Concurrent enrollment pathway: A model for ADN-BSN programs.

INTRODUCTION: The purpose of this article is to share the collaborative planning and execution of these two public universities and one community college in developing an innovative program to increase BSN-prepared nurses. The aim of the collaboration is to offer a high quality, affordable, and time-saving pre-licensure, concurrent enrollment program (CEP) which allows community college ADN students direct access to BSN study, while maintaining excellent program outcomes, and increasing diverse baccalaureate-prepared nurses in practice. METHODS: Key stakeholders in two public educational systems met to discuss the development of a regional collaboration between two state universities and one local community college. The group designed university-specific, concurrent curricular roadmaps for each university. Students admitted in ADN program chose if they want to attend a concurrent enrollment or a traditional plan of study. RESULTS: In Fall 2019, the CEP program was launched admitting 40 ADN students concurrently enrolled in one university. Subsequently, another cohort started in Spring 2020 with 39 students dually enrolled at the other state university. All students in both cohorts resided in the region. Over 75 % of the total CEP enrollees came from diverse backgrounds, 49 % Hispanics, 16 %, Asians, and 8 % African Americans and 4 % native Hawaiians. Forty-four percent were first generation college students. The average age was 25 with a range of 21-39. Twenty percent of the students were male which is above the national average of 12 %. After four semesters, students completed their ADN degree, passed the licensure exam, and transitioned to earn their BSN degree in the university for another two semesters. CONCLUSION: The literature reveals that BSN-prepared nurses contribute to safe patient care. The current number of cost-effective and accessible nursing programs are not sufficient to reach the IOM 80/20 goal, which contributes to the ongoing shortage of BSN-prepared nurses in the nation, including California. Creativity and open collaboration of nurse leaders, faculty, and staff across different levels of education was instrumental in the success of the students and the program.

Grit Levels of Graduate Nursing Students: Why Grit Is Needed in Nursing.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has created a need for nurses who are perseverant and passionate, the definition of grit. This study examined grit levels in Master in Nursing (MSN) and Doctor of Nursing Practice (DNP) students. METHOD: MSN and DNP students were surveyed using the Grit-S scale, which is composed of two parts: Grit-CI (consistency of interest) and Grit-PE (perseverance of effort). RESULTS: Overall, graduate nursing students had high levels of grit as measured by the Grit-S (M = 3.9, SD = 0.5). Perseverance was higher for both MSN and DNP students than passion (M = 4.2, SD = 0.5 vs. M = 3.6, SD = 0.7). There was no difference in Grit-S levels related to program type. CONCLUSION: Graduate nursing students had high levels of grit. With the challenges faced by nursing professionals during the COVID-19 pandemic, nurses with high grit levels may avoid burnout and persevere though challenges. [J Nurs Educ. 2022;61(4):197-200.].

Building coalitions: A statewide nursing organization's role in changing nursing education regulation during the COVID-19 pandemic.

The California Association of Colleges of Nursing (CACN), representing California's baccalaureate and higher degree nursing education programs, has raised concerns for over two-years about the number, relevance, and legitimacy of nursing education regulations. Formal CACN letters to state regulators did not affect change. While California nursing education regulations require 75% direct patient contact for all clinical courses, meeting this requirement became impossible as clinical agencies closed to nursing students during the beginning of the COVID-19 pandemic. Nursing regulatory change was urgently needed to provide greater flexibility in meeting clinical course objectives using simulation and other online learning modalities. At stake was the graduation of over 14,971 RN students from public and private nursing programs. While state regulators opposed a legislative approach, CACN collaborated with stakeholders to support legislation that led to a reduction in direct patient care hours, allowing nursing students to progress and graduate. This longstanding advocacy work was accelerated by the pandemic and required leadership and knowledge about the legislative process for nurse educators to succeed. The ultimate goal for CACN is to forge a more respectful relationship and greater collaboration between educators and regulators to enhance quality, reduce costs, and redundancies in nursing education in this state.

Use of Licensed Vocational Nurses in California Schools: A Descriptive Study.

The demand for schools to provide complex health-care services for students with chronic conditions has induced districts to hire licensed vocational nurses (LVNs). Questions remain about how overlapping responsibilities and skills of nursing staff works to facilitate care. The purpose of this mixed-methods descriptive study was to examine the use of LVNs to identify factors related to the supports and impediments to school nurse (SN) practice. The sample consisted of members of the California School Nurse Organization, and methodologies consisted of an online survey and one-on-one interviews. LVNs perform duties within their scope of practice, allowing SNs time for activities related to the Framework for 21st Century School Nursing PracticeTM, confirming appropriate use, and alignment with National Association of School Nurses guidance on the utilization of LVNs. Identified areas of concern included role definition and orientation and supervision of the LVN. Insights into best practices for the effective addition of the LVN to the team are provided.

Addressing Illness-Related Chronic Absences.

School attendance is a predictor of academic achievement. Chronic absenteeism, defined as missing 10% or more school days affects 14% of all students nationwide. District attendance processes, policies, and data were analyzed in a demographically diverse southern California high school. A review of the attendance history of 117 ninth and tenth graders, who missed at least 10% of days in school, showed that 66% of the absences were due to illness. Prior to the project, these students were not referred for nursing intervention. Results of this quality improvement project supported the adoption of a specific code for absences due to illness. A district procedure for illness chronic absence was adopted to allow early nursing intervention for students with chronic absences prior to the development of illness-related academic underperformance. This project demonstrates nursing roles in the quality improvement and care coordination aspects of the NASN's Framework for 21st Century School Nursing Practice™.

Depression Screening in the School Setting: Identification of the Depressed Adolescent.

Adolescent depression is a silent epidemic in this country. Untreated depression has detrimental effects on physical health, psychosocial well-being, and academic productivity. It is important for school nurses to be able to recognize depression and refer students promptly for treatment. This article and its associated learning module will provide school nurses with updated information on adolescent depression, discuss barriers in depression screening, use of the PHQ-9 (Patient Health Questionaire-9 Item) as an evidence-based depression screening tool in the educational setting, and the important role of school nurses in depression screening. It is anticipated that by increasing awareness and knowledge about adolescent depression and providing training in the use of an evidence-based screening tool, school nurses will have greater confidence in identifying and referring students in need. (A free online depression screening education module developed by the lead author is available at https://sites.google.com/view/depressionscreeningtraining .).

Sailing the "Seven C's" of Leadership.

Nurses are increasingly being called upon to lead changes within health care. How do nurses and, in particular, school nurses become leaders? School nurses lead daily in their work but often do not recognize themselves as leaders. The "Five C's of Leadership"-character, commitment, connectedness, compassion, and confidence-identified by Kowalski and Yoder-Wise are foundational to the development of leadership and are particularly relevant to school nurses and their role. Two additional attributes found in the literature-courage and capacity-also undergird school nursing practice. In this article, we describe how school nurses already embody these leadership qualities. Each leadership attribute is reviewed in light of the literature, followed by specific examples to demonstrate how school nurses provide leadership. Through these illustrations, school nurses can recognize and embrace their present leadership abilities. In addition, by using the "Seven C's" of leadership, school nurses can enhance their inherent leadership abilities.

Does Moral Distress Differ Between California Certified Registered Nurse Anesthetists in Independent Versus Medically Supervised Practice: An Exploratory Study.

The purpose of this exploratory, descriptive study was to determine if moral distress levels differed between certified registered nurse anesthetists (CRNAs) working in medically supervised versus independent practice in California. A 63-question survey was administered to 1,190 California CRNAs. Moral distress was measured by the included Ethics Stress Scale. The response rate was 14.7%, yielding demographic and Ethics Stress scores for 175 respondents. Sixty-five participants answered an open-ended question about moral distress yielding qualitative data. Medically supervised CRNAs had a lower mean moral distress scores (176.8) versus independent practice CRNAs (187.8) (p = .002). Lower scores on the ESS indicate higher moral distress. Qualitative data demonstrated that CRNAs experienced moral distress in the following situations: when pressured to give anesthesia to unoptimized patients, when differences of opinion regarding anesthetic plans occurred, in dealing with end-of-life issues, when working with incompetent providers, and during interprofessional struggles between CRNAs and anesthesiologists. In order to reduce moral distress among CRNAs, implications for practice include increased administrative support, increased communication and reciprocated collegial respect between anesthesiologists and CRNAs, and CRNA representation on ethics committees.

School nurses and care coordination for children with complex needs: an integrative review.

Health care for students with chronic needs can be complex and specialized, resulting in fragmentation, duplication, and inefficiencies. Students who miss school due to chronic conditions lose valuable educational exposure that contributes to academic success. As health-related disabilities increase in prevalence so does the need for the coordination of care within the school and between the school and service providing agencies. This integrative literature review provides a synthesis of published evidence identifying and describing the core concepts associated with the role of school nurses in providing care coordination/case management to students with complex needs. Six core essentials of nurse-provided care coordination were identified: collaboration, communication, care planning and the nursing process, continuous coordination, clinical expertise, and complementary components. Recommendations for improving care coordination were elucidated in the review. Analysis of the literature can help assure application of best practice methods for the coordination of care for students in the school setting.

Assessing health literacy in renal failure and kidney transplant patients.

CONTEXT: A report released in 2004 by the Institute of Medicine estimated that as many as 90 million Americans do not have the necessary skills required to manage complex treatment regimens or navigate through current health care systems successfully. OBJECTIVES: To identify the level of health literacy in patients seen at a suburban transplant center by using the Newest Vital Sign tool to assess health literacy. DESIGN AND SETTING: This descriptive study used survey methods. The convenience sample included 44 adult patients, both English and Spanish speaking, who attended a routine clinic visit at a suburban transplant center. METHODS: The Newest Vital Sign tool was administered during routine outpatient medical visits. Demographic information collected included age, sex, highest level of education, and whether or not the participant was on dialysis or received a kidney transplant. Descriptive statistics were completed for each answer on the tool. Chisquare analyses were done to determine whether demographic factors or the presence of dialysis affected health literacy in this sample. A 1-way analysis of variance between-subjects test was run to compare the effect of primary language and educational level on scores. RESULTS: Of the 44 participants, 18 (41%) had scores indicating a possible likelihood to a high likelihood of limited health literacy. Twenty-nine percent of the English-speaking participants and 89% of the Spanish-speaking participants scored in this range. An association was also found between performance on the survey and level of education. However, assessment of educational level alone is not predictive of health literacy; 8 participants (18%) had a high school or college education yet scored as having limited health literacy.

School asthma screening and case management: attendance and learning outcomes.

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided to link these students to medical care and assure asthma action plans at school. In the 40 children with confirmed diagnosis who received CM, academic performance on standardized testing postintervention was similar to the 76 children who were low risk for asthma. Average days absent due to illness in the CM group were reduced from 5.8 to 3.7 days in the postintervention school year. School nurse screening, CM, and collaboration with a medical provider resulted in early identification, referral, and subsequent treatment of students at risk for asthma and may have contributed to reduced illness absences.

Asian motivators for health promotion.

Change in health behaviors requires motivation on the part of the individual. The aim of this article is to compare elements of the motivation process across cultures. A secondary aim is to determine whether a Western model of behavior change for health promotion, such as the PRECEDE-PROCEED model, can be applied to Asian populations. An integrative review and critical analysis of research literature was done by reviewing 20 studies with observational survey design and 6 integrative literature reviews. Findings show that the motivation process is similar for Eastern and Western cultures, but the motivators are different. The findings identify 10 motivators, congruent with Asian culture, that would allow the PRECEDE-PROCEED model to be used in Asian settings.

Elementary school nurse interventions: attendance and health outcomes.

Regular school attendance is a necessary part of the learning process; student absenteeism has a direct association with poor academic performance. School nurses can influence student attendance. This study describes the impact of school nurse interventions on student absenteeism and student health. A retrospective review of 240 randomly selected elementary student health folders and attendance records was conducted. School nurses were involved with 75% of high-absence students as compared to 66% of low-absence students; they were also more involved with students who had previously identified health conditions. There were no referrals to the school nurse for absenteeism and school nurse interventions were not targeted to attendance, despite 17% of students missing 11 or more school days. Nursing documentation was sparse and primarily task related. Few records contained entries of nursing diagnoses, interventions, or outcomes. Of the 134 interventions provided, only 56 (41.2%) had some information about the condition outcome, but it was insufficient to determine the effectiveness of nursing interventions. Furthermore, the record system did not support the collection of standard information for interventions or outcomes from which effectiveness could be determined. Recommendations include establishment of an attendance referral policy and improved documentation systems, including the use of standardized nursing language to demonstrate student outcomes.

Effect of a brief antiretroviral adherence intervention delivered by HIV care providers.

Antiretroviral therapy (ART) is effective in controlling viral load in many people infected with HIV, but high levels of adherence to ART are needed for prolonged viral suppression. This study evaluated a brief adherence intervention delivered to HIV-positive patients by primary care providers during routine medical examinations. Six clinics were randomly allocated to deliver an intervention focusing on ART adherence (2 clinics) or safer sex (4 clinics). Interventions included written information (posters, brochures, and flyers) and brief counseling from providers and were evaluated with cohorts of randomly selected patients (n = 437) measured before and after a 10-month intervention. Among those 95% or greater adherent at baseline, 91% of patients who received the adherence intervention remained 95% or greater adherent at follow-up compared with 75% of the patients who received the safer sex intervention (chi = 12.59, P < 0.01). This difference was significant in a logistic regression analysis (odds ratio = 2.26; 95% confidence interval = 1.27-4.04), adjusting for baseline adherence, demographics, and HIV medical status. The adherence intervention did not significantly increase the prevalence of 95% or greater adherence among patients less than 95% adherent at baseline. Similar but nonsignificant results were observed for viral load. A brief intervention delivered to HIV patients by their primary providers helped to maintain adequate adherence to ART regimens. More intensive intervention is needed to improve adherence among patients who are initially less than 95% adherent.

Prevalence of and associated risk factors for fluoroquinolone-resistant Neisseria gonorrhoeae in California, 2000-2003.

BACKGROUND: Rates of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) are increasing worldwide and in California. METHODS: As a supplement to established surveillance, the investigation of QRNG in California included expanded surveillance in southern California, with in-depth interviews of patients (who had QRNG during the period of January 2001-June 2002) and a cross-sectional study of patients at 4 sexually transmitted diseases clinics with gonococcal isolates that underwent susceptibility testing (for the period of July 2001-June 2002). RESULTS: The rate of QRNG increased from <1% in 1999 to 20.2% in the second half of 2003. The 2001-2002 expanded surveillance demonstrated that 66 (4.9%) of 1355 isolates were resistant to fluoroquinolones; the majority of these infections occurred after August 2001. Cross-sectional analysis of 952 patients with gonorrhea revealed that the prevalence of QRNG varied geographically during 2001-2002, with the highest rate being in southern California (8.9%) and the lowest being in San Francisco (3.6%). The QRNG prevalence was 8.6% among men who have sex with men (MSM), 5.1% among heterosexual men, and 4.3% among women. Although risk factors for QRNG varied by clinic, multivariate analysis demonstrated independent associations with race/ethnicity, recent antibiotic use, and MSM. CONCLUSIONS: The emergence and spread of QRNG in California appeared to evolve from sporadic importation to endemic transmission among both MSM and heterosexuals. Monitoring of both the prevalence of and risk factors for QRNG infections is critical for making treatment recommendations and for developing interventions to interrupt transmission.

Use of and adherence to antiretroviral therapy is associated with decreased sexual risk behavior in HIV clinic patients.

Previous research suggested that the availability of highly active antiretroviral therapy (ART) was associated with increased risky sexual behavior. This study examined the relationship between unprotected anal or vaginal sex (UAV) and ART use and adherence in a cross-sectional survey conducted in 874 randomly selected, sexually active patients at 6 public HIV clinics in California. Patients completed a standardized interview in 1998-1999 regarding HIV history, sexual behavior, illicit drug use, and ART use and adherence. Thirty-four percent reported UAV, defined as anal or vaginal sex without a condom within the past 3 months. Of 79% on ART, 26% reported <95% adherence. Decreased odds for UAV were found for both ART use, odds ratio (OR) 0.5 (95% CI 0.4-0.7, P < 0.001) and adherence to ART of > or = 95%, OR 0.6 (95% CI 0.4-0.8, P < 0.001). These relationships persisted in most stratified analysis for both ART use and adherence but in multivariate analysis only for ART use. An undetectable HIV RNA was associated with decreased odds of UAV, OR 0.6 (95% CI 0.5-0.8, P < 0.001). Contrary to expectations, use of and adherence to ART and their consequent suppression of HIV were associated with a decreased prevalence of self-reported risky sexual behavior.

Using patient risk indicators to plan prevention strategies in the clinical care setting.

OBJECTIVE: Successful behavioral interventions to promote safe sex must be tailored to the sexual behaviors and relationships of individual patients. The aim of this study is to examine the distribution of unprotected anal and vaginal sex (UAV) and nondisclosure (ND) among categories of HIV-positive men and women based on relationship factors. These factors can be easily assessed and used as a basis for tailoring safer sex counseling in the clinic setting. METHODS: Eight hundred forty HIV-positive persons who were sexually active and attending 1 of 6 clinics in California were surveyed. Participants were categorized on the basis of numbers of partners, sexual orientation, type of relationship, and partner serostatus. Self-reported UAV, ND, and duration of the relationship were reported for each category and were examined. RESULTS: UAV was lower for those with 1 partner (26%) as compared with those with 2 or more partners (50%). ND was also lower for those with 1 partner (20%) as compared with those with 2 or more partners (60%). For those with 1 main partner, we found no significant differences in UAV by sexual orientation. UAV with seronegative main partners ranged from 16% to 20%, whereas UAV with seropositive partners ranged from 37% to 46%. Among men who have sex with men with 2 or more partners, relationships were more likely to be casual, of short duration, and to have higher levels of UAV and ND. CONCLUSION: The number of sex partners, type of relationship, and perceived HIV serostatus of a partner influence sexual behaviors and may be an efficient and effective basis for tailoring prevention messages.

Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment.

OBJECTIVE: To test the efficacy of brief, safer-sex counseling by medical providers of HIV-positive patients during medical visits. SETTING: Six HIV clinics in California. DESIGN: Clinics were randomized to intervention arms evaluated with cohorts of randomly selected patients measured before and after the intervention. PARTICIPANTS: Five-hundred and eighty-five HIV-positive persons, sexually active prior to enrollment. INTERVENTIONS: Prevention counseling from medical providers supplemented with written information. Two clinics used a gain-framed approach (positive consequences of safer-sex), two used a loss-frame approach (negative consequences of unsafe sex), and two were attention-control clinics (medication adherence). Interventions were given to all patients who attended the clinics. OUTCOME MEASURE: Self-reported unprotected anal or vaginal intercourse (UAV). RESULTS: Among participants who had two or more sex partners at baseline, UAV was reduced 38% (P < 0.001) among those who received the loss-frame intervention. UAV at follow-up was significantly lower in the loss-frame arm [odds ratio (OR), 0.42; 95% confidence interval (CI), 0.19-0.91; P = 0.03] compared with the control arm. Using generalized estimating equations (GEE) to adjust for clustering did not change the conclusions (OR, 0.34; 95% CI, 0.24-0.49; P = 0.0001). Similar results were obtained in participants with casual partners at baseline. No effects were seen in participants with only one partner or only a main partner at baseline. No significant changes were seen in the gain-frame arm. CONCLUSIONS: Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles.

Are HIV care providers talking with patients about safer sex and disclosure?: A multi-clinic assessment.

OBJECTIVES: To examine HIV-positive patients' reports of whether HIV care providers ever talked with them about practicing safer sex and disclosing seropositive status to sex partners. DESIGN: Cross-sectional survey (1998-1999) of HIV-positive men and women sampled randomly at six public HIV clinics in California. METHODS: Participants were interviewed and asked whether applicable clinic providers (physician, physician assistant, nurse practitioner, nurse, social worker, health educator, psychologist, psychiatrist) ever talked with them about safer sex or disclosure. Responses were analyzed by clinic site, HIV medical status (viral load), demographic, and behavioral variables (unprotected intercourse, non-disclosure). RESULTS: The sample (n = 839) included heterosexual men (n = 127), men who have sex with men (MSM; n = 607), and women (n = 105). Thirty-nine percent were white, 36% Hispanic, 17% black, and 8% other/mixed ethnicity. Overall, 71% reported that an applicable provider had talked with them at least once about safer sex (range across clinics, 52-94%); 50% reported discussion of disclosure (range across clinics, 31-78%). Discussion of safer sex was more prevalent with physicians than with other clinic staff. In multivariate analyses, in addition to significant clinic differences, MSM (versus heterosexual men) and whites (versus blacks or Hispanics) were less likely to receive prevention messages on these topics. Patients' behaviors (unsafe sex, non-disclosure) and HIV medical status were not independently associated with provider communication. CONCLUSIONS: HIV clinics differed substantially in the percentage of patients who reported that they received prevention messages from clinic staff. Care providers should assess and overcome barriers to providing prevention messages to patients.