Challenges Experienced by Parents of Emerging Young Adults With Type 1 Diabetes Mellitus During the Transition to College.

PURPOSE: The purpose of this study is to gain a deeper understanding of the challenges experienced by parents of emerging young adults (EYAs) with type 1 diabetes mellitus (T1DM) who completed their freshman or sophomore year of college. METHODS: Using a descriptive, qualitative design, 16 parents participated in semistructured interviews that explored factors impacting the college transition for parents of college freshmen and sophomores with T1DM. Participants were recruited from local endocrinology clinics as well as the College Diabetes Network (CDN) Parent Facebook page, the CDN Facebook page, the CDN Twitter feed, and the Delaware Chapter of the JDRF (formerly Juvenile Diabetes Research Foundation). Researchers used a thematic analysis to analyze the data and develop categories. Interviews were conducted and recorded via video conferencing from July 2019 to September 2019. RESULTS: Results represent data from 16 interviews comprising 15 (94%) mothers and 1 father. Thematic analysis resulted in the emergence of 3 themes: managing parental concerns, changes in the parental role, and identifying sources of parental support. Parents identified several challenges including the EYAs' ability to manage T1DM at college, communication with the EYA, and the availability of support for parents. CONCLUSION: Parents experience several challenges during their EYA's transition to college with T1DM. Supporting the needs of parents and EYAs during this time may serve to reduce diabetes-related complications for EYAs and increase overall quality of life for both members of the dyad.

Maternal experiences of caring for a child with a ventricular assist device.

The purpose of this study was to gain a deeper understanding of maternal experiences of caring for their child with a VAD at home as a bridge to transplant. A descriptive, qualitative study was conducted via telephone-recorded guided interviews. Participants were caring for or had a child with a VAD between 4 and 16 years old. Data collection occurred over a 12-month period. Using the snowball sampling technique, a purposeful sample of mothers (n = 6) was consented and completed the interview. The data were analyzed using an iterative process of thematic analysis. Five themes emerged: physical modifications, the loss of independence, the emotional rollercoaster, support from others, and transitions on and off the device. We introduced new evidence about sleep, contraception, and heart transplantation, and how VAD therapy impacts childhood development. The mean duration of VAD support was 263 ± 170 days. Five children had heart transplants by the time of interview. To the best of our knowledge, this is the first qualitative study in the US that explores maternal experiences of caring for a child who is living at home with a VAD. VAD therapy is a novel approach to managing advanced heart failure among children and presents unique challenges when caring for them at home. Results provide insight into the education, physical environment, and support needed by parents.

Risk-Taking Behaviors in Adolescents With Chronic Cardiac Conditions: A Scoping Review.

PROBLEM: Advances in treatment and therapy for children with chronic cardiac conditions have extended their life expectancy. Risk-taking behavior among adolescents requires further exploration. Researchers conducted a scoping review to address a literature gap specific to risk-taking behavior among adolescents with chronic cardiac conditions. ELIGIBILITY CRITERIA: Sources were limited to (1) human subjects, (2) English language or translatable to English, (3) adolescents without age restrictions, (4) all research designs and (5) presence of a chronic cardiac condition. SAMPLE: Searches of six electronic databases (CINAHL Plus Full Text, PubMed, Web of Knowledge, Scopus, ProQuest and Grey Literature Report) were conducted to verify the empirical literature between 1975 and 2018. Seventeen sources were included in this review. RESULTS: Among the 17 sources, 12 sources examined risk-taking behavior by self-report among adolescents with chronic cardiac conditions. Tobacco, alcohol and/or other drug use and physical inactivity were the most prevalent risk-taking behaviors identified through this review. CONCLUSIONS: Findings from this scoping review describe the types of risk-taking behaviors that adolescents with chronic cardiac conditions are engaging in, highlight similarities when compared to other types of chronic conditions, and serve as a foundation for future research among this population. IMPLICATIONS: Discussion of risk-taking behaviors should be integrated into each healthcare encounter beginning in early adolescence and continuing through transition to adulthood and adult health care. Qualitative research studies may serve as an effective method by which to explore risk-taking behavior among adolescents with chronic cardiac conditions in greater detail.

Are college students told by health care providers about their risk factors for developing diabetes?

BACKGROUND AND PURPOSE: Communication about risk factors for diabetes between nurse practitioners and college students may not be occurring as the prevalence of Type 2 diabetes increases. The purpose of this secondary analysis was to evaluate if college students are being told of their risk for diabetes based on known risk factors of weight, sleep, and depressive symptoms. METHODS: Descriptive, cross-sectional study was completed using National Health and Nutrition Examination Survey 2011-2012. Using listwise deletion for all variables in the analyses, the sample (N = 313) included college participants aged 18-25 years. Logistic regression model found that body mass index (BMI), sleep quantity, and gender were significant predictors of not being told one was at risk for diabetes. In those with a BMI >25 kg/m (n = 159), only 22% were told about their risk for diabetes by a health care provider. CONCLUSIONS: Nurse practitioners may not be recognizing the factors that affect on the development of prediabetes in college-age students or not providing guidance for measures to prevent the morbidity related to diabetes. IMPLICATIONS FOR PRACTICE: Nurse practitioners are in a prime position to identify individuals with overweight/obesity, poor sleep, and depressive symptoms and recommend lifestyle changes to prevent the onset of disease.

Development of an Instrument to Assess the Clinical Effectiveness of the Debriefer in Simulation Education.

Simulation education continues to increase in all healthcare curriculums. Measuring how well faculty conduct debriefing sessions within the context of the learning objectives and defined pedagogy of a specific simulation is vital and deficient. The purpose of this study was to develop and test an instrument to assess a debriefer's ability to effectively conduct a debriefing session to evaluate and demonstrate teaching effectiveness and excellence. The instrument, Peer Assessment of Debriefing Instrument (PADI), was developed using a traditional peer-review framework. Using the Delphi technique, an expert panel (n=11) completed an electronic survey and used a 4-point Likert scale to rate the PADI on clarity and understandability. In round III, a consensus >80% was achieved for both structural and content elements. Results revealed that the PADI was a valid and reliability instrument to provide a peer review of the debriefing process across healthcare disciplines. The inter-rater reliability for the average measures was very strong, with interclass correlation coefficient (ICC) = 0.973, and for the single measure was strong, ICC = 0.818. The PADI provides both novice and experienced debriefers with an objective and formative means of performing self-assessment and receiving peer feedback on a debriefing experience.

Peer-Assessment Debriefing Instrument (PADI): Assessing Faculty Effectiveness in Simulation Education.

Evaluating the debriefing skill of faculty in simulations is essential but often challenging. The Peer Assessment Debriefing Instrument (PADI) is a self and peer assessment designed to assess a debriefers' effectiveness and is grounded in current scientific debriefing literature and peer review methodology. This pilot study tested the PADI at three institutions during 10 different healthcare debriefing sessions. The PADI is useful to faculty and administrators of simulation centers by demonstrating ongoing quality improvement and as a guide to train new debriefers.

Development of a Clinical Competency Checklist for Care of Patients Experiencing Substance Withdrawal Delirium or Delirium: Use of a Delphi Technique and Expert Panel.

Health care providers are challenged by the presentation and management of inpatients experiencing substance withdrawal delirium (SWD) and delirium. The current Delphi study used an expert panel to develop a clinical competency checklist for nurse and physician educator use in teaching health care providers about the initial care of patients with SWD or delirium. The checklist includes categories of patient safety, history and information gathering, physical examination and assessment, treatment plan, and patient/family-centered care.

Attitudes of Nurse and Physician trainees towards an interprofessional simulated education experience on Pain Assessment and Management.

An interprofessional group of educators from multiple institutions piloted a simulation-based learning experience focusing on acute pain management. The participants in the program were resident physicians-novice nurse dyads, and medical student-nursing student dyads from large universities and a magnet health care system. Each dyad was challenged to assess and manage acute pain in a simulated hospitalized patient using effective collaboration skills. The simulations included pre-debriefing, simulation, and a debriefing session. Participants completed pre- and post-surveys measuring confidence in pain management and attitudes toward physician-nurse collaboration. There was a significant positive shift in the confidence of the learners' ability to assess and manage acute pain in a hospitalized patient after the simulation and debriefing (23.2% strongly agreed versus 7% at baseline). Participants' attitudes regarding education to enhance interprofessional collaboration improved after the simulation experience (83.9% strongly agreed versus 73.7% at baseline). Based on these encouraging findings, we are extending this interprofessional experience to a larger group of learners with the same targeted dyads.