Nursing Research and Practice The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Pilot Program to Improve Self-Management of Patients with Heart Failure by Redesigning Care Coordination Wed, 23 Apr 2014 16:27:02 +0000 Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care. Jessica D. Shaw, Daniel J. O’Neal III, Kris Siddharthan, and Britta I. Neugaard Copyright © 2014 Jessica D. Shaw et al. All rights reserved. Health Disparities in Genomics and Genetics Tue, 22 Apr 2014 11:55:53 +0000 Ida J. Spruill, Jacquelyn Taylor, Irma B. Ancheta, Adebowale A. Adeyemo, Yolanda Powell-Young, and Willa Doswell Copyright © 2014 Ida J. Spruill et al. All rights reserved. Assessing and Enhancing Health Care Providers’ Response to Domestic Violence Tue, 22 Apr 2014 00:00:00 +0000 This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; , follow-up; ) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants’ quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health care providers’ response to DV. Moreover, there is a great need for evaluating the training programme used. Tuija Leppäkoski, Aune Flinck, and Eija Paavilainen Copyright © 2014 Tuija Leppäkoski et al. All rights reserved. Organizational Culture Shapes the Adoption and Incorporation of Simulation into Nursing Curricula: A Grounded Theory Study Thu, 10 Apr 2014 09:01:58 +0000 Purpose. To create a substantive mid-range theory explaining how the organizational cultures of undergraduate nursing programs shape the adoption and incorporation of mid-to high-level technical fidelity simulators as a teaching strategy within curricula. Method. A constructivist grounded theory was used to guide this study which was conducted in Ontario, Canada, during 2011-12. Semistructured interviews () with participants that included nursing administrators, nursing faculty, and simulation leaders across multiple programs () informed this study. Additionally, key documents () were reviewed. Purposeful and theoretical sampling was used and data were collected and analyzed simultaneously. Data were compared among and between sites. Findings. The organizational elements that shape simulation in nursing (OESSN) model depicts five key organizational factors at the nursing program level that shaped the adoption and incorporation of simulation: (1) leaders working in tandem, (2) information exchange, (3) physical locale, (4) shared motivators, and (5) scaffolding to manage change. Conclusions. The OESSN model provides an explanation of the organizational factors that contributed to the adoption and incorporation of simulation into nursing curricula. Nursing programs that use the OESSN model may experience a more rapid or broad uptake of simulation when organizational factors that impact adoption and incorporation are considered and planned for. Karyn Taplay, Susan M. Jack, Pamela Baxter, Kevin Eva, and Lynn Martin Copyright © 2014 Karyn Taplay et al. All rights reserved. Health Professionals Facing Burnout: What Do We Know about Nursing Managers? Thu, 03 Apr 2014 09:31:25 +0000 Objective. To address the degree of burnout in nursing managers in hospitals of Western Switzerland, including comparison with medical managers, and its relationship with personal, work-related, and organizational characteristics. Methods. Statistical analysis of the scores of the Maslach Burnout Inventory-Human Services Survey from 257 nursing managers who answered a standardized electronic questionnaire. Results. Nursing managers showed a low degree of burnout, which was similar to that of medical managers. Most of them had a low level of emotional exhaustion and a low level of depersonalization, while personal accomplishment was contrasted. Only 2.3% had a high degree of burnout. These findings challenge the hypothesis of high stress being associated with high burnout, as nursing managers can be supposed to have a highly demanding job due to their intermediary position within the hospital hierarchy. Variations of burnout by personal, work-related, and organizational characteristics mainly concerned emotional exhaustion. Conclusion. Though nursing managers face a highly demanding job, they may benefit from resources (including coping strategies and empowerment) which help counterbalance job stress. Unequal distribution of resources may play a central role when facing burnout. Jean-Luc Heeb and Véronique Haberey-Knuessi Copyright © 2014 Jean-Luc Heeb and Véronique Haberey-Knuessi. All rights reserved. Family Health Conversations: How Do They Support Health? Tue, 01 Apr 2014 06:45:12 +0000 Research shows that living with illness can be a distressing experience for the family and may result in suffering and reduced health. To meet families’ needs, family systems intervention models are developed and employed in clinical contexts. For successful refinement and implementation it is important to understand how these models work. The aim of this study was therefore to describe the dialogue process and possible working mechanisms of one systems nursing intervention model, the Family Health Conversation model. A descriptive evaluation design was applied and 15 transcribed conversations with five families were analyzed within a hermeneutic tradition. Two types of interrelated dialogue events were identified: narrating and exploring. There was a flow between these events, a movement that was generated by the interaction between the participants. Our theoretically grounded interpretation showed that narrating, listening, and reconsidering in interaction may be understood as supporting family health by offering the families the opportunity to constitute self-identity and identity within the family, increasing the families’ understanding of multiple ways of being and acting, to see new possibilities and to develop meaning and hope. Results from this study may hopefully contribute to the successful implementation of family systems interventions in education and clinical praxis. Carina Persson and Eva Benzein Copyright © 2014 Carina Persson and Eva Benzein. All rights reserved. Organizing Safe Transitions from Intensive Care Mon, 24 Mar 2014 07:50:50 +0000 Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach. Marie Häggström and Britt Bäckström Copyright © 2014 Marie Häggström and Britt Bäckström. All rights reserved. A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly? Sun, 16 Mar 2014 12:13:27 +0000 Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents’ needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia’s values when designing or implementing ACP interventions in the LTCH settings. Abigail Wickson-Griffiths, Sharon Kaasalainen, Jenny Ploeg, and Carrie McAiney Copyright © 2014 Abigail Wickson-Griffiths et al. All rights reserved. How Do Older Persons Understand the Purpose and Relevance of Preventive Home Visits? A Study of Experiences after a First Visit Mon, 10 Mar 2014 09:55:30 +0000 The aim of this study was to explore and describe older persons’ experiences of their first Preventive Home Visit. Preventive Home Visits (PHV) are health services that aim to promote older persons' health, prevent functional decline, and reduce the need for comprehensive healthcare. The knowledge base to guide the design of effective PHV interventions is scarce. Studies that explore older persons' experiences of the first visit are essential, as compliance with the service is a prerequisite for positive outcomes. An explorative and descriptive design was applied. Qualitative research interviews with ten older persons who had received the first PHV the previous year were analysed with regard to manifest and latent content. The findings revealed that the understanding of the purpose of PHV varied. For some participants, the concepts and aims of health promotion and disease prevention were difficult to comprehend. The possibility to prepare for the visit was sought. All participants appreciated the service; the dialogue quality was good and a trusted municipal contact person provided security. To enhance compliance and ensure effective PHV, the invitation to the PHV service should include clearly stated aims and specific information about the first visit. An individualised, person-centred approach should be applied. Mette Tøien, Morten Heggelund, and Lisbeth Fagerström Copyright © 2014 Mette Tøien et al. All rights reserved. The Facial Affective Scale as a Predictor for Pain Unpleasantness When Children Undergo Immunizations Wed, 05 Mar 2014 16:43:47 +0000 Needle fear is a common problem in children undergoing immunization. To ensure that the individual child’s needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions. Stefan Nilsson, Berit Finnström, Evalotte Mörelius, and Maria Forsner Copyright © 2014 Stefan Nilsson et al. All rights reserved. Interprofessional Collaboration in the Mental Health Services in Norway Sun, 02 Mar 2014 00:00:00 +0000 The aim of this study was to describe and interpret interprofessional collaboration between healthcare professionals (HCPs) working at the district psychiatric centre (DPC) and employed in community mental health care (CMHC) using a dialogue-oriented co-operative approach. Data were collected by means of multistage focus groups and qualitative content analysis was performed. The main theme “development of interprofessional collaboration by means of organisational strategies and interactional styles” encompassed the following categories: “improved communication skills,” “developing structures for coordination and responsibility” and “ increased professional insight into the values and conditions necessary for decision-making.” In conclusion, more attention should be paid to leadership in terms of coordination and feedback. The HCPs must be acknowledged, understood and strengthened in their work to improve the quality of CMHC. Finally, we recommend that a range of organisational and administrative models of care be used in order to support improvement work. Ellen Andvig, Jonn Syse, and Elisabeth Severinsson Copyright © 2014 Ellen Andvig et al. All rights reserved. Factors Influencing Job Satisfaction and Anticipated Turnover among Nurses in Sidama Zone Public Health Facilities, South Ethiopia Mon, 24 Feb 2014 12:40:32 +0000 Background. Workplace turnover is destructive to nursing and patient outcomes as it leads to losing competent and qualified nurses. However, developments of coping strategies demand a clear understanding of workplace variables that either motivate nurses to remain employed or lead them to leave their current jobs. Objective. This study was designed toassess factors influencing job satisfaction and intention to turnover among nurses in Sidama zone public health facilities, in Southern Ethiopia. Method. Cross-sectional study design was carried out on 278 nurses using both qualitative and quantitative data collection methods from May 12 to June 05, 2010. Result. A total of 242 nurses were interviewed giving a response rate of 87%. Nearly two-third (68.6%) of the participants were female, and the mean age was 28 (±6.27) years for both sexes. All job satisfaction subscale except benefit and salary subscale were significant predictors of overall job satisfaction. Satisfactions with work environment and group cohesion (AOR: 0.25 [95% CI: 0.12, 0.51]), single cohesion (AOR: 2.56 [95% CI: 1.27, 5.13]), and working in hospital (AOR: 2.19 [95% CI: 1.12, 4.30]) were the final significant predictors of anticipated turnover of Sidama zone nurses. Conclusions. More than any factors managers should consider the modification of working environment and group cohesions rather than trying to modify nurses to retain and maintain more experienced nurses for the organizations. Agezegn Asegid, Tefera Belachew, and Ebrahim Yimam Copyright © 2014 Agezegn Asegid et al. All rights reserved. Nurses’ Knowledge, Practices, and Barriers in Care of Patients with Pressure Ulcers in a Ugandan Teaching Hospital Mon, 24 Feb 2014 08:49:27 +0000 Pressure ulcers have been identified as a major burden of hospitalization worldwide, and nurses are at the forefront of prevention. The purpose of this study was to determine the nurses’ knowledge and practices regarding risk factors, prevention, and management of pressure ulcers at a teaching hospital in Uganda. The study employed a descriptive cross-sectional design. Fifty-six Ugandan registered practicing nurses were sampled. A composite self-administered questionnaire and an observation checklist were utilized. The nurses had limited knowledge about critical parameters of pressure ulcers. Prevention practices were observed to be unreliable and uncoordinated related to a significant shortage of staff and logistics for pressure ulcer prevention. Nurses had poor access to current literature on pressure ulcer prevention. Translation of nurses’ knowledge into practice is possible if barriers like staff shortage, pressure relieving devices provision, and risk assessment tools are addressed at Mulago. Ivan Mwebaza, Godfrey Katende, Sara Groves, and Joyce Nankumbi Copyright © 2014 Ivan Mwebaza et al. All rights reserved. Simple Measures of Function and Symptoms in Hospitalized Heart Failure Patients Predict Short-Term Cardiac Event-Free Survival Sun, 09 Feb 2014 13:29:06 +0000 Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients () had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4–8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2–13.2; 1.2–75.1; 1.7–99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients. Evanthia Zaharias, Janine Cataldo, Lynda Mackin, and Jill Howie-Esquivel Copyright © 2014 Evanthia Zaharias et al. All rights reserved. Application of Nursing Process and Its Affecting Factors among Nurses Working in Mekelle Zone Hospitals, Northern Ethiopia Thu, 06 Feb 2014 13:09:18 +0000 Background. Nursing process is considered as appropriate method to explain the nursing essence, its scientific bases, technologies and humanist assumptions that encourage critical thinking and creativity, and permits solving problems in professional practice. Objective. To assess the application of nursing process and it’s affecting factors in Mekelle Zone Hospitals. Methods. A cross sectional design employing quantitative and qualitative methods was conducted in Mekelle zone hospitals March 2011. Qualitative data was collected from14 head nurses of six hospitals and quantitative was collected from 200 nurses selected by simple random sampling technique from the six hospitals proportional to their size. SPSS version 16.1 and thematic analysis was used for quantitative and qualitative data respectively. Results. Majority 180 (90%) of the respondents have poor knowledge and 99.5% of the respondents have a positive attitude towards the nursing process. All of the respondents said that they did not use the nursing process during provision of care to their patients at the time of the study. Majority (75%) of the respondent said that the nurse to patient ratio was not optimal to apply the nursing process. Conclusion and Recommendation. The nursing process is not yet applied in all of the six hospitals. The finding revealed that the knowledge of nurses on the nursing process is not adequate to put it in to practice and high patient nurse ratio affects its application. The studied hospitals should consider the application of the nursing process critically by motivating nurses and monitor and evaluate its progress. Fisseha Hagos, Fessehaye Alemseged, Fikadu Balcha, Semarya Berhe, and Alemseged Aregay Copyright © 2014 Fisseha Hagos et al. All rights reserved. The Association between KIF6 Single Nucleotide Polymorphism rs20455 and Serum Lipids in Filipino-American Women Thu, 23 Jan 2014 13:23:31 +0000 The Trp719Arg allele of KIF6 rs20455, a putative risk factor for CHD especially in those with elevated low-density lipoprotein cholesterol (LDL-C), was investigated in Filipino-American women (FAW, ) participating in health screenings in four cities. The rs20455 genotype of each subject was determined by a multiplex assay using a Luminex-OLA procedure. The risk allele Trp719Arg was present in 77% of the subjects. The genotype distribution was 23% Trp/Trp, 51% Arg/Trp, and 26% Arg/Arg. Genotype did not predict the presence of CHD risk factors. Moreover, LDL-C, HDL-C, and triglycerides mean values did not vary as a function of genotype. However, those with the Arg/Arg genotype on statin medication exhibited a significantly higher mean triglycerides level (). Approximately 60% of participants regardless of genotype exhibited LDL-C levels 100 mg/dL but were not taking medication. Approximately 43% of those with the Trp719Arg risk allele on statins exhibited elevated LDL-C levels. Our study suggests that the Trp719Arg allele of KIF 6 rs20455 is common among Filipino-American women; thus, even with borderline LDL-C levels would benefit from statin treatment. Secondly, many participants did not exhibit guideline recommended LDL-C levels including many who were on statin drugs. Irma B. Ancheta, Cynthia A. Battie, Dan Richard, Christine V. Ancheta, Nancy Borja-Hart, Annabelle S. Volgman, and Yvette Conley Copyright © 2014 Irma B. Ancheta et al. All rights reserved. Exploring the Experience of Nursing Home Residents Participation in a Hope-Focused Group Thu, 16 Jan 2014 11:02:30 +0000 A qualitative intervention was used to explore how older adults living in a long-term care environment (nursing home) understand hope and experience being participants in a group in which a hope intervention was carried out. A group project in which each session focused intentionally on a hope strategy was carried out with a convenience sample of 10 women (ages 75–99) who were members of an existing group. Data were analyzed using thematic analysis of the interviews (conducted before the group intervention was carried out and again at the end), field notes, and collaborative conversations regarding emerging themes. Findings from this study suggest that hope is not static and that it can change over time in response to one’s situations and circumstances. Also evident in this study is the potential for using a group process in long-term care to foster hope in an intentional way to make it more visible in the lives of the residents and their environment suggesting that one is “never too old for hope.” Sharon L. Moore, Susan E. Hall, and Jennifer Jackson Copyright © 2014 Sharon L. Moore et al. All rights reserved. Current Continuing Professional Education Practice among Malaysian Nurses Thu, 09 Jan 2014 13:37:25 +0000 Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562) of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6%) and tertiary education was the most unpopular activity (10, 1.3%). The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE) is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses’ (RNs) needs and not simply organizational requirements. Mei Chan Chong, Karen Francis, Simon Cooper, and Khatijah Lim Abdullah Copyright © 2014 Mei Chan Chong et al. All rights reserved. Analysis of Maternal and Child Health Indicators in an Area at Paraná State, Brazil Mon, 30 Dec 2013 18:09:06 +0000 The aim of this study was to analyze maternal and child health indicators and infant mortality rate (IMR) at the cities located at the 18th Health Division (HD) in Parana State, Brazil. In this ecological study we analyzed all live births and infant deaths which occurred from 2000 to 2009 at the 18th HD, collecting data from the Mortality Information Database and the Live Births Information Database. The variables assessed were grouped into maternal, pregnancy and delivery, and neonatal variables. The analysis was conducted using the mean percentage of each variable and the IMR calculated for both periods: from 2000 to 2004 and from 2005 to 2009. The IMR was reduced considerably, following Brazil's and Paraná State's trend. Maternal indicators went down regarding the mean percentage of teenage mothers and low education, whereas they went up regarding mother with 35 years old or older and mothers without a partner. Pregnancy indicators showed increased prematurity and cesarean birth. Neonatal indicators raised in black/brown skin color and low birth weights percentages. This study provides a better understanding of maternal and child health in the cities located at the 18th HD, supplying grounds to plan actions regarding the real needs of each specific city. Emiliana Cristina Melo, Ana Beatriz Guedes Ribeiro, Rosana Rosseto de Oliveira, Robsmeire Calvo Melo Zurita, and Thais Aidar de Freitas Mathias Copyright © 2013 Emiliana Cristina Melo et al. All rights reserved. Evaluating Symptoms to Improve Quality of Life in Patients with Chronic Stable Angina Mon, 23 Dec 2013 11:57:33 +0000 Chronic stable angina (CSA) is a significant problem in the United States that can negatively impact patient quality of life (QoL). An accurate assessment of the severity of a patient’s angina, the impact on their functional status, and their risk of cardiovascular complications is key to successful treatment of CSA. Active communication between the patient and their healthcare provider is necessary to ensure that patients receive optimal therapy. Healthcare providers should be aware of atypical symptoms of CSA in their patients, as patients may continue to suffer from angina despite the availability of multiple therapies. Patient questionnaires and symptom checklists can help patients communicate proactively with their healthcare providers. This paper discusses the prevalence of CSA, its impact on QoL, and the tools that healthcare providers can use to assess the severity of their patients’ angina and the impact on QoL. Jeffrey W. Young Jr and Sheila Melander Copyright © 2013 Jeffrey W. Young and Sheila Melander. All rights reserved. Epigenetics in Research and Practice Sun, 22 Dec 2013 11:13:25 +0000 Debra E. Lyon, Susan G. Dorsey, and Leorey Saligan Copyright © 2013 Debra E. Lyon et al. All rights reserved. Epigenetic Markers of Renal Function in African Americans Thu, 12 Dec 2013 15:14:10 +0000 Chronic kidney disease (CKD) is an increasing concern in the United States due to its rapidly rising prevalence, particularly among African Americans. Epigenetic DNA methylation markers are becoming important biomarkers of chronic diseases such as CKD. To better understand how these methylation markers play a role in kidney function, we measured 26,428 DNA methylation sites in 972 African Americans from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. We then evaluated (1) whether epigenetic markers are associated with estimated glomerular filtration rate (eGFR), (2) whether the significantly associated markers are also associated with traditional risk factors and/or novel biomarkers for eGFR, and (3) how much additional variation in eGFR is explained by epigenetic markers beyond established risk factors and biomarkers. The majority of methylation markers most significantly associated with eGFR (24 out of the top 30) appeared to function, at least in part, through pathways related to aging, inflammation, or cholesterol. However, six epigenetic markers were still able to significantly predict eGFR after adjustment for other risk factors. This work shows that epigenetic markers may offer valuable new insight into the complex pathophysiology of CKD in African Americans. Samantha M. Bomotti, Jennifer A. Smith, Alicia L. Zagel, Jacquelyn Y. Taylor, Stephen T. Turner, and Sharon L. R. Kardia Copyright © 2013 Samantha M. Bomotti et al. All rights reserved. A Framework to Examine the Role of Epigenetics in Health Disparities among Native Americans Mon, 09 Dec 2013 08:45:58 +0000 Background. Native Americans disproportionately experience adverse childhood experiences (ACEs) as well as health disparities, including high rates of posttraumatic stress, depression, and substance abuse. Many ACEs have been linked to methylation changes in genes that regulate the stress response, suggesting that these molecular changes may underlie the risk for psychiatric disorders related to ACEs. Methods. We reviewed published studies to provide evidence that ACE-related methylation changes contribute to health disparities in Native Americans. This framework may be adapted to understand how ACEs may result in health disparities in other racial/ethnic groups. Findings. Here we provide evidence that links ACEs to methylation differences in genes that regulate the stress response. Psychiatric disorders are also associated with methylation differences in endocrine, immune, and neurotransmitter genes that serve to regulate the stress response and are linked to psychiatric symptoms and medical morbidity. We provide evidence linking ACEs to these epigenetic modifications, suggesting that ACEs contribute to the vulnerability for developing psychiatric disorders in Native Americans. Conclusion. Additional studies are needed to better understand how ACEs contribute to health and well-being. These studies may inform future interventions to address these serious risks and promote the health and well-being of Native Americans. Teresa N. Brockie, Morgan Heinzelmann, and Jessica Gill Copyright © 2013 Teresa N. Brockie et al. All rights reserved. Enhancing the Participation of African Americans in Health-Related Genetic Research: Findings of a Collaborative Academic and Community-Based Research Study Wed, 04 Dec 2013 17:23:24 +0000 The involvement of African Americans in research has long been expressed as a concern by the scientific community. While efforts have been undertaken to identify factors inhibiting the participation of African Americans in health-related research, few efforts have been undertaken to have highlight factors associated with their engagement of health-related research. An exploratory study of factors presumed to be associated with participation in health-related research was conducted among a nonprobability sample of African Americans () from a large urban community in the Midwest. The study was guided by a framework that hypothesized the influence of knowledge, beliefs, and perceptions about genetics and the involvement of providers in decision-making on willingness to participate in health-related genetic research. The results revealed that knowledge, beliefs, and perceptions about genetics and the involvement of providers were associated with willingness to engage in health-related genetic research (). The most interesting, however, was that 88.7% of the participants who had not previously been involved in a health-related study who expressed a willingness to participate reported that they “had never been asked.” Study findings suggest the need for research that further examines factors associated with the involvement of African Americans in health-related genetic research. Sandra Millon Underwood, Aaron G. Buseh, Sheryl T. Kelber, Patricia E. Stevens, and Leolia Townsend Copyright © 2013 Sandra Millon Underwood et al. All rights reserved. Participation in Decision Making as a Property of Complex Adaptive Systems: Developing and Testing a Measure Thu, 21 Nov 2013 14:58:39 +0000 Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores. We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems-level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them. Ruth A. Anderson, Donde Plowman, Kirsten Corazzini, Pi-Ching Hsieh, Hui Fang Su, Lawrence R. Landerman, and Reuben R. McDaniel Copyright © 2013 Ruth A. Anderson et al. All rights reserved. Know Your Client and Know Your Team: A Complexity Inspired Approach to Understanding Safe Transitions in Care Wed, 20 Nov 2013 12:00:44 +0000 Background. Transitions in care are one of the most important and challenging client safety issues in healthcare. This project was undertaken to gain insight into the practice setting realities for nurses and other health care providers as they manage increasingly complex care transitions across multiple settings. Methods. The Appreciative Inquiry approach was used to guide interviews with sixty-six healthcare providers from a variety of practice settings. Data was collected on participants’ experience of exceptional care transitions and opportunities for improving care transitions. Results. Nurses and other healthcare providers need to know three things to ensure safe care transitions: (1) know your client; (2) know your team on both sides of the transfer; and (3) know the resources your client needs and how to get them. Three themes describe successful care transitions, including flexible structures; independence and teamwork; and client and provider focus. Conclusion. Nurses often operate at the margins of acceptable performance, and flexibility with regulation and standards is often required in complex sociotechnical work like care transitions. Priority needs to be given to creating conditions where nurses and other healthcare providers are free to creatively engage and respond in ways that will optimize safe care transitions. Deborah Tregunno Copyright © 2013 Deborah Tregunno. All rights reserved. Self-Care and Chronic Disease Mon, 18 Nov 2013 17:26:31 +0000 Victoria Vaughan Dickson, Robyn A. Clark, Eneida Rejane Rabelo-Silva, and Harleah G. Buck Copyright © 2013 Victoria Vaughan Dickson et al. All rights reserved. Public Health Nursing in the 21st Century: Challenges and Opportunities for Women and Children’s Health Sun, 03 Nov 2013 16:14:42 +0000 Sue Peckover, Sophie Mogotlane, Kari Glavin, and Megan Aston Copyright © 2013 Sue Peckover et al. All rights reserved. Attitudes toward Genetic Testing for Hypertension among African American Women and Girls Sat, 02 Nov 2013 10:39:42 +0000 Introduction. Although African American (AA) women have the highest prevalence of hypertension and many genetic studies have been conducted to examine this disparity, no published studies have investigated their attitudes toward genetic testing for hypertension. The purpose of the present study was to use the health belief model as a guide to examine attitudes toward perceived barriers and benefits of genetic testing held by AA multigenerational triads and to determine whether they differed by generation, age, education, or income level. Methods. A descriptive correlational research design were used with 183 African American women and girls from Detroit. Correlations between triad membership, age, income, and education level were examined for association with attitudes toward genetic testing. Results. Increasing age and education were associated with significant differences in attitudes regarding benefits (, , ) and awareness (, , ). No statistically significant differences existed on the three subscales when compared by income levels or triad membership. Conclusions. This highlights the need for increased outreach to younger generations regarding benefits of genetic services. Further research is necessary to determine whether rural and male populations have similar beliefs. Jacquelyn Y. Taylor, Bronwen Peternell, and Jennifer A. Smith Copyright © 2013 Jacquelyn Y. Taylor et al. All rights reserved. Risk Perception and Risk Communication for Training Women Apprentice Welders: A Challenge for Public Health Nursing Wed, 30 Oct 2013 15:47:42 +0000 This research has aimed to identify the perceptions of women apprentice welders about physical, chemical, biological, and physiological risk factors to which they are exposed and evaluate the identification of health disorders self-reported for women apprentice welders before and after implementation of a nursing socioenvironmental intervention. A quantitative study was performed with 27 women apprentice welders (first phase) and before and after an intervention with 18 women (second phase) in Southern Brazil in 2011. The data were analysed using SPSS 19.0. The participants identified the following risk types: physical (96.2%), chemical (96.2%), physiological (88.8%), and biological (62.9%). The results show a significant difference of the pre- and posttest averages for the musculoskeletal system and a posttest average increase for the integumentary, respiratory, and auditory system. A correlation of the women apprentices’ ages and the identification of health disorders were made. It was understood that the perception of women apprentices regarding a particular set of occupational risks is essential for public health nursing to develop an effective risk communication as a positive tool for teaching and learning. Clarice Alves Bonow, Marta Regina Cezar-Vaz, Marlise Capa Verde de Almeida, Laurelize Pereira Rocha, Anelise Miritz Borges, Diéssica Roggia Piexak, and Joana Cezar Vaz Copyright © 2013 Clarice Alves Bonow et al. All rights reserved.