Addressing Moral Distress in Correctional Nursing: A Call to Action.

In 1984, Jameton defined moral distress in nursing practice as the negative experience that occurs "…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue…" (p. 6). Little research has been done about the magnitude and impact of moral distress among nurses working in correctional settings. All correctional nurses (CNs) will experience some form of moral distress during their careers. Consequences include burnout syndrome, blurred professional boundaries, and impaired ethical reasoning. There is a need for strong CN leaders who model professional behavior and provide orientation and mentoring for new CNs. A research agenda is needed to inform strong orientation and continuing education programs to introduce the concept of moral distress and related resources to CNs and to assist them in preventing or mitigating the consequences of moral distress.

A weight loss intervention delivered by peer coaches in primary care: Rationale and study design of the PROMISE trial.

Primary care offers a familiar and accessible clinical venue for patients with obesity to receive evidence-based lifestyle interventions for weight management. However, there are numerous barriers to the implementation of such programs in primary care, and previous primary care weight loss interventions demonstrate modest and temporary effects. Weight loss treatment delivered within primary care by peer coaches may offer a viable and effective alternative. The purpose of this trial is to test the effects of weight loss treatment that includes ongoing support from a peer coach (i.e., trained, salaried community health workers) as compared to self-directed treatment. Peer coach treatment will be delivered over 18 months and includes a combination of in-person, group-based office visits and individual telephone contacts. This weight loss trial will include 375 adults with obesity (BMI = 30-50 kg/m2) randomized from 10 primary care practices. The primary outcome will be changes in body weight at month 18. Secondary outcomes will include key patient-centered outcomes, including quality-of-life, physical and social functioning, mood, and treatment satisfaction. The cost-effectiveness of the peer coach intervention will also be evaluated. If this novel intervention is effective, it could offer a practical and sustainable approach for the delivery of weight loss treatment in primary care that has the potential to improve clinical outcomes for patients, increase treatment options for primary care providers, and reduce obesity-related healthcare utilization and costs.

Barriers and facilitators to HPV vaccination among rural Alabama adolescents and their caregivers.

INTRODUCTION: Half of all new human papillomavirus (HPV) infections occur in adolescents and young adults, and this population has poor HPV vaccination rates. Rural areas of the U.S. have high rates of HPV-related diseases and low vaccination rates as well. The purpose of this study was to determine the perceived barriers and facilitators to HPV vaccination among adolescents and their caregivers in rural south Alabama. METHODS: Vaccinated and non-vaccinated adolescents ages 11-18 years old and primary caregivers were recruited from three rural counties in south Alabama. Participants completed individual interviews to discuss perceived barriers to vaccination and factors influencing their decision to vaccinate. Discussion groups were held to determine potential solutions to barriers elucidated from the interviews. Interview and discussion group transcripts were analyzed, and themes were identified. RESULTS: Approximately 62.5% of adolescents had not initiated the HPV vaccine series. Of those adolescents who started the vaccine series (n = 9, 37.5%), about half completed it (n = 5). Few participants in this study reported speaking with their health care provider (HCP) about the vaccine in the past year. Lack of information about the vaccine, its side effects, and no HCP recommendation were common barriers cited by non-vaccinators. Facilitators to vaccination included cancer prevention, discussion with HCP, and peer testimonials. Potential solutions to barriers were also discussed. CONCLUSIONS: Proposed strategies to increase HPV vaccination were similar between vaccinated and non-vaccinated groups. Education about HPV and the HPV vaccine is needed throughout these rural south Alabama communities to ensure informed decisions are made about vaccination and to increase vaccination rates.

Determinants of Obesity in Two Urban Communities: Perceptions and Community-Driven Solutions.

Objective: In the search of solutions to the rising rates of obesity, community perspectives are important because they highlight areas of need and help determine the level of community support for potential interventions. This study aimed to identify community perceptions of factors associated with obesity in two urban municipalities - one racially mixed and one predominantly African American - and to explore community-driven solutions to the problem of obesity. Methods: The study used Photovoice methodology to understand what community members perceived as obesity-promoting factors in their residential environments. Results: A total of 96 photographs of factors relevant to obesity were discussed. Most commonly depicted were restaurants, grocery stores, fast food, and fitness centers. In 10 race-stratified focus groups, participants made 592 comments on 12 themes, the most common being restaurants, physical activity, food stores, and proposed solutions. The top three themes - restaurants, physical activity, and food stores - accounted for 58% of all barriers to healthy weight. Proposed solutions ranged from personal efforts and peer support, to educating adults and children, to community action. Conclusions: Interventions addressing the immediate food and physical activity environment - restaurants, grocery stores, and resources for physical activity - may have high likelihood of success as they align with community needs and understanding of priorities. Health education and promotion programs that increase food-related knowledge and skills are also needed and likely to receive strong community support.

Parents Speak: A Needs Assessment for Community Programming for Black Male Youth.

INTRODUCTION: Although adolescence can be a difficult developmental period for all children, negative environmental forces make this period particularly risky for many inner-city black males. As part of the Center for Healthy African American Men through Partnerships, this project is utilizing community-based participatory concepts to design and implement programs to address risk-taking behaviors among middle school black males. METHODS: In 2014, parents of black males between the ages of 11 and 14years were recruited from an urban middle school to participate in focus group discussions. Letters were provided to the school to be mailed to parents inviting them to participate in discussion groups. Four focus groups were conducted. Data analyses were conducted fall 2014. RESULTS: Twenty-one parents participated. The major issue affecting the well-being and future success of young black males reported by parents was the lack of social support. Other areas of concern included negative peer pressure, bullying, violence, and lack of opportunities. Across groups, parents identified the lack of male parental presence in households and the subsequent perceived need by the young males to assume leadership roles, anger among the young males, and the lack of licensed counselors to address mental health issues as barriers to success and well-being. Parents emphasized the needs of the individual, family, and community for social support, positive role models, self-esteem, and respect. CONCLUSIONS: The present data can inform prevention programs designed to reduce disparities, such as educational underachievement, exposure to violence, and premature mortality experienced by black males. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Effects of lesions of the subthalamic nucleus/zona incerta area and dorsomedial striatum on attentional set-shifting in the rat.

Patients with Parkinson's disease (PD) show cognitive impairments, including difficulty in shifting attention between perceptual dimensions of complex stimuli. Inactivation of the subthalamic nucleus (STN) has been shown to be effective in ameliorating the motor abnormalities associated with striatal dopamine (DA) depletion, but it is possible that STN inactivation might result in additional, perhaps attentional, deficits. This study examined the effects of: DA depletion from the dorsomedial striatum (DMS); lesions of the STN area; and the effects of the two lesions together, on the ability to shift attentional set in the rat. In a single session, rats performed the intradimensional/extradimensional (ID/ED) test of attentional set-shifting. This comprises a series of seven, two-choice discriminations, including acquisitions of novel discriminations in which the relevant stimulus is either in the currently attended dimension (ID) or the currently unattended dimension (ED shift) and reversals (REVs) following each acquisition stage. Bilateral lesions were made by injection of 6-hydroxydopamine (6-OHDA) into the DMS, resulting in a selective impairment in reversal learning. Large bilateral ibotenic acid lesions centered on the STN resulted in an increase in trials to criterion in the initial stages, but learning rate improved within the session. There was no evidence of a 'cost' of set-shifting - the ED stage was completed in fewer trials than the ID stage - and neither was there a cost of reversal learning. Strikingly, combined lesions of both regions did not resemble the effects of either lesion alone and resulted in no apparent deficits.

Pilot study evaluating the feasibility and initial outcomes of a primary care weight loss intervention with peer coaches.

PURPOSE: The purpose of this single-group pilot study was to evaluate the feasibility, acceptability, and initial outcomes of a novel approach to delivering weight loss treatment in primary care using peer coaches and targeting predominantly African American patients with diabetes or prediabetes. METHODS: Participants (N = 33) were recruited from a family medicine practice for a 6-month lifestyle intervention. Eligible patients were obese adults (body mass index [BMI] ≥30 kg/m(2)) with ≥1 additional cardiometabolic risk factor(s), including (1) elevated hemoglobin A1C or diagnosed diabetes, (2) elevated blood pressure, (3) elevated triglycerides, and/or (4) low high-density lipoprotein. The intervention included a combination of 12 group-based office visits with health professionals plus 12 individual phone contacts with peer coaches. Outcomes included weight loss, program adherence, and program satisfaction. RESULTS: Participants (mean age = 56 ± 10 years; BMI = 42.9 ± 11.0 kg/m(2)) were predominantly female (88%) and African American (85%). Treatment resulted in a significant mean weight loss of -4.5 ± 7.2 kg, and approximately 27% of participants lost ≥5% of their initial body weight. Participants completed approximately 50% of the group visits and 40% of the telephone calls with peer coaches. Participants rated both components of the intervention favorably. CONCLUSIONS: Results of this pilot study indicated that a primary care weight management program including group-based visits and peer-delivered telephone contacts achieved significant weight loss among predominantly African American patients with weight-related comorbidities, including diabetes and prediabetes. Additional research is needed to examine the long-term outcomes of this novel approach and to identify program components supporting patients' success.

Text Messaging as a Method for Health Ministry Leaders to Disseminate Cancer Information.

Mobile phone-based interventions can play a significant role in decreasing health disparities by enhancing population and individual health. The purpose of this study was to explore health ministry leaders (HMLs) and congregation members' communication technology usage and to assess the acceptability of mobile technology for delivery of cancer information. Six focus groups were conducted in two urban African-American churches with trained HMLs (n=7) and congregation members (n=37) to determine mobile phone technology usage and identify barriers and facilitators to a mobile phone intervention. All participants were African-American, majority were female (80% of HMLs; 73% of congregation members), and the mean age was 54 (HMLs) and 41 (congregation members). All of the HMLs and 95% of congregation members indicated owning a mobile phone. All HMLs reported sending/receiving text messages, whereas of the congregation members, 85% sent and 91% received text messages. The facilitators of a text messaging system mentioned by participants included alternative form of communication, quick method for disseminating information, and accessibility. The overall main barriers reported by both groups to using mobile technology include receiving multiple messages, difficulty texting, and cost. Ways to overcome barriers were explored with participants, and education was the most proposed solution. The findings from this study indicate that HMLs and congregation members are interested in receiving text messages to promote healthy lifestyles and cancer awareness. These findings represent the first step in the development of a mobile phone-based program designed to enhance the work of health ministry leaders.

Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity.

As nursing continues to advance health care in the 21st century, the current shift in demographics, coupled with the ongoing disparities in health care and health outcomes, will warrant our ongoing attention and action. As within all health professions, concerted efforts are needed to diversify the nation's health-care workforce. The nursing profession in particular will be challenged to recruit and retain a culturally diverse workforce that mirrors the nation's change in demographics. This increased need to enhance diversity in nursing is not new to the profession; however, the need to successfully address this issue has never been greater. This article discusses increasing the diversity in nursing and its importance in reducing health disparities. We highlight characteristics of successful recruitment and retention efforts targeting racial/ethnic minority nurses and conclude with recommendations to strengthen the development and evaluation of their contributions to eliminating health disparities.

Where's the evidence? An innovative approach to teaching staff about evidence-based practice.

Preparing nurses to incorporate research and evidence-based findings into nursing practice is important to meet the needs of patients and their families in today's healthcare arena. This article highlights the use of a mock trial as an innovative approach to educating staff nurses on evidence-based practice and identifies future implications for educating staff nurses on incorporating evidence into nursing practice.

Factors associated with delays in screening of self-detected breast changes in African-American women.

Breast cancer mortality is higher among African-American women than among White women. African-American women are 25% more likely to present with late stage breast cancer and 20% more likely to die from breast cancer than White women. Treatment delay of 3 months is a significant factor in breast cancer mortality The purpose of this integrative review is to explore factors that impact delays in screening The most common patient-controlled delays were lack of education and knowledge about the perceived seriousness of breast symptoms, the associated risk factors, limited knowledge regarding the potential benefits of early detection in improving breast cancer survival, and expressed fatalistic perspectives about breast cancer. Other variables related to delays included factors such as advancing age, low socioeconomic status, fear of diagnosis, consequences of cancer treatments, shame and embarrassment, misconceptions about the etiology of breast cancer, family priorites, denial, and spirituality including faith-influenced delays.

Perceived barriers to care and attitudes about vision and eye care: focus groups with older African Americans and eye care providers.

PURPOSE: To identify by using focus group methods the perceived barriers to eye care and attitudes about vision and eye care among older African Americans as well as among ophthalmologists and optometrists serving their communities. METHODS: Seventeen focus groups of older African Americans residing in the Birmingham or Montgomery, Alabama, areas were led by an experienced facilitator. Discussion was stimulated by a semistructured script focused on their perceived barriers to eye care and attitudes about vision and eye care. Six focus groups of ophthalmologists and optometrists who practiced in this geographic region addressed the same topics. Discussion was audiotaped and transcribed. Comments were coded using a multistep content analysis protocol. RESULTS: One hundred nineteen African Americans (age range, 59-97 years) and 35 eye care providers (51% ophthalmologists, 49% optometrists) participated. The barrier-to-care problem most frequently cited by both African Americans and eye care providers was transportation. The next most common problems mentioned by African Americans were trusting the doctor, communicating with the doctor, and the cost of eye care; and for eye care providers, the next most common problems were cost, trust, and insurance. With respect to older African Americans' comments on their attitudes about vision and eye care, these comments were predominantly positive (69%), highlighting the importance of eye care and behavior in their lives and attitudes that facilitated care. However, when eye care providers relayed their impressions of African Americans' attitudes about vision and eye care, their comments were largely negative (74%) centering on concerns and frustrations that older African Americans did not have attitudes or engage in behavior that facilitate eye care. CONCLUSIONS: These results provide some guidance for the design of interventions to increase the use of routine eye care in this population. At a societal level, there is a need for affordable and accessible transportation services for older African Americans seeking eye care. For ophthalmologists, optometrists, and their staffs, there is a need for continuing education that imparts culturally sensitive and age-appropriate communication and trust-building skills for interactions with this population. In addition to reinforcing the generally positive attitudes of older African Americans toward the importance of eye care, community-based educational programs should be focused on strategies for overcoming the common barriers to care.

Blockade of mGluR glutamate receptors in the subthalamic nucleus ameliorates motor asymmetry in an animal model of Parkinson's disease.

It has been suggested that Group I metabotropic glutamate receptor antagonists could have potential therapeutic value in the treatment of Parkinson's disease. There is evidence that when given systemically, 2-methyl-6-(phenylethynyl)-pyridine (MPEP), a metabotropic glutamate receptor type 5 (mGluR5) antagonist, produces anti-parkinsonian effects in animal models, but the site of action has not been directly established. In the present study, we examined whether the subthalamic nucleus (STN) and its output structures may mediate such an effect using a unilateral rat model of Parkinson's disease. A battery of simple behavioral tests, reliably sensitive to dopamine depletion, was applied consecutively: (i) prior to surgery; (ii) 3 weeks following a unilateral 6-hydroxydopamine lesion of the substantia nigra pars compacta; (iii) at 1 h, 24 h and 4 days following a microinjection of MPEP, via an indwelling cannula, into the STN, entopeduncular nucleus (EP) or substantia nigra zona reticulata. Unilaterally dopamine-depleted animals typically had severe motor and sensorimotor asymmetries 3 weeks following surgery. Microinjection of 25 nmol MPEP into the STN of these animals significantly attenuated these asymmetries relative to vehicle. Further microinjections of lower doses (5 and 10 nmol) revealed a dose-response effect. Microinjection of MPEP into either the EP or substantia nigra zona reticulata was without effect. These data suggest that MPEP may act at the level of the STN to reduce glutamatergic overactivity and thereby induce anti-parkinsonian effects.

Impact of aging and age-related maculopathy on inactivation of the a-wave of the rod-mediated electroretinogram.

This study examined the impact of aging and age-related maculopathy (ARM) on the inactivation of phototransduction in rod photoreceptors by measuring the recovery of the a-wave using a paired flash electroretinogram technique. Measurements were made on 32 older adults in normal retinal health, 25 with early ARM, 7 with late ARM, and 20 young adults for comparison purposes. ARM presence and severity were defined by the Wisconsin Age-Related Maculopathy Grading System based on grading of fundus photographs. The inactivation of rod phototransduction exhibited an aging-related slowing. Those with early ARM did not exhibit inactivation slowing over and above what would be expected based on normal retinal aging. Persons in the late stages of ARM exhibited dramatic slowing in inactivation kinetics.

Cancer prevention among racial ethnic minorities.

OBJECTIVES: To provide an overview of the cancer disparities among racial and ethnically diverse populations and to describe primary and secondary prevention among them. DATA SOURCES: Published articles, reports, book chapters, and government documents. CONCLUSION: Despite the advances in cancer diagnosis, treatment, and survival, racial and ethnic minorities suffer disproportionately from cancer. Poverty has emerged as a significant factor influencing poor cancer outcomes for all races, but especially among racial and ethnic minorities. IMPLICATIONS FOR NURSING PRACTICE: Continued and sustained efforts are needed on all fronts (education, practice, and research, policy) to improve the poor cancer-related outcomes for minorities.

Impact of aging and age-related maculopathy on activation of the a-wave of the rod-mediated electroretinogram.

PURPOSE: To examine the impact of aging and age-related maculopathy (ARM) on the activation of phototransduction in rod photoreceptors by measuring the a-wave of the flash, full-field electroretinogram (ERG). METHODS: Enrollees consisted of older adults (> or = 60 years of age) in normal retinal health (n = 41) and those with early (n = 39) or late ARM (n = 7), in whom disease presence and severity were defined based on grading of stereoscopic color fundus photographs according to the Wisconsin Age-Related Maculopathy grading system. Young adults (ages 16-30 years; n = 27) were enrolled for comparison purposes. Previously established procedures were used to estimate the ERG response to two families of flash intensities. By computer subtraction of responses, the isolated rod response was identified. Each participant's ensemble rod responses were fit with the following equation to describe the response (R) as function of flash intensity (I), and time (t): R(I,t) = [1 - exp[-I x S x (t - td)2]] x RmP3, where S is sensitivity, td is the delay before onset of the a-wave, and Rm(P3) is the maximum amplitude. RESULTS: In analyses of older adults, there was no impact of early ARM presence or severity on log S, Rm(P3), or td after adjustment for age and intraocular lens presence. Differences between young and old normal subjects in log S, RmP3, and td disappeared when analyses were limited to older adults with intraocular lenses. CONCLUSIONS: When the light absorption of the aged lens is taken into account and reliable definitions of normal retinal aging and ARM are used, the activation of the a-wave as measured by the rod-mediated full-field ERG is not affected by early ARM, nor is it impacted by normal retinal aging.

Impact of an educational program on the safety of high-risk, visually impaired, older drivers.

BACKGROUND: Older drivers (licensed drivers aged 60 years and older) have among the highest rates of motor vehicle collision involvement per mile driven of all age groups. Educational programs that promote safe driving strategies among seniors are a popular approach for addressing this problem, but their safety benefit has yet to be demonstrated. The objective of this study was to determine whether an individualized educational program that promoted strategies to enhance driver safety reduces the crash rate of high-risk older drivers. DESIGN/ SETTING: Randomized, controlled, single-masked intervention evaluation at an ophthalmology clinic. PARTICIPANTS: A total of 403 older drivers with visual acuity deficit or slowed visual processing speed or both who were crash-involved in the previous year, drove at least 5 days or 100 miles per week or both, and were at least 60 years old. INTERVENTION: Patients were randomly assigned to usual care (comprehensive eye examination) or usual care plus an individually tailored and administered educational intervention promoting safe-driving strategies. MAIN OUTCOME MEASURE: Police-reported vehicle collision rate, expressed both in terms of person-years of follow-up and person-miles of travel for 2 years postintervention. RESULTS: The intervention group did not differ significantly from the usual care only group in crash rate per 100 person-years of driving (relative risk [RR], 1.08; 95% confidence interval [CI], 0.71-1.64) and per 1 million person-miles of travel (RR, 1.40; 95% CI, 0.92-2.12). The intervention group reported more avoidance of challenging driving maneuvers and self-regulatory behaviors during follow-up than did the usual care only group (p<0.0001). CONCLUSIONS: An educational intervention that promoted safe-driving strategies among visually impaired, high-risk older drivers did not enhance driver safety, although it was associated with increased self-regulation and avoidance of challenging driving situations and decreased driving exposure by self-report.

The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers.

Visual processing impairment increases crash risk among older drivers. Many older drivers meet the legal requirements for licensing despite having vision impairments that elevate crash risk. In this study, 365 older drivers who were licensed, visually-impaired, and crash-involved in the prior year were randomly assigned to an intervention group or usual-eye-care control group to evaluate the efficacy of an educational intervention that promoted the performance of self-regulatory practices. The educational curriculum was designed to change self-perceptions about vision impairment and how it can impact driver safety and to promote the avoidance of challenging driving situations through self-regulation, leading to reductions in driving exposure. Analyses compared the intervention and control groups at pre-test and 6 months post-test with respect to self-reported perceptions about vision and driving practices. At post-test, drivers who had received the educational intervention were more likely to acknowledge that the quality of their eyesight was less than excellent, report a higher frequency of avoiding challenging driving situations (e.g. left-turns) and report performing more self-regulatory practices (e.g. three right-turns) as compared to controls. Additionally, drivers in the educational intervention group reported significantly fewer days, fewer places and fewer trips made per week as compared to those not receiving the educational intervention. These findings imply that visually-impaired older drivers at higher risk for crash involvement may benefit from educational interventions by reducing their driving exposure and increasing their avoidance of visually challenging driving situations. A critical future step in this research program will be to examine whether this educational intervention has an impact on the safety of these high-risk older drivers by reducing their crash involvement in the years following the educational intervention.