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The unpredictable and volatile economic context, ever-changing demography, explosion of technology, and rapid disruptive health delivery models are only a few of the factors characterizing the constant flux permeating the health care system. Current educational initiatives are corrective and reactive rather than reflective and proactive. Some renowned nurse educators and educational leaders pioneered the departure from a learning emphasis on what nurses do to what nurses become. To foster students’ creative initiatives, faculty of an RN-to-BSN three-semester program thread five stages of a creativity process of exposure, inquiry, discovery, reflection, and evaluation into three interrelated courses in the program of study.

Background COVID-19 has taken its toll on citizens in all 50 states of the United States. The United States (U.S.) leads the world with 30,291,863 confirmed reported cases and 549,664 deaths as of March 29, 2021 compared to globally confirmed cases at 127,442,926 and 2,787,915 deaths as of March 29, 2021. The U.S. federal government primarily left the response to the virus to individual states, and each implemented varying measures designed to protect health of citizens and the state’s economic well-being. Unintended consequences of the virus and measures to stop its spread may include decreased physical activity and exercise, shifting access and consumption of food, and lower quality-of-life. Therefore, our primary goal was to quantify the impact of COVID-19 on health and well-being by measuring changes in physical activity, mental health-quality of life, food security and nutrition in adults ages 40 and older. We believed shifts in health behaviors would be more prevalent in minorities, less educated, lower socio-economic status, older adults, and those with underlying health conditions, so a secondary goal was to determine the impact of COVID-19 on these sub-populations. Methods We conducted an online survey with 9969 adults 40 years and older between 9 August and 15 September 2020 in urban areas across the four U.S. census regions. The survey included questions about demographic variables, pre-existing health conditions, physical activity, access to food, quality-of-life, and nutritional food status and asked participants to respond with information from pre-pandemic and pandemic conditions. We used paired-sample t-tests to detect changes in variables after the start of the pandemic and Cohen’s d to determine effect sizes. Results Our main findings showed a decrease in physical activity since the onset of COVID-19 for minorities and non-minorities. Food security also slightly increased for minorities during the pandemic, but we found no other changes in food security, quality-of-life indicators, or nutritional status of those who responded to this survey. Conclusions It is concerning that physical activity declined. Such activity helps maintain physical and mental health, and it is also an important time to socialize for many older adults. In many ways, our data indicate that the older adult population in U.S. cities may be more resilient than expected during the pandemic. However, the pandemic could have negative impacts that we did not detect, either due to the survey instrument or the timing of our survey, so the health and well-being of older adults should continue to be monitored in order to mitigate potential negative impacts.

Background Physical activity (PA) is an integral part of successful aging. However, many older adults (OAs) are not meeting current PA recommendations. Objective To assess the PA needs, preferences, and practices of community-residing OAs. Study Design, Setting, Participants This qualitative study assessed the PA needs and preferences of 117 community-residing OAs. Thirteen focus groups (FG) were held in Iowa (IA, 5 FG) and Washington, DC (DC, 8 FG). FG discussions centered on perceived PA needs, motivators and barriers, and preferred PA programming attributes. Each FG was audio-recorded. Participants also completed a sociodemographic survey. IA participants (n = 51) were recruited at congregate meal sites while DC participants (n = 66) were recruited from 2 OAs volunteer programs. Measurable Outcome/Analysis FG recordings were transcribed verbatim and reviewed for major themes using standard theme analysis protocols. Sociodemographic data were analyzed using descriptive statistics. Kruskal-Wallis H Test assessed between group differences for sociodemographic attributes (P Results The mean age of participants was 74.4 ± 7.0 years. Participants were mostly educated (77.2%) females (83.1%) in “average or higher” health (84.8%). IA participants were more educated than DC participants (P Conclusions This sample of community-residing OAs are not meeting PA recommendations. The perceived PA needs and preferences were similar regardless of being rural- or urban-residing. These findings provide useful information to better enable tailoring of PA messaging and programming for community-residing OAs.

Background: This research study illustrates the perceptions, opinions, beliefs, and attitudes of older adults residing in an urban community as major factors to understanding barriers and motivators in older African Americans, Hispanics, and Asians adults within Washington, DC. Methods: Eight focus group sessions conducted with 58 older adults to determine their understanding of physical activity and exercise, as well as of barriers to, motivators for, and benefits of physical activity and exercise. Results: The results showed that dance was the preferred physical activity and exercise, fixed or limited income were the main barriers, and prolonged life, more energy, and a stronger body were the main benefits. Conclusion: The results will assist in recommendations to policy makers on programs for older adults that will increase physical activity and exercise for local citizens. These interventions are more likely to increase older adults’ ability to remain in their communities and improve their overall health and well-being.

The maintenance of good health and wellness for individuals and communities depend on the provision of opportunities to prevent health problems and improve their basic health and well-being. The traditional learning approach in the nursing profession is based on individual and curative models of care. However, combating the interrelated triad of heart disease, diabetes, and hypertension that affect a large percentage of younger and older adults in the District of Columbia calls for a paradigm shift of learning toward a collective and social approach such as service-learning. The purpose of this chapter is to illustrate how interprofessional and multi-disciplinary practices are used to tackle health issues and explain how the pedagogical approach, with social and preventive directions, led to the development and sustainable community partnerships in all eight wards of the District of Columbia.

The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods.Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD.Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures.Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184).A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.

Registered nurses and physical therapists working in home healthcare are ideally situated to identify individuals with undiagnosed peripheral arterial disease (PAD). This article focuses on identifying PAD in the lower extremities. The purpose of this continuing education article is to assist the reader in recognizing the role of the home healthcare clinician in identifying and managing PAD. At completion of this module, participants will be able to identify key factors related to PAD, including use of the ankle-brachial index (ABI), and to identify individuals with the disease.