Statewide Assessment of North Carolina Nurse Practitioners' Knowledge of and Attitudes Toward Suicide Awareness and Prevention: Protocol for a Statewide Mixed Methods Study.

BACKGROUND: Suicide is a major public health problem, which affects people of all ages and ethnicities. Despite being preventable, the rates of suicide have steadily climbed (more than a third) over the past 2 decades. OBJECTIVE: Nurse practitioners (NPs) must be responsible for recognizing suicide risk and providing appropriate treatment referrals in addition to having an important role in suicide prevention. The reasons why NPs may not pursue suicide prevention training are their lack of suicide awareness and prevention, limited experiences with suicidal patients, and the stigma associated with mental illness. Before we begin to address the gaps within suicide awareness and prevention skills, we need to first examine NPs' knowledge of and attitudes (stigma) toward suicide prevention. METHODS: This study will comprise a mixed methods approach. First, quantitative data will be collected using the Suicide Knowledge and Skills Questionnaireand the Suicide Stigma Scale (Brief version) questionnaire. An email will be sent to the NPs explaining the purpose of the study. If they consent, they will click on a link to access the surveys on a secure site. In our previous research with this sample, email reminders to nonresponders after 2 and 4 weeks were sent. The quantitative component will be used to inform the qualitative interviews of this study. The Suicide Knowledge and Skills Questionnaire is a 13-item questionnaire comprising 2 subscales: suicide knowledge and suicide skills. All questions are rated on a 5-point Likert scale (1=completely disagree to 5=completely agree). The survey has been shown to differentiate between those with suicide training and those without and has a Cronbach α score of .84. The Suicide Stigma Scale (Brief version) is a 16-item survey that assesses stigma regarding suicide. The items are measured on a 5-point Likert scale (1: strongly disagree to 5: strongly agree) and have a Cronbach α of .98. RESULTS: This study was funded by the Faculty Research Grants program through the Office of the Vice Chancellor for Research and Economic Development at the University of North Carolina at Charlotte. Institutional review board approval was obtained in April 2022. Recruitment occurred between summer and winter 2022. Interview conduction began in December 2022 and will conclude in March 2023. Data will be analyzed during spring and summer 2023. CONCLUSIONS: The study results will add to the literature on NPs' knowledge of and attitudes (stigma) toward suicide prevention. It represents a first step in addressing gaps within suicide awareness and prevention skills, among NPs in their respective practice settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/39675.

International nurse education research collaboration during the COVID-19 pandemic: Researchers' perspectives.

BACKGROUND: International research collaborations in nurse are increasing. However, collaborations in international nurse education research are limited compared to clinical nurse studies. This paper presents the experiences of seven investigators of a multi-country study while conducting collaborative research among nurse students across five continents. OBJECTIVE: This paper aims to describe the experiences and challenges of conducting an international nurse education research and to propose recommendations to enhance these collaborative research experiences. METHODS: Narrative perspectives from nurse educators on the international nurse collaborative experience were described in this discussion paper. RESULTS: International collaboration in nurse education research was a positive and enriching experience. While several challenges were experienced by the collaborators, the presence of facilitating factors, benefits of collaboration, and opportunities for personal and professional growth and development outweighed the challenges. Team leader attributes, active engagement, commitment, genuine interest, and cultural sensitivity are essential in creating a successful international nurse research project. CONCLUSION: International collaborative nurse research fosters expansion of nurse knowledge through sharing of expertise and development of culturally diverse perspectives.

Nurse practitioner model of care for the initiation of pre-exposure prophylaxis: A case series study.

AIM: The purpose of this study was to create and implement a nurse practitioner model of care in the initiation of a pre-exposure prophylaxis (PrEP) protocol with African American men who have sex with men (MSM). DESIGN: A case series design was used to implement the protocol for a nurse practitioner PrEP-based model of care. METHODS: The participatory, evidence-based, patient-focus process (PEPPA) framework and the American Association of Colleges of Nursing (AACN) Doctoral Essentials for Advanced Practice were aligned to guide the development, implementation, and evaluation of this advanced practice role in an urban medical clinic. RESULTS: Seven African American HIV-negative MSM who received treatment under the nurse practitioner PrEP-based model of care had increased PrEP knowledge and medication adherence and did not contract a sexually transmitted infection. CONCLUSIONS: New models of care can be created to meet the Getting to Zero HIV initiative of reducing rates of HIV infections with MSM.

Translation and Validation of Nursing Students' Knowledge and Attitudes of Lesbian, Gay, Bisexual, Transgender Health Concerns Survey in the Greek Language.

Nursing students have limited knowledge of providing quality care to lesbian, gay, bisexual, and transgender individuals. The aim of this study was to explore the psychometric properties of the Nursing Students' Knowledge of and Attitudes toward Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Concerns (NKALH) survey as well as to examine whether sociodemographic variables may affect attitudes toward LGBT individuals. In this cross-sectional study which was carried out from January−March 2022, 258 nursing students from two Greek universities completed the NKALH. For survey translation, the procedure of forward and backward translation was followed. Construct validity, reliability, and internal consistency were explored via confirmatory factor analysis, the test−retest reliability method, and Cronbach's alpha index. The correlation between the dimensions of the attitude subscale was used to explore convergent validity. Analyses were carried out with the Statistical Package for the Social Sciences (SPSS), version 26.0. The level of significance was set at <0.05. Confirmatory factor analysis confirmed that the attitude subscale consists of three dimensions (Comfortable, Responsibility, Willingness to Care). The Pearson test (r) revealed strong correlations between two measurements (Comfortable r = 0.932, p < 0.001, Responsibility r = 0.938, p < 0.001, and Willingness to Care r = 0.915, p < 0.001), indicating good reliability. The Cronbach's alpha index of the total scale was 0.783, highlighting its good internal consistency. Bivariate analysis revealed that sexual orientation, religion, and age are related to knowledge and attitudes toward LGBT individuals. The NKALH survey is a valid and reliable tool to measure the knowledge and attitudes of Greek nursing students on the health concerns of LGBT individuals.

A Brief Educational Pre-exposure Prophylaxis Intervention in an Infectious Disease Clinic: Protocol for a Case Series Study.

BACKGROUND: Black men who have sex with men (BMSM) remain the highest group infected with HIV despite treatment with medications known as pre-exposure prophylaxis (PrEP). PrEP in combination with safer sex practices has shown efficacy in preventing HIV infection. Despite awareness campaigns, PrEP uptake remains low among BMSM. While brief educational interventions have value in fast-paced clinical settings with limited appointment times, a brief PrEP educational intervention has not been initiated with BMSM in a fast-paced outpatient infectious disease clinic in North Carolina. OBJECTIVE: The purpose of this study was to examine the effect of initiating a brief PrEP educational intervention to reduce HIV infection rates in BMSM in a fast-paced infectious disease clinic delivered by a doctoral-prepared nurse practitioner. METHODS: This case-series study uses a brief educational intervention to develop and pilot-test a brief PrEP educational uptake intervention with BMSM. The participants met with the nurse practitioner at 3 different time points: baseline, 4 weeks later (first visit), and at the 3-month follow-up (second visit). We used a pretest-posttest design to examine the primary outcomes of PrEP knowledge, medication adherence, and sexually transmitted infection outcomes. RESULTS: Due to the COVID-19 pandemic, the recruitment process was delayed. From November 1, 2019, to August 30, 2021, a total of 7 participants consented to participate in the study. Data analysis will be completed by the end of September 2022. We will submit a manuscript for publication consideration by December 2022. CONCLUSIONS: Brief educational interventions delivered in a fast-paced infectious disease clinic have the potential to increase PrEP awareness and knowledge, medication adherence, and decreased rates of sexually transmitted diseases in BMSM. This protocol will contribute to the literature on the development of brief PrEP educational interventions and has the potential to be generalized to other populations (eg, women and adolescents). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/33093.

The Impact of Technology on Adolescent Sexual and Reproductive Needs.

The call for articles for the International Journal of Environmental Research and Public Health Special Issue "Using mobile technology to promote adolescent sexual and reproductive health (SRH)" was proposed to identify efforts to provide adolescent SRH services during the COVID-19 pandemic [...].

A Text Messaging-Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study.

BACKGROUND: African Americans have a higher incidence rate of heart failure (HF) and an earlier age of HF onset compared to those of other racial and ethnic groups. Scientific literature suggests that by 2030, African Americans will have a 30% increased prevalence rate of HF coupled with depression. In addition to depression, anxiety is a predictor of worsening functional capacity, decreased quality of life, and increased hospital readmission rates. There is no consensus on the best way to treat patients with HF, depression, and anxiety. One promising type of treatment-cognitive behavioral therapy (CBT)-has been shown to significantly improve patients' quality of life and treatment compliance, but CBT has not been used with SMS text messaging reminders to enhance the effect of reducing symptoms of depression and anxiety in racial and ethnic minority patients with HF. OBJECTIVE: The objectives of our study are to (1) adapt and modify the Creating Opportunities for Personal Empowerment (COPE) curriculum for delivery to patients with HF by using an SMS text messaging component to improve depression and anxiety symptoms, (2) administer the adapted intervention to 10 patients to examine the feasibility and acceptability of the approach and modify it as needed, and (3) examine trends in depression and anxiety symptoms postintervention. We hypothesize that patients will show an improvement in depression scores and anxiety symptoms postintervention. METHODS: The study will comprise a mixed methods approach. We will use the eight steps of the ADAPT-ITT (assessment, decision, administration, production, topical expert, integration, training, and testing) model to adapt the intervention. The first step in this feasibility study will involve assembling individuals from the target population (n=10) to discuss questions on a specific topic. In phase 2, we will examine the feasibility and acceptability of the enhanced SMS text messaging intervention (TXT COPE-HF [Texting With COPE for Patients With HF]) and its preliminary effects with 10 participants. The Beck Depression Inventory will be used to assess depression, the State-Trait Anxiety Inventory will be used to assess anxiety, and the Healthy Beliefs and Lifestyle Behavior surveys will be used to assess participants' lifestyle beliefs and behavior changes. Changes will be compared from baseline to end point by using paired 2-tailed t tests. An exit focus group (n=10) will be held to examine facilitators and barriers to the SMS text messaging protocol. RESULTS: The pilot feasibility study was funded by the Academy for Clinical Research and Scholarship. Institutional review board approval was obtained in April 2021. Data collection and analysis are expected to conclude by November 2021 and April 2022, respectively. CONCLUSIONS: The study results will add to the literature on the effectiveness of an SMS text messaging CBT-enhanced intervention in reducing depression and anxiety among African American patients with HF. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/32550.

A Comparison of the Process and Content of Sexual Communications Among African American Adolescent Children Living in Parent and Grandparent Headed Families.

INTRODUCTION: The process of parental sexual communication has been shown to delay the sexual debut of adolescents; however, few studies have focused on extended family members such as grandparents. The purpose of this study was to compare the process and content of sexual communications among African-American adolescent children living in parent or grandparent headed families. METHODS: A secondary analysis of two de-identified datasets from 80 African-American adolescents was conducted. RESULTS: Findings indicated that there were no significant differences in the sexual communication process in relation to facilitators p= 0.38 and barriers p =0.23 with the discussions. There were however significant differences with adolescents' attitudes (p = 0.04) and feelings regarding sexual abstinence (p =0.01), HIV prevention (p= 0.002) and teen pregnancy (p= 0.010). DISCUSSION: Researchers can use the results of this study as a beginning point in examining the sexual communication process in grandparent-headed families.

Mobile phone, social media usage, and perceptions of delivering a social media safer sex intervention for adolescents: results from two countries.

Purpose: Rates of sexually transmitted infections among adolescents remain high in the United States and Botswana. Mobile phone density rates in Botswana exceed those of the United States. Yet, in both countries, safer sex information continues to be delivered primarily via face-to-face curricula such as Becoming a Responsible Teen and Living as a Safe Teen. While social media shows promise as a medium for delivering risk-reduction information to youth, few studies have been conducted in either country to assess its effectiveness. This study examines adolescents in both countries, their mobile phone and social media usage, and their perceptions of safer sex interventions delivered via social media. Design and methods: Three focus groups were conducted with 28 adolescents 13-18 years of age who lived in the United States (n=14) and Botswana (n=14). Data analysis was ongoing, which informed the data collection process. After the first group, no additional revisions were made to the focus group protocol. An abridged method of analyzing the data was employed. Results: Adolescents in all groups discussed peer pressure and connectedness with mobile phones and social media and had general knowledge of STIs and HIV. The adolescents agreed that adaptation of risk reduction interventions for mobile phone and social media delivery was warranted, and they shared ideas for adaptation. Practice implications: Our findings provide a starting point for researchers interested in developing a social media intervention with global implications for sexual health promotion.

An Examination of Twitter Data to Identify Risky Sexual Practices Among Youth and Young Adults in Botswana.

Botswana has the third highest rate of HIV infection, as well as one of the highest mobile phone density rates in the world. The rate of mobile cell phone adoption has increased three-fold over the past 10 years. Due to HIV infection rates, youth and young adults are the primary target for prevention efforts. One way to improve prevention efforts is to examine how risk reduction messages are disseminated on social media platforms such as Twitter. Thus, to identify key words related to safer sex practices and HIV prevention, we examined three months of Twitter data in Botswana. 1 December 2015, was our kick off date, and we ended data collection on 29 February 2016. To gather the tweets, we searched for HIV-related terms in English and in Setswana. From the 140,240 tweets collected from 251 unique users, 576 contained HIV-related terms. A representative sample of 25 active Twitter users comprised individuals, one government site and 2 organizations. Data revealed that tweets related to HIV prevention and AIDS did not occur more frequently during the month of December when compared to January and February (t = 3.62, p > 0.05). There was no significant difference between the numbers of HIV related tweets that occurred from 1 December 2015 to 29 February 2016 (F = 32.1, p > 0.05). The tweets occurred primarily during the morning and evening hours and on Tuesdays followed by Thursdays and Fridays. The least number of tweets occurred on Sunday. The highest number of followers was associated with the Botswana government Twitter site. Twitter analytics was found to be useful in providing insight into information being tweeted regarding risky sexual behaviors.

Self-care management strategies used by Black women who self-report consistent adherence to antihypertensive medication.

BACKGROUND: Black women in the USA have the highest prevalence rate of hypertension (HTN) contributing to a higher risk of organ damage and death. Research has focused primarily on poorly controlled HTN, negative belief systems, and nonadherence factors that hinder blood pressure control. No known research studies underscore predominantly Black women who report consistent adherence to their antihypertensive medication-taking. The purpose of this study was to describe self-care management strategies used by Black women who self-report consistent adherence to their antihypertensive medication and to determine the existence of further participation in lifestyle modifications, such as eating a healthy diet and increasing physical activity. METHODS: Using a qualitative descriptive design, four focus groups with a total of 20 Black women aged 25-71 years were audio-taped. Transcripts were analyzed using qualitative content analysis. Participants were included in the study if they scored perfect adherence on the medication subscale of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. RESULTS: Medication adherence was predicated on three themes: HTN experience, involvement with treatment regimen, and a strong motivated mentality. Black women would benefit from treatment approaches that are sensitive to 1) diverse emotional responses, knowledge levels, and life experiences; 2) two-way communication and trusting, collaborative relationships with active involvement in the treatment regimen; 3) lifestyle modifications that focus on health benefits and individual preferences; and 4) spiritual/religious influences on adherence. CONCLUSION: The use of self-care management strategies to enhance antihypertensive medication adherence is key to adequate blood pressure control and the reduction of cardiovascular events. This study provides preliminary insight for future research to develop interventions to aid those Black women who struggle with medication adherence and are disproportionately impacted by HTN.

Examination of Lesbian, Gay, Bisexual, and Transgender Health Care Content in North Carolina Schools of Nursing.

BACKGROUND: Nursing students require academic and clinical training in preparation for the increased demand for culturally competent care. One group that is in need of culturally knowledgeable health care providers is lesbian, gay, bisexual, and transgender (LGBT) individuals. The purpose of this study was to examine how LGBT health care content is integrated into North Carolina schools of nursing curricula and to examine the existence of specific LGBT policies. METHOD: A survey was mailed to 70 deans and directors of RN programs in North Carolina. RESULTS: Over 90% of the schools indicated that LGBT health care issues were taught in the curricula. The majority of the content was taught as an "other" course (37%). More than two thirds of the schools devoted less than 5 hours teaching LGBT content. CONCLUSION: LGBT health care content is being taught, yet the presence of specific LGBT practice policies is basically nonexistent. [J Nurs Educ. 2017;56(4):223-226.].

African American Transgender Women's Individual, Family, and Organizational Relationships: Implications for Nurses.

Guided by the relational cultural theory, we conducted a qualitative study to examine the relationship experiences of African American transgender women living in North Carolina. A convenience sample of 15 transgender women participated in the study. Semi-structured interviews, guided by an investigator-developed interview guide, were used to explore the personal experiences of transgender women on individual, family, and organizational levels. The findings provide a scheme for understanding the process through which transgender women's relationships hinder or enhance their ability to connect with individuals, family, and organizations. Nurses can use these findings to better understand the connectedness that occurs or does not occur in transgender women's relationships and provide culturally competent care to empower them to become resilient.

Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic.

OBJECTIVES: The purpose was to pilot the feasibility and impact of a 4-week transition-to-care program on quality of life for heart failure patients. BACKGROUND: The transition from the acute care to the outpatient setting has been shown to be a critical time with heart failure patients. METHODS: A pre- and post-test design was used. Quality of Life, measured by the Minnesota Living with Heart Failure Questionnaire, and hospital readmissions were the outcomes. A convenience sample of 50 persons was recruited into a multidisciplinary transition-to-care program for heart failure patients following hospitalization. Thirty-six (72%) completed the study. RESULTS: There was a significant improvement in quality of life. Men reported greater improvement in physical symptoms and less emotional distress when compared to women. Only 2 participants were readmitted within 30 days. CONCLUSIONS: Study findings support improved quality of life and decreased readmission rates following a multidisciplinary transition-to care program for heart failure patients.

Using mobile technology to promote safe sex and sexual health in adolescents: current practices and future recommendations.

Youth and young adults (19-24 years of age) shoulder the burden of sexually transmitted infections accounting for nearly half of all new infections annually. Mobile technology is one way that we have reached this population with safer sex information but challenges exist with the delivery process. The literature between 2010 and 2015 was reviewed for data on safe sex and sexual health information delivered using mobile cell phone devices. A search for relevant databases revealed that 17 articles met our inclusion criteria. Findings suggest that mobile cell phone interventions are an effective mode for delivering safe sex and sexual health information to youth; those at the highest risk may not be able to access cell phones based on availability and cost of the text messages or data plans.

Generational differences in the sexual communication process of African American grandparent and parent caregivers of adolescents.

PURPOSE: This study assessed generational differences in the sexual communication process between 40 African American parent and 40 grandparent caregivers of adolescent children. DESIGN AND METHODS: The study reports findings from a secondary analysis of data from two databases. The HIV Risk Reduction Survey was used to examine the sexual communication process. RESULTS: Grandparents wanted to talk about sex and had open sexual communications, while parents valued sexual abstinence and had limited communications. PRACTICE IMPLICATIONS: Based on the findings, healthcare providers and programs need to recognize that differences do exist between parents and grandparents with sexual communications.

Sexual communication needs of African American families in relation to faith-based HIV prevention.

In this study, we examined the sexual communication needs of African-American parents and their adolescent children in relation to faith-based HIV prevention. Eight focus groups of 10 members each were conducted, four with parents and four with adolescents. The sessions were audiotaped and transcribed verbatim. Findings indicated that some African Americans are not knowledgeable about sexually transmitted infections. The sample members were not in agreement about when sexual communications should begin, yet the majority felt that the church was the best place to have these discussions. Healthcare professionals can use the findings from this study to assist faith-based organizations to strengthen the sexual communication skills of African-American families.

Text-messaging-enhanced HIV intervention for African American adolescents: a feasibility study.

We examined the feasibility and acceptability of an HIV prevention intervention for African American adolescents delivered via mobile cell phones and looked at intervention-related changes in beliefs and sexual behaviors. We used a longitudinal one-group comparison design with data collected at three points. Forty adolescents, 13-18 years old, participated in the Becoming a Responsible Teen intervention followed by the delivery of daily multimedia messages for 3 months. The mobile-cell-phone enhanced intervention was feasible and acceptable to the participants. Greater HIV knowledge, improved attitudes toward condoms, and increased perceived HIV risk scores were observed with older adolescents (16-18 years old). Behavior trends showed a decrease in the number of times participants reported engaging in unprotected sexual intercourse over the previous 2 months. Mobile-cell-phone multimedia-text-messaging boosters tested in this study provided preliminary evidence of efficacy of the enhanced HIV prevention intervention for African American youth.

Adolescents' perceptions of a mobile cell phone text messaging-enhanced intervention and development of a mobile cell phone-based HIV prevention intervention.

PURPOSE: This study examined African American adolescents' perceptions of a mobile cell phone (MCP)-enhanced intervention and development of an MCP-based HIV prevention intervention. DESIGN AND METHODS: One focus group was conducted with 11 adolescents who participated in the Becoming a Responsible Teen Text Messaging project. RESULTS: Adolescents said they benefited from the MCP-enhanced approach and were receptive to the idea of developing an MCP-based intervention. PRACTICE IMPLICATIONS: Nurses can use the findings of this report as a starting point in examining the development of MCP-based sexuality education with parents and adolescents.