP simulation in mental health nursing is an effective strategy to bolster confidence, improve depression screening skills, and enhance therapeutic communication skills. [J Nurs Educ. 2022;61(4):209-212.].

Factors Associated with Self-Reported Hypertension Among Black Women.

A Black woman has an 85.7% chance of developing hypertension in her lifetime, yet she is less likely to be optimally treated. The purpose of this research report is to describe the factors associated with self-reported hypertension in a sample of Black women. A descriptive study was conducted using a researcher-developed survey. Responses were obtained from 201 adult Black women from 19 to 92 years of age. Descriptive and comparative analyses were performed. The frequency of self-reported hypertension in the sample was low (n = 54, 27%). The self-report hypertension group was significantly older (p < 0.05) and obese (61%). There were significant associations between self-report hypertension and greater income (c2 = 9.24, p = 0.002, f = 0.232), self-report hypertension and higher education (c2 = 5.66, p = 0.017, phi = 0.182), and self-report hypertension and not having Medicaid (c2 = 5.05, p = 0.025, f = 0.174). APRNs should stress the importance of routine health screenings and healthy lifestyle behaviors in accordance with patient needs.

Parenting African American Children With Autism: The Influence of Respect and Faith in Mother, Father, Single-, and Two-Parent Care.

PURPOSE: Parents are the most significant contributor to care of children with autism spectrum disorder (ASD), and as such research on African American parenting in ASD is conspicuously absent. Findings relevant to parenting are discussed from a study with urban African American families caring for children with ASD. DESIGN: An ethnonursing study was conducted with 24 African American family members of children with ASD and 28 professionals. Data were analyzed and reported as themes. FINDINGS: Two universal themes of were found of respect and faith in God and family that influenced parental care. Two diverse themes of mother's watchful care and father's protective care, along with differences in feelings of isolation and dependence on supports were found among single- and two-parent families. Discussion and Practice Implications: When health care professionals increase their knowledge and understanding of cultural practices in the parental care of children with ASD, they provide health care that is culturally congruent.

Equipping African American Clergy to Recognize Depression.

Many African Americans (AAs) use clergy as their primary source of help for depression, with few being referred to mental health providers. This study used face-to-face workshops to train AA clergy to recognize the symptoms and levels of severity of depression. A pretest/posttest format was used to test knowledge (N = 42) about depression symptoms. Results showed that the participation improved the clergy's ability to recognize depression symptoms. Faith community nurses can develop workshops for clergy to improve recognition and treatment of depression.

African American families on autism diagnosis and treatment: the influence of culture.

Cultural factors such as health care access and autism spectrum disorder (ASD) symptom interpretations have been proposed as impacting delayed diagnosis and treatment for African American children with ASD. A qualitative study of urban African American families caring for their child with autism was conducted with 24 family members and 28 ASD professionals. Cultural caring meant families protected their child from harm including potential or actual distrustful encounters, and took action for their child and community to optimize their child's health and address the knowledge deficits of ASD within their community. Families and professionals believed cultural influences delayed families' receiving and seeking appropriate health care for the African American child with ASD affecting timely autism diagnosis and treatment.

African American Clergy and Depression: What they know; What they want to know.

UNLABELLED: Nearly 40% of African Americans use clergy as their primary source of help with depression. However, less than half of African American clergy are trained in counseling. OBJECTIVES: 1) to examine how African American cler recognize depression and 2) identify what they need to more effectively identify and address depression in their congregants. DESIGN: This was a descriptive, quantitative study using a Personal Profile Questionnaire and a Mental Health Counseling Survey. RESULTS: Sixty-five clergy completed the data collection tools; approximately 50% had some training in counseling. The majority could identify signs of depression. Eighty-one percent stated they needed additional education about depression and access to referral resources. CONCLUSIONS: If clergy take an active role in addressing the issue of depression and establishing liaisons with mental health professionals the stigma associated with depression could be greatly reduced, and individuals might enter into treatment earlier thus improving their quality of life.

Conditions that influence a primary care clinician's decision to refer patients for depression care.

The objective of this study was to identify conditions that influence primary care clinicians' referral decisions related to depression care. Forty primary care clinicians (15 general internists, 10 nurse practitioners, and 15 family practice physicians) were included in this study. The clinicians participated in semistructured interviews and completed two quantitative instruments (with 33 items on depression treatment decision making and 32 items on provider attitudes toward psychosocial care). Data analysis revealed that several conditions influence a clinician's decision to refer a depressed patient to a mental health specialist: the patient's resources, the clinician's comfort in prescribing antidepressants and counseling patients with depression, and familiarity with a mental health specialist and practice environment. The decision to refer a patient with depression to a mental health specialist is a complex process involving the clinician, patient, and practice-related issues. Understanding these relationships may provide strategies to improve depression care management and lead to the design of depression care quality-improvement interventions that accommodate primary care practice context. The findings from this study suggest a need to increase mental health training opportunities for primary care clinicians to strengthen their skills and comfort level in managing depressed patients and encourage the development of relationships between primary care clinicians and mental health specialists to facilitate timely and accessible mental health care for patients.

Reinvention of depression instruments by primary care clinicians.

PURPOSE: Despite the sophisticated development of depression instruments during the past 4 decades, the critical topic of how primary care clinicians actually use those instruments in their day-to-day practice has not been investigated. We wanted to understand how primary care clinicians use depression instruments, for what purposes, and the conditions that influence their use. METHODS: Grounded theory method was used to guide data collection and analysis. We conducted 70 individual interviews and 3 focus groups (n = 24) with a purposeful sample of 70 primary care clinicians (family physicians, general internists, and nurse practitioners) from 52 offices. Investigators' field notes on office practice environments complemented individual interviews. RESULTS: The clinicians described occasional use of depression instruments but reported they did not routinely use them to aid depression diagnosis or management; the clinicians reportedly used them primarily to enhance patients' acceptance of the diagnosis when they anticipated or encountered resistance to the diagnosis. Three conditions promoted or reduced use of these instruments for different purposes: the extent of competing demands for the clinician's time, the lack of objective evidence of depression, and the clinician's familiarity with the patient. No differences among the 3 clinician groups were found for these 3 conditions. CONCLUSIONS: Depression instruments are reinvented by primary care clinicians in their real-world primary care practice. Although depression instruments were originally conceptualized for screening, diagnosing, or facilitating the management of depression, our study suggests that the real-world practice context influences their use to aid shared decision making-primarily to suggest, tell, or convince patients to accept the diagnosis of depression.

Perceptions of health status among women and men in an urban homeless population.

The rate of homelessness in Cincinnati, Ohio, has more than doubled in size since 1986. Currently there are an estimated 25,000 homeless persons living in the city. Recent surveys indicate that 58% of Cincinnati's homeless people report having no available source of healthcare and use hospital emergency rooms as their primary source of healthcare. To make matters worse, many homeless people avoid available health-care services due to perceptions of the disrespect, rudeness and/or the insensitivity of health-care workers. This study used the Health Perceptions Questionnaire (HPQ) (Ware, 1976) to measure beliefs about prior, current, and future health status in a population of 100 (N = 100) homeless persons. Within this culturally and socially diverse sample, the average score on the General Health Rating Index was 69.73 on a scale of 22-110. Scores on the Prior Health and Resistance to Illness subscales differed significantly by gender, with males having higher mean scores than did females. In addition, scores on the Health Worry subscale differed according to the homeless persons' reported source of healthcare.

Toll-like receptor-4-mediated macrophage activation is differentially regulated by progesterone via the glucocorticoid and progesterone receptors.

Macrophage function has been demonstrated to be subject to modulation by progesterone. However, as this steroid hormone can act through the glucocorticoid receptor as well as the progesterone receptor, the mechanism of action has not been precisely characterized. To determine the mode of action, we compared the ability of progesterone, norgestrel (a synthetic progesterone-receptor-specific agonist) and dexamethasone (a synthetic glucocorticoid receptor agonist) to modulate macrophage function following stimulation of the Toll-like receptor-4 (TLR-4) ligand lipopolysaccharide (LPS). The results demonstrate that following stimulation of TLR-4 with LPS and cotreatment with either progesterone or dexamethasone, but not norgestrel, there is a significant reduction in nitric oxide (NO) production, indicating that this progesterone-mediated effect is through ligation of the glucocorticoid receptor. In contrast, LPS-induced interleukin-12 (IL-12) production could be downregulated by all three steroids, indicating that ligation by progesterone of either the glucocorticoid or the progesterone receptors or both could mediate this effect. While progesterone downmodulated NO-mediated killing of Leishmania donovani by activated macrophages in vitro, most probably via the glucocorticoid receptor, it had little effect on Toxoplasma gondii growth in these cells. This would suggest that progesterone-mediated increased susceptibility to T. gondii during pregnancy is more likely to be related to the ability of the hormone to downregulate IL-12 production and a type-1 response utilizing the progesterone as well as the glucocorticoid receptors.

The culture of pregnancy and infant care in African American women: an ethnographic study.

In Hamilton County, Ohio, the infant mortality rate for African American infants in 2002 was 18.1 per 1,000 live births compared with 14.4 for the United States. It is essential to engage community residents and leaders in identifying the underlying cultural factors contributing to this disparity. The purpose of the study was to explore the cultural contexts of prenatal and infant care practices among African American women of childbearing age living in an urban community located in Hamilton County, Ohio. This was an ethnographic community-based participatory research study. Seven participants were recruited for the study. Family support from mothers and sisters in obtaining needed resources related to pregnancy and child care emerged as the central theme. A strong family-based social network was core to the culture of pregnancy and infant care for these women. Nurses should consider developing family-centered interventions to reduce disparity in infant health.

Self-advocacy in health care decision-making among elderly African Americans.

The purpose of this study was to identify factors that influence the self-advocacy expressions of elderly African Americans. The sample consisted of 100 elderly African Americans who responded to a series of questions about the characters in seven vignettes. Each vignette told a story about an elderly African American in a health care dilemma. The health care dilemma became more complex as the age of the main character increased. In addition, each participant completed the Multi-dimensional Health Locus of Control Scale and the Philadelphia Geriatric Morale Scale. Statistically significant differences were found between males and females and educational levels on the Powerful Others Subscale. A statistically significant relationship was found between high self advocacy expressions and marital status. Twenty-four percent (24.1%) of the participants rated as having high self-advocacy expressed dissatisfaction with their health status. The findings demonstrate some of the complexities involved in the study of elderly African Americans particularly related to the major impact of life experiences on their lives today.

A case study in the use of community-based participatory research in public health nursing.

There is growing demand for research using a community-based participatory (CBPR) approach. CBPR requires that the academic research team actively partner with community members and stakeholders in the entire research process. The community members are full partners with the researchers in relation to the development and implementation of the study, analysis of the data, and dissemination of the findings. The purpose of this article is to review four basic principles of CBPR and provide an example of how these CBPR principles were used in an ethnographic study related to the culture of African American infant health. In the pilot study, CBPR provided the framework for recruitment and retention of participants, ongoing data analysis, and dissemination of findings. Using CBPR provided the researchers an introduction into the selected community. Community members served as key informants about the culture of the community and provided access to potential participants. The community partners contributed to analysis of emerging themes and in the dissemination of findings to the community, stakeholders, and the scientific community. CBPR provides opportunities for community health nurse researchers to conduct research with vulnerable populations and sets the stage for implementing evidenced-based nursing interventions in the community.

A study of the level of knowledge about diabetes management of low-income persons with diabetes.

Diabetes education has proven to be an effective intervention for the management of diabetes. Persons with lower education levels, the majority of whom have low incomes, receive less diabetes self-management education (DSME) than their peers. This study compared the diabetes knowledge level of low-income adults who did not have a high school diploma or general equivalency diploma with those who did. We conducted a survey among residents of 4 low-income neighborhoods in Cincinnati, Ohio, using a cross-sectional descriptive design. Surveys included information related to diabetes self-management and level of education. The only questions for which there was a significant difference between the 2 groups were those pertaining to the causes and treatment of hypoglycemia. Survey results were used to validate the need for a DSME program for low-income adults in Cincinnati, Ohio. A DSME program was developed specifically for persons with low literacy.

Plant active components - a resource for antiparasitic agents?

Plant essential oils (and/or active components) can be used as alternatives or adjuncts to current antiparasitic therapies. Garlic oil has broad-spectrum activity against Trypanosoma, Plasmodium, Giardia and Leishmania, and Cochlospermum planchonii and Croton cajucara oils specifically inhibit Plasmodium falciparum and Leishmania amazonensis, respectively. Some plant oils have immunomodulatory effects that could modify host-parasite immunobiology, and the lipid solubility of plant oils might offer alternative, transcutaneous delivery routes. The emergence of parasites resistant to current chemotherapies highlights the importance of plant essential oils as novel antiparasitic agents.