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Today in the U.S. there are more female military veterans than ever before. Female veterans report worse overall health than male veterans. Given the unique complexities of veteran healthcare issues, face-to-face experiences using simulated environments where students interact with veterans can support learning about the unique needs of veterans. The National League for Nursing Advancing Care Excellence for Veterans (ACE.V) has developed a series of case studies that can be used to train nursing students about veteran healthcare. This is a program evaluation that used qualitative analysis of students’ written responses to evaluate the effectiveness of a simulated opportunity. The simulated ACE.V case focused on Jenny Brown, a veteran of the Iraq conflict diagnosed with posttraumatic stress disorder, now pregnant. A presentation by a veteran prior to the simulation enhanced the training. Three themes emerged following the training with the debriefing: (a) increased knowledge and confidence, (b) empathy for veterans, and (c) appreciation for the complexities of veteran care. We successfully used one ACE.V case scenario enhanced with a veteran speaker to introduce veteran healthcare to nursing students.

Objective: Completion of human papil­lomavirus (HPV) vaccine series among Texas Hispanic adolescents is low compared to national data. We examined the associa­tion between HPV vaccine initiation and completion among Hispanic adolescents in a rural, Texas-Mexico border county and specific individual and neighborhood-level characteristics.Design: Cross-sectional analysis of data from a broader cancer prevention program.Setting: Underserved colonias communities in a Texas-Mexico border county.Participants: Hispanic mothers or caregiv­ers (n=712) and adolescents aged 11-17 years (n=1120) linked to publicly available data about their neighborhood.Methods: Logit and multi-level mixed-effects logistic regression of individual- and neighborhood-level data.Main Outcome Measures: HPV vaccine adherence (ie, initiation and completion) as reported in either the Texas Immunization Registry or adolescents’ electronic medical records, measured at the end of the cancer prevention program.Results: Factors associated with HPV vac­cine initiation and completion were female gender (P

Background Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning the distinctive challenges cancer caregivers face amid COVID-19. Additionally, this paper will present practical insights into the diverse intervention approaches that can assist in the delivery of digital health solutions for cancer caregivers amid and beyond COVID-19.Methods A systematic review of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus in September, 2020. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy was developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process.Results NA—This is a protocol study.Conclusions COVID-19 has uprooted cancer care as we know it. Due to barriers introduced by the COVID-19 pandemic, such as medical resources rationing, cancer caregivers often have to step up to address patients' healthcare needs and wants. This, in turn, will exert substantial stress on informal caregivers, above and beyond COVID-19-related burdens the general public shoulders on a daily basis. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond.Study Protocol Registration: PROSPERO CRD42020196301

Chronic hepatitis C virus (HCV) increases the risk for hepatocellular carcinoma. Despite higher prevalence of HCV in persons born 1945–1965 (baby boomer), screening has not been widely adopted. Both primary care providers (PCPs) and associate care providers (ACPs) need to be educated about the rationale and methods to screen for HCV. In five Federally Qualified Health Centers serving low-income Hispanic communities, PCPs and ACPs attended a 50-min training lecture about HCV epidemiology, screening methods, and evaluation. Using a 12-item questionnaire, knowledge and attitudes were compared for PCPs and ACPs at baseline (pre-test) and following training (post-test). A higher proportion of PCPs correctly answered 3 of 6 knowledge questions on both pre-test and post-test but ACPs’ showed more improvement in knowledge (all P

Background South Texas Latinas experience higher cervical cancer incidence and mortality compared to Latinas nationwide. Despite the availability of effective human papillomavirus vaccines, South Texas Latino/a adolescents sub-optimally complete the series. Research shows provider recommendation strongly predicts vaccine uptake, but minority adolescents are less likely to report that their provider recommended the vaccine and series completion. There is also scant information on the HPV vaccine administration process in clinic practices providing vaccination services to Latino adolescents with limited access to healthcare resources. The purpose of the study was to describe providers’ experience with administering the HPV vaccine to Latino/a patients in their practices. Methods The study used qualitative description to describe the experience of 15 South Texas healthcare providers (doctors and nurses) with the process of HPV vaccine administration in their practices. We conducted open ended, audio-recorded interviews, which were subsequently transcribed verbatim and uploaded into Atlas.(ti) 7.0 for analysis. The interviews yielded detailed descriptions of barriers and facilitators that could potentially impact HPV vaccine uptake. Results Providers identified parental exposure to provider recommendation as enhancing HPV acceptance and existing policies and implementation of evidence-based practices as facilitators of HPV vaccine uptake. Barriers ranged from parental fears of adolescent sexual activity and potential vaccine side effects to lack of transportation and the cost of the vaccine. Conclusion These findings reflect barriers and facilitators to administering the HPV vaccine previously identified and also highlight issues unique to the situation among Latinos in South Texas. Implications include the need to design and implement efforts to improve provider-parent communication and enhance parental and adolescent patients’ understanding of and confidence in the HPV vaccine. Furthermore, policy changes are needed to rectify organizational/structural challenges to HPV vaccine administration.

Background With patients becoming more complex and presenting with multiple comorbid diagnoses, exposing students to multidimensional care situations in a controlled, simulated environment is one way to better prepare nursing students to enter clinical practice. The National League for Nursing Advancing Care Excellence for Veterans (ACE.V) developed an unfolding case study of a pregnant veteran with posttraumatic stress disorder to train nursing students in a simulation laboratory. Method This is a descriptive evaluation of safety, communication, assessment, and educational intervention skills of 253 undergraduate nursing students undergoing training using the ACE.V in three simulated environments: in a short-stay mental health care unit, at home, and in an obstetrical unit. Results Across the four skill sets, students were most likely to achieve the communication skills. Students' skills improved as the case evolved through the three time-sequenced care environments. Conclusion The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care.

Purpose Type 2 diabetes mellitus (T2DM) is an urgent public health problem and disproportionately affects Mexican Americans. The gut microbiome contributes to the pathophysiology of diabetes; however, no studies have examined this association in Mexican-Americans. The objective of this study was to compare gut microbiome composition between Mexican-Americans with and without T2DM. Methods This was a cross-sectional study of volunteers from San Antonio, TX. Subjects were 18 years or older and self-identified as Mexican American. Subjects were grouped by prior T2DM diagnosis. Eligible subjects attended a clinic visit to provide demographic and medical information. Thereafter, subjects recorded their dietary intake for three days and collected a stool sample on the fourth day. Stool 16s rRNA sequences were classified into operational taxonomic units (OTUs) via the mothur bayesian classifier and referenced to the Greengenes database. Shannon diversity and bacterial taxa relative abundance were compared between groups using the Wilcoxon rank sum test. Beta diversity was estimated using Bray-Curtis indices and compared between groups using PERMANOVA. Results Thirty-seven subjects were included, 14 (38%) with diabetes and 23 (62%) without diabetes. Groups were well-matched by body mass index and comorbid conditions. Shannon diversity was not significantly different between those with and without T2DM (3.26 vs. 3.31; p = 0.341). Beta diversity was not significantly associated with T2DM diagnosis (p = 0.201). The relative abundance of the most common bacterial phyla and families did not significantly differ between groups; however, 16 OTUs were significantly different between groups. Conclusions Although alpha diversity was not significantly different between diabetic and non-diabetic Mexican Americans, the abundance of certain bacterial taxa were significantly different between groups.

BACKGROUND Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. OBJECTIVE This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. METHODS The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. RESULTS The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. CONCLUSIONS This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively.

Chronic hepatitis C virus (HCV) increases the risk for hepatocellular carcinoma. Despite higher prevalence of HCV in persons born 1945-1965 (baby boomer), screening has not been widely adopted. Both primary care providers (PCPs) and associate care providers (ACPs) need to be educated about the rationale and methods to screen for HCV. In five Federally Qualified Health Centers serving low-income Hispanic communities, PCPs and ACPs attended a 50-min training lecture about HCV epidemiology, screening methods, and evaluation. Using a 12-item questionnaire, knowledge and attitudes were compared for PCPs and ACPs at baseline (pre-test) and following training (post-test). A higher proportion of PCPs correctly answered 3 of 6 knowledge questions on both pre-test and post-test but ACPs' showed more improvement in knowledge (all P 0.05). ACPs had more favorable attitudes about linking patients to care on pre- and post-tests than PCPs, and ACPs' attitudes improved on all 6 items versus 4 for PCPs. Both PCPs and ACPs improved knowledge and attitudes after training about HCV screening but ACPs had more favorable attitudes than PCPs. Engaging the entire primary care practice team in learning about HCV screening promotes knowledge and attitudes necessary for successful implementation.

Background Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively.

Aims and objectives The objective of this study was to identify support needs of low income baby boomers recently diagnosed with chronic hepatitis C virus infection. Background The United States Preventive Services Task Force has endorsed one-time screening of all baby boomers (born 1945 to 1965) for hepatitis C because 75% of the estimated 2 to 3 million persons with chronic infection are in this age range. We hypothesized that persons diagnosed by routine screening would have significant psycho-emotional, cognitive, and health care challenges that need to be met by collaborative care and services from nurses and other health care personnel. Design Qualitative descriptive study of data from three focus groups with predominantly minority participants (N=16). Data were analyzed using qualitative content analysis, transcribed data were categorized by 3 domains in a previously developed model and a new domain identified in this study. Frequencies of unique participants’ comments about each theme were calculated. Results Elucidated domains were: 1) psycho-emotional effects due to social stigma, shame, fear, dealing with risky behaviors; 2) social effects due to concerns about infecting others; and 3) cognitive deficits because of poor understanding about HCV infection and its care. A new domain related to health care emerged reflecting the following themes: poor access to care, barriers to costly treatment, and navigating complex care for comorbidities. Despite these challenges, participants strongly endorsed universal baby boomer hepatitis C virus screening. Conclusion This study describes psycho-emotional and social challenges of people dealing with a hepatitis C diagnosis that are compounded by poor knowledge and barriers to supportive care. Relevance to clinical practice Nursing and other allied health personnel require structured support programs to assist older persons diagnosed with hepatitis C with addressing these common challenges with the ultimate goal of achieving a cure. This article is protected by copyright. All rights reserved.

Background: Health literacy is a requisite skill for making personal health and health care decisions. Low health literacy may contribute to lower cervical cancer screening rates and cervical cancer health disparities among Mexican-American women in South Texas. Objective: To explore older Mexican-American women's health literacy related to cervical cancer from the perspective of Zarcadoolas, Pleaseant, and Greer's health literacy model. Methods: We conducted five focus groups and seven individual interviews with 30 Mexican and Mexican-American women in South Texas. We analyzed demographic data using descriptive statistics and conducted thematic analysis of focus group and individual interview data. Key Results: Several themes reflected the domains of health literacy, including fundamental literacy (“speaking of language”), science literacy (cancer prevention), cultural literacy (“we are different”), civic literacy (the availability of “consejos” [advice]), and media literacy (e.g., “telenovelas” [soap-operas] teach a lot). In this article, we present findings related to culture and language under the domains of fundamental and cultural literacy. Conclusions: Mexican-American women's cultural values and language use may serve as both deterrents and incentives to cervical cancer screening. The meaning of words can be lost in translations. Health care providers can use this information to provide cervical cancer screening education congruent with Mexican-American's culture, language, and code switching. [ HLRP: Health Literacy Research and Practice . 2019;3(1):e1–e8.] Plain Language Summary: The understanding of culture and language can help health care providers improve cervical cancer screening practices among Mexican-American women. The results from this study can be used to individualize patient care and to develop education and communication strategies that are similar to the population we serve, including Mexican-American women.

Cancer screening reduces mortality rates for breast, cervical, and colon cancer. Yet cancer screening rates for Latina women are lower than for non-Latino Whites, and below Healthy People 2020 goals. Additionally, Latinos face many health care access barriers. This study examined health care access and utilization in relation to cancer screening among low-income Latina women recruited from a high-risk area and enrolled in a navigation-plus-education intervention.Latina women considered rarely or never screened for breast, cervical, or colorectal cancer were recruited from community-based organizations and events (N = 691). We gathered self-reported survey data on insurance status, usual source of care, health care utilization, and cancer screening behavior. We conducted multivariable logistic regression models to estimate odds ratios of receipt of at least one cancer screening test.Overall, 28% of women received at least one cancer screening test. Results indicated that women without insurance (odds ratio [OR] = 2.08; confidence interval [CI] = 1.09, 3.98) and without a doctor's visit in the past year (OR = 2.02; CI = 1.28, 3.18), compared with their counterparts, had greater odds of receiving at least one screening test.Findings highlight the continued need to explore ways to support uninsured individuals' screening efforts and further investigate barriers among insured women who are not up-to-date with screenings.

The United States is becoming older and increasingly diverse in cultures, languages and socioeconomic standing. However, providing culturally and linguistically adequate health promotion programs for ethnically diverse older adults remains a challenge. Research investigating the relationships between ethnicity, socioeconomic status and disease has been limited. This clinical demonstration project explored the relationship between falls and ethnicity and socioeconomic status in a group of community dwelling older adults in San Antonio, TX, using a culturally and linguistically adapted clinical video novela on fall prevention. The video, available in English and Spanish, was designed using quality indicators from the Assessing Care for Vulnerable Older Elders (ACOVE) criteria. Data were collected using pre and post surveys asking general demographic information, fall risk factors, general knowledge of falls and satisfaction with video. Zip codes were used as a proxy for socioeconomic status. Data were managed with REDCap and analyzed using the SAS V9.4 statistical software. 172 individuals attending different senior community centers and one clinic screened the video. 45.2% self-identified as Hispanic. 31 watched the video in Spanish. Significant relationships were found between mean household income and fear of falling (chi2=11.92, df=3, p

Around 7 million grandparents in the U.S live with grandchildren under 18 and 39% have primary caregiving responsibilities. In Texas, more than 313,499 children under age 18 live with a grandparent who is responsible for them. Hispanic grandparents are disproportionately more likely to care for grandchildren compared to non-Hispanic whites. In San Antonio, Texas, 36.6 % of grandparents are the primary caregivers for their grandchildren. Parental substance abuse disorders have been identified as one of the causes prompting child removal from parental custody. To understand the experience of custodial Hispanic grandmothers raising their grandchildren, three focus groups were conducted in English and Spanish by three bilingual investigators. Twenty-three grandmothers, mean age 60, caring for an average of 3.2 children, 2 months to 17 years of age participated in the focus groups. The narratives were transcribed and analyzed in the source language. The following overarching themes were identified: Family is family, parenting all over again, this is a struggle but a blessing, what did I do wrong? , fear of losing the children to foster care, I do not trust anybody with my children, financial and legal challenges, role captivity, aging as a limitation, and hope for the future. The findings from the study contribute to the body of knowledge necessary to foster urgent policy changes aimed at supporting these grandparents who feel unjustly treated by human services agencies and the legal system. Programs to support custodial Hispanic grandmothers need to be linguistically congruent and culturally competent.

The number of Latino older adults living with Alzheimer’s disease and related dementias (ADRD) could increase more than six-fold, from fewer than 200,000 in 2004 to more than 1.3 million by 2050 . One-third of Hispanic households report having at least one family caregiver (36%). 63% of Latino family caregivers are in high burden situations compared to 51% of non-Latino caregivers. Although in recent years research with Latino caregivers has increased, studies examining the family as a unit in a culture in which familismo is a central value, remain limited. The purpose of this study was to describe the experience of Latino families caring for loved ones living with ADRD along the illness trajectory. Group interviews were conducted with families caring for individuals in different stages of dementia. Interviews were conducted in English or Spanish, transcribed verbatim, and analyzed in the source language by bilingual investigators. In contrast to the numerous positive aspects of caregiving reported by individual Latino caregivers in previous studies, preliminary analysis of family group interviews revealed predominantly negative perceptions of the family caregiving experience. Families reported conflict between family members, feelings of resentment, lack of family member involvement, and uneven distribution of caregiving duties. The complex nature of fulfilling family duties as dictated by familismo appears to have idealistic and realistic consequences for families. Further exploration of Latino family dynamics in the context of dementia caregiving is needed.

Approximately 90 million people in the United States lack basic literacy skills, which affect health behaviors. Cervical cancer is preventable and treatable, yet few older Hispanic women seek screening and continue to be a high-risk group for cervical cancer. A literature review was conducted to address the relationship between cervical cancer screening, health literacy, and older Hispanic women. Eighty studies were reviewed, and nine addressed health literacy and Hispanic women. One study addressed the association between functional health literacy and Pap smear screening among older Hispanic women. Few studies have explored the association between preventive cervical cancer screening and health literacy among older Hispanic women. Nurses must assess health literacy and be prepared to provide care, which is culturally, and linguistically appropriate to improve health outcomes. Further research is needed to be inclusive of all populations including older Hispanic women.

Hispanic older adults assuming caregiving roles continue to increase in unprecedented numbers. Development of programs to assist these caregivers to manage their stress and the demands placed on them has also increased. However, the vast majority of these programs are developed focusing more on the specific needs and characteristics of the care-recipients than on caregiver commonalities determined by cultural values. At the core of Hispanic culture are: Familismo, collectivism, personalismo, marianismo, and respeto. We aimed to compare the experience of older Hispanic family caregivers of relatives living with Alzheimer’s disease or related dementias (ADRD), and Hispanic grandparents caring for their grandchildren as a result of parental substance abuse disorders. We conducted a content analysis of qualitative ethnographic interviews of these two populations of caregivers. While the realities of daily caregiving duties were of different nature (dementia vs. childrearing), regardless of care-recipient, caregivers provided narratives supporting the themes: duty to family first, sense of satisfaction, willingly sacrificing, sense of purpose, physically exhausting, emotionally draining, financially straining, role challenges, role captivity, legal stressors, fear, and major stressor. More commonalities than differences were found. Caregivers differed in the root cause of fear (institutionalization vs. children placement in foster care), and the major stressor in their lives. For grandparents the stressor was the perceived or actual continued parental substance abuse. In addition to culturally congruent evidence-based programs to assist Hispanic caregivers to manage their levels of stress, urgent policy changes are needed to support Hispanic family caregivers regardless of age /type of care-recipient.