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Intimate partner violence (IPV) may be a more common problem than some conditions for which pregnant women are routinely screened and evaluated. Screening for IPV necessitates competence in assessment using reliable and valid instruments. The present study examines the concordance in the prevalence of abuse reported by 436 high-risk postpartum mothers using (1) a single item hospital screen, (2) trained paraprofessional interviewer-interview format, and (3) the Conflict Tactics Scale (CTS), a standardized research instrument. The hospital screen identified 4% of the sample as scared, threatened or hurt, the Family Stress Checklist (FSC) identified 16.9% of the fathers as having severe potential for violence, and the CTS identified 18.6% of the sample as victims of physical abuse at the hands of the baby's father. There was minimal overlap between the ratings of severe potential for violence and the occurrence of violence as assessed by the CTS. Study findings illustrate the inadequacy of current procedures for detecting IPV with high-risk populations and highlight the need to develop reliable and valid assessments that can be easily utilized in the hospital setting. [ABSTRACT FROM AUTHOR]

The concepts of hope, self-esteem, and social support have been identified as important factors in understanding a wide range of adolescent behaviors. The purpose of this exploratory study was to examine the relationship of perceived hopefulness, self-esteem, and social support with pregnancy status. Employing a cross-sectional design, a sample of pregnant (n = 58) and nonpregnant (n = 91) adolescents between the ages of 14 and 18 completed the Hopefulness Scale for Adolescents (HSA), the Rosenberg Self-Esteem Scale (RSES), and the Norbeck Social Support Questionnaire (NSSQ). Multiple regression analyses were used to assess the association of pregnancy status with hopefulness, self-esteem, and social support while controlling for age and socioeconomic status (SES). The effects of pregnancy status on each psychosocial variable were examined independently. Findings revealed pregnancy status was not associated with hopefulness, self-esteem, or perceived social support when age and SES were controlled. [ABSTRACT FROM AUTHOR]

Background: Government programs-targeting chronic disease patients with high health care costs-focus on clinical conditions, factors internal to the health care system, and individual patient education, not on addressing modifiable social determinants of health to reduce health care utilization., Objective: To evaluate differences in sociodemographic variables and health care utilization between patients with chronic obstructive pulmonary disease (COPD) who reported food insecurity and those who did not., Methods: This descriptive retrospective cross-sectional study used data from the electronic health records of a convenience sample of 854 participants with a discharge diagnosis of COPD or COPD with acute exacerbation, admitted via the emergency department of participating hospitals in Southern California. Chi-square (or Fisher's exact) tests and t tests were used to evaluate group differences, and multivariate (or Firth) logistic regression to identify factors that increased the odds of emergency department visits and hospitalizations., Results: Significant differences between groups were identified for food insecurity (sometimes or often vs never insecure) and age ( P  < .001), race ( P  = .022), medical insurance ( P  < .001), zip code ( P  = .022), homeless status ( P  < .001), smoking status ( P  < .001), and emergency department visits ( P  = .033). No significant differences were found for food insecurity and hospitalizations ( P  = .592)., Conclusion: This study contributes to the growing body of research supporting the association of upstream social factors (food insecurity, homelessness, zip code) and downstream health outcomes (repeated emergency room visits), and how existing programs can be effectively utilized to impact downstream health outcomes such as health care utilization., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Nurses and respiratory therapists working on the frontline during the pandemic surge were short-staffed and worked extended hours while adding new tasks to already demanding workloads. As the world watched news covering COVID-19's effect, nurses and respiratory therapists lived through the daily stress of treating each patient with care, dignity, and compassion. Limited studies have focused on this population, which is vital to providing care and saving lives; research is needed to understand nurses' and respiratory therapists' experiences during the COVID-19 pandemic., Objective: The study aimed to understand nurses' and respiratory therapists' experiences during the COVID-19 pandemic., Methods: A qualitative descriptive study, informed by naturalistic philosophy, was designed to obtain a detailed account of participants' experiences during the pandemic surge. A purposive sample was recruited and enrolled from the community through professional organizations and snowball sampling from December 2021 to September 2022. Data was analyzed using thematic analysis., Results: Participants were seven registered nurses and six respiratory therapists employed full-time in an intensive care unit, step-down intensive care unit, emergency department, or medical-surgical unit; seven (53.8%) with an associate degree, and six (46.2%) with a bachelor's degree. Eight (66.7%) self-identified as White, one Asian, one non-Hispanic Black, and two Pacific Islanders. The mean age was 40, and 10 (76.9%) were female. Six primary themes emerged: (a) the work-life experience before the COVID-19 pandemic, (b) the work-life experience during the COVID-19 pandemic, (c) the personal life experience during COVID-19, (d) the coping period, (e) the professional role change, and (f) the work and personal life experiences post COVID-19 surge., Conclusion: The knowledge gained from this study can help improve understanding of the professional quality of life, the need for organizational and community support, and for healthcare professionals to seek help and practice self-care to prevent burnout and secondary traumatic stress., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Falls are the most prevalent adverse event among hospitalized patients. Multilevel risk factors are associated with falls, yet falls continue., Purpose: To evaluate the relationship between the Johns Hopkins Fall Risk instrument, patient characteristics, and perception of fall risk., Methods: The Johns Hopkins Fall Risk score, patient perception of fall risk, and patient characteristics were analyzed among inpatient adults (n = 201) from 5 acute care units in a large southern California medical center., Results: Bivariate analyses revealed that fall risk was inversely associated with participants' confidence in their ability to perform high fall risk behaviors without help and without falling ( P = .018)., Conclusions: Perception of fall risk is a promising new indicator in preventing falls. Patient perception of fall risk may elicit a behavior change to help prevent falls. Increased health care provider awareness of patient perception of fall risk may improve fall risk interventions and prevention programs., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

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

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ 2 (3, N  = 2483) = 20.21, P  < .001, Cramer's V  = .09), hospice diagnosis (χ 2 (5, N  = 3481) = 22.66, P  < .001, Cramer's V  = .08), pain severity (χ 2 (1, N  = 3464) = 19.75, P  < .001, Cramer's V  = .08), and age ( t (393.17) = 2.84, P  = .005, d  = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ 2 (11)  =  45.25, P  < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P  = .02), were single (OR = 1.6, P  = .02), and had moderate to severe pain (OR = 1.4, P  = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

Objective: To examine the relationships among depression and anxiety symptomatology, stigma of mental illness, levels of social support, and select demographics among hospitalized women in the postpartum period., Design: Descriptive, cross-sectional, correlational., Setting: A convenience sample of 105 English-speaking and Spanish-speaking women was recruited and enrolled from a 208-bed free-standing Southern California women's community hospital postpartum unit serving a diverse community., Measurements: Data were collected on potential covariates including participants' characteristics, depression and anxiety symptomatology, social support, and stigma., Results: Sixteen participants were classified as high risk for depression or anxiety based on the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7. Anxiety was significantly associated with all stigma subscales; the strongest association was with Internal Stigma (r = .46, p < .001, moderate effect), followed by Disclosure Stigma (r = .36, p < .001, moderate effect) and External Stigma (r = .30, p = .002, moderate effect). All social support subscales were negatively associated with depression and anxiety; the Friends subscale had the strongest correlations with depression (r = -.27, p = .006, small effect) and anxiety (r = .34, p = .001, moderate effect). Firth (penalized likelihood) logistic regression analysis was conducted to ascertain the effects of study covariates on the likelihood of participants being at risk for postnatal depression or anxiety. The significant factor that increased the odds of participants being in the high-risk group was decreased social support (adjusted OR = 0.46, 95% CI [0.24, 0.76], p = .003)., Conclusion: These results show the enduring prevalence of postnatal depression and anxiety and the relevance of stigma and social support in aggravating or mitigating symptomatology. There is a need for comprehensive standardized screening to ensure the identification of and referral to treatment for women at risk., Competing Interests: Author Disclosures The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2022. Published by Elsevier Inc.)

Background: The maternal and neonatal consequences of not receiving treatment for opioid use disorders (OUDs) is well known. To prevent adverse outcomes and provide appropriate treatment and services, it is imperative to understand factors influencing pregnant women with OUDs to seek treatment., Objectives: The purpose of this study is to identify barriers and facilitators related to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids., Method: Retrospective analysis of data from the National Survey on Drug Use and Health (NSDUH), using 2016, 2017, and 2018 NSDUH data. Sample included 122 pregnant and 3,305 nonpregnant women who misused opioids., Results: Significant associations were noted among women who misused opioids ( n = 3,427); age (χ 2 = 25.406, p < .001), race/ethnicity (likelihood ratio [LR] = 17.721, p < .007), geographic location (χ 2 = 7.585, p < .023), health insurance (LR = 13.909, p < .016), tobacco use within the past year (χ 2 = 7.058, p = .008), and alcohol use within the past month (χ 2 = 76.783, p < 0.001), 3.3% pregnant and 1.8% nonpregnant women who misuse opioids perceive a need to obtain treatment; 10.7% pregnant and 6.5% nonpregnant women currently receiving treatment for opioid misuse. The Strengthening the Reporting of Observational studies in Epidemiology checklist was used to develop the study., Conclusions: It is our responsibility to equally focus efforts on understanding the construct of perceived need and help seeking behaviors among pregnant women, as well as, deploy known techniques to engage them in recovery. Further research is necessary to explore the construct of perceived need in this population, as well as, strategies to increase engagement.

Objectives: There is extensive literature from various disciplines on self-care , an important aspect of nursing intervention via evaluation and education, but its meaning remains unprecise due to the difficulty integrating the diverse definitions developed over time across disciplines. Therefore, it is vital to clarify the meaning of self-care and formulate the defining attributes, antecedents, and consequences to self-care., Methods: Walker and Avant's concept analysis approach was used to analyze the concept of self-care. A search of the literature was completed using the databases CINAHL, PubMed, and EBSCOhost for years 1975-2020; literature search included peer-review articles, full-text publications, and available in English. A total of 31 articles were reviewed, and saturation was reached., Results: An extensive review of the literature revealed salient characteristics that reflected the most frequently used terms associated with the concept. Guided by Walker and Avant's method, three defining attributes emerged as common themes: awareness, self-control, and self-reliance., Conclusions: A clarified definition was identified: the ability to care for oneself through awareness, self-control, and self-reliance in order to achieve, maintain, or promote optimal health and well-being., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The authors.)

Purpose: Increasing patient activation facilitates self-management of health, improves health outcomes, and lowers health care expenditures. Extant research notes mixed findings in patient activation by race/ethnicity. The purpose of the study was to examine the relationships among patient activation, select patient characteristics, and glycemic control among Filipino Americans. Methods: A cross-sectional study was conducted with a convenience sample of Filipino Americans ( n =191), with a diagnosis of diabetes mellitus type 1 or type 2, recruited from a southern California adult primary care clinic between December 2017 and March 2018. Patient activation, select characteristics, and hemoglobin A1c (HbA1c) levels were assessed. Bivariate and logistic regression analyses were used to identify correlates of glycemic control. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist was used to develop the study. Results: Participants with HgbA 1 C≤7.0% reported statistically higher patient activation measure (13 items) (PAM-13) natural log score (mean [ M ]=60.32, standard deviation [SD]=13.50) compared to those with an HgbA 1 C>7.0%, M =52.58, SD=10.19, F (1)=11.05, p <0.001. Multivariate logistic regression using age, low-density lipoprotein, and PAM-13 natural log was statistically reliable distinguishing between A 1 C≤7.0 and A 1 C>7.0, -2 LogLikehood=1183.23, χ 2 (3)=15.44, p <0.001. Conclusions: Patient activation is an important factor in supporting glycemic control. Findings support interventions to target patient activation. Providers are encouraged to use racial/ethnic-centered engagement strategies in resolving health disparity with racial and ethnic minorities to facilitate patient activation and improve health outcomes in patients with diabetes., Competing Interests: No competing financial interests exist., (© Razel B. Milo et al., 2021; Published by Mary Ann Liebert, Inc.)

Emerging adults have been raised in the digital age and are therefore prime candidates for using a patient portal to manage chronic conditions. The limited body of research both identifies the underutilization of the patient portal and suggests increased use of the portal for the chronically ill as a tool to alleviate caregiver stress, as well as a potential modality to assist emerging adults to manage their chronic illnesses. This qualitative study was completed to obtain an understanding of emerging adults familiarity with the electronic patient portal and to elicit the perception of the usefulness of the portal to support self-management of type I diabetes. Findings provide a preliminary understanding of how a sampling of emerging adults with type I diabetes uses, perceives the benefits of, and wants to improve technology for diabetes self-management.

Purpose: The purpose of this study was to examine potential gender disparities in relation to factors associated with sepsis management among a cohort of patients admitted through an emergency department with a discharge diagnosis of severe sepsis or septic shock. Sepsis is one of the leading causes of death globally, with significant associated costs. Predictors of survival for those with sepsis-related diagnoses are complex., Design and Methods: The study had a retrospective, descriptive cross-sectional design. The sample (N = 482) included patients 18 years of age or older who presented to the emergency department of a nonprofit, Magnet-recognized, acute care hospital located in southern California. Subjects included those who subsequently met the criteria for a discharge diagnosis of severe sepsis or septic shock as defined by the Surviving Sepsis Campaign. Patient characteristics, clinical variables, care management processes, and outcomes were extracted from the electronic health record. A multivariate model was analyzed., Findings: The sample included 234 women (48.5%) and 248 men (51.5%). Logistic regression with eight independent variables (discharge diagnosis, age, comorbidities, length of hospital stay, source of infection, first serum lactate level measured, recommended fluids administered, and gender) reliably predicted odds for patient survival, ϰ 2 (12) = 118.38, p < .001, and correctly classified 77.3% of cases. All eight independent variables significantly contributed to the model. Men had a higher likelihood of hospital survival than women (odds ratio 1.68; 95% confidence interval 1.01-2.79; p = .045)., Conclusions: The Surviving Sepsis Campaign has provided a clear pathway for care of patients with sepsis-related diagnoses. Therapeutic strategies should be developed to address differences in outcome by gender. The adoption of more aggressive applications of evidence-based interventions for these patients may result in better patient outcomes., Clinical Relevance: Providers should understand the importance of adhering to sepsis protocols, minimizing treatment disparities, and recognizing gender differences., (© 2019 Sigma Theta Tau International.)

Aims and Objectives: To identify correlates of glycemic control among people with type 2 diabetes mellitus., Background: Approximately 28.8 million adults have type 2 diabetes mellitus in the United States with $245 billion spent on disability and lost productivity. The importance of self-management activities in type 2 diabetes mellitus treatment is well recognised. Extant studies have explored self-management activities of individuals with type 2 diabetes mellitus with mixed findings. Continued attention is warranted to identify predictors of glycemic control., Design: A cross-sectional study., Methods: A convenience sample, aged 18 and 75 years with a diagnosis of type 2 diabetes mellitus, was recruited and enrolled from three southern California community-based organisations between June-December 2016. Perceived self-efficacy, diabetes knowledge, self-management activities, select demographics, chronic conditions and HbA1C levels were assessed. Bivariate and multiple regression analyses were use to identify correlates of glycemic control. The STROBE checklist for cross-sectional studies was used to develop this study., Results: The total number of participants included in analyses was 100. Sixty-nine per cent had HbA1C ≥7%; average number of years with type 2 diabetes mellitus was 8.6 (SD = 6.52); 57% were female; and 54% had a high school or greater education. The multiple regression model significantly predicted 20% of the variance in HbA1C levels, F(6, 93) = 4.91, p < 0.001, adj. R 2   = 0.192. Level of education, β = 0.36, p = 0.001, and years with type 2 diabetes mellitus, β = 0.28, p = 0.004, significantly contributed to the model., Conclusions: Lower level of education and longer duration with diabetes were associated with poor glycemic control. Study outcomes support interventions are needed to target the ongoing educational needs of individuals with type 2 diabetes mellitus., Relevance to Clinical Practice: Nurses are encouraged to increase their awareness of the impact of level of education and diabetes duration when providing individualised care to individual's with type 2 diabetes mellitus., (© 2019 John Wiley & Sons Ltd.)

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

Objectives: Globally, healthcare systems are using the Electronic Health Record (EHR) and elements of clinical decision support (CDS) to facilitate palliative care (PC). Examination of published results is needed to determine if the EHR is successfully supporting the multidisciplinary nature and complexity of PC by identifying applications, methodology, outcomes, and barriers of active incorporation of the EHR in PC clinical workflow., Methods: A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999 - 2017 of human subject peer-reviewed articles in English containing original research about the EHR and PC., Results: The search returned 433 articles, 30 of which met inclusion criteria. Most studies were feasibility studies or retrospective cohort analyses; one study incorporated prospective longitudinal mixed methods. Twenty-three of 30 (77%) were published after 2014. The review identified five major areas in which the EHR is used to support PC. Studies focused on CDS to: identify individuals who could benefit from PC; electronic advanced care planning (ACP) documentation; patient-reported outcome measures (PROMs) such as rapid, real-time pain feedback; to augment EHR PC data capture capabilities; ,and to enhance interdisciplinary communication and care., Discussion: Beginning in 2015, there was a proliferation of articles about PC and EHRs, suggesting increasing incorporation of and research about the EHR with PC. This review indicates the EHR is underutilized for PC CDS, facilitating PROMs, and capturing ACPs., Competing Interests: Conflict of interest statement. None declared.

Identification and referral of women with high-risk pregnancies to hospitals better equipped and staffed to provide care for them have been important steps to improve birth outcomes. Based on recent recommendations from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to provide regionalized maternal care for pregnant women at high risk and reduce rates of maternal morbidity and mortality, health care organizations and providers have refocused their attention to women's well-being rather than solely on the well-being of the fetus or newborn. Opportunities to improve practice and birth outcomes exist through the implementation of a more standardized and integrated system of risk-appropriate care., (Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess whether individuals attending a community clinic had the necessary Internet access and experience to use the patient portal, while examining covariates of education, income, and self-perception of health with past and anticipated portal use. Methods: Adults attending an urban, community primary care clinic were invited to participate in a brief survey assessing current Internet access and use, past portal use, and anticipated future portal use. Survey responses were analyzed using descriptive and multivariate statistics. Results: One hundred fifteen participants ranging in age from 18 to 84 years (mean 42.1, standard deviation 17.1) completed the survey; 6 (5%) in Spanish. Thirty-five (30%) self-identified as Latino; 12 (10%) as Asian; and 20 (17%) as other. Almost 80% reported their health as good or better. Although 38% reported some college and 47% reported being college graduates, 60% reported household incomes were <$50,000. Most (87%) used the Internet for >1 year. Fewer than half (42%) had past portal use, with significant differences associated with weekly Internet use (Fisher's exact=9.59; p =0.02) and smart phone access (Fisher's exact=6.15; p =0.02). Computer Internet access was significantly associated with income (Fisher's exact=16.91; p <0.001). Logistic regression identified that computer Internet access was a significant predictor (odds ratio 9.9 (95% confidence interval: 1.7-58.8) of future portal use, controlling for smart phone use, health status, gender, and age. Conclusions: Among this highly educated but lower economic sample, computer Internet access and smart phone access were associated with past portal use and anticipated future use., Competing Interests: No competing financial interests exist.

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

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

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

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

Aims and Objectives: To report an analysis of the concept of perinatal post-traumatic stress disorder., Background: Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs., Design: Concept analysis via Walker and Avant's approach., Methods: The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumatic stress disorder., Results: Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumatic stress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes., Conclusions: Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder., Relevance to Clinical Practice: Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes., (© 2017 John Wiley & Sons Ltd.)

Background: Little is known about the health care utilization patterns of individuals with pediatric autism spectrum disorder (ASD)., Objectives: Electronic health record (EHR) data provide an opportunity to study medical utilization and track outcomes among children with ASD.  Methods: Using a pediatric, tertiary, academic hospital's Epic EHR, search queries were built to identify individuals aged 2-18 with International Classification of Diseases, Ninth Revision (ICD-9) codes, 299.00, 299.10, and 299.80 in their records. Codes were entered in the EHR using four different workflows: (1) during an ambulatory visit, (2) abstracted by Health Information Management (HIM) for an encounter, (3) recorded on the patient problem list, or (4) added as a chief complaint during an Emergency Department visit. Once individuals were identified, demographics, scheduling, procedures, and prescribed medications were extracted for all patient-related encounters for the period October 2010 through September 2012., Results: There were 100,000 encounters for more than 4,800 unique individuals. Individuals were most frequently identified with an HIM abstracted code (82.6%) and least likely to be identified by a chief complaint (45.8%). Categorical frequency for reported race (2 = 816.5, p < 0.001); payor type (2 = 354.1, p < 0.001); encounter type (2 = 1497.0, p < 0.001); and department (2 = 3722.8, p < 0.001) differed by search query. Challenges encountered included, locating available discrete data elements and missing data., Conclusions: This study identifies challenges inherent in designing inclusive algorithms for identifying individuals with ASD and demonstrates the utility of employing multiple extractions to improve the completeness and quality of EHR data when conducting research.

Objective: To test the feasibility of a relaxation guided imagery (RGI) intervention for mothers of hospitalized preterm infants and to explore the biobehavioral effects of RGI on their distress, responsiveness, and physiological stress., Design: Single sample, pretest-posttest design., Setting: A large Level III NICU in Southern California., Participants: Twenty mothers of hospitalized preterm infants (24-32 weeks gestational age)., Methods: Correlational analyses of RGI use with self-reported measures of distress (perceived stress, state anxiety, and depression symptoms), awakening salivary cortisol level, and salivary cortisol awakening response collected from mothers at baseline and after 8 weeks of an RGI intervention., Results: Nineteen mothers completed the study. Average use of RGI varied from 1.7 to 7.4 times per week (mean = 4.46, standard deviation = 2.7). Greater average use of RGI was correlated with lower awakening cortisol levels (r = -.38), greater cortisol awakening response (r = .36), and lower levels of distress (perceived stress [r = -.38], anxiety [r = -.43], and depression [r = -.41])., Conclusion: Relaxation guided imagery may be a feasible and acceptable intervention to reduce mental and physiologic stress and improve responsiveness in mothers of hospitalized preterm infants., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

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

Purpose: Contributors to disparities in sepsis management have been attributed to genetic susceptibility, differences in clinical presentation, and healthcare delivery. The influence of gender on survival or mortality of patients with sepsis-related diagnoses is unclear. The purpose of the current study was to systematically review published research to identify factors and outcomes associated with sepsis management and outcomes based on gender differences., Methods: Covering a period from 2006 to 2016, a literature search was conducted on four electronic data bases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO, MedlinePlus, and PubMed. Content analysis of each article was performed independently by two authors. The guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was the method used to assess the quality of evidence of the articles in this review., Findings: A full review was completed on a total of 452 identified potentially relevant publications, and 7 publications met inclusion criteria. The methodological approaches included prospective and retrospective observational studies, and prospective and historical cohort studies. The aim of these studies was to identify if gender differences exist related to sepsis-related mortality, completion of Surviving Sepsis Campaign resuscitation bundle elements, sepsis-related care processes, and sepsis-related incidence and source., Conclusions: Clinical sepsis studies evaluating gender and sepsis-related management and mortality are inconclusive and complex. Three different outcomes exist: no difference, higher risk in females, or higher risk in males. Further studies are needed to support the presence of gender disparities on sepsis-related healthcare outcomes., Clinical Relevance: Providers should understand the importance of adhering to sepsis protocols and minimizing treatment disparities including gender differences., (© 2017 Sigma Theta Tau International.)

Background: Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes., Aims: The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge., Methods: The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge., Results: Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R 2 = 0.42, F [10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model., Linking Evidence to Action: The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content., (© 2017 Sigma Theta Tau International.)

Aims and Objectives: To report an analysis of the concept of maternal risk and explore implications for practice using Walker and Avant's eight step method analysis., Background: Although mortality during pregnancy is a relatively rare occurrence, serious maternal morbidities are increasingly present in today's pregnant population. Risk factors have been identified that increase the potential for morbidities and subsequent care modalities have been implemented to decrease this risk. However, despite the wide use of the term 'risk' in the medical and nursing literature, determining a common definition is difficult. Differences in the understanding of risk during pregnancy can hinder the ability to provide consistent and appropriate care., Design: Concept analysis., Methods: A search of the English literature was completed using the databases CINAHL, PubMed, Medline, and Google Scholar for years 2000-2014 using the keywords 'risk', 'maternal' and 'pregnancy'., Results: Three defining attributes of risk were identified: chance of injury/loss, cognitive recognition and the decision-making processes. The antecedent of risk is the ability to understand the situation and cognitive ability to think about the potential consequences and adverse outcomes. Consequences of risk include the actual action taken as a result of the decision-making process., Conclusion: This paper contributes to the understanding of risk allowing for the development of an individualised plan of care for each pregnant woman and empowering the nurse to advocate for appropriate care. Findings in this analysis assist nurses in bridging the gap in communication between the provider's and pregnant woman's interpretation of risk., Relevance to Clinical Practice: The analysis of risk resulted in the identification of differences in perceptions of risk that can potentially result in miscommunication between provider and pregnant woman and increase the risk of inadequate or incomplete care., (© 2016 John Wiley & Sons Ltd.)

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

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

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

Purpose: This study aims to examine adolescent level of knowledge concerning obesity risk., Design and Methods: Qualitative and quantitative data were collected using a staged process. Data collected with (a) Obesity Risk Knowledge Scale (ORK-10), (b) focus groups, (c) scientific advisory group input, and (d) the Adolescent Obesity Risk Knowledge Scale (AORK)., Results: The AORK is tailored from the ORK-10 (α = .53) to capture adolescents' knowledge of obesity complications and/or risks (α = .68)., Practice Implications: The AORK integrates questions for assisting practitioners to initiate discussions about obesity and lifestyle choices with adolescents and their families., (© 2015, Wiley Periodicals, Inc.)

The purpose of this study was to examine the feasibility and acceptability of an auricular acupuncture (AA) insomnia regimen among Operation Iraqi Freedom and Operation Enduring Freedom veterans with post-traumatic stress disorder and sleep disturbance. Secondarily, this study examined the effect of an AA insomnia regimen on objective sleep times by wrist actigraphy, subjective sleep times by sleep diary, and sleep quality ratings utilizing the Pittsburg Sleep Quality Index. Veterans (n = 30) were randomized to receive a 3-week AA insomnia regimen. Veterans receiving the AA insomnia regimen reported it as a more acceptable treatment for sleep disturbance than subjects in the control group (AA group median = 5 vs. control group median = 3, p = 0.004). Significant differences between groups were found on the sleep quality and daytime dysfunction components of the Pittsburgh Sleep Quality Index (p = 0.003, p = 0.004). No other significant differences between groups were found for objective and subjective sleep measures. These results suggest that an AA insomnia regimen may improve sleep quality and daytime dysfunction among veterans with post-traumatic stress disorder. Future, large-scale, prospective clinical trials are needed to examine AA effects on sleep., (Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.)

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

Purpose: The promotion of quality of life (QOL) and healthy development across the person's life span can result in long and meaningful lives. The purpose of this study was to examine relationships between spiritual well-being (SWB), depression, and QOL for adults with paraplegia., Design: A descriptive correlational design was used for this study., Methods: A purposive sample of 75 participants completed the Ellison's SWB Scale, the Center for Epidemiologic Studies-Depression Scale, and a QOL scale., Findings: Quality of life was significantly associated with SWB (r = .47, p = .01), and depression (r = -.59, p = .01), 43% of the variance in QOL was explained by age, gender, length of stay, SWB, and depression (F[5,69] = 10.45, p < .001)., Conclusions: Participants with a strong sense of purpose or meaning in life were more likely to experience a higher QOL., Clinical Relevance: Rehabilitation nurses can help guide patients to the discovery of what brings purpose and meaning to their lives., (© 2014 Association of Rehabilitation Nurses.)

Maternal depression (MD) is a condition that has wide-ranging effects on the woman, her family, and the broader global society. It is generally agreed that MD is associated with untoward effects on the developmental trajectory of offspring. The aim of this article is to review the historical and theoretical underpinnings informing current thought linking MD with infant development, and to highlight some of the neuroendocrine and epigenetic processes related to MD and its sequelae. A broad understanding of the association between MD and infant developmental outcomes can inform nursing care of the childbearing family.

Background: The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women., Method: Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants., Results: A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms., Conclusion: In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

Background: Poor sleep, common during pregnancy, is associated with negative health risks. The study aimed to identify predictors of clinically significant insomnia among pregnant Latinas., Methods: A total of 1289 pregnant Latinas recruited from obstetric clinics completed the Insomnia Severity Index (ISI) and questions about demographics and sleep., Results: Clinically significant insomnia (ISI≥10) was present among 17% of participants. Significant correlates of clinically significant insomnia were higher scores on the Edinburgh Postnatal Depression Scale (EPDS) after removing the sleep item (47% of women with EPDS≥9 and 9% with EPDS<9), completing measures in English (rather than Spanish: 26% versus 13%), and income but not pregnancy week, age, highest education level, or marital status. The highest percentage of clinically significant insomnia (59%) was experienced by women with EPDS≥9 who completed measures in English. The lowest percentage of clinically significant insomnia (6.2%) was experienced by women with EPDS<9 who completed measures in Spanish., Conclusions: In this sample of low-income, mostly Spanish-speaking pregnant Latinas, rates of clinically significant insomnia appear to be higher than rates among nonpregnant Latinas. Rates of clinically significant insomnia are particularly high among Latinas with elevated depressive symptom severity, a known risk for insomnia. Acculturation, as indicated by completing measures in English, may be another risk specific to Latinas, possibly owing to loss of some ethnicity-specific protective factors (e.g., social support, strong family ties, and group identity). It will be important to directly test this explanation in future research.

Understanding how depression is conceptualized is key to designing effective screening and treatment procedures. Of particular concern is maternal depression in Latinas, given the high Latina birthrate. We conducted two focus groups of pregnant Latinas to elicit their perceptions of and experiences with maternal depression. Women reported familiarity with the concept of maternal depression and that their experiences with depression were linked to social support from family and friends. Women also indicated that they felt responsible for coping and recovering from depression independently. How experiences with depression interact with traditional Latino idioms of distress, needs further investigation.

Problem: Effective prevention requires understanding vulnerable populations, early signs of health risks, and the impact of social contexts. We tested a model of co-occurring mental health risks among at-risk youth experiencing school difficulties., Methods: We analyzed data from a random sample of 336 at-risk youth, grades 9-12, who completed a comprehensive risk/protective factors assessment., Findings: Simultaneously controlling for correlations among health risks, we observed systematic associations among risk factors, with generally consistent patterns for males and females., Conclusions: The findings underscore the importance of developing interventions that incorporate contextual influences and of identifying common adaptable strategies for attenuating co-occurring health risks for at-risk youth., (© 2013 Wiley Periodicals, Inc.)

Aims:   To explore the feasibility and acceptability of a clinical nurse leader (CNL) role to improve interdisciplinary collaboration (IC) within a fragmented acute-care microsystem., Background:   Fragmented patient care is associated with preventable adverse healthcare outcomes. IC decreases fragmentation and improves patient care quality. The CNL role is theorized to provide the necessary leadership and competency skill base to impact IC at the optimal organizational level, the point of care where most healthcare decisions are made., Methods:   This study used a descriptive non-experimental design. CNL daily workflow was developed to target empirical determinants of IC. Descriptive data were collected from multiple stakeholders using an investigator-developed survey., Results:   Findings indicate the integration of the role is feasible and acceptable to the microsystem healthcare team., Conclusions:   Preliminary evidence suggests the CNL role may be an effective intervention to facilitate IC. More research is needed to support the CNL role's association with microsystem IC., Implications for Nursing Management:   The CNL role presents an innovative opportunity for clinical and administrative leadership to partner together to redesign a healthcare delivery system and improve patient care quality., (© 2012 Blackwell Publishing Ltd.)

Background: The current fragmented healthcare system, characterized by a lack of collaborative, patient-centered care processes, creates significant barriers to providing quality patient care. The clinical nurse leader (CNL) is theorized to provide clinical leadership at the point-of-practice to maintain cross-disciplinary collaborative processes that lead to integrated quality care., Objectives: The aim of this study was to assess the impact of CNL integration into an acute care microsystem on care quality, as measured by patient satisfaction with care., Methods: A short interrupted time series design was used to measure patient satisfaction with multiple aspects of care 10 months before and 12 months after integration of the CNL role on a progressive care unit, compared with a control unit. Data were obtained from Press Ganey surveys, and analysis was completed using a publicly available program for short time series data streams., Results: Clinical nurse leader implementation was correlated with significantly improved patient satisfaction with admission processes (r = + .63, p = .02) and nursing care (r = +.75, p = .004), including skill level (r = .83, p = .003) and keeping patients informed (r = .70, p = .003). There was no significant correlation with improved patient satisfaction with physician care (r = .31, p = .14) or discharge processes (r = .33, p = .23) postimplementation. Control data showed no significant changes in patient satisfaction measures throughout the study time frame., Discussion: The positive correlation between CNL-mediated collaborative care processes and improvements in patient satisfaction with care quality provides empirical evidence of outcomes achievable through CNL implementation. Research is needed to explore the full range of achievable outcomes and to determine the specific processes by which these outcomes are realized.

Maternal depression is highly prevalent (10-20%) during the perinatal period, with rates as high as 35% to 40% for Latinas. However, few Latinas are either identified or treated during the perinatal period. The Perinatal Mental Health (PMH) model was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, collaborative care intervention for addressing depression among Mexican American mothers. It attends to sociocultural and socioeconomic dimensions and is delivered by trained mental health advisors in obstetric care settings. This article describes the feasibility and acceptability of using the PMH. Participants (N = 79) were selected from a 1st-year ongoing randomized trial in community obstetric clinics. The intervention seems feasible and acceptable; low-income Latinas, identified as depressed during the perinatal period, reported having access to a range of appropriate community services and high satisfaction.

Purpose: The study examined the relationships between self-efficacy and physical activity in adolescent and parent dyads., Design and Methods: A cross-sectional, correlational design was used to explore the relationships among levels of parent physical activity, parent-adolescent self-efficacy, and adolescent physical activity. Descriptive and multivariate regression analyses were conducted in a purposive sample of 94 adolescent/parent dyads., Results: Regression results indicated the overall model significantly predicted adolescent physical activity (R(2) = .20, R(2)(adj) = .14, F[5, 70]= 3.28, p= .01). Only one of the five predictor variables significantly contributed to the model. Higher levels of adolescent self-efficacy was positively related to greater levels of adolescent physical activity (β= .29, p= .01)., Practice Implications: Practitioners are encouraged to examine the level of self-efficacy and physical activity in families in an effort to develop strategies that impact these areas and ultimately to mediate obesity-related challenges in families seeking care., (© 2011, Wiley Periodicals, Inc.)

The primary purpose of this study was to examine the previously untested relationships between moral distress, compassion fatigue, perceptions about medication errors, and nurse characteristics in a national sample of 205 certified critical care nurses. In addition, this study included a qualitative exploration of the phenomenon of medication errors in a smaller subset of certified critical care nurses. Results revealed statistically significant correlations between moral distress, compassion fatigue, and perceptions about medication errors in this group. Implications for critical care nurses seeking to create work environments conducive to the reduction of medication errors are explored.

Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep?