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The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

Parenting stress is common and may lead to worsening health, particularly in the context of other risk factors such as mental disorders or a history of abuse. This study investigated how parenting-related stress impacts the effect of abuse experiences on health among mothers with mental health disorders. Survey data was analyzed from 172 predominantly Hispanic mothers receiving outpatient behavioral health services. Most (80.2%) mothers had experienced abuse. Those reporting childhood abuse had 3.82 greater odds of experiencing abuse in adulthood. Findings demonstrated worse health outcomes among those experiencing abuse in both childhood and adulthood and those with a greater number of abuse experiences. Caregiving load intensified the relationship between abuse and anxiety and sleep disturbance. Parenting self-agency intensified the relationship between abuse and cigarette use. These findings have important implications for mental health nursing practice by identifying parenting-stress as an important target for interventions to improve health among women with histories of abuse and mental health disorders.

Background: There is a lack of diversity in the master's prepared nursing workforce. One nursing school implemented a scholarship program for students from disadvantaged backgrounds enrolled in the Family Nurse Practitioner and Adult Gerontology Primary Nurse Practitioner tracks. Method: Awardees were required to be full-time students from disadvantaged backgrounds with financial need. Each student was matched with a faculty member for regular mentorship. Student progress was evaluated every three months, with follow-up 1 year after graduation. Results: A total of 45 students received the Scholarship for Disadvantaged Students (SDS) over 2 consecutive years. Of the 45 students, 26 (58%) identified themselves as Hispanic and 11 (24%) as black. A total of 42 (93%) of 45 SDS students completed the original plan of study and passed the national certification board. Conclusion: The SDS serves as a model of an effective mentorship program to assist nurse practitioner students from disadvantaged backgrounds. [ J Nurs Educ . 2020;59(5):287–290.]

This study extended research on syndemics for women with mental disorders by including self-reported mental and physical health conditions. Syndemics explain complex relationships among co-occurring conditions, and the social circumstances that influence their overlap. Data were from the baseline assessment of a randomized trial of Healthy Home, a nursing home-visit intervention for women with children. 172 adult women who were in mental health or substance use treatment completed measures (in Spanish or English) of anxiety, depression, violence during adulthood, physical health, and cigarette use. Structural Equation Modeling was used to evaluate a single-factor syndemic, and to test the relationships of theoretical predictors of the syndemic: income, number of children, women’s abuse during childhood, mental health stigma, social support, and stress. Results supported a single factor syndemic model that explained variation in mental health, physical health, and violence during adulthood. Stress, β = .45, p < .001, and stigma, β = .22, p = .007, were related to the syndemic factor. There was evidence that self-reported mental and physical health share covariation, which suggested that integrated services for women with mental disorders may have synergistic effects on health. Findings suggest the need to develop and test interventions that address stress and stigma as a means of reducing health disparities for women with mental disorders.

Introduction: HIV transmission presents an ongoing risk to Hispanic women, and prevention efforts remain a priority. The use of technology to prevent HIV transmission among Hispanic women and those of lower socioeconomic status underscore the need for effective implementation of technology. The purpose of this study is to describe technology preferences and predictors of the use of the internet for HIV prevention among low-income Hispanic women. Method: A secondary analysis was conducted using baseline data from an intervention to prevent HIV among 320 Hispanic women. The parent study was SEPA, Salud (health), Educación (education), Promoción (promotion), y [and] Autocuidado (self-care). Results: Most participants reported using personal technology, such as smartphones (90.6%), the internet (78.1%), and personal email (67.5%), every day. Most (71.3%) participants were open to learning about HIV education via the internet. In the logistic regression analysis, education and time since the last visit to the health care provider were significant predictors of the use of the internet to learn about HIV prevention, after controlling for age, living with the partner, and years living in the United States. Conclusion: Hispanic women demonstrated high levels of comfort with different forms of technology. These results indicated the potential to expand future HIV intervention efforts by implementing electronic dissemination of bilingual and culturally appropriate information for Hispanic women of diverse ages.

Highlights • Strong faculty academic human caring presence is paramount during the exponential use of asynchronous, remote learning during the COVID-19 pandemic. • Caring pedagogy, presence, and Communitas support the holistic learning and teaching needs of nursing higher education in times of global crisis. • A theory-guided, holistic caring pedagogical approach is offered to augment remote learning pedagogy and to further humanize remote learning. • Suggested caring and narrative pedagogical approaches aim to support student success during such times of immense stress and crisis. • Creation of Caring Spaces and other modalities to transcend physical distancing of faculty and students are offered to humanize remote or online teaching and learning and to nurture togetherness, or Communitas, within the virtual classroom., Background Strong faculty academic human caring presence is paramount during the exponential use of asynchronous, remote learning during the COVID-19 pandemic. Purpose The purpose of this article is to provide a holistic, theoretical foundation for evidence informed-caring pedagogical practices. Methods Watson's (2008; 2018) Unitary Caring Science theoretical approach offers one pedagogical caring framework for advancing teaching-learning in the digital age. Discussion Examples to humanize the virtual classroom and remote or online teaching include narrative, theory-guided pedagogical approaches, such as creation of caring spaces and other modalities to transcend physical distancing and nurture Communitas (caring community) among of faculty and students. Conclusion A theory-guided, holistic caring pedagogical approach supports the needs of both faculty and nursing students.

Unprecedented financial and logistical barriers in educating nurses during COVID-19 have threatened nursing education. The purpose of this article is to provide a template to facilitate the maintenance and stability of teaching and learning in a pandemic environment for nursing school administration and faculty leaders. The National Incident Management System (NIMS), previously used in training nurses for emergency preparation and response, has been applied as a guiding framework. The framework consists of five elements: Preparedness, Communication/Information Management, Resource Management, Command and Ongoing Management/Maintenance. This paper addresses how schools of nursing may apply each of these elements to address both the needs of the institution and community. The Comprehensive Vulnerability Management paradigm is further offered as a lens for professional development. Free preparedness education is showcased from leading nursing and healthcare professional and government organizations. Finally, the Quality and Safety Education for Nurses competencies are used for integrating NIMS and social dimensions of disaster. Such tools may equip academic leaders at schools of nursing to surmount challenges posed by the pandemic, and to ensure educational readiness to respond to global health crisis through use of the NIMS framework., Highlights • The COVID-19 pandemic has produced unprecedented barriers to nursing education. • Supporting nursing education and sustaining academic institutions of nursing to respond to the current global emergency and future health needs is an ongoing priority. • The National Incident Management System provides a template to guide nursing school administration and faculty to address challenges presented by the COVID-19 pandemic. • Nursing school academic leaders can utilize opportunities for professional development to advance skills for emergency management during COVID-19.

Charcot neuropathy osteoarthropathy, known as Charcot's foot, is a condition of the foot most frequently related to diabetes mellitus. It is associated with a high mortality rate, especially among patients with diabetes, therefore prompt identification and management of the condition by nurses in emergency departments is important. This article describes the pathophysiology, signs and symptoms and diagnosis of Charcot's foot, and offers guidance for initial care in emergency settings. Emergency nurses in the UK have an important role in recognising patients with this condition to ensure they receive optimal treatment and follow-up.

Use of bedside ultrasonography to identify life-threatening injuries for patients with blunt and penetrating trauma is the standard of care in the emergency department. The "FAST" examination-focused assessment with sonography for trauma-ultrasound scan of the chest and abdomen allows clinicians to assess critical regions for free fluid without use of invasive procedures as quickly and as often as needed. In addition, ultrasonography has a high degree of sensitivity and specificity and is safe during pregnancy. For patients requiring evaluation of the pleura, the "eFAST" (or extended FAST) may be conducted, which may serve to locate pleural effusions, hemothorax, and pneumothorax. However, ultrasound quality is operator dependent and is recommended with other diagnostic measures to provide a complete clinical picture of trauma patients. Ongoing development of ultrasound competency among established clinicians and nurse practitioner students is vital to maintain diagnostic accuracy and ensure quality care for trauma patients in the emergency department.

Introduction: For the past 7 years, a nursing school has conducted biannual medical missions in a virtually inaccessible area in Haiti. Each medical mission team provides primary care, pediatric and gynecological examinations for up to 6 days in the impoverished island nation. Methods: To improve the safety of participants engaged in this humanitarian travel medicine endeavor and enhance efficiency, the United States National Incident Management System (NIMS) has been implemented as a framework. This integrated system has 5 components: (1) Preparedness, (2) Communication/Information Management, (3) Resource Management, (4) Command and Management, and (5) Ongoing Management/Maintenance. This system was originally designed for government agencies and non-governmental organizations responding to disasters and other global health emergencies. A structural plan using the framework can be implemented as an effective model for future international missions. Results: Implementation of the framework increased efficiency. While missions previously averaged approximately 100 patients daily, after incorporation of NIMS, this figure rose to 140 patients. Additionally, student feedback indicated increases in perceptions of safety and security. Conclusion: The NIMS framework applied by the Haiti medical missions team provided organizational structure and leadership for this humanitarian effort in travel medicine. Integrating NIMS into the mission has extended the outreach of global medical systems to the most rural areas of Haiti and improved care for vulnerable populations with limited access to healthcare. This framework may be used to assist other academic institutions organize safe and effective travel medicine endeavors.

Zika has emerged as a rapidly spreading infection worldwide. Clinicians in many parts of the world must be prepared to screen for symptoms and diagnose patients with this disease. In particular, pregnant women who may have experienced exposure to Zika must be treated with care and sensitivity due to serious risk for pregnancy complications among those who contract the infection. In response to the outbreak, patient management guidelines have been established for all who may be symptomatic or potentially at risk of infection with Zika. Clinicians globally can prepare to implement such protocols to help contain this disease.

Scientific advances have enabled thousands of individuals to extend their lives through organ donation. Yet, shortfalls of available organs persist, and individuals in the United States die daily before they receive what might have been lifesaving organs. For years, the legal foundation of organ donation in the United States has been known as the Dead Donor Rule, requiring death to be defined for organ donation purposes by either a cardiac standard (termination of the heartbeat) or a neurological one (cessation of all brain function). In this context, one solution used by an increasing number of health care facilities since 2006 is donation after circulatory death, generally defined as when care is withdrawn from individuals who have known residual brain function. Despite its increased use, donation after circulatory death remains ethically controversial. In addition, some ethicists have advocated forgoing the Dead Donor Rule altogether and allowing donation before or near death in certain circumstances. However, nurses and other health professionals must carefully consider the practical and ethical implications of broadening the Dead Donor Rule—as may be already occurring—or removing it entirely. Such changes could harm both the integrity of the health care system as well as efforts to secure organ donation commitments from the public and are outweighed by the moral and pragmatic cost. Nurses should be prepared to confront the challenge posed by the ongoing scarcity of organs and advocate for ethical alternatives including research on effective care pathways and education regarding organ donation.

Charged with making decisions to protect and enhance patient well-being, a nurse relies on nursing judgment to render effective patient care. Nursing judgment is the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients. This concept analysis uses the Walker and Avant method to demonstrate the role of nursing judgment in assessments and interventions, delegation of tasks, and prioritization of care. Nurses, other health care collaborators, and recipients of health care should be aware of the role played by nursing judgment to improve patient care and the health care system.

Purpose: To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting. Design: Randomized controlled trial. Setting: Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami. Participants: Three hundred twenty Hispanic women. Intervention: The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology. Measures: Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use. Analysis: Differences at baseline by group were assessed using Wilcoxon rank sum test, χ2, and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables. Results: Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%). Conclusion: The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.

Background: Heart failure (HF) is a leading cause of death in the United States and the world. Patients experience substantially reduced longevity and quality of life. Although treatments are available to slow disease progression, medication adherence is necessary. Previous research has explored interventions to increase adherence for HF patients, yet barriers to medication adherence remain. Objective: This systematic review examined articles describing adherence interventions among HF patients. The World Health Organization’s model of Adherence to Long-Term Therapies, developed with patients with chronic illnesses, was used as a conceptual framework. The model describes barriers to adherence as grouped into five factors: patient factors , therapy-related factors , condition-related factors , social/economic factors , and health care/system factors . Methods: A search was conducted in databases CINAHL, PubMed and Scopus to identify interventional studies comprised exclusively of patients diagnosed with HF and their families. Inclusion criteria for articles were evaluation and reporting of adherence as an outcome. Interventions were then considered in context of the WHO factor or factors addressed. Results: This review identified 24 articles meeting inclusion criteria. Of these, all 24 addressed patient factors , 17 discussed therapy-related factors , 11 addressed condition-related factors , 15 addressed social/economic factors , and 15 addressed healthcare/system factors . Discussion: Every intervention in the review examined patient factors of beliefs and behaviors. However, no intervention considered the therapy-related factor of the immediacy of benefit. Among condition-related factors , none of the interventions addressed the role of fatigue. The limited examination of the relationship of race and ethnicity ( social/economic factors ) on adherence was surprising, as previous research has linked these factors to adherence. Conclusions: Categorizing adherence interventions by WHO factors is useful to evaluate the scope of previous research. More work is needed to identify how therapy-related , condition-related and social/economic factors among HF patients can be incorporated into future adherence interventions.

Tobacco use is a major threat to public health. Current guidelines suggest that healthcare professionals in the emergency department provide routine smoking cessation screening and interventions. Evidence suggests that an educational intervention among registered nurses in the emergency department may increase education and referral for smoking cessation of patients who use tobacco products. An educational module regarding smoking cessation counseling was provided to registered nurses in the emergency department at a private hospital in South Florida. A pre- and postintervention self-reported survey evaluated changes in nurses asking about tobacco use; advising to quit; assessing readiness, assisting, and arranging follow-up for patients who smoke to quit; and encouraging pharmacological agents. All participating nurses screened for tobacco use most of the time before and after the intervention. However, the number of nurses who assessed readiness, assisted, arranged follow-up for patients and encouraged the use of pharmacological agents increased significantly in the postsurvey. Study findings agree with previous research indicating that nurses routinely screen for tobacco and advise to quit. However, implementing smoking cessation education and referral resources may better equip registered nurses in the emergency department to take an active role initiating follow-up interventions for patients who screen positive for tobacco use. Educational interventions among these nurses can increase knowledge of and utilization of existing resources to help patients quit.

Background A critical component of doctor of nursing practice (DNP) education is practice immersion. DNP programs require 1000 hours of clinical practice experience to obtain the DNP degree. Problem Faculty struggle with providing meaningful clinical experiences congruent with the role of the DNP. Approach This article describes a unique practice immersion course joining DNP students with community health care partners to provide meaningful experiences with the potential to transform health care. DNP students are assigned system-level projects designed to create organizational change. Outcomes Over the course of 4 years, the practice immersion opportunities more than doubled from 30 to 66 live projects. Integrating collaborative practice immersion into the curriculum builds students' leadership skills and strengthens long-standing bonds among academia, practice, and the community. Conclusions The creation of structured, meaningful collaborations between DNP students and community partners is an approach that has the potential to facilitate transformative, sustainable change in health care.

Purpose A major component of hospital stroke care involves prompt identification of stroke in admitted patients. Delays in recognizing stroke symptoms and initiating treatment for in-hospital stroke can adversely impact patient outcomes. This quality improvement intervention used simulation together with a traditional lecture to instruct nurses at a university hospital about a new stroke protocol being implemented to increase rapid recognition of stroke and meet Joint Commission National Hospital Inpatient Quality Measures. The paper aims to discuss these issues. Design/methodology/approach In total, 86 registered nurses from the neurology and cardiology units attended a lecture and participated in a simulation scenario with a standardized patient exhibiting stroke symptoms. Participants completed a ten-item pre-test to measure their knowledge of stroke care prior to the lecture; they repeated the test pre-simulation and once again post-simulation to evaluate changes in knowledge. Findings Overall mean stroke knowledge scores increased significantly from pre-lecture to pre-simulation, and from pre-simulation to post-simulation. Simulation plus lecture was more effective than lecture alone in increasing knowledge about hospital stroke protocol despite assigned unit (cardiology or neurology), years of experience, or previous exposure to simulation. Research limitations/implications All eligible nurses who agreed to participate received training, making it impossible to compare improvements in knowledge to those who did not receive the training. Originality/value A diverse array of nursing professionals and their patients may benefit from simulation training. This quality improvement intervention provides a feasible model for establishing new care protocols in a hospital setting.

To maximize healthcare efforts toward environmental sustainability while ensuring patient and community safety, a comprehensive understanding regarding solid waste properties and disposal practices of care for infectious patients is needed. This observational study quantified the solid waste generated from two patientrooms in contact isolation for infection with methicillin resistant Staphylococcus aureus for 168 hours (7 days). A total of 3,322 solid waste items amounting to approximately 65 kilograms (kg) of solid waste was generated. Of this, 43% of the solid waste were attributed to personal protective equipment (PPE) used with infectious isolation procedures (e.g., gowns, packaging, non-latex gloves). In one year, total waste accumulation for one isolated patient could total approximately 1,690kg. Further study is needed to support updated isolation and solid waste disposal practices that preserve the safety of patients and healthcare personnel while considering environmental sustainability. In this article the authors review the background and significance of current, solid waste practices and the study method used to begin to inform isolation protocol changes. After presenting and discussing their findings, they note the study limitations, and offer nursing implications and solutions to promote environmental stewardship. They conclude by identifying the need for further study of unregulated solid waste disposal generated in caring for infectious patients so as to promote environmental sustainability.

Background: There is disparity in the nursing work-force of minority leaders. The aim of this article is to describe and evaluate an innovative program designed to provide mentorship and increase leadership skills of minority nursing students. Method: An innovative mentorship program was developed including coordination of financial aid meetings, incorporating technology, enacting an online preimmersion course, choosing and training mentors, hosting a lunch-and-lead leadership series, and using intensive review sessions and tutoring. Program evaluation data were analyzed using mixed methods. Results: All 40 participants passed the NCLEX-RN and had obtained employment after the program. Of the 20 respondents, 25% already had obtained a leadership role in nursing. Qualitative data about the program revealed categories of leadership, networking, mentorship, more time, and gratitude. Conclusion: This program was successful in promoting retention, graduation, and development of future minority nurse leaders. [ J Nurs Educ. 2018;57(9):526–534.]

The number of refugees increased in recent years due to factors worldwide, including violence, wars, political strife, and natural disasters. Refugees who are Hispanic women (RHW) in South Florida are a vulnerable population at risk of acquiring HIV infection. Although studies have shown a relationship between self-efficacy for HIV prevention and behavior changes, none have studied RHW. The purpose of this study was to assess whether predictors suggested by the literature were related to self-efficacy for HIV prevention in a sample of RHW. The study is a secondary analysis that uses baseline data from a randomized controlled experimental study, SEPA. A total of 99 refugee Hispanic women from South Florida, 18–50 years of age, participated in the study. There were two predictors of self-efficacy. HIV knowledge was positively related to self-efficacy, and living with a partner was inversely related to self-efficacy for HIV prevention. Culturally competent sexual health education interventions in this population may impact self-efficacy for HIV prevention.

Background: Heart failure is a leading cause of death in the United States and a condition of particular concern for the African American population. Although effective treatments are available for the disease, medication adherence is a key determinant of survival. Objective: This systematic review examines articles from the last 15 years that research medication adherence and African American heart failure patients. Methods: A systematic review of the published literature was conducted to identify articles examining predictors and outcomes of medication adherence among African Americans and then using Sister Callista Roy’s Health Adaptation conceptual framework - physiological, self-concept, role function and interdependence. Results: This review identified 14 articles that met inclusion criteria, most of which focused on physiological predictors, noting that age and comorbid conditions such as dialysis status may play a role in medication adherence. Psychological, cultural and social determinants were also found to impact adherence behaviors. Conclusions: More research is needed to examine other components of the Health Adaptation model, especially socioeconomic and healthcare system level predictors.