Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden.

OBJECTIVE: To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS: The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS: The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION: NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.

The Inflection Point Model: A Model to Explore the Hidden Burdens of Non-Cancerous Genitourinary Conditions.

OBJECTIVE: To propose a conceptual model to identify points along the condition course where actions or inaction affect downstream burdens of non-cancerous genitourinary conditions (NCGUC). MATERIALS AND METHODS: The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened an interdisciplinary meeting to comprehensively consider the burdens of NCGUCs. Subsequently, the authors met monthly to conceptualize the model. RESULTS: Inflection points (IP) describe time points during a condition course that are sensitive to change. Our proposed Inflection Point Model (IPM) helps conceptualize burden/benefit trade-offs in any related decision and provides a platform to identify the downstream aggregate burden of a NCGUC across multiple socio-ecological levels at a single time point, which may be summed across the condition course to measure cumulative burden. Two personae demonstrate the utility of this model to better understand impacts of 2 common NCGUCs. CONCLUSION: The IPM may be applied in multiple contexts: narrowly to explore burden of a single NCGUC at a single IP; or more broadly, to address multiple conditions, multiple IPs, or multiple domains/levels of social ecology. Applying the IPM may entail combining population data describing prevalence of NCGUCs, associated behaviors, and resulting outcome patterns that can be combined with suitable mathematical models to quantify aggregate and cumulative burden. The IPM challenges stakeholders to expand from the individual to include broader levels of social ecology. Application of the IPM will undoubtedly identify data gaps and research needs that must be fulfilled to delineate and address the burden of NCGUCs.

Innovation in Health Policy Education: Examples From Jonas Policy Scholars.

In the decade since the Institute of Medicine published the Future of Nursing report, the development of a pipeline of doctorally prepared nursing leaders proficient in research, leadership, teaching, and practice has been one of great successes. The investment of Jonas Philanthropies, in collaboration with donors and foundation partners, has supported scholarships to more than 1,000 scholars nationwide. Scholars are prepared to lead health care reform in education, practice, and leadership. This article shares four examples of creative approaches to teaching health policy with students and professionals who may inspire similarly creative approaches to prepare future health policy leaders.

How to try this: Assessment of transient urinary incontinence in older adults.

Urinary incontinence in older adults is associated with an increased risk of institutionalization, as well as with urinary tract infections and depression. Transient urinary incontinence arises suddenly, lasts less than six months, and results from reversible causes. Many caregivers erroneously consider urinary incontinence to be inevitable in older adults, especially in hospitalized patients. Failure to identify and respond to transient urinary incontinence may lead to established incontinence and to other poor outcomes after hospital discharge. A bladder diary and a mnemonic are two methods nurses can use to assess for transient urinary incontinence and its treatable underlying causes. For a free online video showing nurses using these methods, go to http://links.lww.com/A311.

Improving knowledge and attitudes toward older adults through innovative educational strategies.

Our country's rapidly growing older adult population represents the core business of health care; however, few nurses are adequately prepared to care for their unique needs. This is caused, in part, by the limited attention paid by nursing educators to incorporating basic gerontological nursing principles into undergraduate programs. During the last 7 years, the American Association of Colleges of Nursing, through the generous support of the John A. Hartford Foundation, has led several initiatives to improve gerontological nursing education in baccalaureate programs. This article describes innovative educational strategies successfully implemented by three nursing programs--New York University, Tuskegee University, and University of Rhode Island--to increase knowledge and improve attitudes of nursing students in caring for older adults. Successful strategies include a long-term care guide, a senior mentor experience, student assignments addressing diversity issues, student debates, critical reflective journalizing, and an evaluation tool for measuring student attitudes. These strategies are readily reproducible and assist faculty to easily integrate gerontological nursing content into the curriculum while simultaneously enhancing student attitudes and knowledge.