She came to me for care, why would I say no? Survey results of advanced practice nurses caring for transgender and gender diverse patients.

BACKGROUND: Literature has recognized deficient knowledge of transgender or gender diverse (TGD) patient needs that can negatively affect health care. Prior research on education has shown little progress responsive to TGD health care needs from nursing. Findings from this demonstrate some improvement, however slight. This study examined the education of family nurse practitioners (FNPs) providing care to TGD patients. PURPOSE: The purposes of this study were to describe the relationship between location of practice and TGD patient care and to identify emerging themes related to the care of TGD individuals. METHODS: Surveys were sent to 3,500 FNPs. Surveys were completed by 356. RESULTS: No significant results were found between location of practice and TGD patient care or between location of education and TGD curricular inclusion. Statistical significance was found between inclusion of TGD content and participants' year of graduation. Those graduating in or after 2011 were more likely to report receiving content. Themes emerged in four areas related to practice area, role, location, and education. This study highlights inadequacy of curricular inclusion of TGD health needs. Findings underscored ways FNPs sourced best practices to provide health care to TGD people. IMPLICATIONS FOR CLINICAL PRACTICE: These findings provide additional support for the need to educate FNPs to reduce barriers for TGD persons in accessing affirming health care.

A population study of the NYS measles epidemic: Lessons learned.

OBJECTIVES: In 2019 the United States experienced the largest outbreak of measles in 27 years, 19 years after the United States declared measles eliminated. The purpose of this paper was to present a population study of a measles outbreak within Orthodox Jewish communities in New York that led to the elimination of religious exemption for school mandated vaccines. METHODS: Peer reviewed articles, news media, health department, and government resources were used to investigate environmental factors that led to this outbreak. State, county, and city immunization records were accessed to explore measles compliance rates before and after policy change. RESULTS: Rockland County had low compliance rates compared to the rest of the state, and the elimination of religious exemptions raised compliance rate almost to state level. In all but one affected New York City zip codes, compliance following policy change rose to 97.95%-99.15%. CONCLUSIONS: Overall, changes in measles compliance rates reflect policy goals, but localized differences imply a need for more customized interventions for each unique community. Public health planning to promote vaccination should be sensitive to the concerns and perceptions of each community in order for health interventions to have a positive effect.

Lesbian, Gay, Bisexual, and Transgender Inpatient Satisfaction Survey: Results and Implications.

BACKGROUND: Disparities in health care among lesbian, gay, bisexual, or transgender (LGBT) communities have been researched in primary care, but few have examined these phenomena among LGBT inpatients. METHODS: Descriptive correlational study. A questionnaire was emailed to an LGBT population for a total of 508 participants. Questionnaires addressed level of satisfaction with hospital employees and whether this was related to their sexual orientation or gender identity (SOGI). Descriptive statistics describe participants and hospitals. χ2 was used to examine satisfaction and belief based on SOGI, recommendation to LGBT friends, and the relationship between location and likelihood of recommendation. RESULTS: Those reporting dissatisfaction were likely to indicate it was related to their SOGI. They were less likely to recommend the hospital to LGBT friends or family. Analysis between location and recommendation identified rural hospitals as less likely to be recommended. DISCUSSION: Lesbian, gay, bisexual, or transgender patients perceived lack of courtesy by hospital employees to be related to their SOGI.

Results and implications from a gender minority health education module for advance practice nursing students.

Nursing literature has recognized deficits in lesbian, gay, bisexual, transgender, queer-specific care. Of particular concern is lack of knowledge about gender minorities. Lack of knowledge remains despite this populations' increased health disparities. This pilot study investigates pre- and post-knowledge of medical guidelines, disparities, policies, and attitudes specific to gender minorities among advanced practice nursing students attending a gender minority health module. All participants in this pilot study completed a questionnaire on content and a transphobia scale to evaluate its effect on attitudes. Students were also surveyed on previous experience with gender minority patients. Students indicated sex and gender identity as female, with a mean age of 33.5 years. Twenty-seven percent of the students reported experience with gender minority patients. Wilcoxon signed rank test indicated statistically significant improvement in knowledge and improved scores on transphobia. This study demonstrated a module on the health of gender minorities is an effective method for increasing student knowledge of gender minority health care.

U.S. Nurse Practitioner Beliefs About Routine HIV Screening: Predicting Behaviors.

HIV is a preventable infection. Effective HIV prevention interventions, which include routine HIV screening, have reduced HIV transmission. As health care providers, nurse practitioners (NPs) have a role in screening for HIV. In this study, we explored NP attitudinal, social normative (expectation and priority), and behavioral control (perceived barriers and facilitators) beliefs that predicted their self-reported HIV screening behaviors. The Theory of Planned Behavior guided the study. Data from 141 NPs were collected through a cross-sectional, paper and pencil survey. Findings revealed that the belief that "my office staff supports routine HIV screening with my patients" predicted HIV screening, whereas the belief that "consent from a parent/guardian should be obtained before screening for HIV in a person younger than 18 years" predicted less HIV screening. Nurse practitioners identified social normative expectations to be most influential in predicting their routine HIV screening behaviors.

HIV screening intentions, behaviors, and practices among nurse practitioners.

BACKGROUND AND PURPOSE: HIV/AIDS is a significant public health issue for individuals living in the United States. Federal agencies and key stakeholders recommend routine HIV/AIDS screening among individuals aged 13-64 of age, yet few studies focus on the nurse practitioner's (NP) perspective. The purpose of this study was to examine routine HIV screening intentions, behaviors, and practices using a national sample of NPs. METHODS: Cross-sectional study utilizing a random sample of 600 NPs from the American Association of Nurse Practitioners™ organization. A total of 141 NPs returned complete responses to the paper and pencil questionnaire and were included in the study. CONCLUSIONS: One-quarter (25%, n = 35) of the NPs reported routine HIV screening behavior. Half (48%, n = 67) reported intentions to increase routine HIV screening in the next year. HIV screening practices were reported as risk-based and patient-initiated among this sample of NPs. IMPLICATIONS FOR PRACTICE: In the U.S. healthcare system, NPs serve as leaders in primary and secondary prevention, screening and identifying individuals who are unaware of their HIV infection. Greater coordinated efforts and new system approaches are needed to help NPs adapt HIV screening recommendations and practice guidelines.

Barriers to Asthma Management as Identified by School Nurses.

Asthma rates are increasing in children. School nurses have opportunities to care for children with asthma but need to overcome barriers impacting their ability to manage asthma in the school setting. This study (a) assessed barriers present in the school setting, (b) determined the impact of barriers on performance of asthma management behaviors, and (c) determined the impact of barriers on importance ratings of asthma management behaviors, asthma self-efficacy, and asthma attitudes (N = 537). Results revealed 72% of the nurses reported at least one barrier. As numbers of barriers increased, performance of asthma management behaviors decreased. Significant relationships were found between specific asthma management behaviors and specific barriers. No significant relationships were found between barriers and asthma self-efficacy, asthma attitude, or importance ratings of asthma management behaviors. Removing barriers may allow the nurse to perform at greatest effectiveness, enhancing the positive outcomes that result from appropriate asthma management.

Informal caregivers and detection of delirium in postacute care: a correlational study of the confusion assessment method (CAM), confusion assessment method-family assessment method (CAM-FAM) and DSM-IV criteria.

OBJECTIVES: Delirium is a common, serious and potentially life-threatening syndrome affecting older adults. This syndrome continues to be under-recognised and under treated by healthcare professionals across all care settings. Older adults who develop delirium have poorer outcomes, higher mortality and higher care costs. The purposes of this study were to correlate the confusion assessment method-family assessment method and confusion assessment method in the detection of delirium in postacute care, to correlate the confusion assessment method-family assessment method and diagnostic and statistical manual of mental disorders text revision criteria in detection of delirium in postacute care, to determine the prevalence of delirium in postacute care elders and to describe the relationship of level of cognitive impairment and delirium in the postacute care setting. Implications for Practice Delirium is disturbing for patients and caregivers. Frequently . family members want to provide information about their loved one. The use of the CAM-FAM and CAM can give a more definitive determination of baseline status. Frequent observations using both instruments may lead to better recognition of delirium and implementation of interventions to prevent lasting sequelae. METHODS: Descriptive studies determined the strengths of relationship between the confusion assessment method, confusion assessment method-family assessment method, Mini-Cog and diagnostic and statistical manual of mental disorders text revision criteria in detection of delirium in the postacute care setting. RESULTS: Prevalence of delirium in this study was 35%. The confusion assessment method-family assessment method highly correlates with the confusion assessment method and diagnostic and statistical manual of mental disorders text revision criteria for detecting delirium in older adults in the postacute care setting. Persons with cognitive impairment are more likely to develop delirium. Family members recognise symptoms of delirium when asked. DISCUSSION: The confusion assessment method-family assessment method is a valid tool for detection of delirium. IMPLICATIONS FOR PRACTICE: Delirium is disturbing for patients and caregivers. Frequently. family members want to provide information about their loved one. The use of the CAM-FAM and CAM can give a more definitive determination of baseline status. Frequent observations using both instruments may lead to better recognition of delirium and implementation of interventions to prevent lasting sequelae.

Using the Health Belief Model to Understand School Nurse Asthma Management.

Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses' asthma management behaviors in relationship to asthma knowledge, asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors. Results indicated that asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors were associated with performance of asthma management behaviors. The higher the rating of importance of asthma management behaviors, the more likely school nurses were to perform the behaviors (p < .05). Higher levels of asthma self-efficacy were associated with performance of asthma management behaviors, indicating the importance of strengthening school nurses' asthma self-efficacy in asthma management. By understanding factors influencing performance of asthma management behaviors by school nurses, interventions can be implemented to increase asthma management behaviors, leading to improved outcomes for students with asthma.

Cues-to-Action in Initiating Lesbian, Gay, Bisexual, and Transgender-Related Policies Among Magnet Hospital Chief Nursing Officers: A Demographic Assessment.

This study explored Magnet Chief Nursing Officers' cues-to-action initiating lesbian, gay, bisexual, or transgender (LGBT)-specific policies. Homonegativity has a negative effect on employee recruitment and retention and patient satisfaction. Little has been known about what cues-to-action might initiate LGBT inclusive training. Surveys were mailed to 343 Chief Nursing Officers. Cues-to-action survey was used to assess what inspires initiation of LGBT training. Demographic surveys were used to assess what impact variables might have on cues-to-action. Age, sex, religiosity, location, and region had significant effect on cues-to-action. Developing demographically informed training and policies for LGBT equality in health care is suggestive of greater employee and patient satisfaction.

Magnet nurse administrator attitudes and opportunities: toward improving lesbian, gay, bisexual, or transgender-specific healthcare.

OBJECTIVE: This study explored Magnet® hospital chief nursing officers' (CNOs') attitudes toward gays and lesbians and the impact that these attitudes have on providing advocacy for lesbian, gay, bisexual, or transgender (LGBT) patients and staff. BACKGROUND: Homonegativity encompasses both heterosexism and homophobia and has profound effects on the health of LGBT populations. Little has been reported about the attitudes of CNOs toward LGBT populations and how these might impact advocacy for LGBT healthcare. METHODS: Surveys were electronically mailed to 343 Magnet CNOs. The Modern Homonegativity Scale was used to assess attitudes, and additional statements were developed to assess the comfort level of the respondent in advocating for LGBT populations. RESULTS: Attitudes among CNOs toward LGBT populations and comfort with advocating for LGBT populations were positively correlated. Those demonstrating less homonegative attitudes were more likely to feel comfortable advocating for LGBT patients and staff. CONCLUSIONS: Recognizing and addressing bias among nurse leaders through education are important to ensure equitable healthcare for patients and employees.

Functional health status among rural and urban older adults in Taiwan: the effect of personal control and social control.

AIM: To assess the relationship between perceived social control/personal control and functional health status among older adults in rural and urban Taiwan. BACKGROUND: The ageing of the population is poised to emerge as a preeminent worldwide phenomenon. It is assumed that even though older adults experience many decades of autonomy and independence, the potential for illness or bodily decline will induce a serious reduction in the level of perceived control in older adult populations. METHOD: This is a descriptive correlational study using a secondary data base, Social Environment and Biomarkers of Aging Study. Social Environment and Biomarkers of Aging Study is a nationally representative study of health outcomes in the Taiwanese population. RESULTS: Both perceived levels of social control and personal control had a statistically significant relationship with functional health status. Functional health status was significantly higher for urban older adults than their rural counterparts. CONCLUSIONS: Personal control and social control were both found to be predictors of functional health status. Major findings are supported by previous studies. RELEVANCE TO CLINICAL PRACTICE: Nurses should create programs and plan activities to assist older adults to enhance their perceptions of social control or personal control in order to improve the health status of older adults and minimize associated health care costs.

Domestic violence: what do nurse practitioners think?

PURPOSE: To examine factors that influence nurse practitioners' (NPs) ability to incorporate universal domestic violence screening practices (e.g., asking, identifying, referring and reporting) into their practices. DATA SOURCES: A stratified random survey of certified NPs in New York state was conducted in 1999. There were 118 family, women's health, OB/GYN, and adult NPs in the survey. Chi-square and ANOVA were used to analyze the data. CONCLUSIONS: There were significant differences in the domestic violence screening practices among women's health, OB/GYN, adult, and family NPs. Women's health and OB/GYN NPs were more likely to ask screening questions and identify victims of domestic violence than their other NP counterparts. IMPLICATIONS FOR PRACTICE: There is a need to identify strategies that encourage all NPs to incorporate universal domestic violence screening behaviors into their practices.

Health risk behaviors among adolescents attending rural, suburban, and urban schools: a comparative study.

This study describes differences in health risk behaviors among 2,017 adolescents attending rural, suburban, and urban school districts in upstate New York. Differences in risk behaviors regarding use of tobacco, alcohol, and illegal substances; sexual activity; and carrying weapons were analyzed. A consistent pattern emerged from the analysis of the data, with rural students at most risk. The findings reinforce the need to focus on the relationship between residence and health risk behaviors, so that intervention programs specific to the needs of rural, suburban, and urban adolescents can be developed.