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This paper seeks to open a dialogue concerning the current trend in hiring non-nurse faculty (NNF) to tenure track positions in schools/colleges of nursing. The evolution of non-nurses as faculty, including a review of contemporary papers in affecting this trend, is offered. Three means of involving non-nurses in advancing our discipline are presented. The impact of the growing trend of NNF is discussed relative to the integrity of our discipline and effects on education. We conclude by suggesting a manner of proceeding and raise questions for furthering dialogue.

Background Asthma is the most common chronic condition among children with high-frequency emergency department (ED) utilization. Previous research has shown in outpatients seen for asthma that acute care visits predict subsequent health care utilization. Among ED patients, however, the optimal method of predicting subsequent ED utilization remains to be described. The goal of this study was to create a predictive model to identify children in the ED who are at risk of subsequent high-frequency utilization of the ED for asthma. Methods We used 3 years of data, 2013-2015, drawn from the electronic health records at a tertiary care, urban, children's hospital that is a high-volume center for asthma care. Data were split into a derivation (50%) and validation/test (50%) set, and 3 models were created for testing: (1) all index patients; (2) removing patients with complex chronic conditions; and (3) subset of patients with in-network care on whom more clinical data were available. Each multivariable model was then tested in the validation set, and its performance evaluated by predicting error rate, calculation of a receiver operating characteristic (ROC) curve, and identification of the optimal cutpoint to maximize sensitivity and specificity. Results There were 5535 patients with index ED visits, of whom 2767 were in the derivation set and 2768 in the validation set. Of the 5535 patients, 125 patients (2.3%) had 4 or more visits for asthma in the outcome year. Significant predictors in models 1 and 2 were age and number of prior ED visits for asthma. For model 3 (additional clinical information available), the predictors were number of prior ED visits for asthma, number of primary care visits, and not having a controller medication. Areas under the ROC curve were 0.77 for model 1, 0.80 for model 2, and 0.77 for model 3. Conclusions Administrative data available at the time of ED triage can predict subsequent high utilization of the ED, with areas under the ROC curve of 0.77 to 0.80. The addition of clinical variables did not improve the model performance. These models provide useful tools for researchers interested in examining intervention efficacy by predicted risk group.

Purpose A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status. Procedures We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status. Findings We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR Conclusions Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.

The Fitzpatrick Skin Phototypes (FSP) were developed to classify skin color and response to ultraviolet radiation. FSP are used clinically to assess risk for sunburn and skin cancer. Our aim was to determine the criterion-related validity of self-reported FSP when compared with skin color and sunburn history, controlling for age, race/ ethnicity, and seasonality/geography. We performed a secondary analysis of data (N=466) from an observational study. The racial/ethnic composition of the sample was 45% White/White Hispanic (WWH), 40% Black/Black Hispanic (BBH), and 15% Other Identities. Outcome measures were self-reported FSP and sunburn history, as well as physiological measures of skin color (L* lightness/darkness, a* redness/greenness, b*yellowness/blueness). Correlation between FSP and L* was -.77 (95% CI -.81, -.73; P

Background Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases. Objectives To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables. Methods We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted. Results We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28–5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears. Conclusion External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.

While the sexual behaviours of different racial and ethnic groups have been studied extensively in the USA, Arab Americans are relatively understudied. The purpose of our study is to describe sexual attitudes and behaviours of Arab American young adults, to explore gender differences and the factors associated with five primary sexual behaviours (solo and partnered masturbation, oral, vaginal and anal sex). We conducted a cross-sectional quantitative study using a self-administered survey, which included measures of Arab ethnic identity, religiosity and sexual attitudes and behaviours. The survey was completed by 100 Arab American young adults (18-25 years old). Almost half of the sample reported being engaged in at least one of the five primary sexual behaviours in the past six months. In bivariate analysis, there were significant gender differences in sexual attitudes and all the primary sexual behaviours except for anal sex. Sexual attitudes and religiosity were significant predictors of partnered masturbation, oral and vaginal sex. Our findings challenge Arab societal assumptions that unmarried Arab American young adults do not engage in sexual behaviours, including risky behaviours, warranting further research to prevent unintended sexual health outcomes.

To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision-making intervention and evaluate feasibility and acceptability of intervention procedures.Group-randomized longitudinal pilot study.In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE (N = 40) to a dose-matched attention control intervention (N = 40). BREATHE is a one-time shared decision-making intervention delivered by clinicians during routine office visits. Ten clinicians were randomized and trained on BREATHE or the control condition. Participants were followed monthly for 3 months post-intervention. Data were collected from December 2017 - May 2019 and included surveys, lung function tests, and interviews.Participants were Black/multiracial (100%) mostly female (83%) adults (mean age 45). BREATHE clinicians delivered BREATHE to all 40 participants with fidelity based on expert review of audiorecordings. While the control group reported improvements in asthma control at 1-month and 3-month follow-up, only BREATHE participants had better asthma control at each timepoint (β = 0.77; standard error (SE)[0.17]; p ≤ 0.0001; β = 0.71; SE[0.16]; p ≤ 0.0001; β = 0.54; SE[0.15]; p = .0004), exceeding the minimally important difference. BREATHE participants also perceived greater shared decision-making occurred during the intervention visit (β = 7.39; SE[3.51]; p = .03) and fewer symptoms at follow-up (e.g., fewer nights woken, less shortness of breath and less severity of symptoms) than the controls. Both groups reported improved adherence and fewer erroneous medication beliefs.BREATHE is a promising brief tailored intervention that can be integrated into office visits using clinicians as interventionists. Thus, BREATHE offers a pragmatic approach to improving asthma outcomes and shared decision-making in a health disparity population.The study addressed the important problem of uncontrolled asthma in a high-risk vulnerable population. Compared with the dose-matched attention control condition, participants receiving the novel brief tailored shared decision-making intervention had significant improvements in asthma outcomes and greater perceived engagement in shared decision-making. Brief interventions integrated into office visits and delivered by clinicians may offer a pragmatic approach to narrowing health disparity gaps. Future studies where other team members (e.g., office nurses, social workers) are trained in shared decision-making may address important implementation science challenges as it relates to adoption, maintenance, and dissemination. TRAIL REGISTRATION: clinicaltrials.gov # NCT03300752.目的: 评估呼吸 (评估哮喘治疗的简短干预) 的干预效果, 一种新颖的简短共同决策干预, 并评估干预程序的可行性和可接受性。 设计: 分组随机纵向试点研究。 方法: 总共有80名患有不受控持续性哮喘的成人参与了一项对照呼吸 (N=40) 和剂量匹配的注意力控制干预 (N=40)试验。呼吸是临床医生在常规的门诊就诊中提供的一次性共同决策干预。10名临床医生被随机分配并接受呼吸或对照条件的培训。受试者在干预后的3个月内每月接受一次随访。数据收集于2017年12月至2019年5月, 其中包括调查、肺功能测试和访谈。 结果: 参与者为黑人/多种族 (100%) , 大部分为女性 (83%)成人 (平均年龄45岁) 。呼吸临床医生根据专家对录音的回顾, 准确地为所有40名参与者提供了呼吸服务。尽管对照组在1个月和3个月的随访中报告了哮喘控制的改善, 但只有呼吸参与者在每个时间点有更好的哮喘控制(β=0.77; 标准误差 (SE)【0.17】;p≤0.0001;β=0.71;SE【0.16】;p≤0.0001;β=0.54;SE【0.15】;p=.0004) , 超过了最小重要差异。与对照组相比, 呼吸参与者还认为在干预访视期间, 发生了更多的共同决策, (β=7.39;SE【3.51】;p=0.03) , 随访时症状出现地更少 (例如, 醒夜更少, 呼吸急促更少, 症状较轻) 。两组患者的依从性均有所改善, 错误的用药观念也有所减少。 结论: 呼吸是一种有效的短期定制干预, 可将临床医生作为干预与门诊就诊结合使用。因此, 呼吸提供了一个务实的方法来改善哮喘的结果和健康不平等人群的共同决策。 影响: 本项研究解决了高危易感人群中失控哮喘的重要问题。与剂量匹配的注意力控制条件相比, 接受新简短定制的共同决策干预的参与者在哮喘转归方面有显著改善, 且其在共同决策方面有更大的参与度。将简短的干预措施纳入到门诊就诊中, 并由临床医生提供, 可能提供缩小健康差距的务实方法。在未来的研究中, 其他团队成员 (如办公室护士、社会工作者) 将接受共同决策方面的培训, 这可能会解决实施科学在采用、维护和传播方面的重要挑战。 试验注册: clinicaltrials.gov # NCT03300752.

Aim To evaluate the preliminary effectiveness of the BRief Evaluation of Asthma THerapy intervention, a 7-min primary care provider-delivered shared decision-making protocol that uses motivational interviewing to address erroneous asthma disease and medication beliefs. Design A multi-centre masked two-arm group-randomized clinical trial. Methods This 2-year pilot study is funded (September 2016) by the National Institute of Nursing Research. Eight providers will be randomized to one of two arms: the active intervention (N = 4) or a dose-matched attention control (N = 4). Providers will deliver the intervention to which they were randomized to 10 Black adult patients with uncontrolled asthma (N = 80). Patients will be followed three months postintervention to test the preliminary intervention effects on asthma control (primary outcome) and on medication adherence, lung function, and asthma-related quality of life (secondary outcomes). Discussion This study will evaluate the preliminary impact of a novel shared decision-making intervention delivered in a real world setting to address erroneous disease and medication beliefs as a means of improving asthma control in Black adults. Results will inform a future, large-scale randomized trial with sufficient power to test the intervention's effectiveness. Impact Shared decision-making is an evidence-based intervention with proven effectiveness when implemented in the context of labour- and time-intensive research protocols. Medication adherence is linked with the marked disparities evident in poor and minority adults with asthma. Addressing this requires a novel multifactorial approach as we have proposed. To ensure sustainability, shared decision-making interventions must be adapted to and integrated into real-world settings. Trial registration Registered at clincialtrials.gov as NCT03036267 and NCT03300752.

People interpret virginity in a variety of ways with different implications for sexual identity and behaviour. In Arab societies, heterosexuality and compulsory virginity before marriage are traditionally understood as ideals for a 'good' Arab girl, a 'good' Arab family and, consequently, a 'good' Arab society. In this study, our goal was to gain an in-depth understanding of the enactment of sexual agency and decision-making around virginity from the perspectives of Arab women living in the USA. We conducted a qualitative phenomenological study involving interviews with ten women whose accounts could be grouped into three distinct types: 'For me, it's the person you marry that you will be doing these things with'; 'I want to wait until marriage but I know there might be a possibility where I'm not'; and 'I started dating this guy, and I did lose my virginity to him'. The life stories of the women illustrate different ways of enacting sexual agency that are strongly influenced by socio-cultural norms and contexts. Our findings have important implications for future research to better understand decisions and behaviours about virginity and how Arab women in the USA enact their sexuality.

Background Risky driving behaviors contribute to adolescent injury, disability, and death, yet little is known about how mental health factors are associated with adolescent driving behaviors. Objectives The purpose of the research was to determine the association of risky driving behaviors and mental health symptoms in novice adolescent drivers. Methods We recruited a convenience sample ( n = 60) of adolescents to complete an assessment of driving performance errors in a high-fidelity simulator (Simulated Driving Assessment [SDA] Error Score) and a self-report measure of risky driving (Behavior of Young Novice Drivers Survey [BYNDS]). Participants also completed a mental health assessment of self-reported symptoms of depression (Center for Epidemiologic Studies-Depression Scale) and attention-deficit/hyperactivity disorder (ADHD; inattention and hyperactivity–impulsivity), conduct disorder, and oppositional defiant disorder (Conners-3 self-report and parent report). We evaluated the cross-sectional relationships between SDA Error Score, BYNDS, and mental health survey data with descriptive statistics, bivariate correlations, and linear regression. Results In linear regression models, higher self-reported inattentive ADHD T-scores were associated with higher SDA Error Score (model adjusted R 2 = .20). Higher self-reported T-scores of hyperactive–impulsive ADHD and conduct disorder were associated with higher BYNDS total scores (model adjusted R 2 = .32). Parent report measures were not associated with adolescent BYNDS total score or SDA Error Score. Discussion These data highlight the association of risky driving with adolescent symptoms of inattention, hyperactivity, and conduct disorder. The early stage of independent driving is an important time for addressing the relationship between driving performance and mental health conditions.

Pregnant and parenting adolescents often experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative Exposure Therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are threefold: a) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents, b) describe NET’s theoretical principals, its therapeutic process, and provide review of existing evidence and c) to discuss NET as a potential treatment to address that mental health burden among adolescents experiencing IPV-related PTSD and depression.

Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk and often results from distractions, such as cell phone calls, texting, and peer passengers. We report on the development of a web-based intervention based on the Theory of Planned Behavior that aims to reduce adolescent driver inattention ( Let’s Choose Ourselves). In Phase I, we collected qualitative and quantitative data on adolescents’ attitudes, perceived behavioral control, and subjective norms about driver inattention through focus groups with newly licensed adolescent drivers. In Phase II, we developed the content in an e-learning delivery system, performed beta- and pilot testing, and made refinements. In Phase III, we conducted a randomized controlled trial to evaluate feasibility. The development of Let’s Choose Ourselves provides information for school nurses regarding intervention development strategies as well as promotion of safe adolescent driving by reducing driver inattention.

Background Cardiovascular disease accounts for more than half of all deaths in the hemodialysis (HD) population. Although much of this mortality is associated with fluid overload (FO), FO is difficult to measure, and many HD patients have significant pulmonary congestion despite the absence of clinical presentation. Cohort studies have observed that FO, as measured by bioimpedance spectroscopy (BIS), correlates with mortality. Other studies have observed that lower sodium intake is associated with less fluid-related weight gain, improved hypertension, and survival. Whether sodium intake influences FO in HD patients as measured by BIS is not known. Objective The aims of the study were to determine the feasibility of assessing the impact of sodium restriction on body fluid composition as measured by BIS among patients with three levels of sodium intake and to determine if there are statistical and/or clinical differences in BIS measures across sodium intake groups. Methods We used a double-blinded randomized controlled trial design with three levels of sodium restriction, 2,400 mg per day, 1,500 mg per day, and unrestricted (control group), to test our aims. Forty-two HD patients from a tertiary acute care academic institution associated with three urban DaVita dialysis centers were enrolled. Participants remained in the inpatient center for 5 days and 4 nights and were randomly assigned to sodium intake groups. Body fluid composition was measured with BIS. Results Recruitment, enrollment, and retention statistics supported the feasibility of the study design. Regression analyses showed that there were no statistically significant differences among sodium intake groups on any of the outcomes. Discussion Our data suggest the need for additional research into the effects of sodium restriction on body fluid composition.

Background: Caregivers of stroke survivors often suffer depressive symptoms that interfere with their own health. Early recognition may lead to attenuation of symptoms and better health and well-being for caregivers. Objective: We examined characteristics of caregivers and stroke survivors associated with caregivers’ depressive symptoms in the early poststroke period. Methods: We conducted a prospective, longitudinal exploratory observational study with a convenience sample of 63 caregivers of older adult (≥ 65 years) stroke survivors recruited from urban acute-care settings. We enrolled caregivers by 2 weeks poststroke (T1) and revisited them 4 weeks later (T2). Depressive symptoms were measured using the Patient Health Questionnaire-9. A separate unadjusted linear mixed model was computed to explore significant associations between each caregiver or stroke-survivor characteristic and depressive symptoms. Results: Caregivers, on average, reported mild depressive symptoms at T1 and T2. Each of the following characteristics was independently associated with caregiver depressive symptoms over the first 6 weeks poststroke: caregiver uncertainty (p p p = 0.858 on waking, p = 0.231 evening), coping (p p = 0.006), race (p = 0.022), income (p = 0.001), time spent on care (p = 0.039), and stroke-survivor race (p = 0.033) and functional status (p = 0.003). At T2, caregiver depressive symptoms were correlated with evening cortisol level (p = 0.001). Conclusions: Caregiver and stroke-survivor characteristics may help identify caregivers at highest risk for early depressive symptoms and guide interventions aimed at their resolution.

Fear of falling (FOF) creates a psychological barrier to performing activities for many older adults. The negative impact of fear of falling increases risk of curtailment of activities, future falls, and injury. The specific aim for this study was to investigate the relationship between two fear of falling measures used in clinical research, the FOF Likert scale and Falls Self Efficacy Scale-International (FES-I). The study included a convenience sample of 107 high-risk, community-dwelling, mostly Black (94%) members from one Program for All-Inclusive Care for the Elderly program. The FOF scale is one-item asking to rate overall concern about falling, while the FES-I is 16-items rating concern about falling during physical and social activities. One-way ANOVA and Kruskal-Wallis were highly significant (F-value = 22.25, R-squared = 0.39, p 0.0001). The Graded Response Model statistics demonstrated one underlying latent factor, fear of falling. This study supports the use of both tools for thorough FOF measurement.

PURPOSE: The purpose of this qualitative focus group elicitation research study was to explore teen driver perceptions of peer passengers and driver inattention. DESIGN & METHODS: We utilized focus groups for data collection and content analysis to analyze the data, both of which were guided by the theory of planned behavior. We conducted 7 focus groups with 30 teens, ages 16-18, licensed for ≤1year to examine attitudes, perceived behavioral control, and norms related to driving inattention and peer passengers. RESULTS: The sample was 50% male, mean age 17.39 (SD 0.52) with mean length of licensure 173.7days (SD 109.2). Three themes emerged: 1) "Good and not good" passengers; 2) Passengers and technology as harmful and helpful; and 3) The driver is in charge. CONCLUSIONS: While passengers can be a source of distraction, our participants also identified passenger behaviors that reduced risk, such as assistance with technology and guidance for directions. PRACTICAL IMPLICATIONS: An understanding of teens' perceptions of peer passengers can contribute to the development of effective interventions targeting teen driver inattention. Nurses are well-positioned to contribute to these teen crash prevention efforts.Copyright © 2016 Elsevier Inc. All rights reserved. Language: en

Aim In hemodialysis patients, the need to have intercurrent sodium and water intake removed by ultrafiltration increases disease burden through the symptoms and signs that occur during hemodialysis (HD). This added burden may be mitigated by reduction of dietary sodium intake. The National Kidney Foundation (NKF) recommends 2400 mg of dietary sodium daily for patients on HD, and the American Heart Association (AHA) suggests 1500 mg, evidence is lacking, however, to support these recommendations in HD. Moreover, little is known about the relationship of specific levels of dietary sodium intake and the severity of symptoms and signs during ultrafiltration. Our goal will be to determine the effects of carefully-monitored levels of sodium-intake as set forth by the NKF and AHA on symptoms and signs in patients undergoing (HD). Methods We designed a three-group (2400 mg, 1500 mg, unrestricted), double blinded randomized controlled trial with a sample of 42 HD participants to determine whether 1. Symptom profiles and interdialytic weight gains vary among three sodium intake groups; 2. The effect of HD-specific variables on the symptom profiles among the three groups and 3. Whether total body water extracellular volume and intracellular volume measured with bioimpedance varies across the three groups. We will also examine the feasibility of recruitment, enrollment, and retention of participants for the five-day inpatient stay. Conclusion Curbing dietary sodium intake may lead to improvement in intradialytic symptom amelioration and potential for better long-term outcomes. Generating empirical support will be critical to ascertain, and espouse, the appropriate level of sodium intake for patients receiving HD.

Racial discrimination is a ubiquitous experience for Black adolescents; it has been linked to poorer psychological outcomes including higher depressive symptoms and lower self-esteem. However, the mechanisms through which racial discrimination is associated with psychological well-being are still not well understood, particularly among Black early adolescents. The current study investigated two dimensions of racial discrimination: racial discrimination frequency (RDfreq) and racial discrimination stress (RDstress). Specifically, we explored the prevalence of RDfreq and RDstress among Black youth and whether RDstress mediated the association between RDfreq and psychological well-being. Seventy-four Black middle school students (68.1% female; mean age = 12.1) completed self-report questionnaires assessing RDfreq, RDstress, depression, and self-esteem; 72 were included in the final analyses. Mediation analyses were conducted using bootstrapping. Ninety percent of the sample reported experiencing some type of racial discrimination and 99% reported that these experiences bothered them. Controlling for age, gender, and ethnicity, RDstress partially mediated the relationship between RDfreq and depression. Study findings elucidate one pathway in which racial discrimination influences psychological well-being.

Background Fatigue is a common symptom in patients with pulmonary arterial hypertension (PAH); however, the impact of fatigue on daily physical activity in PAH is unknown. Accelerometry is a validated measure for assessing physical activity. We hypothesized that patients with PAH reporting higher levels of fatigue would have lower daily physical activity measured by accelerometry. Methods We performed a prospective cohort study of 15 women with PAH. On day 1, subjects completed the Multidimensional Fatigue Inventory (MFI), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR), and a 6-min walk test. Subjects wore the accelerometer on their dominant hip and completed an activity diary for 7 days. On day 15, subjects repeated the MFI and the US CAMPHOR, and then wore the accelerometer and completed an activity diary for an additional 7 days. All multivariate analyses were adjusted for age, BMI, and PAH type. Results The mean age was 50.5 years, and 53% had idiopathic or heritable PAH. During the 2 weeks, subjects were mostly sedentary (85% of the time), although 10% of their time was spent performing low-level activity. Lower average daily counts were associated with worse self-reported energy levels, whereas less day-to-day physical activity variability was associated with more self-reported mental fatigue, physical fatigue, and total activity. Higher percentage of activity bouts was also associated with worse energy. Conclusions Women with PAH may spend most of their time being sedentary, and lower self-reported energy levels are associated with less daily activity. Interventions to improve symptoms such as fatigue may also increase physical activity levels in PAH.

Introduction Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk. The objective of this study was to deploy an initial study of a web-based intervention (Let’s Choose Ourselves) designed to improve adolescent driver attention to the roadway. Methods We used a randomized controlled trial design in a sample of adolescent drivers to test if a web-based intervention decreased cell phone engagement in driving simulation at 3 months as compared with controls. As secondary hypotheses, we tested if the intervention increased the use of peer passengers to manage distractions and decreased eyes off the forward roadway in driving simulation and decreased self-reported risky driving behaviors. Adolescents, aged 16-17 years, licensed for ≤90 days were randomized to Let’s Choose Ourselves with distractions in the simulator protocol at baseline, Let’s Choose Ourselves with no distractions, an attention control intervention on healthy eating with distractions, or attention control with no distractions. We used Poisson regression modeling to test the primary and secondary hypotheses. Results The trial included 60 adolescents (66.7% female, 78.3% non-Hispanic white subjects, mean age 16.8 years, licensed 50.8 days). In Poisson regression, controlling for sex, we found no significant effects of Let’s Choose Ourselves on primary or secondary outcomes. However, there was a significant effect of visit on self-report outcomes, with self-reported distracted driving behaviors increasing over time. Discussion Although there were no significant effects of Let’s Choose Ourselves, self-reported risky driving behaviors increased over time. Further investigation of the relationship between driving experience and increasing inattention to the road in adolescents is warranted.

Background: Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system—specifically reproductive health-related encounters—have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study. Methods: We performed a secondary analysis of cross-sectional data from the third wave of the Chicago Health and Life Experiences of Women (CHLEW) Study, a longitudinal study of SMW in the Midwestern United States. We performed multivariable logistic regression to address the study aims, restricting the sample to women ages 21–45 (n = 430). Results: Reporting a previous pregnancy was consistently positively associated with past-year Pap testing. In the multivariable model, bisexual identity and disclosing one's sexual orientation to healthcare providers were also positively associated with past-year Pap test. Conclusions: This analysis provides preliminary evidence that SMW who have been pregnant are more likely to receive Pap testing and that multiple sociodemographic factors are likely to impact screening in this population. Clinicians should screen all patients with a cervix for cervical cancer and should encourage screening for all SMW. Future studies should prioritize longitudinal analyses to examine the temporality of reproductive history and healthcare seeking, focus on where SMW seek care, and understand how intersecting components of identity may shape the healthcare utilization of this population.

Objectives To explore whether patient's personal beliefs about inhaled corticosteroid (ICS) and integrative medicine (IM) are discussed at routine primary care visits for asthma. Background Negative medication beliefs and preferences for IM can be salient barriers to effective asthma self-management. Method A qualitative analysis of transcripts from 33 audio-recorded primary care visits using conventional content analysis techniques. Results Four themes emerged when providers had knowledge of patient's beliefs: negative ICS beliefs, IM use for asthma, decision-making and healthy lifestyles. Two themes were identified when providers did not have this knowledge: asthma self-management and healthy lifestyles. Conclusion When providers had knowledge of their patient's IM endorsement or negative ICS beliefs, they initiated conversations about these modifiable beliefs. Without training in IM and in effective communication techniques, it is unlikely that providers will be able to effectively engage in shared decision-making aimed at improving asthma self-management.

Background Nursing students practicing in healthcare settings may increase risks to consumers, if impaired by drugs and/or alcohol, and are incapable of practicing safely. Several agencies implemented educational/professional policies, designed to protect healthcare consumers from risks. Policies addressing impaired nursing students vary among these agencies, and no nationally implemented policy exists for the treatment of impaired nursing student practice in the United States. Purpose This scoping study synthesizes substance abuse policy among nursing students, guided by the research question: What professional and state policies exist to address substance abuse among U.S. nursing students? The broader term, substance abuse, was used because alcohol-specific policies were not identified. Methods Evidence was drawn from several policy documents identified through electronic sources that include national nursing organizations (NNOs) and nurse practice acts (NPAs) and rules. A comparative analysis was conducted on the identified policies to determine similarities and differences at the national and state levels and between national and state levels. Results Four NNO policies, 50 U.S. states, District of Columbia, and two U.S. territories' NPAs were selected for review based on selection criteria. Six areas were identified in NNO policies, and four were identified in NPAs that addressed chemically impaired nursing students. Conclusions This review of current policy provided evidence that identifies and describes areas of concern. Impaired nursing practice, which includes nursing students, remains a major issue, complicated by the inconsistencies noted particularly within the reviewed NPAs. Knowledge gained from this review will be used to guide future research and subsequent state policy development.

Virginity is part of our existence in the world as embodied sexual subjects. While many meanings are associated with virginity, in most of the Arab world virginity relates to the presence of a hymen and extends to encompass the honor of the Arab community, and virginity loss commonly relate to first vaginal intercourse. This study explored the meanings of virginity from the perspectives of Arab and Arab American women. A qualitative phenomenological approach, informed by the philosophy of Maurice Merleau-Ponty, was used to conduct in-depth interviews with ten women. We identified one over-arching theme Virginity as Identity, and two major themes Embodiment of Virginity and “We are Arabs.” To reach an embodied virginity, participants went through a disembodied virginity process, reflecting society’s perceptions and values of virginity related to anatomical presence of a hymen and society’s honor. “We are Arabs” describes the ways women identified with the Arab ethnic identity as a shared overall identification, but differed from one lived experience to another, and influenced how participants embodied virginity. Our participants provided a better understanding of the diverse meanings of virginity that move beyond the binary of virginity and virginity loss, and into a spectrum of embodied meanings. Findings suggest the need for future research around sexuality in Arab Americans with attention to socio-political contexts in order to understand the nature and context of sexual initiation and its impact on sexual behaviors and well-being.

Background The self-reported prevalence of alcohol use among U.S. college students decreased from 90.5% in 1980 to 79.2% in 2012. National efforts exist to reduce alcohol misuse among college students in the United States, yet little research addresses substance abuse among nursing students and even less addresses alcohol misuse. Alcohol misuse in nursing students may result in patient harm. Purpose This scoping study describes the state of the science of alcohol misuse among nursing students, guided by the research question: "What is the current state of alcohol misuse among U.S. nursing students?" Methods Evidence was drawn from several scholarly sources. Articles were included if they addressed U.S. nursing students; alcohol misuse; substance abuse or chemical impairment; prevalence rates; and/or characteristics including nursing student behaviors, attitudes, and beliefs. Using thematic analysis, common themes were extracted, followed by hand coding those themes and using NVivo qualitative software. Results Six studies met inclusion criteria. Three themes, eight subthemes, and several gaps in knowledge were identified. The themes include "high prevalence exists," "necessity of supportive environments," and "hopelessness without policies." Subthemes include "root cause," "vulnerable population," "scholarship and substance use," "education," "identification of risk factors," "prevention and deterrents," "safety," "ethical and legal issues," and "consequences." Conclusions On the basis of this analysis, several research questions were developed to explore alcohol misuse in this population. Alcohol was the most often used substance. Nursing students were unaware of a safe level of consumption and the potential negative health-related and professional effects associated with alcohol misuse.

Background Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults. Objectives This mixed-methods study (1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and (2) evaluated the clinical utility of the tool as a communication prompt in primary care. Methods Comprehensive literature reviews and content experts identified candidate items for our instrument that were distributed to 304 subjects for psychometric testing. In the second phase content analysis of 33 audio-recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. Results Psychometric testing of the instrument identified 17 items representing ICS beliefs (α = .59) and CAM endorsement (α = .68). Test-retest analysis demonstrated a high level of reliability (intraclass correlation coefficient = 0.77 for CAM items and 0.79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma ( P = .04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. Conclusion Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence might be a leveraging tool to change the content of communications during clinic visits.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has promise as a clinical intervention for health-compromising behaviors. We used a randomized controlled design in an Emergency Department (ED) setting to determine the efficacy of a nurse-delivered SBIRT to address risky driving in people 18 to 44 years of age. Risky drivers ( n = 476) were randomized to brief intervention (BIG), contact-control (CCG), or no-contact-control (NCG) groups and were followed at 3, 6, 9, and 12 months. Outcomes included safety belt use, speeding, and driving through traffic lights. Safety belt use, times speeding between 10 and 19 mph over speed limit, and times driving through a yellow light declined significantly in the BIG as compared with the CCG at 3, 6, and 9 months. SBIRT reduced risky driving in our sample, but its effects did not persist after 9 months. We suggest that SBIRT has the potential to reduce vehicular-related injury in the 9 months after a brief intervention.

Anhedonia presents itself in a myriad of disease processes. To further develop our understanding of anhedonia and effective ways to manage it, the concept requires clear boundaries. This paper critically examined the current scientific literature and conducted a concept analysis of anhedonia to provide a more accurate and lucid understanding of the concept. As part of the concept analysis, this paper also provides model, borderline, related, and contrary examples of anhedonia.

Caregivers' stress following a family member's stroke is likely accentuated by its associated uncertainty. The purpose of the current study was to examine the effect of uncertainty on caregivers' perceived and physiological stress (i.e., salivary cortisol). A prospective, longitudinal observational study was conducted with a convenience sample of 40 caregivers and stroke survivors recruited from acute care settings. Linear mixed models were used. Greater uncertainty was associated with higher perceived stress ( p < 0.001), but not with physiological stress ( p = 0.32 on waking, p = 0.06 evening), over the first 6 weeks post-stroke. A significant association between uncertainty and evening salivary cortisol level was found at 6 weeks post-stroke ( p = 0.009). Recognition of uncertainty early in the caregiving period and targeted interventions may be useful in reducing perceived stress for this group. [ Journal of Gerontological Nursing, 43 (11), 30–40.]

Problem identification Arab American women are an ethnic minority and immigrant population in the United States with unique and nuanced sociocultural factors that influence preventive health behaviors. The aims of this article are to evaluate and synthesize the existing evidence on cervical cancer screening behaviors, as well as determine factors that influence these behaviors, among Arab American women. . Literature search Extensive literature searches were performed using PubMed, CINAHL®, Scopus, Embase, and Cochrane databases; articles published through October 2015 were sought. . Data evaluation Of 17 articles, 14 explicitly identified Arab and/or Muslim women and cervical cancer screening in either the title or the abstract; the remaining three focused on cancer attitudes and behaviors in Arab Americans in general but measured cervical cancer screening. Eleven articles reported different aspects of one intervention. Because of methodologic heterogeneity, the current authors synthesized results narratively. . Synthesis Key factors influencing cervical cancer screening were identified as the following. Conclusions Cervical cancer screening rates among Arab American women are comparable to other ethnic minorities and lower than non-Hispanic White women. Findings are inconsistent regarding factors influencing cervical cancer screening behaviors in this underrepresented group. . Implications for research Significant need exists for more research to better understand cervical cancer prevention behaviors in this group to inform culturally relevant interventions. Healthcare providers play a crucial role in increasing cervical cancer screening awareness and recommendations for Arab American women.

Emergency departments (ED) are a point of care for many young adults and may provide a teachable moment leading to behavioral change. We determined the descriptive epidemiology of health-compromising behaviors in the young adult ED population by computing demographic-adjusted estimates of prevalence and frequency of hazardous drinking, risky driving, cigarette smoking, fast-food consumption, lack of exercise, and sleep deficit. We screened 8,815 young adults during an ED visit. Younger males had higher levels of fast-food and cigarette consumption. Non-Whites and females reported more days of little to no exercise. Whites and older individuals reported more nights of less sleep. Younger Whites reported consuming the most alcohol, with males consuming more than females. Risky driving was more frequent among younger males. Prevalence of health-compromising behaviors varied by demographics, but was higher than in the general population. Prevention strategies such as implementing a teachable moment in the ED may hold promise to reduce health-compromising behaviors.

This chapter reviews the genital injury prevalence, location of genital injury, injury in consensual intercourse, documentation, common definition of genital injury pattern, skin color, and best practice. It outlines the forensic examination, and treatment as well as collection of evidence from a victim of sexual assault. Examination after sexual assault is needed for early intervention, and treatment of physical injuries and for the purpose of collection of transferred forensic evidence from the victim’s body. Detection and management of genital injury is important from both a health care and a criminal justice standpoint. Genital injury prevalence is calculated by using the frequency of genital injury in a given population. Following sexual assault, the prevalence of genital injury varies by examination type and ranges from 5% on direct visualization. Sexual Assault Response Teams are collaborative groups that bring together multidisciplinary sexual assault stakeholders to improve the community response to sexual assault.

Migration across international borders places tremendous stress on immigrant families and may put women at greater risk for intimate partner violence. In this study, we used narrative analysis methods to explore how nine Mexican immigrant women in the Northeastern United States described their experiences of intimate partner sexual violence, and how these stories were embedded within narratives of transition and movement across borders. We identified three major themes: The Virgin and the Whore, The Family, and Getting Ahead. We share important implications for researchers and health and social service providers working with this population.

Background Rates and frequencies of alcohol consumption remain unknown among nursing students, and risk and protective factors associated with alcohol misuse are poorly understood. Nursing curricula often lack content on substance use disorders among nurses, which is reported to begin prior to or during college. Purpose The aims of the study were to examine nursing students' perceptions of the risk and protective factors associated with alcohol behaviors among themselves and their peers and to identify substance use policies and their influence. Methods We used the Photovoice method, which employs participatory action research. Participants were screened for alcohol misuse via AUDIT-C, and thoughts and perceptions were obtained regarding their alcohol consumption behaviors through self-expression and group advocacy. Data were collected from four focus groups that included nine undergraduate nursing students. Results Data reflected the following key issues: stress, environmental influences, societal acceptance, and availability of alcohol. Participants identified that the following problems place them at risk for alcohol misuse: lack of addiction/alcohol education; nursing program expectations increase stress/anxiety; unhealthy habits, social isolation, and individual influences; peer influence/the college experience; and ineffective and unenforced campus policies. Protective factors included university policies; life experiences; and nursing program policies, responsibilities, peer influences, and perceived reputation. Conclusion This action research informed a dialogue with colleagues regarding nursing students' stressors and resulting professional ramifications. Recommendations for future work include investigation of expressed social isolation from university peers and its effects on their alcohol consumption behaviors and increase alcohol education with emphasis on adaptive coping strategies in a stressful professional role in Bachelor of Science in Nursing curricula.

The background of this article is that assessment and quantification of skin color is important to health care; color is one indicator of overall health and is linked to oxygenation, tissue perfusion, nutritional status, and injury. The purpose is to describe how skin color varies across racial/ethnic groups so that the information can be applied to clinical practice. The method used is cross-sectional, descriptive design ( n = 257). We recorded self-defined race/ethnicity and used a spectrophotometer to measure skin color at two anatomic sites. Skin color variables included L* (light/dark), a* (red/green), and b* (yellow/blue). As regards results, we found significant differences in L*, a*, and b* values by site and race/ethnicity in White, Asian, and Biracial participants. L*: F(3, 233) = 139.04, p < .01 and F(3, 233) = 118.47, p < .01. Black participants had significantly lower mean L* values and wider ranges of L*, a*, and b* as compared with other groups. In regard to application, these findings suggest that clinicians and researchers should plan and provide care based on skin color, rather than race/ethnicity.

Skin is the primary interface between health care providers and patients and is assessed clinically to predict physiological stability or instability. The biomechanical properties of human skin, most notably elasticity and viscoelasticity, are critical to its protective function. In this article, the authors describe the physiological basis for skin elasticity and viscoelasticity. The authors discuss the role of viscoelasticity in nursing science and consider avenues for scientific exploration of the skin’s biomechanical properties, including applications in pressure ulcer research, injury, and healing. They also discuss the Cutometer® as one option for measurement of viscoelasticity in clinical and bench research protocols.

To estimate federal dollars spent on critical care research, the cost of providing critical care, and to determine whether the percentage of federal research dollars spent on critical care research is commensurate with the financial burden of critical care.The National Institutes of Health Computer Retrieval of Information on Scientific Projects database was queried to identify funded grants whose title or abstract contained a key word potentially related to critical care. Each grant identified was analyzed by two reviewers (three if the analysis was discordant) to subjectively determine whether it was definitely, possibly, or definitely not related to critical care. Hospital and total costs of critical care were estimated from the Premier Database, state discharge data, and Medicare data. To estimate healthcare expenditures associated with caring for critically ill patients, total costs were calculated as the combination of hospitalization costs that included critical illness as well as additional costs in the year after hospital discharge.Of 19,257 grants funded by the National Institutes of Health, 332 (1.7%) were definitely related to critical care and a maximum of 1212 (6.3%) grants were possibly related to critical care. Between 17.4% and 39.0% of total hospital costs were spent on critical care, and a total of between $121 and $263 billion was estimated to be spent on patients who required intensive care. This represents 5.2% to 11.2%, respectively, of total U.S. healthcare spending.The proportion of research dollars spent on critical care is lower than the percentage of healthcare expenditures related to critical illness.

PROBLEM: Intimate partner violence (IPV) is a serious social problem that affects all members of a household. Approximately 22% of violent crimes perpetrated against women and 3% against men are related to IPV, and often children witness these crimes. This paper addresses the evidence related to the short- and long-term consequences on the physical, psychosocial, and emotional status of child witnesses. METHODS: A systemic review and analysis of the literature was performed with 24 articles from 2000 to 2010 that were identified through electronic search strategies. FINDINGS: Differences were found in the behaviors of children who witness and do not witness IPV that have short- and long-term consequences and affect relationships with same-sex peers, dating partners, and future partners with a clear pattern of dose-response. CONCLUSIONS: Healthcare providers can implement theoretically driven, gender and culturally appropriate interventions for children with a history of IPV exposure with outcomes that positively affect the lives of children. Language: en

Writing for publication is a fulfilling activity that strengthens our discipline by building the knowledge we need for practice. Most writing teams work in a collaborative manner to determine authorship credit depending on the relative intellectual contributions of each author. Written memos of understanding at the beginning of a project help to clarify roles and ensure appropriate recognition for all contributors. By respecting the importance of intellectual property, nurse authors can ensure that an entire writing team can receive the benefits of publishing together in peer-reviewed journals.

We estimated the societal costs imposed by and the relative contributions of risky driving, drinking-driving, and substance use among young adults visiting a large urban emergency department who exhibited both high-risk driving and problem drinking.Emergency department patients aged 18 to 44 who screened positive for risky driving and problem drinking (n = 275) were surveyed regarding driving behaviors, substance use, injuries, work absences, health care utilization, legal problems, and traffic crashes over the previous year. These data, supplemented by police crash reports, were used to estimate costs. Univariate and multivariate regressions tested for associations between costs (logarithmically transformed) and risky driving, drinking-driving, and substance use.Societal costs related to driving behavior and substance use averaged $19,342 per person, annually. One in 4 individuals had experienced a mild or moderate injury in the prior year, but no one in our sample had been involved with a severe injury or fatality. One in 5 had been in a crash in the prior year. Risky driving was significantly associated with higher health care costs in multivariate models and with total costs in univariate and multivariate models. Alcohol use was associated with increased injury and crash costs. Drinking-driving was not associated with increased costs in multivariate models but was associated with reduced health care costs. A one standard deviation increase in risky driving was associated with increased health care costs of $159 and increased total costs of $1306 per person, annually.Risky driving imposes significant costs, even controlling for substance use and drinking-driving. Interventions to reduce risky driving may be cost-saving to society.