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To examine the effect of oncology nurse navigators (ONNs) on the number of emergency department (ED) visits and hospital admissions (HAs) of adults with cancer post-outpatient chemotherapy.1,370 patients with cancer between January 1, 2018, and December 31, 2019, in a comprehensive community cancer center in southern California.A descriptive cross-sectional study was conducted using retrospective electronic health records. Primary analysis included bivariate and multiple linear regression to identify correlates of ED visits and HAs in terms of ONN involvement.About 35% of patients had an ED visit or HA. Anemia, dehydration, and pain were common diagnoses. No significant differences were found in ED visits and HAs by ONN group. Medicare and chemotherapy administration location contributed to the likelihood of ED visits; nausea, pain, and pneumonia contributed to the likelihood of HAs.ED visits and HAs are not appropriate clinical outcomes to measure ONNs' efficacy. Further research is needed to understand the long-term fiscal and operational outcomes of ONNs.

Background: The maternal and neonatal consequences of not receiving treatment for opioid use disorders (OUDs) is well known. To prevent adverse outcomes and provide appropriate treatment and services, it is imperative to understand factors influencing pregnant women with OUDs to seek treatment. Objectives: The purpose of this study is to identify barriers and facilitators related to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids. Method: Retrospective analysis of data from the National Survey on Drug Use and Health (NSDUH), using 2016, 2017, and 2018 NSDUH data. Sample included 122 pregnant and 3,305 nonpregnant women who misused opioids. Results: Significant associations were noted among women who misused opioids ( n = 3,427); age (χ2 = 25.406, p < .001), race/ethnicity (likelihood ratio [LR] = 17.721, p < .007), geographic location (χ2 = 7.585, p < .023), health insurance (LR = 13.909, p < .016), tobacco use within the past year (χ2 = 7.058, p = .008), and alcohol use within the past month (χ2 = 76.783, p < 0.001), 3.3% pregnant and 1.8% nonpregnant women who misuse opioids perceive a need to obtain treatment; 10.7% pregnant and 6.5% nonpregnant women currently receiving treatment for opioid misuse. The Strengthening the Reporting of Observational studies in Epidemiology checklist was used to develop the study. Conclusions: It is our responsibility to equally focus efforts on understanding the construct of perceived need and help seeking behaviors among pregnant women, as well as, deploy known techniques to engage them in recovery. Further research is necessary to explore the construct of perceived need in this population, as well as, strategies to increase engagement.

Purpose: Increasing patient activation facilitates self-management of health, improves health outcomes, and lowers health care expenditures. Extant research notes mixed findings in patient activation by race/ethnicity. The purpose of the study was to examine the relationships among patient activation, select patient characteristics, and glycemic control among Filipino Americans. Methods: A cross-sectional study was conducted with a convenience sample of Filipino Americans (n=191), with a diagnosis of diabetes mellitus type 1 or type 2, recruited from a southern California adult primary care clinic between December 2017 and March 2018. Patient activation, select characteristics, and hemoglobin A1c (HbA1c) levels were assessed. Bivariate and logistic regression analyses were used to identify correlates of glycemic control. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist was used to develop the study. Results: Participants with HgbA1C≤7.0% reported statistically higher patient activation measure (13 items) (PAM-13) natural log score (mean [M]=60.32, standard deviation [SD]=13.50) compared to those with an HgbA1C>7.0%, M=52.58, SD=10.19, F(1)=11.05, p7.0, −2 LogLikehood=1183.23, χ2(3)=15.44, p

To examine the relationships among depression and anxiety symptomatology, stigma of mental illness, levels of social support, and select demographics among hospitalized women in the postpartum period.Descriptive, cross-sectional, correlational.A convenience sample of 105 English-speaking and Spanish-speaking women was recruited and enrolled from a 208-bed free-standing Southern California women's community hospital postpartum unit serving a diverse community.Data were collected on potential covariates including participants' characteristics, depression and anxiety symptomatology, social support, and stigma.Sixteen participants were classified as high risk for depression or anxiety based on the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7. Anxiety was significantly associated with all stigma subscales; the strongest association was with Internal Stigma (r = .46, p .001, moderate effect), followed by Disclosure Stigma (r = .36, p .001, moderate effect) and External Stigma (r = .30, p = .002, moderate effect). All social support subscales were negatively associated with depression and anxiety; the Friends subscale had the strongest correlations with depression (r = -.27, p = .006, small effect) and anxiety (r = .34, p = .001, moderate effect). Firth (penalized likelihood) logistic regression analysis was conducted to ascertain the effects of study covariates on the likelihood of participants being at risk for postnatal depression or anxiety. The significant factor that increased the odds of participants being in the high-risk group was decreased social support (adjusted OR = 0.46, 95% CI [0.24, 0.76], p = .003).These results show the enduring prevalence of postnatal depression and anxiety and the relevance of stigma and social support in aggravating or mitigating symptomatology. There is a need for comprehensive standardized screening to ensure the identification of and referral to treatment for women at risk.

AIMS AND OBJECTIVES To identify correlates of glycemic control among people with type 2 diabetes mellitus. BACKGROUND Approximately 28.8 million adults have type 2 diabetes mellitus in the United States with $245 billion spent on disability and lost productivity. The importance of self-management activities in type 2 diabetes mellitus treatment is well recognised. Extant studies have explored self-management activities of individuals with type 2 diabetes mellitus with mixed findings. Continued attention is warranted to identify predictors of glycemic control. DESIGN A cross-sectional study. METHODS A convenience sample, aged 18 and 75 years with a diagnosis of type 2 diabetes mellitus, was recruited and enrolled from three southern California community-based organisations between June-December 2016. Perceived self-efficacy, diabetes knowledge, self-management activities, select demographics, chronic conditions and HbA1C levels were assessed. Bivariate and multiple regression analyses were use to identify correlates of glycemic control. The STROBE checklist for cross-sectional studies was used to develop this study. RESULTS The total number of participants included in analyses was 100. Sixty-nine per cent had HbA1C ≥7%; average number of years with type 2 diabetes mellitus was 8.6 (SD = 6.52); 57% were female; and 54% had a high school or greater education. The multiple regression model significantly predicted 20% of the variance in HbA1C levels, F(6, 93) = 4.91, p

Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.

Perinatal complications linked to maternal comorbidities contribute to increased healthcare utilization through an extended postpartum length of stay (LOS). Understanding factors influencing postpartum LOS may minimize the adverse effects associated with comorbidities and complications. The purpose of this study was to identify risk factors with the greatest odds of increasing postpartum LOS. Linked 2008-2009 hospital discharge and birth certificate data were used to examine comorbidities and complication codes in 1 015 424 births. The overall rate for an extended LOS (vaginal: >5 days/cesarean: >6 days) was 3.63 per 1000 live births. Complications were present in 17% of pregnancies; multiple complications were seen in 1%. Chronic hypertension was associated with an extended stay for both vaginal and cesarean births (odds ratio [OR] = 5.89 [95% CI, 4.39-7.88]; OR = 3.57 [95% CI, 3.05-4.17], respectively). Puerperal infections (OR = 6.86 [95% CI, 5.73-8.21]), eclampsia (OR = 17.07 [95% CI, 13.76-21.17]), and transfusions (OR = 11.66 [95% CI, 9.20-14.75]) occurred most frequently and conferred the highest odds of an extended stay for vaginal births. Cerebrovascular conditions (OR = 15.32 [95% CI, 11.90-19.60]) and infection (OR = 15.35 [95% CI, 10.11-23.32]) conferred the highest odds of an extended LOS for cesarean births. The earlier risk factors are recognized, the sooner processes can be initiated to optimize organizational preparation, thus decreasing adverse maternal outcomes and extended hospital stays.

The purpose of this study was to: (a) investigate the relationships among the variables of self-esteem, social support and hopefulness in adolescent females, and (b) determine if significant differences exist between the hopefulness of pregnant and non-pregnant adolescent females The framework for this study was derived from the literature and based on the concepts of self-esteem, social support, and hopefulness. Research suggests that social support and self-esteem are key constructs in predicting hopefulness towards the future and were selected as factors in constructing a theoretical framework for the explanation of adolescent hopefulness. The Symbolic Interactionist perspective provided the theoretical basis for the framework and is evident in the conceptualizations of self-esteem, social support, and adolescent hopefulness. Within this framework, the situation of adolescent pregnancy was taken as offering a specific context in which the explanation of hopefulness needed further elaboration. From this framework hypotheses were derived specifically to test with a sample of adolescent females. This descriptive correlational study utilized a volunteer convenience sample of 149 female adolescents who responded to four questionnaires: Hinds' Hopefulness Scale for Adolescents, Rosenberg's Self-esteem Scale, Norbeck's Social Support Questionnaire, and a demographic and personal data questionnaire. Data were analyzed using descriptive and multivariate statistical procedures. Findings included statistically significant positive relationships between social support (total functional support) and hopefulness, and social support and SES for the entire sample of adolescent females. T-tests revealed significant differences between the self-esteem, perceived social support, age and SES of the pregnant and non-pregnant subjects. Pregnant adolescent females were significantly older, reported significantly lower SES, and perceived social support, but significantly higher self-esteem. There were no significant differences between the hopefulness levels of the two groups. Multiple regression analysis indicated that of the variables included in the study social support was indicated to explain 3% of the variance in hopefulness while self-esteem explained none. While the framework provided direction, 97% of the variance in hopefulness remains unexplained leaving a wide range of potential variables untapped for future investigation.

Purpose: To assess whether individuals attending a community clinic had the necessary Internet access and experience to use the patient portal, while examining covariates of education, income, and self-perception of health with past and anticipated portal use. Methods: Adults attending an urban, community primary care clinic were invited to participate in a brief survey assessing current Internet access and use, past portal use, and anticipated future portal use. Survey responses were analyzed using descriptive and multivariate statistics. Results: One hundred fifteen participants ranging in age from 18 to 84 years (mean 42.1, standard deviation 17.1) completed the survey; 6 (5%) in Spanish. Thirty-five (30%) self-identified as Latino; 12 (10%) as Asian; and 20 (17%) as other. Almost 80% reported their health as good or better. Although 38% reported some college and 47% reported being college graduates, 60% reported household incomes were 1 year. Fewer than half (42%) had past portal use, with significant differences associated with weekly Internet use (Fisher's exact=9.59; p=0.02) and smart phone access (Fisher's exact=6.15; p=0.02). Computer Internet access was significantly associated with income (Fisher's exact=16.91; p

Objective To test the feasibility of a relaxation guided imagery (RGI) intervention for mothers of hospitalized preterm infants and to explore the biobehavioral effects of RGI on their distress, responsiveness, and physiological stress. Design Single sample, pretest–posttest design. Setting A large Level III NICU in Southern California. Participants Twenty mothers of hospitalized preterm infants (24–32 weeks gestational age). Methods Correlational analyses of RGI use with self-reported measures of distress (perceived stress, state anxiety, and depression symptoms), awakening salivary cortisol level, and salivary cortisol awakening response collected from mothers at baseline and after 8 weeks of an RGI intervention. Results Nineteen mothers completed the study. Average use of RGI varied from 1.7 to 7.4 times per week (mean = 4.46, standard deviation = 2.7). Greater average use of RGI was correlated with lower awakening cortisol levels (r = −.38), greater cortisol awakening response (r = .36), and lower levels of distress (perceived stress [r = −.38], anxiety [r = −.43], and depression [r = −.41]). Conclusion Relaxation guided imagery may be a feasible and acceptable intervention to reduce mental and physiologic stress and improve responsiveness in mothers of hospitalized preterm infants.

The patient portal, increasingly available to patients, allows secure electronic communication with physicians. Although physician attitude toward the portal plays a crucial role in patient adoption, little information regarding physician opinion of the portal is available, with almost no information gathered in the pediatric environment. Using a mixed-methods approach, physicians in a large pediatric medical facility and integrated delivery network were surveyed using an online quantitative questionnaire and structured interviews. Physicians reported the portal's role in more communication efficiency for patients, parents, and providers. The portal's acceptance also introduces new challenges such as frequent questions from some parents and medical visit avoidance.

Purpose Contributors to disparities in sepsis management have been attributed to genetic susceptibility, differences in clinical presentation, and healthcare delivery. The influence of gender on survival or mortality of patients with sepsis-related diagnoses is unclear. The purpose of the current study was to systematically review published research to identify factors and outcomes associated with sepsis management and outcomes based on gender differences. Methods Covering a period from 2006 to 2016, a literature search was conducted on four electronic data bases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO, MedlinePlus, and PubMed. Content analysis of each article was performed independently by two authors. The guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was the method used to assess the quality of evidence of the articles in this review. Findings A full review was completed on a total of 452 identified potentially relevant publications, and 7 publications met inclusion criteria. The methodological approaches included prospective and retrospective observational studies, and prospective and historical cohort studies. The aim of these studies was to identify if gender differences exist related to sepsis-related mortality, completion of Surviving Sepsis Campaign resuscitation bundle elements, sepsis-related care processes, and sepsis-related incidence and source. Conclusions Clinical sepsis studies evaluating gender and sepsis-related management and mortality are inconclusive and complex. Three different outcomes exist: no difference, higher risk in females, or higher risk in males. Further studies are needed to support the presence of gender disparities on sepsis-related healthcare outcomes. Clinical Relevance Providers should understand the importance of adhering to sepsis protocols and minimizing treatment disparities including gender differences.

Background Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. Aims The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers’ perceptions of readiness for hospital discharge. Methods The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. Results Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses’ skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. Linking Evidence to Action The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.

Background Despite emphasis on identifying personal and clinical characteristics that place patients at higher risk for posttraumatic stress syndrome after intensive care, the extent of screening for the syndrome in intensive care patients is unknown. Objectives To examine the feasibility and acceptability of a screening tool to detect posttraumatic stress syndrome, screen for the syndrome soon after discharge from intensive care to identify patients at risk for post-traumatic stress disorder, and determine personal and clinical factors related to higher scores on the screening instrument. Methods A single-center, cross-sectional design was used. At 2 to 4 weeks after hospital discharge, 41 patients treated in an intensive care unit completed the screening instrument and the Screening Experience Questionnaire via telephone. Associations between participants’ characteristics and scores were examined, and screening experiences were described. Results Participants reported that the screening instrument was easy to understand, caused little distress, and could be completed in an acceptable time frame. Participants reported that they had not been screened via a formal process or received education during or after their stay in the unit. Among the participants, 44% preferred screening in the outpatient setting. Higher scores on the screening tool were associated with history of depression, moderate levels of sedation, and intensive care unit delirium. Conclusions The majority of intensive care patients most likely are not being screened for posttraumatic stress syndrome despite a higher risk for the syndrome in these patients than in the general population.

PURPOSE The purpose of this study was to examine potential gender disparities in relation to factors associated with sepsis management among a cohort of patients admitted through an emergency department with a discharge diagnosis of severe sepsis or septic shock. Sepsis is one of the leading causes of death globally, with significant associated costs. Predictors of survival for those with sepsis-related diagnoses are complex. DESIGN AND METHODS The study had a retrospective, descriptive cross-sectional design. The sample (N = 482) included patients 18 years of age or older who presented to the emergency department of a nonprofit, Magnet-recognized, acute care hospital located in southern California. Subjects included those who subsequently met the criteria for a discharge diagnosis of severe sepsis or septic shock as defined by the Surviving Sepsis Campaign. Patient characteristics, clinical variables, care management processes, and outcomes were extracted from the electronic health record. A multivariate model was analyzed. FINDINGS The sample included 234 women (48.5%) and 248 men (51.5%). Logistic regression with eight independent variables (discharge diagnosis, age, comorbidities, length of hospital stay, source of infection, first serum lactate level measured, recommended fluids administered, and gender) reliably predicted odds for patient survival, ϰ2 (12) = 118.38, p < .001, and correctly classified 77.3% of cases. All eight independent variables significantly contributed to the model. Men had a higher likelihood of hospital survival than women (odds ratio 1.68; 95% confidence interval 1.01-2.79; p = .045). CONCLUSIONS The Surviving Sepsis Campaign has provided a clear pathway for care of patients with sepsis-related diagnoses. Therapeutic strategies should be developed to address differences in outcome by gender. The adoption of more aggressive applications of evidence-based interventions for these patients may result in better patient outcomes. CLINICAL RELEVANCE Providers should understand the importance of adhering to sepsis protocols, minimizing treatment disparities, and recognizing gender differences.

ObjectivesGlobally, healthcare systems are using the electronic health record (EHR) and elements of clinical decision support (CDS) to facilitate palliative care (PC). Examination of published results is needed to determine if the EHR is successfully supporting the multidisciplinary nature and complexity of PC by identifying applications, methodology, outcomes, and barriers of active incorporation of the EHR in PC clinical workflow.MethodsA systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999–2017 of human subject peer-reviewed articles in English containing original research about the EHR and PC.ResultsThe search returned 433 articles, 30 of which met inclusion criteria. Most studies were feasibility studies or retrospective cohort analyses; one study incorporated prospective longitudinal mixed methods. Twenty-three of 30 (77%) were published after 2014. The review identified five major areas in which the EHR is used to support PC. Studies focused on CDS to: identify individuals who could benefit from PC; electronic advanced care planning (ACP) documentation; patient-reported outcome measures (PROMs) such as rapid, real-time pain feedback; to augment EHR PC data capture capabilities; and to enhance interdisciplinary communication and care.DiscussionBeginning in 2015, there was a proliferation of articles about PC and EHRs, suggesting increasing incorporation of and research about the EHR with PC. This review indicates the EHR is underutilized for PC CDS, facilitating PROMs, and capturing ACPs.

Purpose This study aims to examine adolescent level of knowledge concerning obesity risk. Design and Methods Qualitative and quantitative data were collected using a staged process. Data collected with (a) Obesity Risk Knowledge Scale (ORK-10), (b) focus groups, (c) scientific advisory group input, and (d) the Adolescent Obesity Risk Knowledge Scale (AORK). Results The AORK is tailored from the ORK-10 (α = .53) to capture adolescents' knowledge of obesity complications and/or risks (α = .68). Practice Implications The AORK integrates questions for assisting practitioners to initiate discussions about obesity and lifestyle choices with adolescents and their families.

Electronic fetal monitoring (EFM) is used widely during labor & delivery, but existing solutions limit patient mobility, are uncomfortable, and do not consistently capture fetal heart rate (FHR) and uterine activity (UA) signals. A wireless EFM system was developed that features wearable US and tocodynamometer devices that conform to the body and do not require cables or belts. Benchtop testing demonstrated that the devices can accurately and consistently measure simulated FHRs and UAs over clinically meaningful ranges and body curvatures. The wearable EFM devices are expected to provide more reliable signal capture independent of maternal movement and repositioning, while also significantly improving patient comfort and mobility.

Background Human papillomavirus (HPV) is the most common sexually transmitted infection, with at least half of sexually active people contracting the virus—a leading etiology for genital warts and anal, cervical, laryngeal, penile, vaginal, and vulvar cancers. Research suggests HPV is higher among U.S. military personnel than in U.S. civilian populations and can result in significant morbidity or complications and limit U.S. military’s duties or deployable status. Objectives The aim of the study was to identify determinants of HPV vaccination among U.S. Navy personnel. Methods Participants ( N = 233) recruited from both active duty and activated reservists, attached to Commander, Naval Surface Force, U.S. Pacific Fleet (COMNAVSURFPAC), located in Japan and the United States, completed an anonymous online survey between June and October 2015. Bivariate analysis was used to examine relationships between sociodemographic, psychological factors, and HPV vaccination. Logistic regression was utilized to identify factors that increase odds for HPV vaccination. Results HPV vaccination was associated with gender; having deployed in the past 3 years; having heard of HPV, HPV testing, and HPV vaccine; HPV self-rating knowledge; where one heard about the vaccine; belief the chain of command recommends the vaccine; and HPV general knowledge, testing knowledge, and vaccine knowledge ( p < .05). The regression model was statistically significant, χ 2 (19) = 97.216, p < .001; four variables contributed to the model. Discussion Determinants of HPV vaccination were female gender; hearing about HPV vaccine from a healthcare provider, media, or Internet; belief the chain of command recommends the HPV vaccine; and greater HPV vaccine knowledge. Results augment healthcare professionals’ and policy makers’ existing evidence-based knowledge of the determinants of HPV vaccination to help develop effective HPV immunization policies and programs

The aim of this study was to examine the feasibility of integrating teamwork training into an established Pediatric Advanced Life Support (PALS) program to assess the effect on teamwork and collaboration among interprofessionals.Lack of teamwork and ineffective communication are common contributors to hospital sentinel events. Interprofessional teamwork training to support a culture of patient safety is advocated; however, training methods and related expenses vary widely.This study used a descriptive design. All participants received PALS recertification training; the intervention group received an additional 2-hour TeamSTEPPS (R) 2.0 Essentials curriculum with didactic and video critique including role-play on error, communication behaviors, and standard terms. Data were collected on perceptions of teamwork and collaboration. χ, Mann-Whitney U, and t tests were used.The intervention group reported significantly higher perceptions of teamwork and collaboration, situational awareness, and ability to help a team make decisions.Results suggest that integrating brief team training into an existing PALS program is a feasible, cost-effective, and sustainable method to provide interprofessional team training and positively influence the culture of safety.

Oxytocin (OT), a neuropeptide produced primarily in the hypothalamus, is associated with both critical physiological and psychological processes, particularly stress and feelings of affiliation. Increasingly, researchers are seeking ways to reliably incorporate OT as an outcome biomarker in clinical research. Previously, OT levels were measured in plasma or urine. Recently, researchers have measured this biomarker in saliva, particularly when conducting research in clinical and community settings. In spite of increased interest in the use of salivary OT in clinical research, procedures for handling, transport, and analysis of specimens vary. It is not known if significant OT protein degradation occurs if samples are initially transported on wet ice before being frozen. The aim of this study is to evaluate the effect of transport media (wet vs. dry ice) on OT levels derived from saliva collected from 12 postpartum women residing in the community. Saliva collected from each participant was divided between two microcentrifuge tubes (MIDSCI, Valley Park, MO), one placed on wet ice and one on dry ice for transport from the participant’s home to the laboratory freezer. Time from collection to storage freezer was recorded. Laboratory personnel, blinded to method of transport, batch processed the samples. No significant differences in OT levels were found by transport method. Despite large interperson variations in OT levels, there were negligible intraperson variations. Although further research is required to identify factors (including transport time) related to interperson variation, this study supports the use of wet ice as a means of transporting salivary OT specimens in community-based research.

The purpose of this study was to examine the feasibility and acceptability of an auricular acupuncture (AA) insomnia regimen among Operation Iraqi Freedom and Operation Enduring Freedom veterans with post-traumatic stress disorder and sleep disturbance. Secondarily, this study examined the effect of an AA insomnia regimen on objective sleep times by wrist actigraphy, subjective sleep times by sleep diary, and sleep quality ratings utilizing the Pittsburg Sleep Quality Index. Veterans (n = 30) were randomized to receive a 3-week AA insomnia regimen. Veterans receiving the AA insomnia regimen reported it as a more acceptable treatment for sleep disturbance than subjects in the control group (AA group median = 5 vs. control group median = 3, p = 0.004). Significant differences between groups were found on the sleep quality and daytime dysfunction components of the Pittsburgh Sleep Quality Index (p = 0.003, p = 0.004). No other significant differences between groups were found for objective and subjective sleep measures. These results suggest that an AA insomnia regimen may improve sleep quality and daytime dysfunction among veterans with post-traumatic stress disorder. Future, large-scale, prospective clinical trials are needed to examine AA effects on sleep.

Purpose The promotion of quality of life (QOL) and healthy development across the person's life span can result in long and meaningful lives. The purpose of this study was to examine relationships between spiritual well-being (SWB), depression, and QOL for adults with paraplegia. Design A descriptive correlational design was used for this study. Methods A purposive sample of 75 participants completed the Ellison's SWB Scale, the Center for Epidemiologic Studies-Depression Scale, and a QOL scale. Findings Quality of life was significantly associated with SWB (r = .47, p = .01), and depression (r = −.59, p = .01), 43% of the variance in QOL was explained by age, gender, length of stay, SWB, and depression (F[5,69] = 10.45, p

Purpose: Family health is a system comprising routines or habitual practices. This study investigated the relationships between maternal self-efficacy (SE) and obesity, habitual smoking, breastfeeding, and children’s sleeping patterns. Methods: Participants (98 women) attending a weight loss clinic reported on themselves and their 172 biological children. Mothers provided demographic information for parents and children and completed the 20-item Family Nutrition and Physical Activity Scale (FNPA). Maternal SE was assessed with a 13-item Confidence Survey, which measures confidence to carry out activities related to healthy family meals and family activity. FNPA results have been reported in an earlier publication. Results: Normal-weight mothers had more favorable (higher) SE scores compared with overweight mothers. There were positive relationships between SE and the FNPA and children’s sleep patterns in younger children. There were no significant relationships between SE and children’s body mass index (BMI), breastfeeding patterns, or parental smoking habits. Higher SE was associated with FNPA constructs related to family and meal patterns, restriction/reward, screen time behavior and monitoring, family activity involvement and family routine. Children’s BMI was correlated with mother’s FNPA score. Breastfeeding was associated with only the family environment construct of FNPA and ethnicity. Conclusion: This study looked at relationships between SE and selected behaviors that have been associated with family health. Maternal SE has positive relationships with some healthy habits/family routines. More research is needed regarding the factors that influence SE in family systems for health promotion.

Dyspnea is a common symptom in end-stage lung cancer patients and is only infrequently controlled. Currently, the use of complimentary therapies using traditional Chinese medicine (TCM), including auricular application of Vaccaria segetalis (a small seed), is understudied. Acupressure using auricular Vaccaria segetalis application has been reported as effective in reducing dyspnea when applied to a specific area of the ear associated with lung function in the TCM paradigm.The purpose of this feasibility study was to evaluate the effects of standardized auricular acupressure therapy using Vaccaria segetalis on dyspnea intensity and distress and oxygen saturation in end-stage lung cancer patients.The experimental design was three conditions with eight measurement points in time. Patients were randomly assigned to one of three treatment conditions: (1) Standard Care (SC); (2) SC with Vaccaria segetalis taped to random auricular locations (placebo); and (3) SC with Vaccaria segetalis taped to the auricular location deemed specific to lung function in TCM. Subjects were 11 hospice patients with advanced lung cancer and dyspnea. Dyspnea intensity and distress were measured by the Cancer Dyspnea Scale (CDS) and oxygen saturation was measured by pulse oximeter at eight time points.Non-parametric statistical analyses suggest the presence of acupressure effects with medium to large effects and significant effect for dyspnea effort.This pilot information suggests the need for further study of auricular acupressure using Vaccaria segetalis in the dyspneic advanced lung cancer population.

This article presents the feasibility and acceptability of using mobile health technology by community health workers (CHWs) in San Juan Province, Dominican Republic, to improve identification of pregnancy complications and access to care for pregnant women. Although most women in the Dominican Republic receive four antenatal care visits, poor women and adolescents in remote areas are more likely to have only one initial prenatal visit to verify the pregnancy. This community-based research began when community leaders raised concern about the numbers of their mothers who died in childbirth annually; San Juan's maternal mortality rate is 144/100,000 compared to the Caribbean rate of 85/100,000. Eight CHWs in three communities were taught to provide third-trimester antenatal assessment, upload the data on a mobile phone application, send the data to the local physician who monitored data for "red flags," and call directly if a mother had an urgent problem. Fifty-two pregnant women enrolled, 38 were followed to delivery, 95 antenatal care postintake were provided, 2 urgent complications required CHW home management of mothers, and there were 0 deaths. Stakeholders endorsed acceptability of intervention. Preliminary data suggest CHWs using mobile health technology is feasible, linking underserved and formal health care systems with provision of primary care in mothers' homes.

Identification and referral of women with high-risk pregnancies to hospitals better equipped and staffed to provide care for them have been important steps to improve birth outcomes. Based on recent recommendations from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to provide regionalized maternal care for pregnant women at high risk and reduce rates of maternal morbidity and mortality, health care organizations and providers have refocused their attention to women's well-being rather than solely on the well-being of the fetus or newborn. Opportunities to improve practice and birth outcomes exist through the implementation of a more standardized and integrated system of risk-appropriate care.

Contributors to disparities in sepsis management have been attributed to genetic susceptibility, differences in clinical presentation, and healthcare delivery. The influence of gender on survival or mortality of patients with sepsis-related diagnoses is unclear. The purpose of the current study was to systematically review published research to identify factors and outcomes associated with sepsis management and outcomes based on gender differences.Covering a period from 2006 to 2016, a literature search was conducted on four electronic data bases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO, MedlinePlus, and PubMed. Content analysis of each article was performed independently by two authors. The guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was the method used to assess the quality of evidence of the articles in this review.A full review was completed on a total of 452 identified potentially relevant publications, and 7 publications met inclusion criteria. The methodological approaches included prospective and retrospective observational studies, and prospective and historical cohort studies. The aim of these studies was to identify if gender differences exist related to sepsis-related mortality, completion of Surviving Sepsis Campaign resuscitation bundle elements, sepsis-related care processes, and sepsis-related incidence and source.Clinical sepsis studies evaluating gender and sepsis-related management and mortality are inconclusive and complex. Three different outcomes exist: no difference, higher risk in females, or higher risk in males. Further studies are needed to support the presence of gender disparities on sepsis-related healthcare outcomes.Providers should understand the importance of adhering to sepsis protocols and minimizing treatment disparities including gender differences.

Aims and objectives To report an analysis of the concept of perinatal post-traumatic stress disorder. Background Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal–child outcomes result in increased morbidity, mortality and healthcare costs. Design Concept analysis via Walker and Avant's approach. Methods The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006–2015, containing the terms perinatal and post-traumatic stress disorder. Results Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumatic stress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal–infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal–infant outcomes. Conclusions Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder. Relevance to clinical practice Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal–infant outcomes.

© The Author(s) 2015. This qualitative project used structured interviews with nine parents to examine perceptions of the electronic health record (EHR) and associated patient portal in the treatment of their child's autism spectrum disorder. Thematic analysis identified six complementary themes including: Familiarity and exposure to the EHR, changing experience of care (streamlining appointments, providing more rapid medical record access, increasing clinician awareness of the complexity of their child's medical treatment, and facilitating prescriptions), portal use, patient/EHR/portal interaction, interoperability, and mother as care coordinator. While aware of the patient portal, only one-third had registered to use it and these parents reported only limited use. In general, perceptions of the electronic health record are positive, but the patient portal has yet to have needed consumer adoption. Further research and functionality are needed to increase portal registration and greater portal integration in patient care.

Background: Diabetes is a global problem. According to WHO (2014) the global prevalence of diabetes was estimated to be 9% among adults aged 18+ years. In 2012, an estimated 1.5 million deaths were directly caused by diabetes. Of note, more than 80% of diabetes deaths occur in low- and middle-income countries. It is predicted that diabetes will be the 7th leading cause of death in 2030. Of concern is the vast majority of people living with pre diabetes are unaware they have it. Without lifestyle changes to improve their health, an estimated 15% to 30% of people with pre diabetes will develop type 2 diabetes within 5 years. Simple screening methods may identify risk and facilitate conversations with patients to identify specific barriers to making healthy lifestyle choices to decrease risk for diabetes. Purpose of the study: To examine the use of the CDC 7 item Pre-Diabetes Screening Test (PST) to identify “at risk” patients and their response to lifestyle education. Methods: A cross-sectional design with purposive sampling of overweight men and women attending a weight loss clinic located in Southern California. Using venipuncture, A1C was examined when patients were identified high risk based on the Pre Diabetes Screening Test. Follow up consultation was provided and data were collected at four months. Results: All participants (N=70) screened “high risk” PST >9,70.5% (49) were pre diabetic based on A1C levels. At 4 months follow-up findings indicated patient weight changes of 6-30 pounds, reductions in A1C levels, and increased physical activity. Significance: Realizing the predictability of simple screening abilities can help reinforce the ease in assessing, increase awareness of prediabetes risk in adults, and start a conversation for healthy behaviors.

Aims and objectives To report an analysis of the concept of maternal risk and explore implications for practice using Walker and Avant's eight step method analysis. Background Although mortality during pregnancy is a relatively rare occurrence, serious maternal morbidities are increasingly present in today's pregnant population. Risk factors have been identified that increase the potential for morbidities and subsequent care modalities have been implemented to decrease this risk. However, despite the wide use of the term ‘risk’ in the medical and nursing literature, determining a common definition is difficult. Differences in the understanding of risk during pregnancy can hinder the ability to provide consistent and appropriate care. Design Concept analysis. Methods A search of the English literature was completed using the databases CINAHL, PubMed, Medline, and Google Scholar for years 2000–2014 using the keywords ‘risk’, ‘maternal’ and ‘pregnancy’. Results Three defining attributes of risk were identified: chance of injury/loss, cognitive recognition and the decision-making processes. The antecedent of risk is the ability to understand the situation and cognitive ability to think about the potential consequences and adverse outcomes. Consequences of risk include the actual action taken as a result of the decision-making process. Conclusion This paper contributes to the understanding of risk allowing for the development of an individualised plan of care for each pregnant woman and empowering the nurse to advocate for appropriate care. Findings in this analysis assist nurses in bridging the gap in communication between the provider's and pregnant woman's interpretation of risk. Relevance to clinical practice The analysis of risk resulted in the identification of differences in perceptions of risk that can potentially result in miscommunication between provider and pregnant woman and increase the risk of inadequate or incomplete care.

This study assessed the current state of knowledge regarding the use of the integrated electronic health record (EHR) patient portal for pediatric clinical care. A systematic examination of the research on implementation, utilization, and evaluation of the integrated EHR patient portal among pediatric patients has not been previously conducted. Therefore, the purpose of the present study was to systematically review existing research on the state of the science, describe the way others have defined the patient portal, and examine pediatric patient portal utilization.Covering a period from 1992 to 2014 a literature search was conducted on four electronic databases. Only articles in English were reviewed. Studies were included if they reported the use of a patient portal integrated with an electronic health record and captured pediatric medial encounters. Qualitative or quantitative studies of any design were eligible as long as they focused on patients (or parents) who access their health records through an electronic portal tied to an EHR and reported measures of satisfaction, attitudes on use, barriers and facilitators, adherence, or clinical and health outcomes. Content analysis of each article was performed independently by at least two authors using an extraction grid of study qualities, and quality and relevance of the studies were also assessed.Of a total of 189 potentially relevant publications identified, 31 full-text publications were obtained after screening titles and abstracts. After a full review, 11 publications corresponding to seven studies met the inclusion criteria. The methodological approaches included cross-sectional surveys, retrospective analysis, qualitative studies, and usability testing. In general, feedback was positive. The most frequent negative comments about the portal reflected concern about teenager interaction with the portal and how that might affect communication among patient, parent, and provider. Some users were frustrated with the complexity of medical terminology used.Reflecting the additional considerations of pediatric proxy access and fewer chronically ill patients, pediatric medicine has yet to use the patient portal as a modality for outcomes measurement. Given the paucity of studies within this age group, it is difficult to measure outcome improvements or the effect of patient record access on healthcare behaviors. This systematic review presents innovative research on the general acceptance of the patient portal among parents and highlights that the implementation of the portal is still in its early stages and has yet to be used widely in diverse populations or studies in a longitudinal manner. Further studies should confirm that protected access to health information and secure communication and information sharing with healthcare providers have an impact in the pediatric population on healthcare outcomes.

This study surveyed Certified Registered Nurse Anesthetist (CRNA) members of the American Association of Nurse Anesthetists (AANA) on their frequency of call-shift fatigue, fatigue symptoms, medical errors associated with fatigue, and use of fatigue countermeasures and avoidance strategies. A secondary aim was to identify predictors of call-shift fatigue. An invitation to complete an anonymous electronic survey was sent to 2,500 randomly selected AANA members. Data were collected on CRNAs' fatigue experience, call-shift length and frequency, errors in patient care, and use of fatigue countermeasures and avoidance strategies. Analysis included descriptive and inferential statistics. Logistic regression was used to identify predictors of call-shift fatigue. Of 325 CRNAs who provided data, 82% reported experiencing call-shift fatigue, 87% used fatigue countermeasures, 77% used fatigue-avoidance strategies, and 28% reported committing a medical error because of fatigue. Predictors included hours to recovery from a call shift (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.04-1.12), working 5 to 6 calls per month (OR = 3.78, CI = 1.17-12.23), working 7 or more calls per month (OR = 4.87, CI = 1.93-12.33), use of fatigue countermeasures (OR = 5.44, CI = 2.15-13.77), and fatigue symptoms (OR = 2.19, CI = 1.03-4.67). Call-shift fatigue is a common problem among CRNAs and is associated with medical errors and negative health consequences.