An Integrative Review of the Use of the Individual and Family Self-Management Theory in Research.

The extent of the application of the Individual and Family Self-Management Theory (IFSMT) in research has yet to be determined. The purpose of this analysis was to review the use of the IFSMT in published research and evaluate posited constructs and relationships. Dimensions and categories of the IFSMT and the interrelationships were generally supported in the 77 articles reviewed. A majority focused on self-management of chronic conditions in the adult population. More research on the strength, direction, and interaction of relationships is needed. Defining and exploring social constructs, including race, ethnicity, and gender, should be prioritized in future IFSMT research.

Clinical Nurse Specialist Transition to Practice.

PURPOSE: A quality improvement/evidence-based practice project identified the critical components of clinical nurse specialist (CNS) transition-to-practice (TTP) needs based on the experiences and perceptions of entry-level CNSs (n = 4), experienced CNSs (n = 7), and directors of nursing (n = 6) employed in a tertiary healthcare center. Structured 60- to 90-minute face-to-face discussions were conducted. DESCRIPTION: As knowledge workers, CNSs are critical to investigating, solving, and transforming some of the most challenging current and future healthcare problems. Lack of standardized CNS TTP may result in variable levels of practice, knowledge, skill attainment, and ability to attain interdisciplinary practice competencies. OUTCOMES: Findings included identification of entry-level CNS TTP key components: 16 categories with 8 critical categories identified as imminent needs. Challenges identified included stakeholders' lack of knowledge/understanding of the CNS role and scope; enormous TTP expectations of entry-level CNSs; transdisciplinary relationships and collaboration; leadership culture and collaboration; organizational culture; deliberate practice; and lack of support, resources, and basic needs. CONCLUSION: Critical components for advanced deliberate practice within a CNS TTP program include an organizational culture and subculture that understands and values the CNS, along with tiered sustainable support from preceptors, mentors, and support CNSs across the setting and system.

The Effect of Racism and Discrimination on the Health of Milwaukee's African American Population.

BACKGROUND: This scoping review focuses on the intersections of racism, health, and health care, as well as interventions for the African American population in Milwaukee, Wisconsin-one of the most hypersegregated regions in the country. We investigate what existing research provides about the impact of segregation and racism on health and consider how community setting informs health interventions, practice, and policy. METHODS: We analyzed studies that address racism and health in Milwaukee to assess the state of the science in this area. We searched databases using the terms "African American," "racism," "segregation," and "health." A total of 296 studies resulted, and 54 met the inclusion criteria. RESULTS: Racism is a known determinant of health. However, a lack of research investigating the impact of racism on health in Milwaukee County leaves a knowledge gap necessary for improving health among African American residents. The adverse effects of racism on health are compounded by the social, economic, and policy context of geographic and social segregation that limit access to care and resilience. Themes identified in the review include measures of physical and mental health, community factors related to health (eg, housing, environmental contamination, economic and social exclusion), intervention strategies, and theoretical gaps. DISCUSSION: Professionals must work across disciplines and social sectors to address the effects of racism on the physical and mental health of African American individuals in urban metropolitan environments. Health research and medical interventions in hypersegregated communities must center structural racism in their analysis.

Nurses' Autonomy and Perceived Barriers to Pain Management in Nursing Home Residents.

Nurses' autonomy is essential for optimal pain management in nursing home (NH) residents. However, little is known about nurses' autonomy and how it relates to the issue of unrelieved pain in NH residents in Jordan and beyond. The current descriptive comparative study aimed to compare the prevalence of barriers to pain assessment and management in NH residents, perceived by nurses according to their autonomy level. Participating nurses were found to have low levels of clinical autonomy. A significant difference in the prevalence of perceived barriers to pain assessment and management was found among nurses according to their autonomy level. Findings provide a better understanding of nurses' autonomy and their perceived barriers to pain assessment and management in NH residents. Findings also highlight the significance of nurses' autonomy for the assessment and management of pain in NH residents. [Journal of Gerontological Nursing, 47(8), 45-52.].

Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics.

OBJECTIVE: This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS: This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS: The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each. CONCLUSION: This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.

Association of nurses' level of knowledge and attitudes to ageism toward older adults: Cross-sectional study.

This study aims to examine how the sociodemographic and professional characteristics of nurses in Jordan correlate with their levels of knowledge, attitudes, and ageism toward older adults. Ageism has not been studied in Jordan as it pertains to nurses, so a descriptive, correlational, cross-sectional design, with a convenience sample of 317 Jordanian nurses, using the Fact on Aging Quiz 1, Fraboni Scale of Ageism, and Relating to Older People Evaluation was conducted in January to February 2019. Significant ageism was found, and differences in knowledge, attitudes, and negative ageism vary among nurses by sociodemographic/professional characteristics. Knowledge and attitudes toward older adults significantly correlate with negative ageism which is associated with poor health outcomes for older adults. Our findings reveal that even in a country with high religious observance and close family ties, ageism exists in healthcare settings because of nurses' poor knowledge and attitudes toward older adults. These findings have implications for nursing education, clinical practice, and health policy. Changes across these sectors based on the findings may contribute to reducing ageist practices and improving older adult health outcomes.

Factors related to advance care planning among older African American women: Age, medication, and acute care visits.

OBJECTIVES: Advance care planning (ACP) is linked with high-quality clinical outcomes at the end of life. However, ACP engagement is lower among African Americans than among Whites. In this study, we sought to identify correlates of ACP among African American women with multiple chronic conditions for two reasons: (1) African American women with multiple chronic conditions have high risks for serious illnesses, more intensive treatments, and circumstances that may require substitutes' decision-making and (2) identifying correlates of ACP among African American women can help us identify important characteristics to inform ACP outreach and interventions for this group. METHODS: A cross-sectional survey was conducted with 116 African American women aged ≥50 years who were recruited from the central area of a mid-western city. RESULTS: On average, participants were 64 years old (SD = 9.42). The majority were not married (78%), had less than a college education (50%), and had an annual income of $15,000 (54%). Their mean numbers of chronic conditions and prescribed medications were 3.31 (SD = 1.25) and 8.75 (SD = 4.42), respectively. Fifty-nine per cent reported having talked with someone about their preferences (informal ACP); only 30% had completed a living will or a power of attorney for healthcare (formal ACP). Logistic regression showed that age, the number of hospitalizations or emergency department visits, and the number of prescription medications were significantly correlated with both informal and formal ACP; other demographic and psychosocial characteristics (the knowledge of ACP, self-efficacy, and trust in the medical system) were not. SIGNIFICANCE OF RESULTS: Results of this study suggest a need for targeted, culturally sensitive outpatient ACP education to promote ACP engagement in older African American women, taking into account age, the severity of chronic conditions, and levels of medication management.

Factors Related to Medication Self-Management in African American Older Women.

Individuals with multiple chronic diseases are often prescribed medications for each condition and thus must manage a drug regimen. Medication self-management is challenging for most individuals with chronic diseases, but it can be especially difficult for African American older women. This study investigated how medical mistrust, caregiver role strain, and other relevant variables may be associated with medication self-management behaviors (MSMB) among African American older women, and whether goal congruence and self-efficacy mediated the relationship between the predictor variables and MSMB. A sample of 116 African American older (age >50 years) women from central Milwaukee participated in this correlational, cross-sectional study. Although goal congruence and self-efficacy were not found to act as mediators, the main finding was that goal congruence, self-efficacy, and age predicted 30% of the variance in MSMB. The results suggest that it is essential to strengthen individual self-efficacy, determine the goals that individuals have for their medication regimen, and develop support mechanisms to help patients attain these goals to better manage chronic disease. [Res Gerontol Nurs. 2019; 12(2):71-79.].

Reaching and Supporting At-Risk Community Based Seniors: Results of a Multi-church Partnership.

The purpose of this study was to determine the impact of a nurse-led, church-based educational support group for "at-risk," older African Americans on hospitalization and emergency department use. Study nurses enrolled 81 "at-risk" older adult members of ten churches. Participants completed a trifold pamphlet identifying personal health information and support, and they attended eight monthly educational/support group sessions in their church during the 10-month intervention. Study nurses completed a risk assessment interview with each senior both pre- and post-participation. The study nurse completed post-program assessments with 64 seniors, a 79% retention rate. At the program's conclusion researchers conducted a focus group with the study RNs and used an anonymous written survey to gather participant appraisals of program elements. Neither hospitalization nor emergency department/urgent care usage was significantly different from pre- to post-program. Session attendance was moderate to high and over half of the seniors brought a family member or friend to one or more sessions. The majority of seniors initiated positive health changes (e.g., smoking cessation, weight loss, or diet changes). Participants expressed high satisfaction and expressed satisfaction to perceive that they were supporting other seniors in their community. We conclude that this intervention was successful in engaging and motivating seniors to initiate health behavior change and contributed to a health-supportive church-based community. To demonstrate a statistically significant difference in hospital and ED usage, however, a stronger intervention or a larger sample size is needed.

Training lay volunteers to promote health in central-city African American churches.

In a nation plagued by skyrocketing healthcare costs, is there an affordable way to address health needs of older African Americans in medically underserved areas? The Milwaukee, Wisconsin's Elder Community Health Upholder (ECHU) project indicates yes, we can. The key: A partnership that guides committed volunteers focused on establishing and sustaining health initiatives in faith-based settings.

Integrating ethics and quality improvement: practical implementation in the transitional/ extended care setting.

A major challenge in health care today is to provide high-quality care that results in the best outcomes possible for patients and residents within the limits of available resources. Throughout the past decade, there has been a call from ethicists for health care institutions to integrate the ethics and quality improvement processes. This article describes how a transitional/extended care facility integrated the quality improvement process within an ethical framework to achieve high-quality care while controlling cost.