Self-Care of Diabetes and Diabetes Distress in Non-Hispanic Black Adults With Type 2 Diabetes.

PURPOSE: The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes. METHODS: This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress. RESULTS: Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management. CONCLUSIONS: In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.

Establishing and Affirming Social Connections: Recruiting Non-Hispanic Black Adults with Type 2 Diabetes.

The underrepresentation of non-Hispanic Black adults in clinical research impacts the generalizability and usefulness of research findings. The purpose of this article is to discuss recruitment strategies used in a research study examining the self-care of diabetes and diabetes distress in non-Hispanic Black adults with type 2 diabetes. In this cross-sectional correlation study, the participants were non-Hispanic Black adults with type 2 diabetes living in North Carolina. A questionnaire collected sociodemographic and clinical characteristics. This study was analyzed using descriptive statistics. In total, 512 individuals accessed the online survey. After data screening, 275 participants were used for data analysis. Sixteen recruitment sites provided letters of support, and 13 were active in the recruitment process. Most participants learned about the research study via social media. Social connections resulting in recruitment partners and using social media supported the successful recruitment. The recruitment strategies implemented can inform researchers of effective evidence-based recruitment strategies to increase the participation of non-Hispanic Black adults in clinical research.

Identifying barriers and facilitators to seeking care for symptoms of bacterial sepsis: A qualitative study.

AIM: Research suggests that early access to quality care is essential to improving bacteraemia outcomes and reducing the risk of developing sepsis because it allows for early intervention. Currently, there are limited data regarding the facilitators and barriers that alter the trajectory of arrival at the hospital when patients in the United States experience symptoms of bacteraemia and sepsis. This study sought to explore and describe the facilitators and barriers to seeking care for suspected bacteraemia and sepsis symptoms. DESIGN: A qualitative descriptive study. METHODS: Ten men and women were recruited using convenience sampling. The study used audio-recorded semi-structured interviews and the collection of socio-demographic data as the data collection techniques. Thematic analysis was used, including inductive and deductive approaches, to analyse the data. RESULTS: During data analysis, the codes related to barriers and facilitators were collapsed into three themes-symptom recognition, psychosocial support and healthcare planning and coordination. PATIENT CONTRIBUTION: The patients' participation in the study has contributed to our understanding of patients' perspectives and experiences in the pre-hospital phase and provides important insights into what barriers and facilitators are encountered. Study findings highlight the need to develop interventions to improve patient decision time, patient-provider interactions and knowledge of bacteraemia and sepsis through patient and provider education.

Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults.

BACKGROUND: Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days). OBJECTIVE: The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART. METHODS: In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one's efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study. RESULTS: Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims. CONCLUSIONS: Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47320.

Perceived Effectiveness of Nursing Faculty of Clinical Video Simulation for Use in Nurse Practitioner Education.

Quality clinical placements for nurse practitioner students are increasingly challenging to locate and sustain, restricting faculty opportunities to assess student clinical competency. With the additional impact of COVID-19 restricting access to in-person clinicals and simulations, faculty began to incorporate virtual clinical simulation experiences. This cross-sectional design study examined nurse practitioner faculty's perception that by including videos with the accompanying faculty guides found at the University of North Carolina at Greensboro School of Nursing Clinical Video Simulation Series site, students' clinical decision making could be enhanced and that video simulation can be used to assess clinical competency.

Characteristics of Hospitalized Adults 55 and Older With Clostridioides difficile Infection.

Clostridioides difficile infection in older adults can result in severe infection, difficulty in treating, and complicated disease process, yet few studies have examined the characteristics of hospitalized older adults and recurrent Clostridioides difficile infection. A retrospective cohort study was conducted to explore the characteristics of hospitalized adults 55 years and older with initial Clostridioides difficile infection and recurrences by extracting routinely documented data in the electronic health record. A sample of 1,199 admissions on 871 patients was included, with a recurrence rate of 23.9% ( n = 208). During the first admission, there were 79 deaths (9.1%). Clostridioides difficile infection recurrence was more prevalent in patients between 55 and 64 years old, and if discharged to a skilled nursing facility or with home health services. Chronic diseases significantly more prevalent in recurrent Clostridioides difficile infection included hypertension, heart failure, and chronic kidney disease. On initial admission, no laboratory abnormalities were significantly associated with recurrent Clostridioides difficile infection. This study indicates the need for utilizing routinely captured electronic health record data during acute hospitalizations to aid in targeting care to reduce morbidity, mortality, and recurrence.

Exploration of pre-hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study.

AIM: We explored patient pre-hospital delays in seeking care for symptoms of bacteremia and sepsis. DESIGN: A qualitative descriptive study. METHODS: In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi-structured interviews by telephone. The tape-recorded interviews were transcribed, coded and analysed using the Common-Sense Model of Self-Regulation. Data analysis continued until May 2021. RESULTS: The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help-seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co-morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient-reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.

The Experiences of African American Male Caregivers.

Aging of the population has led to an increasing number of caregivers. While research has been conducted on caregiver experiences, less is known about the experiences of African American males in the U.S. This qualitative descriptive study describes the experiences of 13 African American men who acted as caregivers to adult chronically ill or debilitated loved ones, the majority of whom provided care during the COVID-19 pandemic. The revised Sociocultural Stress and Coping Model (R-SSCM) guided this study. Individual interviews were conducted via the Zoom application. Content analysis revealed four themes: (1) "My time to take the reins", (2) "It's a male thang", (3) "Caring amid a pandemic", and (4) "Effects of the caregiver's journey". This study's findings in relation to the literature provide overdue attention to the African American male caregiving experience, especially in relation to the COVID-19 pandemic. The implications of our findings include the need for more culturally congruent support services for African American male caregivers, as well as increased efforts to encourage trust in the healthcare system-especially in relation to vaccination for the SARS-CoV-2 virus.

Low-Income, Older African Americans' Engagement in and Perceptions of a Smartphone-Based Ecological Momentary Assessment Study of Physical Activity and Sedentary Behavior.

BACKGROUND AND OBJECTIVES: Smartphone-based ecological momentary assessment (EMA) methods can provide novel insights into modeling and predicting activity-related behaviors, yet many racial and ethnic minority groups report barriers to participating in mobile health research. We aim to (a) report on strategies used to successfully recruit and retain minority older adults in a smartphone-based physical activity and sedentary behavior EMA study and (b) report on participants' perceptions of study acceptability. RESEARCH DESIGN AND METHODS: Researchers partnered with trusted individuals and community organizations serving older adults to facilitate recruitment for an 8-day EMA study of minority older adults' physical activity and sedentary behavior. Additional strategies such as having experienced, culturally competent team members and available technical support were employed to further recruitment and retention efforts. A poststudy questionnaire assessed participants' perceptions of study acceptability. RESULTS: In total, 123 minority older adults were recruited, 102 met inclusion criteria, 91 completed the study, and 89 completed the poststudy questionnaire. The sample consisted of predominantly low-income African American women with an average age of 70 years. Responses to open-ended questions revealed that the most enjoyable aspects of study participation were the ability to learn more about themselves, contribute to science and/or their community, engage in a new activity, and receive financial compensation. Participants reported the least enjoyable aspects of the study included the frequency of EMA questionnaires, apprehension of missing EMA questionnaires, carrying the smartphone, and difficulty wearing the accelerometer. Most participants (97%) expressed interest in being contacted for future studies. DISCUSSION AND IMPLICATIONS: Low-income, older African Americans reported positive perceptions of a smartphone-based EMA study of physical activity and sedentary behavior. Findings suggest that applying demonstrated strategies to engage this population in technology-based health research can enhance recruitment and retention efforts; however, it is unclear which strategies are most effective in reducing participation barriers.

The effect of an exergame on physical activity among older adults residing in a long-term care facility: A pilot study.

BACKGROUND: Older adults who engage in arranged residential video games have the potential to gain health benefits such as increase in physical activity beyond purposeful movement with movement-based games. METHODS: A Nintendo Wii video gaming system was implemented for six-weeks as a physical activity intervention with long-term care residents to determine the impact on exercise benefits/barriers, self-efficacy for exercise, and physical activity levels. RESULTS: Paired t-tests revealed improvement in exercise benefits/barriers, self-efficacy for exercise, and physical activity levels, albeit none with statistical significance (all p > .05). CONCLUSIONS: The use of the Nintendo Wii as an intervention to enhance physical activity for older adults in nursing home residents should be considered for use over a longer duration of time with older adults.

A Quality Improvement Project Comparing Two Treatments for Deep-Tissue Pressure Injuries to Feet and Lower Legs of Long-term Care Residents.

OBJECTIVE: To retrospectively examine clinical outcomes from a feasibility study that compared two treatment options for deep-tissue pressure injuries (DTPIs), including the clinical indicators increasing the risk of deteriorating DTPIs among long-term care residents. METHODS: A retrospective chart audit of 40 DTPIs from 33 long-term care residents in two long-term care facilities was conducted to compare (1) polymeric membrane dressings (PMDs) with offloading and (2) a skin barrier film with offloading. RESULTS: Of the 13 DTPIs treated with PMDs, only 23% deteriorated to a stage 3 or 4 pressure injury (PI), whereas of the 27 DTPIs treated with skin barrier film, 41% deteriorated to a stage 3 or 4 PI. The clinical factors found to increase the risk of developing and deteriorating DTPIs included weight loss, hypoalbuminemia, debility, dementia, coronary artery disease, and cerebrovascular disease. CONCLUSIONS: The PMD group's DTPIs evolved into fewer open PIs despite having higher percentages of clinical indicators for DTPIs. The project findings support the use of PMD dressings for DTPIs; however, more robust research is warranted.

Creating a Gerontological Nursing Digital Repository Within a Learning Management System.

BACKGROUND: Faculty who teach gerontological nursing are challenged to deliver competency-based baccalaureate nursing education. Because our courses are divided into multiple sections and taught by a variety of faculty, the need for a peer-reviewed, curated repository of gerontological learning materials was conceived. METHOD: Syllabi for prelicensure and RN-to-baccalaureate nursing (BSN) degree gerontological courses were reviewed. Stufflebeam's Content, Input, Process and Product (CIPP) model of program evaluation provided a framework to guide the process of identifying existing resources and gaps in eLearning materials. Using the Learning Object Review Instrument, faculty determined the relevance and applicability of eLearning materials. RESULTS: A crosswalk between the syllabi and the American Association of Colleges of Nursing-recommended geriatric nursing competencies was completed to evaluate eLearning materials identified as valuable. Consensus was reached, and content was placed in the learning management system. CONCLUSION: This project can serve as a model for other course faculty and faculty in other specialty areas to enhance the curriculum by providing readily available, multifaceted instructional resources. [J Nurs Educ. 2019;58(10):607-610.].

Recognition and management of Clostridium difficile in older adults.

Clostridium difficile infection (CDI) is increasing in the outpatient setting, and older adults are at a higher risk for contracting CDI and experiencing poor outcomes. NPs may see this infection in the primary care setting. This article focuses on the presentation, treatment, and clinical practice implications for CDI in community-dwelling older adults.

Frailty in the older adult: will you recognize the signs?

With the rapid aging of the oldest old, it is inevitable that nurse practitioners will encounter frail patients across care settings. Presented through a case study, this article addresses the clinical characteristics of frailty, strategies to prevent this geriatric syndrome, and recommendations for care.

Teaching while learning while practicing: reframing faculty development for the patient-centered medical home.

Soaring costs of health care, patients living longer with chronic illnesses, and continued attrition of interest in primary care contribute to the urgency of developing an improved model of health care delivery. Out of this need, the concept of the team-based, patient-centered medical home (PCMH) has developed. Amidst implementation in academic settings, clinical teachers face complex challenges not previously encountered: teaching while simultaneously learning about the PCMH model, redesigning clinical delivery systems while simultaneously delivering care within them, and working more closely in expanded interprofessional teams.To address these challenges, the authors reviewed three existing faculty development models and recommended four important adaptations for preparing clinical teachers for their roles as system change agents and facilitators of learning in these new settings. First, many faculty find themselves in the awkward position of teaching concepts they have yet to master themselves. Professional development programs must recognize that, at least initially, health professions learners and faculty will be learning system redesign content and skills together while practicing in the evolving workplace. Second, all care delivery team members influence learning in the workplace. Thus, the definition of faculty must expand to include nurses, pharmacists, social workers, medical assistants, patients, and others. These team members will need to accept their roles as educators. Third, learning to deliver health care in teams will require support of both interprofessional collaboration and intraprofessional identity development. Fourth, learning to manage change and uncertainty should be part of the core content of any faculty development program within the PCMH.

Older adults with bipolar disorder: guidelines for primary care providers.

The purpose of this article is to present evidence-based guidelines to facilitate early diagnosis and appropriate treatment of older adults with symptoms of bipolar disorder. Assessment criteria, diagnostic tools, and interventions to optimize care of older adults with bipolar disorder--with a focus on implications for primary care providers--are described.

Clinical practice characteristics of gerontological nurse practitioners: a national study.

PURPOSE: To determine the clinical practice characteristics of gerontological nurse practitioners (GNPs) in the United States and ascertain whether length of employment, geographic region of practice, work setting, and educational preparation influence GNPs' delivery of advanced clinical services and clinical procedures. DATA SOURCES: The Gerontological Nurse Practitioner Practice Profile was mailed to a stratified random sample of 1000 GNPs certified by the American Nurses Credentialing Center. CONCLUSIONS: Despite the growing demands for GNPs, of the 472 GNPs who responded to the survey, only half were working full-time as a GNP. Although the role was established over 30 years ago, 56% of the respondents indicated that they were the first GNP in the position. There was a statistically significant positive relationship between being the first GNP in his or her practice and the percent of primarily medical advanced clinical services performed. GNPs who worked in multiple clinical setting performed more advanced clinical services and medical procedures than GNPs who only worked in one setting. IMPLICATIONS FOR PRACTICE: This study provides insight into the complex practice characteristics of GNPs. GNPs are combining the nursing skills so necessary to care for older adults with advanced clinical services and clinical procedures deemed medical acts. Various factors influence how GNPs practice, including geographic location, type of practice, and whether the GNP was the first person to be employed as a nurse practitioner at the practice.

Prescribing patterns of gerontological nurse practitioners in the United States.

PURPOSE: To identify the prescribing patterns of gerontological nurse practitioners (GNPs) as reported on the Gerontological Nurse Practitioner Practice Profile. Specifically, the study examined (a) GNPs' frequency of prescribing certain categories of medications for older adults; (b) the influence of practice, education, and experience variables on prescribing practices of GNPs; and (c) the rate of prescribing inappropriate medications for older adults based on the list of medications on the modified Beers Criteria. DATA SOURCES: The study was part of a larger descriptive survey that examined the practice characteristics of GNPs using the Gerontological Nurse Practitioner Practice Profile. A stratified random sample of 1000 GNPs certified by American Nurses Credentialing Center was sent surveys; 472 usable surveys were returned. Only the 234 GNPs who indicated that they were currently practicing full time as a GNP were included in this analysis. CONCLUSIONS: Ninety-three percent of the respondents indicated that they had prescriptive privileges. The most commonly prescribed types of medications were analgesics, antihypertensives, cardiovascular drugs, and diabetic medications. The prescribing patterns of these GNPs were not influenced by education, years of practice, or selected practice characteristics. There was a significant difference in the prescribing of inappropriate medication among office-based GNPs and those who worked in long-term care settings. The GNPs in the ambulatory care setting had a tendency to prescribe inappropriate medications more frequently than those in long-term care facilities. Overall, self-reported prescribing of inappropriate medications among the GNPs participating in this study, however, was low. IMPLICATIONS FOR PRACTICE: The findings of this study indicate that GNPs are prescribing medications for complex medical conditions.