Glycemic control: Can nurse practitioners on interprofessional collaborative practice teams enhance clinical outcomes?

BACKGROUND AND PURPOSE: Care coordination and specialized knowledge of prescriptive authority are fundamental to advanced nursing practice. Little research documents patient clinical outcomes in primary care when nurse practitioners are members of an interprofessional education and collaborative practice (IPECP) team. This cross-sectional study examined differences in glycemic control among Texas patients who received care by a Family Nurse Practitioner (FNP) and an IPECP team in one calendar year. METHODS: A convenience sample of 120 adult volunteers with diabetes was followed in a community-based clinic by an FNP; of these, 34 received additional care by an IPECP team. Data on selected demographic indices and HgbA1c were derived from the health center's Electronic Medical Record using a retrospective review, and linkage with the federally funded IPECP Project database. CONCLUSIONS: Patients with two or more FNP visits and two or more visits with the IPECP team had statistically significant reductions in HgbA1c levels at the end of 1 year. IMPLICATIONS FOR PRACTICE: Actualizing point-of-care treatment adjustments is a particular strength of advanced practice nurses but potentially a missed opportunity on interprofessional teams. Further study is needed on clinical outcomes of nurse practitioner contributions to IPECP team care.

Enhancing resilience, empowerment, and conflict management among baccalaureate students: outcomes of a pilot study.

To manage interpersonal conflict, nursing students need evidence-based interventions to strengthen stress resiliency, psychological empowerment, and conflict management skills. A pilot 1-group, pre-post-design, 2-semester intervention used simulated experiences to enhance these skills with 60 undergraduate nursing students. Findings suggest that integration of conflict resolution skills throughout the curriculum, with repeated opportunities to practice using a variety of styles of conflict management in relation to situational factors, may be beneficial to prepare students for the challenges of today's healthcare environment.

Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students.

AIMS: This article is a report of a Neuman Systems Model-guided correlational study of the relations of stress resiliency, psychological empowerment, selected demographic characteristics (age, ethnicity, semester in school) and conflict management styles. BACKGROUND: Emerging evidence suggests that stress resiliency and psychological empowerment can strengthen student nurses in academic achievement and coping with stress. Little is known about conflict management styles of students and the relationship to empowerment, resiliency and the implications for managing workplace conflict. METHODS: A correlational study was conducted in Spring 2010 with 166 baccalaureate students. Most participants were female, single, Hispanic and 25 years old. The data collection instruments included the Stress Resiliency Profile, the Psychological Empowerment Instrument, the Conflict Mode Instrument and a demographic inventory. Descriptive and inferential correlational statistics were used to analyse the data. RESULTS: Students scored in the high range for focusing on their deficiencies in conflict situations; they scored above the 60th percentile for avoiding and accommodating behaviours and were less likely to use competing or collaborating strategies to manage conflict. Empowerment scores were significantly correlated with stress resiliency scores. Students with high scores on empowerment had high scores on the skill recognition subscale of the Stress Resiliency Profile suggesting more resilience; high scores on empowerment were related to high necessitating subscale scores of the Stress Resiliency Profile suggesting a predisposition to stress. CONCLUSIONS: Neuman Systems Model may provide guidance for educators to strengthen student nurses' management of stressors in the workplace.

A family history intervention: enhancing cardiovascular risk assessment.

This article describes the effect of individualized counseling using family history data and objective cardiovascular risk factors on intent to change and actual exercise behavior in a diverse sample of working adults. Using a longitudinal, quasi-experimental, crossover design, objective data (blood lipids, glucose, blood pressure, and body mass index) and subjective data (awareness of heart disease risk, depression, spirituality, and knowledge of family history) were collected from 91 (mostly female and with a mean age of 45 years) primary and secondary teachers in a southwestern city. The Transtheoretical Model of Change guided the study and measured intent to exercise. Objective risks in this sample mirrored national indices of risk for obesity and abnormal lipids. Although some participants increased their exercise, no significant differences were found between the groups in exercise behavior at 6 and 12 months. Using knowledge of family history to raise awareness and encourage lifestyle changes related to cardiovascular risk warrants further study.

Awareness of heart disease among female college students.

OBJECTIVE: Awareness of heart disease as the leading cause of death in women has increased over the past 10 years, but little is known about the awareness level of college students. This study evaluated the level of awareness and knowledge of heart disease in women among college students. METHODS AND RESULTS: Using a cross-sectional design, a sample of 320 women from a private university was queried. A 13-item survey assessed demographic information and awareness of cardiovascular disease (CVD). The mean age was 23 years; the majority were single and of Hispanic ethnicity. Almost one third believed breast cancer was the greatest problem facing women. One half recognized CVD as the leading cause of death among women. Students aged 18-24 years were significantly less likely to identify heart disease/heart attack as the leading cause of death in women compared with students aged 25-34 years. Significant ethnic differences in perceptions of risk were found. Family history and obesity were seen as major contributors to CVD; less than a fourth ever discussed CVD with their healthcare provider. Information was gained primarily from television, magazines, and the Internet. Exercise and maintenance of healthy blood pressure were viewed as priorities in prevention of CVD. CONCLUSIONS: Results add to the body of research on CVD risk and the need for intervention to increase awareness and knowledge of heart disease risk among younger and ethnically diverse young women and raises questions about the role of colleges and universities in promotion of student health. Colleges and universities may provide the last opportunity to reach youth as a group to affect lifestyle changes.

An exploratory study of cardiac health in college athletes.

A common assumption is that college athletes are healthy based on their age and level of physical activity. This study used a descriptive correlational design to explore relationships and predictors of physical fitness levels among an ethnically diverse sample of 135 college athletes from a National College Athletic Association Division II university. Both subjective and objective indices of cardiac health and physical fitness level (blood pressure [BP], body mass index [BMI], waist-to-hip ratio, waist circumference, hip circumference, blood lipids, glucose, and VO(2max)) were collected. Minimal research exists with this population or with such an array of subjective and objective measures. More than one fourth of the athletes had a BMI in the overweight range, one fifth was prehypertensive, and one fourth had lower-than-recommended high-density lipoprotein (HDL) cholesterol levels. Waist circumference accounted for 21% of the variance in systolic BP level. These factors may predispose the college athletes to cardiac risk in the future when exercise regimens are reduced. Gender differences were found in all physical size variables and in physical fitness levels, with physical fitness level alone predicting gender correctly 98.5% of the time. Differences support the need to account for gender and fitness levels in cardiac risk assessment of young populations.

Family history: value-added information in assessing cardiac health.

The purpose of this study was to describe family health history profiles and objective indices of cardiac health among ethnically diverse working adults. Family history of disease is an important predictor of individual health, yet is underused by clinicians. Participants were staff in an elder-care facility and completed a web-enabled program capturing family history, objective cardiovascular measures (blood lipids, blood pressure, height, weight, and waist-to-hip ratio), and subjective measures (anxiety, spirituality, and health status appraisal). Of the 44 participants, 89% were unable to provide complete information about their family health and mortality for the three-generation genogram; 25% had one or more first-degree relatives with cardiac disease; and more than two thirds had first-degree relatives with diabetes. More than 80% of the sample exhibited objective indices of risk including body mass indexes in the overweight or obese categories. Family history information was incorporated into health screening and enabled more appropriate health counseling for these employees.

Workplace health promotion--strategies for low-income Hispanic immigrant women.

Addressing health disparities for vulnerable populations in the United States is a national goal. Immigrant Hispanic women, at increased risk for heart disease, face obstacles in receiving adequate health care. Health promotion, especially for Hispanic women, is hindered by language, access to care, lack of insurance, and cultural factors. Innovative health education approaches are needed to reach this population. This article describes the development and evaluation of a culturally sensitive cardiac health education program based on findings from a study of 21 older immigrant Hispanic women employed as housekeepers at a small university in south Texas. Systolic and diastolic blood pressures had decreased 17 months after the intervention.

Cardiovascular risk among older Hispanic women: a pilot study.

This study used a descriptive correlational design to describe the relationship between cardiovascular risk and anxiety, spirituality, acculturation, and the objective indices of cardiac risk among a sample of 21 adult Hispanic women. Objective indices of risk included weight, blood pressure, blood lipids, and glucose. Four survey instruments were used to assess anxiety, spirituality, acculturation, and perceived risk. Findings revealed that all study participants had 3 or more risk factors, placing them in the moderate risk category for developing heart disease or having a heart attack within 10 years. State and trait anxiety scores were lower than the normative samples for adult women. Spirituality scores were higher than average; individuals with higher anxiety scores had lower spirituality scores. More research is needed to determine the health needs of unskilled workers with limited education in employment settings.

Cultural attitudes, knowledge, and skills of nursing faculty toward patients from four diverse cultures.

This study used a convenience sample of 94 nursing faculty recruited among attendees of two professional conferences to describe faculty attitudes toward and perceived level of confidence in cultural knowledge of patients representing four ethnic groups. The study also explored relationships between these variables and the respondents' demographic characteristics. Respondents completed the Cultural Attitudes Scale, the Cultural Self-efficacy Scale, and a demographic survey and wrote a response to an open-ended question. Mean scores indicated moderately positive attitudes toward and moderate-to-high confidence levels in cultural knowledge related to caring for four ethnic groups. Three variables accounted for 33% of the variability in level of confidence in skill in transcultural care: cultural content was included in the curriculum of the employing nursing school, education courses in culture, and the predominant ethnicity of the patients for whom care was provided. Repeated exposure to persons from other cultures was the most frequently cited means of increasing personal comfort in caring for ethnically diverse patients. Only 53% of the respondents remembered cultural content in their own academic preparation. Findings suggest that cultural exposure opportunities enhance faculty-perceived confidence in knowledge and attitudes toward people from other cultures.

Cardiac health: relationships among hostility, spirituality, and health risk.

This study examined hostility, spirituality, and indices of health risk among 100 young, primarily males of Hispanic background. Over half of the subjects were prehypertensive or hypertensive; one third had at least 2 objective risk factors for cardiac disease; and younger participants had lower spirituality scores and higher cynical distrust scores. Body mass index, spirituality, and glucose accounted for 29% of variance in systolic blood pressure; body mass index and age accounted for 39% of variance in diastolic blood pressure. The tools to assess cardiac risk (blood pressure, history, capillary blood screening, body mass index) are all "low tech" and low cost but used together are powerful in identifying risk populations.

Cultural attitudes, knowledge, and skills of a health workforce.

This study describes cultural attitudes, knowledge, and skill of 409 health care workers using the Ethnic Attitude Scale, the Cultural Self-Efficacy Scale, and a demographic inventory. Findings suggest cultural knowledge and educational preparation of the health worker may influence cultural skills. Workers that were most confident in their cultural skills in working with other cultural groups were more confident in knowledge of cultural concepts and had higher education levels. The results also suggest gaps in workers' knowledge of other cultures and how to care for them in culturally sensitive ways. Educational interventions may enhance workers' knowledge. Whether such enhanced knowledge yields improved patient care outcomes remains to be answered.

Family planning patterns and acculturation level of high-risk, pregnant Hispanic women.

This article describes acculturation level and family planning patterns among a convenience sample of 100 Hispanic women experiencing high-risk pregnancies. The majority were having a second pregnancy and had complications secondary to gestational diabetes or pregnancy-induced hypertension. Most were from Mexico, married, had little formal education, and were very Mexican oriented in their beliefs and values. Almost 75 percent returned for a postpartum visit compared with 14 percent who returned for the family planning visit at one year after giving birth. Age and gravidity were inversely correlated with return for family planning visits: gravidity was a significant predictor of number of post-birth visits.

Access to preventive health care: is method of payment a barrier for immigrant Hispanic women?

This study describes the payment category of 397 low-income Hispanic women and the relationship to compliance with family planning visits the first year postbirth. Only one-fourth of the women returned for the one-year family planning visit, when they would have received well-woman care. Pay category was not a factor in identifying those who returned. Health system barriers, patient cultural beliefs, and life circumstance may explain why women enter and then leave apparently seamless systems of care. To increase preventive care, more study is needed of interventions that build on women's existing cultural prescriptions for health behavior by health professionals who portray postbirth checks as wellness checks.

A call to action. Acculturation level and family-planning patterns of Hispanic immigrant women.

PURPOSE: To describe family-planning patterns of Hispanic women and to determine their relationship to acculturation level and to selected maternal demographic, pregnancy, and infant birth indices. DESIGN: Descriptive correlational. METHODS: A convenience sample of 376 Hispanic women was drawn from prenatal clinics in a large, public teaching hospital in the Southwest United States. Acculturation status was assessed during the prenatal period using the Acculturation Rating Scale for Mexican Americans II. Maternal data concerning pregnancy, infant birth, postpartum, and family planning were abstracted from the hospital record. Data were analyzed using descriptive, correlational, and multiple regression procedures. RESULTS: Most women were of Mexican origin, first generation in the United States, and oriented toward traditional Mexican cultural beliefs and values. Most were married, had less than an eighth-grade education, and experienced a first or second healthy pregnancy with healthy birth outcomes. Over 66% of the women returned for at least one visit in the first year postbirth; compliance at 1 yr declined to 28%. Five variables were significantly correlated with family-planning visit compliance: number of pregnancies, generation in the United States, acculturation level, trimester of first prenatal visit, number of prenatal visits, and gestational age of newborn. CLINICAL IMPLICATIONS: Nurses are in a pivotal position to educate the Mexican immigrant woman about healthcare for herself and for her family, but need to recognize cultural influences on family-planning behavior. Effective interventions build on existing knowledge, beliefs, and practices of traditional immigrant women. It is important to include the generation in the United States as an indicator of adherence to traditional values and beliefs.