Advance Care Planning Engagement Strategies for Primary Care Providers Seeing Diverse Patient Populations: A Scoping Review.

Diverse patients are less likely than Whites to have advance care planning. The primary purpose of this scoping review was to summarize recent evidence about advance care planning engagement interventions for primary care providers working with diverse patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. Peer-reviewed articles published in English since 2000 reporting the results of studies testing intervention programs in primary care to improve advance care planning with adult, racially diverse populations were included. Searches were conducted in 5 online databases and yielded 72 articles. Gray literature yielded 23 articles. Two authors independently reviewed the abstracts of 72 articles determining that 9 articles met the aim of this review. These studies were analyzed by communication tools and other resources, population, intervention, primary outcomes, instruments, and primary findings and organized into 3 categories: ( a ) provider-focused interventions, ( b ) patient-focused interventions, and ( c ) multilevel interventions. Improvement in advance care planning outcomes can be achieved for racially diverse populations by implementing targeted advance care planning engagement interventions for both providers and patients. These interventions can be used in primary care to increase advance care planning for diverse patients. More research is needed that evaluates best practices for integrating advance care planning into primary care workflows.

Selecting a journal for your manuscript: A 4-step process.

BACKGROUND: Identifying the most appropriate journal for a manuscript can be challenging for both experienced and novice nurse authors. Several factors should be considered when selecting a journal (e.g., peer-reviewed, target audience, type of manuscripts accepted, type of copyright and publishing model used). Selecting the most appropriate journal can save time for both authors and publishers. PURPOSE: The purpose of this article is to provide nurses, particularly those new to scholarly publishing, with clear, plain language guidance on the processes and considerations involved in selecting a journal for publication. METHODS: A librarian and a nurse educator collaborated to develop an innovative 4-step process to help authors select the most appropriate journal for their manuscript. RESULTS: A case study is used to illustrate the process, and a worksheet is provided to guide the reader through the selection of an appropriate journal for their manuscript. CONCLUSIONS: This manuscript can be used by individual nurse authors to find the most appropriate journal for their manuscript, as a teaching tool for nurse educators, and for others mentoring nurse authors who are new to publishing.

Workplace bullying and risk of burnout in nurses: a systematic review protocol.

OBJECTIVE: The objective of this review is to assess the association between workplace bullying and nurse burnout. INTRODUCTION: Internationally, workplace bullying has been linked to nurse burnout. Burnout is of significant concern due to its association with nurses' intent to quit, job dissatisfaction, reduced empathy and patient satisfaction. While there have been systematic reviews conducted on workplace bullying, none have explored its association with nurse burnout. INCLUSION CRITERIA: This review will consider studies that include licensed nurses in any clinical setting in any country. Only studies in which the Negative Acts Questionnaire-Revised was used to measure licensed nurses' exposure to workplace bullying and in which the Maslach Burnout Inventory was used to measure burnout (i.e. the outcome of interest) will be considered. Prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies will be considered for inclusion. METHODS: Key information sources to be searched for studies in English from 1990 to the present include CINAHL, Embase, PsycINFO, PubMed and Scopus. Two independent reviewers will screen titles, abstracts and full texts of selected citations against the inclusion criteria and appraise for methodological quality. Two reviewers will independently use the standardized data extraction tool to extract data from studies used in the review. Studies will, where possible, be pooled in a statistical meta-analysis. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation, where appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019128798.

Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review.

OBJECTIVE: The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals. INTRODUCTION: Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic. INCLUSION CRITERIA: Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. METHODS: A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools. RESULTS: Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. CONCLUSIONS: Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.

Critical librarianship in health sciences libraries: an introduction.

The Medical Library Association recently announced its commitment to diversity and inclusion. While this is a positive start, critical librarianship takes the crucial concepts of diversity and inclusion one step further by advocating for social justice action and the dismantling of oppressive institutional structures, including white supremacy, patriarchy, and capitalism. Critical librarianship takes many forms, but, at its root, is focused on interrogating and disrupting inequitable systems, including changing racist cataloging rules, creating student-driven information literacy instruction, supporting inclusive and ethical publishing models, and rejecting the notion of libraries as neutral spaces. This article presents examples of the application of critical practice in libraries as well as ideas for applying critical librarianship to the health sciences.

Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice.

BACKGROUND: Nurses engaged in evidence-based practice (EBP) have two important sets of tools: Critical appraisal tools and reporting guidelines. Critical appraisal tools facilitate the appraisal process and guide a consumer of evidence through an objective, analytical, evaluation process. Reporting guidelines, checklists of items that should be included in a publication or report, ensure that the project or guidelines are reported on with clarity, completeness, and transparency. PURPOSE: The primary purpose of this paper is to help nurses understand the difference between critical appraisal tools and reporting guidelines. A secondary purpose is to help nurses locate the appropriate tool for the appraisal or reporting of evidence. METHODS: A systematic search was conducted to find commonly used critical appraisal tools and reporting guidelines for EBP in nursing. RATIONALE: This article serves as a resource to help nurse navigate the often-overwhelming terrain of critical appraisal tools and reporting guidelines, and will help both novice and experienced consumers of evidence more easily select the appropriate tool(s) to use for critical appraisal and reporting of evidence. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses (Melnyk & Gallagher-Ford, 2015; Melnyk, Gallagher-Ford, & Fineout-Overholt, 2017). RESULTS: Nine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool's use in a publication are provided. LINKING EVIDENCE TO ACTION: Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies. This article is a resource for understanding the difference between critical appraisal tools and reporting guidelines, and identifying and accessing appropriate tools or guidelines.

CULTURE OF OPPRESSION IN AFRICAN-AMERICANS WITH HEART FAILURE.

African-Americans are disproportionately affected and have a greater incidence of heart failure compared to other populations. Current literature identifies many contributory factors, among which is the role of culture. Culture, defined to include socioeconomic status and the historical and sociological experience of African-Americans, may play a pivotal role in how clients manage their symptoms of heart failure. This study attempts to explain how culture contributes to the lack of successful management of heart failure among African-Americans using the framework of Hofstede's cultural dimensions of power distance and individualism.

Behavior-change action plans in primary care: a feasibility study of clinicians.

PURPOSE: Collaborative goal-setting--with clinician and patient together deciding on concrete behavior-change goals-may be more effective in encouraging healthy behaviors than traditional clinician-directed advice. This study explores whether it is feasible for clinicians to engage patients with coronary heart disease (CHD) risk factors in collaborative goal-setting and concrete action planning during the primary care visit. METHODS: Primary care clinicians were trained in goal-setting and action planning techniques and asked to conduct action plan discussions with study patients during medical visits. Clinicians' experiences were documented through post-visit surveys and with questionnaires and semistructured interviews at the end of the study. RESULTS: Forty-three clinicians and 274 patients with CHD risk factors participated in the study; 83% of the patient encounters resulted in a behavior-change action plan. Goal-setting discussions lasted an average of 6.9 minutes. Clinicians rated 75% of the discussions as equally or more satisfying than previous behavior-change discussions, and identified time constraints as the most important barrier to adopting the goal-setting process. CONCLUSIONS: Collaborative goal-setting between clinicians and patients for improved health behaviors is viewed favorably by clinicians in primary care. Time constraints could be addressed by delegating goal-setting to other caregivers.

Using action plans to help primary care patients adopt healthy behaviors: a descriptive study.

PURPOSE: An action plan is an agreement between clinician and patient that the patient will make a specific behavior change. The goals of this study are to: determine whether it is feasible for patients to make action plans in the primary care visit; determine whether patients report carrying out their action plans; and describe the action plans patients choose. METHODS: Forty-three clinicians in 8 primary care sites were recruited to hold action-plan discussions with patients. Research assistants contacted patients by telephone 3 weeks later to assess whether patients had conducted their action plans. RESULTS: Eighty-three percent of enrolled patients (228) made an action plan during a primary care visit. Of the 79% who recalled making the action plan when interviewed by telephone 3 weeks later, 56% recalled the details of their action plan, and an additional 33% recalled the general nature of the action plan. At least 53% of patients making an action plan reported making a behavior change consistent with that action plan. CONCLUSIONS: Most patients reported making a behavior change based on an action plan, suggesting that action plans may be a useful strategy to encourage behavior change for patients seen in primary care.