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Background The opioid epidemic continues and although some initiatives have shown promise in reducing the number of opiates prescribed, few studies have focused on education of general surgery patients about home storage and safe disposal. The purpose of this feasibility study was to explore the use of an online video intervention to prepare surgical patients to properly dispose of unused opioids. Methods Eligible patients undergoing elective general surgery between August and October 2019 were enrolled into this prospective randomized controlled feasibility study. Patients with reported opioid use preoperatively were excluded from the study. The control group followed usual care, and the intervention group received usual care plus a brief educational video guided by the theory of reasoned action describing safe storage and disposal practices of unused opioid pills. Measures were collected at baseline and 2 wk postoperatively. Results A total of 40 participants were enrolled in the study; average age was 44.7 (range 21-75 y); most were Caucasian, educated, and employed. Recruitment took 11 wk, and the retention rate was excellent at 85%. Differences in opioid disposal were not significantly different by age, sex, education, or type of surgery. The video intervention was positively received, but the majority (80%) still stored their pills unsecured. Conclusions Results demonstrate that a video intervention addressing safe storage and disposal practices of unused opioids is feasible, and more research is needed to determine efficacy in increasing rates of secure storage and disposal of unused opioid pills.

Transitional diabetes self-management (DSM) for children and their families is complicated. This article was undertaken to provide an exemplar of DSM strategies used by one family that were based on developmental milestones from preschool through college age. Two brothers who were both diagnosed with type 1 diabetes before the age of 2 years reflected on how their parents began a DSM navigation process during their early preschool years. Personal strategies and recommendations successfully resulted in both youths transitioning to college. With the parents serving as DSM coaches to the boys, an interdependent relationship was built. Key recommendations include 1) starting early, 2) being consistent and flexible, 3) using “invisible actions” and “what ifs,” 4) incorporating technology and community resources into DSM, and 5) building confidence with shared problem-solving.

The American Geosciences Institute in cooperation with its member societies has developed the Framework for Addressing Racial and Ethnic Equity in Geosciences Professional Societies. The geoscience societies are a pivotal area to influence the culture of the geosciences, and in response to the events of June 2020, many societies determined they needed to directly act on the issue of equity in the geosciences. Being birthed from a federation of US-centric organizations, the Framework has clear US-aligned approaches and boundaries. However, the baseline proposed actions are fundamentally universal and meet the goal of the authoring committee to provide a framework from which we hope geoscience organizations of all types would use it to craft their own specific action plan and policies. A critical component of this framework for the committee was to ensure definable actions were included. Some of these suggested actions and their intended extensions will be discussed. Additionally, ongoing conversations among the societies, with the US National Academy of Sciences Board on Earth Science and Resources, and other science organizations have begun to examine what the path forward looks like. One area that AGI particularly is concerned about is the process of measuring progress. Understanding and recognizing the impacts of efforts like this is critical to ensure agile responses for success. But with AGI's intimate knowledge of much of the U.S. federal data, some of the ambiguities and definitional challenges within the US system complicates the ability to directly measure progress and for which further discussion of what success looks like is critically needed.

Background The hospitalization of a family member in an intensive care unit can be stressful for the family. Family bedside rounds is a way for the care team to inform family members, answer questions, and involve them in care decisions. The experiences of family members with intensive care unit bedside rounds have been examined in few studies. Objectives To describe (1) the experiences of family members of patients in the intensive care unit who participated in family bedside rounds (ie, view of the illness, role in future management, and long-term consequences on individual and family functioning) and (2) the experiences of families who chose not to participate in family bedside rounds and their perspectives regarding its value, their illness view, and future involvement in care. Methods A qualitative descriptive study was done, undergirded by the Family Management Style Framework, examining families that participated and those that did not. Results Most families that participated (80%) found the process helpful. One overarching theme, Making a Connection: Comfort and Confidence, emerged from participating families. Two major factors influenced how that connection was made: consistency and preparing families for the future. Three types of consistency were identified: consistency in information being shared, in when rounds were being held, and in informing families of rounding delays. In terms of preparing families for the future, families appeared to feel comfortable with the situation when a connection was present. When any of the factors were missing, families described feelings of anger, frustration, and fear. Family members who did not participate described similar feelings and fear of the unknown because of not having participated. Conclusion What health care providers say to patients’ families matters. Families may need to be included in decision-making with honest, consistent, easy-to-understand information.

Background: Studies have demonstrated beneficial effects of exercise on cardiovascular disease biomarkers for healthy individuals; however, a comprehensive review regarding the effect of exercise on cardiovascular disease biomarkers in at-risk populations is lacking. Methods: A literature search was performed to identify studies meeting the following criteria: randomized controlled study, participants with pathology/activity limitations, biomarker outcome (total cholesterol, high-density lipoprotein, low-density lipoprotein, C-reactive protein, insulin, triglycerides, or glucose), and exercise intervention. Means and standard deviations from each biomarker were used to calculate standardized Cohen’s d effect sizes with 95% confidence intervals. Results: In total, 37 articles were included. The majority (44/57; 77%) of data points demonstrated moderate to strong effects for the reduction in total cholesterol, triglycerides, and low-density lipoprotein, and elevation in high-density lipoprotein following exercise. The majority of data points demonstrated strong effects for reductions in blood glucose (24/30; 80%) and insulin (23/24; 96%) levels following exercise intervention. Conclusion: Evidence is heterogeneous regarding the influence of exercise on cardiovascular disease biomarkers in at-risk patients, which does not allow a definitive conclusion. Favorable effects include reductions in triglycerides, total cholesterol, low-density lipoprotein, glucose, and insulin, and elevation in high-density lipoprotein following exercise intervention. The strongest evidence indicates that exercise is favorable for the reduction in glucose and cholesterol levels among obese patients, and reduction of insulin regardless of population.

The aims of this qualitative descriptive study were to describe how past experiences with research (including communication, information, values, and support) may contribute to research fatigue among youth and parents of youth with HIV, cystic fibrosis, and Type 1 diabetes. Eighteen parents and youth were purposively recruited from outpatient subspecialty clinics at a major academic medical center. They took part in qualitative interviews and completed a demographics form and the Decisional Conflict Scale. Youth participants also completed the Erikson Psychosocial Stage Inventory. Two major themes emerged: Blurred Lines and Hope for the Future. Research fatigue was not found in this sample. Results point to challenges with informed consent in settings where research and clinical care are integrated and suggest that protective factors allow for continued participation without excess burden on youth and parents. Strategies to minimize research fatigue and support engagement in research are offered.

BACKGROUND: Parents often become the caregivers for their adult children with serious mental illness (SMI) due to the chronic and debilitating course of the illness and shortages in funding for community mental health services and residential placements. OBJECTIVE: To examine parents’ management styles when caring for adult children with SMI and parents’ perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning. DESIGN: A qualitative descriptive study using semistructured interviews with parents caring for adult children with SMI. The study was undergirded by Knafl and Deatrick’s Family Management Style Framework. RESULTS: Four major themes emerged from the data describing prolonged and difficult phases that parents and the family undergo in caring for an adult child with SMI. CONCLUSIONS: Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, and violence prevention for adult children and their families.

Background: Measurement of intervention fidelity is an essential component of any scientifically sound intervention trial. However, few papers have proposed ways to integrate intervention fidelity data into the execution of these trials. Objective: The purpose of this article is to describe the intervention fidelity process used in a randomized controlled trial of a human patient simulator intervention and how these data were used to monitor drift and provide feedback to improve the consistency of both intervention and control delivery over time in a multisite education intervention for parents of children with newly diagnosed Type 1 diabetes. Methods: Intervention fidelity was measured for both the intervention and control condition by direct observation, self-report of interventionist delivery, and parent participant receipt of educational information. Intervention fidelity data were analyzed after 50%, 75%, and 100% of the participants had been recruited and compared by group (treatment and control) and research site. Results: The sample included 191 parents of young children newly diagnosed with Type 1 diabetes. Observations scores in both intervention and control groups indicated a high level of intervention fidelity. Treatment receipt was also high and did not differ by treatment group. The teaching session attendance rates by site and session were significantly different at Time Point 1 (50% enrollment); following study staff retraining and reinforcement, there were no significant differences at Time Point 3 (100% enrollment). Implications: Results demonstrate the importance of monitoring intervention fidelity in both the intervention and control condition over time and using these data to correct drift during the course of a multisite clinical trial.

Poorer adolescent readers are often regarded by teachers as unable to read whole narratives and given short, simplified texts, yet are expected to analyse every part in a slow laborious read through. This article reports on a mixed methods study in which 20 English teachers in the South of England changed their current practice to read two whole challenging novels at a faster pace than usual in 12 weeks with their average and poorer readers ages 12-13. Ten teachers received additional training in teaching comprehension. Students in both groups made 8.5 months’ mean progress on standardised tests of reading comprehension, but the poorer readers made a surprising 16 months progress but with no difference made by the training programme. Simply reading challenging, complex novels aloud and at a fast pace in each lesson repositioned ‘poorer readers’ as ’good’ readers, giving them a more engaged uninterrupted reading experience over a sustained period. However, the qualitative data showed that teachers with the additional training provided a more coherent faster read and better supported poorer readers by explicitly teaching inference, diagnosed students’ ‘sticking places’ mid-text and created socially cohesive guided reading groups that further supported weaker readers but also stretched the average/good readers.

Objective Parents who have a child newly diagnosed with type 1 diabetes (T1D) must quickly learn daily diabetes self-management. An RCT was conducted using human patient simulation (HPS) to enhance parents learning diabetes self-management with children with new-onset T1D. The purpose of this study was to describe parents’ perspectives of using HPS to augment diabetes education. Methods A qualitative descriptive design was used with open-ended in-depth interviews of parents (n = 49) post-intervention. Qualitative directed content analysis was used. Results The majority of parents were positive about learning with HPS. Although a few parents said the HPS was “hokey” or “creepy,” most reported the visual and hands-on learning was realistic and very beneficial. Seeing a seizure increased their fear although they would have panicked if they had not had that learning experience, and it helped build their diabetes self-management confidence. Recommendations included teaching others with the HPS (grandparents, siblings, babysitters, and school nurses). Conclusion HPS-enhanced education is an acceptable and viable option that was generally well-received by parents of children with new-onset T1D. Practice implications The technique should be studied with parents of children with other chronic illnesses to see if the benefits found in this study are applicable to other settings.

Purpose – The purpose of this paper is to evaluate the status and impact of a recently formed Resident and Family Council to determine whether the group was achieving the goals of improving long-term care facility relationships, enhancing communication and promoting positive change within the facility. Design/methodology/approach – The pilot evaluation was designed to develop recommendations for future sustainability, of the council, as well as providing wider lessons about the benefits and potential pitfalls of such groups. Data were gathered utilizing participatory qualitative research methods. Semi-structured interviews were conducted with nine council members, representing all groups within the Resident and Family Council. Documents relating to the work of the council and observational field notes maintained during meetings were also analyzed. Findings – A number of themes and dynamics were identified relating to communication, collaboration and future sustainability. Practical implications – Recommendations for initiating Resident and Family Councils should include surveying interest within long-term care facilities, involving the facility ombudsmen or volunteer coordinator, and assessing resources within the community, such as volunteer organizations or partnering with local education organizations. Originality/value – This original research can serve as a template for establishing Resident and Family Councils within long-term care facilities.

Recommendations by the National Institute of Nursing Research and other groups have strongly encouraged nurses to pay greater attention to cost-effectiveness analysis when conducting research. Given the increasing prominence of translational science and comparative effective research, cost-effective analysis has become a basic tool in determining intervention value in research. Tracking phone-call communication (number of calls and context) with cross-checks between parents and healthcare providers is an example of this type of healthcare utilization data collection. This article identifies some methodological challenges that have emerged in the process of collecting this type of data in a randomized controlled trial: Parent education Through Simulation-Diabetes (PETS-D). We also describe ways in which those challenges have been addressed with comparison data results, and make recommendations for future research.

BACKGROUND AND OBJECTIVES: There is increasing emphasis on the importance of patient and family engagement for improving patient safety. Our purpose in this study was to understand health care team perspectives on parent-provider safety partnerships for hospitalized US children to complement a parallel study of parent perspectives. METHODS: Our research team, including a family advisor, conducted semistructured interviews and focus groups of a purposive sample of 20 inpatient pediatric providers (nurses, patient care technicians, physicians) in an acute-care pediatric unit at a US urban tertiary hospital. We used a constant comparison technique and qualitative thematic content analysis. RESULTS: Themes emerged from providers on facilitators, barriers, and role negotiation and/or balancing interpersonal interactions in parent-provider safety partnership. Facilitators included the following: (1) mutual respect of roles, (2) parent advocacy and rule-following, and (3) provider quality care, empathetic adaptability, and transparent communication of expectations. Barriers included the following: (1) lack of respect, (2) differences in parent versus provider risk perception and parent lack of availability, and (3) provider medical errors and inconsistent communication, lack of engagement skills and time, and fear of overwhelming information. Providers described themes related to balancing parent advocacy with clinician’s expertise, a provider’s personal response to challenges to the professional role, and parents balancing relationship building with escalating safety concerns. CONCLUSIONS: To keep children safe in the hospital, providers balance perceived challenges to their personal and professional roles continuously in interpersonal interactions, paralleling parent concerns about role ambiguity and trust. Understanding these shared barriers to and facilitators of parent-provider safety partnerships can inform system design, parent education, and professional training.

Purpose The purpose of this article is to report the focus group perspectives of preteens’ and parents’ experiences with a feasibility intervention entitled PREP-T1 (Preteen Re-Education with Parents–Type 1 Diabetes), an interactive education and peer mentoring intervention. Methods The parent and preteen focus groups were conducted by the principal investigator, coinvestigator, and note takers at 2 sites. The preteen-parent groups were conducted concurrently with a total of 11 preteens and 11 parents. Note-based qualitative content analysis was used, resulting in preteen-parent perspectives on reeducation and strategies for families to work more effectively in managing type 1 diabetes (T1DM). Results The findings suggest that the preteens enjoyed learning about their diabetes management from a teen educator mentor in conjunction with a human patient simulator. They reported this type of peer support would benefit other preteens with T1DM. Parents were overwhelmingly positive about their interactions with the parent educator mentor in conjunction with the psychologist and about focusing on how to better collaborate with their preteens on diabetes management decision making. Further recommendations about the timing and intervention dose were also discussed. Conclusions Moderated peer mentoring with technology has potential as a means for teaching preteens and their parents shared diabetes management. These data will be used to inform the PREP-T1 fully powered intervention study.

Background and Purpose: The purpose of this study was to develop a reliable and valid measure of faculty response patterns to the needs of underrepresented minority (URM) nursing students. Methods: A mixed-method approach. Results: The 10-item scale was found to be valid (content validity index [CVI] = .81) and reliable (Cronbach's alpha = .81). Principle component factor analysis with varimax rotation yielded a 3-factor solution that explained 66% of the variance in faculty engagement with URM students. The Cronbach's alpha for the 3 factors ranged from .72 to .78. Higher scores were associated with older faculty who had been teaching longer and had more experience teaching URM students. Conclusion and Implications: The results of the study provide preliminary evidence for the internal consistency and content, criterion-related, and construct validity of the scale.

Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.

This study examines two case studies of failed leadership in school-based professional development. We describe the two initiatives and look to current leadership theories to help account for the events that occurred. The sociologist Bourdieu’s concept of habitus offers an approach to understanding the relationship between individual agency and structural determinism. Chaos and complexity theory conceptualize organizations from a systems level where relationships and connections among all constituents—both inside and outside—are the focus. In addition, transformational and charismatic leadership theories allow for a consideration of leadership characteristics. While much can be learned from failed attempts, a comparative analysis of failed and successful strategies may assist leaders in avoiding the pitfalls of these challenging times while simultaneously providing strategies for success.

There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the “driver’s seat.” The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens ( n = 22) and parents ( n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents. Concurrently, mothers met with a parent mentor and psychologist to discuss growth and development, and collaborative shared management. Comparison dyads discussed hypoglycemia management with a nurse. Preteens slightly improved in diabetes knowledge; the experimental arm had higher problem-solving scores. Parents in the experimental arm had higher self-efficacy scores. Findings will inform future research.

Purpose The purpose of this study was to develop and test the feasibility of a parent-to-parent support intervention for parents whose child has recently been diagnosed with type 1 diabetes in the United Kingdom. Methods The research team conducted a formative evaluation, working with parents to design an individual-level parent-to-parent support intervention. Issues of recruitment, uptake, attrition, pattern of contact, and intervention acceptability were assessed. Results A US program was adapted in collaboration with a parents’ advisory group. Of 19 parents nominated as potential mentors by their pediatric diabetes specialist nurses, 12 (63%) volunteered and 11 continued for the 12-month intervention period. Thirty-three children were diagnosed with diabetes in the study period, with 25 families eligible to participate as recipients of the intervention; 9 parents from 7 of those families participated, representing 28% of those eligible. Feedback from parents and clinic staff identified peer support as a welcome service. Lessons were learned about the nature of the supporting relationship (eg, proximity, connectedness, and managing endings) that will enhance the design of future peer support programs. Conclusions Parent-to-parent support in the context of newly diagnosed childhood diabetes in the United Kingdom is feasible to deliver, with good engagement of mentors and clinic staff. The program was acceptable to parents who chose to participate, although uptake by parents whose child had been recently diagnosed was lower than expected. The results merit further investigation, including exploration of parent preference in relation to peer support.

This study explored parents' perspectives regarding their involvement in safety for their hospitalized children. We employed qualitative description and semistructured interviews of parents of children in an urban tertiary hospital ward. Content analysis revealed 4 parent themes: risks to child safety and comfort, hospital role as a protector, participation in safety varies by individual and organizational factors, and balancing safety with "speaking up" interpersonal risks. We suggest key concepts to incorporate into staff education and family engagement/safety programs to develop effective partnerships between clinicians and parents.

Guidelines for managing children with type 1 diabetes (TIDM) at summer camp (ADA, 2007) has been clearly outlined by the American Diabetes Association (ADA) and is similar to day care or school guidelines except for the acknowledgement of increased physical activity. Diabetes camp allows opportunities for school-aged children and adolescents to interact with peers who also have diabetes but also provides an opportunity for them to live and learn more about their chronic condition in a safe environment. Self-management is promoted in a relaxed setting. Camp provides parents a respite from the pressures of day-to-day diabetes management. Recent empirical studies suggest improved short term (after 7 months) glycemic control for adolescents, especially girls with T1DM after attending summer camp (Wang, Stewart, Tuli, & White, 2008). Typically, there is an experienced medical director at the camp who oversees the daily diabetes care of the children in partnership with the nursing staff educators, nutritionists, and in some instances, nursing, medical and pharmacy students (Condren, 2003). Camp counselors are also a critical group to the functioning of the camp and the day-to-day management of each child’s diabetes as they have 24/7 contact with the children. They should be very familiar and comfortable with the identification and management of hypo-/hyperglycemia including administering glucagon(ADA, 2007). For the Joslin and Barton Diabetes camps, diabetes education for the camp staff occurs prior to start of camp. The camp staff have had varying exposure with diabetes, some have T1DM and have attended camp themselves, others have no personal experience with T1DM. Training includes overall review of pathophysiology, signs and symptoms of hypoglycemia and hyperglycemia with associated treatment (including emergency treatment), glucose monitoring, insulin injections, pump therapy, nutrition, insulin use and exercise, and psychological issues (ADA, 2007). Human Patient Simulation (HPS) has been used in medical education (Alinier, Hunt, Gordon, & Harwood, 2006) for almost four decades, but only in the past ten years has nursing employed this educational strategy to enhance student nurse education (Dunn, 2004). In particular, the ability to improve critical thinking, decision making and clinical skills makes it potentially a viable teaching strategy to help teach caregivers of children with special health care needs (and in this case, T1DM). These life-sized computerized manikins can provide real time diabetes management experiences for parents in a controlled health care setting. Using this teaching strategy may help caregivers more quickly learn and become confident in managing the chronic condition. No reports could be found where this teaching technology has been used to educate camp staff. We were especially interested in those counselors who had not been exposed to T1DM and its management and to see if HPS would augment their learning experiences at the beginning of the camp orientation. Therefore, the purpose of this study was to pilot test the use of HPS with young adult camp staff. The aims included: To test the feasibility of teaching camp counselors with a learning vignette on hypoglycemia using the HPS compared to the standard education experience To measure differences between the experimental and control group on their diabetes knowledge and self-efficacy To explore differences controlling for baseline exposure of caring for individuals with T1DM.

Objectives. We used a community-based participatory research (CBPR) approach to plan and implement free TB skin testing at an adult education center to determine the efficacy of CBPR with voluntary tuberculosis (TB) screening and the prevalence of TB infection among immigrant and refugee populations. Methods. We formed a CBPR partnership to address TB screening at an adult education center that serves a large immigrant and refugee population in Rochester, Minnesota. We conducted focus groups involving educators, health providers, and students of the education center, and used this input to implement TB education and TB skin testing among the center's students. Results. A total of 259 adult learners volunteered to be skin-tested in April 2009; 48 (18.5%) had positive TB skin tests. Conclusions. Our results imply that TB skin testing at adult education centers that serve large foreign-born populations may be effective. Our findings also show that a participatory process may enhance the willingness of foreign-born persons to participate in TB skin-testing efforts.

Purpose The purpose of this mixed-methods descriptive study with parents of children newly diagnosed with type 1 diabetes was to explore their experiences with peer social support following the Social Support to Empower Parents (STEP) intervention and the usefulness of the Family Management Measure (FaMM) in this population. Methods Parents who were in the experimental arm of STEP were recruited. Qualitative interviews were conducted (n = 21), and 11 parents completed the FaMM, a quantitative family-functioning measure. Qualitative content data analysis was conducted and compared to the descriptive measure analysis. Findings Three themes were identified: availability, practical tips, and common ground. Five FaMM subscales were reliable (α > .80) in this small sample. Conclusions The findings illustrate that the STEP intervention is helpful, providing the participants with emotional, affirmational, and informational social support. The use of the FaMM is a first step in assessing family management in families with children with type 1 diabetes.

Purpose The purpose of this study was to test the efficacy of a social support intervention with parents of children Methods For this randomized, controlled clinical trial, 10 parent mentors of children diagnosed with T1DM ≥1 year and 60 parent participants were recruited from 2 pediatric diabetes centers. Mentors were trained to provide social support (home visits and phone calls) for 12 months to families in the experimental arm (32 mothers). Control group parents (28 mothers) received the phone number of an experienced parent (not trained to give social support) to call as needed. Findings Mothers in the experimental and control arms differed at baseline only in birth order of the child with T1DM. The 2 groups did not differ significantly at 3, 6, or 12 months in parent concern, confidence, worry, impact on the family, or perceived social support. Mothers in the experimental arm identified the parent mentor as someone they would seek for advice and issues regarding growth and development, sleep, eating habits, and identification of community agencies. Parent mentors consistently referred mothers to health care providers for advice on medications and treatments but helped them incorporate this advice into day-to-day management. Conclusion Mothers in the experimental arm valued the mentors’ help in adjusting to the diagnosis, but this value was not measured by the study instruments. Focus group research is under way to clarify the concept of parent mentor social support and to develop a social support measurement tool.

This study was undertaken to improve the cultural and linguistic sensitivity of an established parent-mentor training curriculum for Latino parents of young children newly diagnosed with type 1 diabetes. The cultural sensitivity of curriculum components was determined by interviewing four Latino mothers raising five children (aged 7 to 12 years) with type 1 diabetes. The mothers recommended offering resources in English and Spanish, including access to bilingual taxi service, providing access to family diabetes education on child development and preparation of healthy traditional cultural foods, and training for babysitting children with diabetes. They also suggested offering after-school and weekend diabetes clinics to decrease interference with work and school activities.

This article describes the role of a committee in the Graduate School of Nursing at the University of Massachusetts, Worcester, that is referred to as the research advisory committee. It was developed to sustain the research mission, to facilitate faculty scholarship, and to provide a venue for presubmission grant review (hence called mock review) in a graduate school of nursing that is not considered "research intensive." We present its historical framework, the development of a mock review process, faculty accomplishments thus far, and our plans for the future. It is hoped that our experiences of building and supporting faculty research efforts in a research dynamic environment may provide guidance for others working in similar institutions.

Objective : The preparation of reflective practitioners is crucial with the ever changing dynamics of the healthcare environment. Reflection involves the personal collection of information with subsequent contemplation and deliberation. This reflective process serves as the basis for gaining understandings, attaching meaning and guiding future actions. A challenge for nursing faculty is to implement new and innovative methods to assess and evaluate both reflection and affective learning. The purpose of this study is two-fold; to develop a theory-based coding system to assess affective learning, and to evaluate the feasibility and applicability of this coding system in reading and responding to students’ reflective clinical journals. Methods : The coding system is based on an alignment of the affective domain taxonomy and Mezirow’s theory of transformative learning. A research team developed this system, and then utilizing predetermined coding guidelines, scored clinical journal entries written by graduate entry pathway students. Inter-rater reliability and qualitative data in the form of faculty anecdotal comments supported on-going revisions to the coding system. Results : In the early stages of the coding, the IRR averaged 0.5 with the last set ranging from 0.75-1.00. Team meeting and the use of the research team’s anecdotal logs served to address inconsistencies in the process. Conclusions : The results of this study support the feasibility to both establish a consistent theoretical foundation to guide student assessment and evaluation of affective learning. Identification of student exemplars was also created to orient new faculty concerning the stages of reflection. The results of this study also support the course design process in terms of alignment of student learning objectives, instructional methods and evaluation plans.

Purpose The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. Methods Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. Findings This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement. Conclusions The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)–provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild’s diabetes care team.

Objective To evaluate the efficacy of Parent Education Through Simulation–Diabetes (PETS-D; clinical trial registration NCT01517269) for parents of children Design and Methods Subjects were randomized to the HPS parent diabetes education or the vignette-only arm. Using linear mixed modeling, we compared HPS and vignette-only groups at 2, 6, and 14 weeks. Effect modification of treatment by dichotomized child’s age (high school) was also tested. All analyses were intent to treat and adjusted for baseline outcome level and clustering within site. Results We recruited 191 parents (116 children). Mean baseline A1C was 12%. Overall treatment-related differences were modest. There was a statistically significant effect modification of HPS by child’s age, with a larger HPS benefit among parents of younger children for several outcomes: A1C (8.16% vs 9.48% in control; P = .006), lower state anxiety ( P = .0094), and higher fear of hypoglycemia ( P = .03) for parents of children Conclusions Modest treatment-related differences may reflect ceiling/floor effects in many of the outcomes; we also compared HPS with another intervention rather than to usual education. Parents of younger children receiving the intervention may feel more comfortable with lower A1C levels because of management awareness gleaned from the HPS experience. Future research will include a retrospective case-control study of very young children.

Eliminating health disparities by the year 2010 has become a clear priority for nursing and health sciences research. To date, much of the research has relied on traditional analytic methods to identify the disparities and develop clinical interventions. However, health disparities are typically embedded in complex, cultural and contextual issues. Interventions to improve access, quality and care among vulnerable populations need to be developed with these factors in mind. This article illustrates the benefits of using Qualitative Description as one method for assessing, developing and refining interventions with vulnerable populations. Qualitative Description study results have tremendous potential to translate directly to pressing health care situations and provide clear information about ways to improve care.

Issue addressed: Factors supporting and constraining the ability of health service workers to incorporate health promotion into their work.

Issues addressed: Using the concepts of program budgeting and marginal analysis (PBMA), the South Eastern Sydney Health Promotion Service conducted a budget audit to inform future planning. PBMA is an economic tool that examines relationships between services, costs, outputs and outcomes for health. Method: The goals, objectives and process and intermediate outcomes of program areas were summarised. Staff time spent on different activities was estimated, and goods and services budgets calculated. Staff suggested changes to programs and operations, given a 5% and 33% increase, and 5% and 33% decrease in funding. To assist informed decision making, information on good practice, local data and other relevant material was provided. Results were collated, themes identified and discussed and recommendations for change made. Results: Program budgets accounted for 61% of total funds; the remainder was spent on specialist support, administration and operational costs. Three programs (nutrition, physical activity and capacity building) each received more than 20% of the program funding, and four (tobacco, sun, falls and schools) each received less than 10%. Projects within the health service, school and child care settings received the most resources; initiatives for Aboriginal people received the least. Conclusions: The process led to changes in program funding (increased resources to tobacco and Aboriginal health at the expense of sun protection and capacity building) and informed the new health promotion strategic plan. (author abstract)

issues and purpose.To examine the day-to-day experiences of mothers raising children 4 years of age and younger with type 1 diabetes. design and methods.The descriptive design compared mothers of children with (n = 25) and without diabetes (n = 25). Mother-child observations were completed for children with diabetes. results.Mothers of children with diabetes are very skilled in reading their children's behavioral cues. Mothers'concerns included the fear of hypoglycemia and seizure activity, access to daycare centers, and babysitting services capable of caring for their children's condition. These responses significantly differed from the control group mothers. practice implications.Nurses can affirm that hypoglycemia-related fears are normal and help mothers identify community resources that might ease the burden of care required, especially during the early postdiagnosis period.

The purpose of this study was to garner expert opinion from health care (HC) (n = 68) and non-HC (n = 15) managers on the issues likely to impact the work of entry level physical therapists and qualities for employment success. Students enrolled in a professional phase physical therapy (PT) course conducted 83 manager interviews. The authors arrived at consensus regarding manager opinions on important HC issues and qualities for employment success with a modified Delphi technique. The Chi-square test was used to determine if HC issues and employment qualities differed among the managers' professions and settings. PT managers (n = 50) found ancillary staff use to be a more important HC issue than did other HC managers (n = 18), 68.0% versus 27.8%, respectively (p = 0.009). Otherwise, PT managers were similar to other HC managers in their opinions on the pertinent HC issues. HC managers reported business skills to be not as essential for career success as non-HC managers did (n = 15), 22.1% versus 66.7%, re...

Issues and controversies in chronic illness research are discussed, with data and examples from a program of research dealing with children and adolescents with diabetes. The key differences that demand consideration include prevalence, developmental issues, measurement, cultural issues, the lack of viable models, use of controls, the importance of the family, and ethical concerns.

Promoting tobacco cessation is an important part of the work of clinicians and staff in primary care practice. This article describes the significant public health impact of helping patients quit using tobacco through the use of an effective clinic-based intervention. The most effective strategies are to develop organization commitment, ask every patient about tobacco use at every visit and document it, advise all tobacco users to quit, assess readiness to quit, provide at least brief behavioral counseling, provide follow-up soon after quit date, conduct at least basic evaluations of each component of the process, and assess the quit rate for the practice as a whole.

OBJECTIVE Given the urgent need to develop effective programs that improve the ability for adolescents to achieve metabolic control equivalent to programs studied in the Diabetes. Control and Complications Trial, we have undertaken a clinical trial to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve metabolic control and quality of life in adolescents implementing intensive therapy regimens. RESEARCH DESIGN AND METHODS A total of 65 youths between the ages of 13 and 20 years, who elected to initiate intensive insulin therapy, were randomly assigned to one of two groups: the intensive management with CST group and the intensive management without CST group. CST consists of a series of small group efforts designed to teach adolescents the coping skills of social problem-solving, social skills training, cognitive behavior modification, and conflict resolution. Data were collected at pre-intervention and at 3 months following the use of the Self-Efficacy for Diabetes scale, Children's Depression Inventory, Issues in Coping with IDDM scale, and the Diabetes Quality of Life: Youth scale. Clinical data (HbA1c, adverse effects) were collected monthly. RESULTS The experimental and control groups were comparable on all measures at baseline. Results show that adolescents who received CST had lower HbA1c and better diabetes self-efficacy and were less upset about coping with diabetes than adolescents receiving intensive management alone. In addition, adolescents who received the CST found it easier to cope with diabetes and experienced less of a negative impact of diabetes on quality of life than those who did not receive CST. CONCLUSIONS CST is useful in improving not only an adolescent's metabolic control, but also their quality of life. As more pediatric providers aim for improved control, in adolescents with diabetes, the addition of this behavioral intervention may be helpful in achieving metabolic and life goals.

OBJECTIVE Quality of life is an important criterion for assessing outcomes of treatment in chronic illness related to psychosocial well-being. The purpose of this study was to evaluate the factors that influence quality of life in adolescents with IDDM. RESEARCH DESIGN AND METHODS Self-reports were obtained from 52 adolescents (age 13-20 years, mean 16.1 ± 1.9 [mean ± SD], diabetes duration 8.2 ± 3.4 years, 49% female) using the following scales: Diabetes Quality of Life for Youths, Children's Depression Inventory, Issues in Coping with Diabetes, Diabetes Family Behavior Scale, Family Adaptability and Cohesion, Self-Efficacy for Diabetes, and the Adolescent Coping Orientation. Metabolic control was measured by HbA1c. RESULTS Teenagers whose diabetes had the greater impact (R2 = 0.48) and were less satisfied (R2 = 0.45) felt that management was more difficult (r = 0.56) and that diabetes was more upsetting (r = 0.63). They also used fewer rebellion strategies for coping (r = −0.44), had lower diabetes self-efficacy (r = −0.36), and had more depressive symptoms (r = 0.61). Higher impact was also associated with higher family warmth and caring (r = −0.54) and lower family adaptability (r = −0.42). Teenagers who were more worried (R2 = 0.37) about their diabetes felt that management was more difficult (r = 0.40) and that diabetes was more upsetting (r = 0.58), and they used less rebellion (r = −0.49) and more ventilation (r = 0.42) to cope, had lower diabetes (r = −0.40) and medical (r = −0.30) self-efficacy, were more depressed (r = 0.55), and their families were less warm and caring (r = −0.33). HbA1c levels were not associated with quality of life or any other psychosocial factors except in teenagers who perceived their families as providing more guidance and control. These teenagers had lower HbA1c values than those whose families were less involved. CONCLUSIONS Even teenagers who are successfully achieving HbA1c goals of therapy may perceive diabetes as having a negative impact on their lives, be depressed, and find diabetes difficult to manage. Diabetes treatment teams need to pay equal attention to the psychosocial needs to the quiet, nonrebellious teen with well-controlled diabetes from a supportive family as they do to the rebellious adolescent with poorly controlled diabetes.

As principals assume their roles in an urban bureaucracy, what are some of the personal and organizational factors that support or restrict their efforts to bring about school change? Based on interviews with newly appointed principals, this study concludes that external and internal factors interact to influence leadership behavior. External factors, particularly role models, district expectations, and personal and organizational support, influence principals’ sense of self-efficacy. This internal factor, in turn, appeared to play an important mediating role influencing principals’ interpretation of the organizational context and their problem-solving processes.

The purpose of this article is to review the Health Insurance Portability and Accountability Act (HIPAA), the Privacy Rule, the Security Rule, and common issues encountered by researchers related to these federal privacy and security requirements. This article discusses the misconceptions that researchers may hold about HIPAA, including the process for reviewing protected health information when preparing to conduct a study, potential constraint on participant recruitment, and application of HIPAA to a researcher's clinical population. We also present ways to reframe the negative connotations associated with this regulation and provide tips for researchers about how to work with HIPAA when planning and conducting a study and reporting on study findings. Finally, we suggest that the principles of HIPAA be considered when conducting studies in international settings.

Purpose To purpose of the pilot study was to evaluate the use of a pediatric human patient simulator (HPS) to teach parents diabetes management for their children newly diagnosed with type 1 diabetes, referred to as Parent Education Through Simulation–Diabetes. Methods A focus group study and 2 pilot studies (1-group study and a randomized 2-group study) were used to develop and test a teaching intervention. Parents were recruited from the Pediatric Diabetes Clinic at UMass Memorial Medical Center. A brainstorming group (n = 6) discussed the simulator concept and what modifications would be necessary to enhance parent teaching; the authors also developed the initial hypoglycemia and hyperglycemia teaching vignettes. Two focus groups (n = 13) discussed the acceptance of using a simulator and the timing and content of the teaching sessions. Based on their recommendations, a 1-group pretest-posttest pilot was conducted with parents (n = 10) receiving hypoglycemia education enhanced with the HPS, followed by a randomized 2-group pilot study (n = 16). Findings The focus group participants enthusiastically supported the use of the pediatric HPS after diagnosis and made recommendations for the timing and content of the teaching sessions. Major findings from the pilot work included (1) successful recruitment of 16 participants from only 1 site within 6 weeks, (2) instrument reliability demonstrated for all scales, and (3) mean change from baseline in the predicted direction for all measures. Conclusions The HPS has the potential of providing parents an innovative means of learning diabetes management through visualization during the early months after diagnosis and so warrants a powered study to determine its efficacy.

Purpose To pilot test a social support intervention for fathers of children Design and methods The pilot study was part of a larger randomized, controlled clinical trial. Father participants (28 fathers of children newly diagnosed) were recruited from two pediatric diabetes centers. For 12 months fathers (n = 19) and their spouses in the experimental arm received social support (home visits and phone calls). Control group fathers (n = 9) and their spouses received the phone number of an experienced parent (but not formally educated to provide social support) to call as needed. Results Fathers in the intervention group had significantly greater confidence but scored higher on worry at 12 months than control group fathers. Fathers in the two groups did not differ significantly in disease-related concerns or perceived disease impact on the family, nor did they differ significantly in perceived amount and helpfulness of their daily management. However, mothers overall perceived fathers as contributing more care and help than fathers perceived themselves (p > .10). Fathers in the experimental arm identified parent mentors as individuals they would seek advice regarding day-to-day management and community agencies. Over this 4.5 year study, 6 of 28 father participants and two of the three father mentors dropped out. Clinical implications Nurses caring for families with young children newly diagnosed with T1DM should consider fathers social support needs and encourage their participation in day-to-day management.

English as a Second Language programs serve large foreign-born populations in the US with elevated risks of tuberculosis (TB), yet little is known about TB perceptions in these settings. Using a community-based participatory research approach, we elicited perceptions about TB among immigrant and refugee learners and staff at a diverse adult education center. Community partners were trained in focus groups moderation. Ten focus groups were conducted with 83 learners and staff. Multi-level, team-based qualitative analysis was conducted to develop themes that informed a model of TB perceptions among participants. Multiple challenges with TB control and prevention were identified. There were a variety of mis-perceptions about transmission of TB, and a lack of knowledge about latent TB. Feelings and perceptions related to TB included secrecy, shame, fear, and isolation. Barriers to TB testing include low awareness, lack of knowledge about latent TB, and the practical considerations of transportation, cost, and work schedule conflicts. Barriers to medication use include suspicion of generic medications and perceived side effects. We posit adult education centers with large immigrant and refugee populations as excellent venues for TB prevention, and propose several recommendations for conducting these programs. Content should dispel the most compelling misperceptions about TB transmission while clarifying the difference between active and latent disease. Learners should be educated about TB in the US and that it is curable. Finally, TB programs that include learners and staff in their design and implementation provide greater opportunity for overcoming previously unrecognized barriers.

Hepatitis C Treatment Experiences and Decision-Making Among Patients Living with HIV Infection Abstract Hepatitis C infection is a major problem for approximately 250,000 HIV-infected persons in the United States. Although HIV infection is well controlled in most of this population, they suffer liver-associated morbidity and mortality. Conversely, HCV treatment uptake remains quite low (15–30%). Therefore, the purpose of this qualitative study was to explore HCV treatment experiences and decision-making in adults with HIV infection. The study sample included 39 co-infected adults, 16 in the HCV-treated cohort (who were interviewed up to 3 times) and 23 in the HCV-non-treatment cohort. Analysis of interviews identified 2 treatment barriers (fears and vicarious experiences) and 4 facilitating factors (experience with illness management, patient-provider relationships, gaining sober time, and facing treatment head on). Analysis of these data also revealed a preliminary model to guide intervention development and theoretical perspectives. Ultimately, research is urgently needed to test interventions that improve HCV evaluation and treatment uptake among HIV-infected patients.