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Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer, caregivers, and clinicians has gained more attention and importance, yet few articles have systematically examined SDM, specifically in the adult oncology population. This review aims to explore SDM within the oncology literature and help identify major gaps and concerns, with the goal to provide guidance in the development of clear SDM definitions and interventions.We conducted a scoping review using the Arksey and O'Malley approach along with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in four databases that included publications since 2016.Of the 364 initial articles, eleven publications met the inclusion criteria. We included articles that were original research, cancer related, and focused on shared decision making. Most studies were limited in defining SDM and operationalizing a model of SDM. There were several concerns revealed related to SDM: (1) racial inequality, (2) quality and preference of the patient, caregiver, and clinician communication is important, and (3) the use of a decision-making aid or tool provides value to the patient experience.Inconsistencies regarding the meaning and operationalization of SDM and inequality of the SDM process among patients from different racial/ethnic backgrounds impact the health and quality of care patients receive. Future studies should clearly and consistently define the meaning of SDM and develop decision aids that incorporate bidirectional, interactive communication between patients, caregivers, and clinicians that account for the diversity of racial, ethnic, and sociocultural backgrounds and preferences.

OBJECTIVE: Rural public libraries have been proposed as ideal locations from which individuals can access a telemedicine visit, but limited adoption of this practice suggests significant barriers remain. The purpose of this study was to determine rural public librarians' perspectives on the benefits and barriers to offering patrons the ability to use their public library for a telemedicine video visit, and to suggest strategies for moving this practice forward. DESIGN: Qualitative content analysis. SAMPLE: Fifteen rural US librarians and library directors. MEASUREMENTS: Individual interviews were conducted to determine perspectives on the benefits of and barriers to implementing telemedicine in public libraries. RESULTS: We identified four themes from the data: rural public libraries increase healthcare access in a trustworthy location, librarians are supportive of telemedicine, but have concerns, limited resources drive barriers to telemedicine implementation in rural libraries, and small rural libraries continued in-person service during the COVID-19 pandemic. CONCLUSION: Rural public libraries can be an important part of achieving equitable access to care, particularly with regard to chronic disease management in rural populations. Rural public health nurses can be instrumental in promoting collaborations between local libraries and regional health systems that may help libraries overcome financial barriers to this practice.

Purpose: Rural residents are less likely to engage in cancer risk-reduction behaviors than their urban counterparts. Rural cancer disparities may be related to limited access to and comprehension of cancer-related health information. The object of this study was to identify how rural residents access and understand cancer health promotion and prevention information. Sample: Twenty-seven residents of Central Virginia Methods: We used a qualitative design with semi-structured interviews and a focus group (n=27) with rural and non-rural residents living in Central Virginia to accomplish the study aim. Findings: Four themes were identified from the data: 1) non-rural Central Virginia residents seek health information from a variety of electronic sources, 2) rural Central Virginia residents typically seek health care information directly from health care professionals, 3) residents throughout Central Virginia encounter confusing health care information, and 4) rural residents report incorrect cancer-related information. Conclusions: Lack of internet access coupled with healthcare shortages may limit the ability of rural residents to contextualize and verify inaccurate health information. Nurses serving a rural population should consider assessing each rural patient’s internet access and disseminating printed cancer health promotion materials to rural clients without internet access. Keywords: rural health; healthcare disparities; access to care; cancer health promotion; health literacy; cancer DOI: https://doi.org/10.14574/ojrnhc.v21i1.663

Aim: The aims of this analysis are to (1) identify the concept of rural resiliency in cancer survivors in the nursing literature and (2) propose a conceptual framework that may help nurses leverage rural resilience to improve survivorship care. Background: Rural cancer survivors demonstrate rural resiliency by utilizing aspects of rural culture to improve their psychosocial distress. However, resiliency in rural cancer survivors is poorly understood. Design: We used Walker & Avants’ concept analysis approach to direct article selection, review, and analysis. Review methods: We identified a definition, antecedents, consequences, attributes, empirical referents, and related terms, and provide model, contrary, and borderline case examples. Results: We identified 29 articles that met inclusion criteria. We propose a conceptual model of rural resiliency that is grounded in three domains of rural culture: spirituality, cultural norms, and social capital. Attributes of rural culture within these domains impact a cancer survivor’s psychosocial health, leading to either negative or positive psychosocial outcomes. Conclusion: A better understanding of how rural resiliency impacts cancer survivors can help clinicians and researchers provide culturally-targeted post-treatment interventions. Our proposed conceptual framework may guide nurse researchers to develop measurement tools that evaluate rural resilience and its impact on health outcomes. Keywords: rural, cancer survivor, resilience, concept analysis, conceptual frameworkDOI: https://doi.org/10.14574/ojrnhc.v21i1.676

Specimen contamination generates unreliable results, leading to potential misdiagnosis and improper treatments. The purpose of this multidisciplinary continuous quality improvement project was to implement an evidence-based diagnostic stewardship program to reduce urine specimen contamination rates. We conducted educational in-service sessions introducing a 3-step preanalytical protocol within the emergency department. Pre- and postintervention chart review was used to evaluate the impact on urine contamination. Urine culture contamination rates were significantly reduced between the pre- and postintervention phases (χ2 = 3.78, P = .05). An evidence-based preanalytical protocol supplemented with an educational intervention reduced the contamination of urine specimens.

Diagnosing delirium in hospice patients is challenging owing to the multifactorial causes and symptoms of delirium that can mimic natural end-of-life processes. When delirium goes unrecognized in hospice patients, preventable causes can be left untreated, leading to sequelae that are misaligned with the principles of hospice care. We conducted an evidence-based quality improvement project on a 10-bed inpatient hospice unit aimed at increasing nursing staff knowledge about assessing delirium, with a focus on preventable causes. Nurses were trained in use of the Nursing Delirium Screening Scale, which was implemented over a 5-week period. Increases in knowledge were evaluated with a pretest and posttest. We used a paired t test to determine knowledge improvement. Use of the tool was evaluated using a survey. Nurses demonstrated significantly improved knowledge after the educational session (P = .009). Survey results indicated overwhelmingly that nurses valued having an easy-to-use tool to assess delirium in their patients. Because we used a paper-based tool during the project, which was found to be cumbersome by staff, our next steps are to determine the feasibility of implementing the tool into the electronic medical record.

In the U.S., those who lack broadband internet have limited ability to connect to care providers over a telemedicine video visit (VV). During the coronavirus disease pandemic, VVs have become incre...

Objective Ongoing environmental changes increasingly require public health nurses to understand how environmental factors impact the health of populations. One approach to researching these impacts is incorporating environmental research methods to determine associations between harmful exposures and health. We use the Salton Sea in Southern California as a demonstration of how environmental exposure can be examined using air parcel trajectory analysis. Design We demonstrate a methodology for public health nurses to better understand and apply data from the Hybrid Single-Particle Lagrangian Integrated Trajectory meteorological model to estimate the effect of airborne particulate matter from a single source. Measurements We explain a method for tracking air parcel trajectories to populations: selection of meterological data to identify air parcels, geographic identification of population centers, generation of trajectories, classification of trajectory dispersions, adjusting for atmospheric stability, and merging environmental variables with health data. Conclusions Climate change-related environmental events are expected to become more commonplace and disproportionately affect those populations impacted by health disparities. Public health nurses can identify communities at risk so that public health nursing researchers can use these techniques in collaboration with environmental science to robustly examine health effects of proximal air pollution sources for communities at risk.

Rural cancer survivors have worse quality of life than their urban counterparts. Telemedicine is a potential solution to connecting rural residents with specialized cancer providers during the survivorship period, but limitations in broadband may stifle the impact. Using data from a feasibility study evaluating a telemedicine intervention aimed at connecting rural Virginia cancer survivors with their care team located at a cancer center associated with an academic medical center, we sought to evaluate the ability of rural survivors to access the intervention and suggest strategies for improving access to rural cancer survivorship care. We used a descriptive design with geospatial and quantitative methods to understand broadband access, driving time to a satellite telemedicine site, and ability to utilize a borrowed cellular-enabled tablet to participate in the intervention for cancer survivors living in Central Virginia. Our study participants resided in census tracts where an average of 58% of households have adequate broadband access necessary to support a telemedicine videoconferencing intervention. Average driving time to the nearest telemedicine site was 29.6 min. Those who utilized the borrowed tablet experienced considerable difficulty with utilizing the technology. Rural cancer populations do not have equal access to a cancer survivorship telemedicine intervention. Telemedicine interventions aimed at connecting cancer survivors with their academic medical center-based cancer providers may be ineffective if survivors do not have access to either fixed broadband or a satellite clinic. Future research needs to evaluate other sites from which rural survivors can connect, such as rural public libraries.

Background Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities. Methods County- and city-level cross-sectional data for 2011–2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression. Results For incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region. Conclusions Rurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.

ObjectivesEven when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. During our telemedicine-delivered intervention aimed at identifying rural survivors with high distress and connecting them with psychosocial care, fewer than 1/3 of those with high distress accepted a referral. The purpose of this research was to examine the reasons rural cancer survivors did not accept a psychosocial referral.MethodsWe utilized a qualitative descriptive design to analyze data from interviews conducted with participants who had been offered a psychosocial referral during the intervention. Interviews were conducted 6 weeks following the intervention (n=14) and 9 months after the completion of the intervention (n=6).ResultsUltimately, none of the rural cancer survivors in our study engaged with a psychosocial care provider, including those who had originally accepted a referral for further psychosocial care. When explaining their decisions, survivors minimized their distress, emphasizing their self-reliance and the need to handle distress on their own. They expressed a preference for dealing with distress via informal support networks, which was often limited to close family members. No survivors endorsed public stigma as a barrier to accepting psychosocial help, but several suggested that self-stigma associated with not being able to handle their own distress was a reason for not seeking care.Significance of ResultsRural cancer survivors’ willingness to accept a psychosocial referral may be mediated by the rural cultural norm of self-reliance, and by self-stigma. Interventions to address referral uptake may benefit from further illumination of these relationships as well as a strength-based approach that emphasizes positive aspects of the rural community and individual self-affirmation.

Current research suggests that for certain types of gastrointestinal endoscopes, longer shelf life (the interval of storage after which endoscopes should be reprocessed before their reuse) may not increase the likelihood of endoscope contamination. Scope contamination may, in fact, be related primarily to either inadequate disinfection processes or inadvertent contamination during storage, not to duration of storage. The purpose of this study evaluated the presence of bacteria and fungus following liquid chemical sterilization in colonoscopes and gastroscopes, after 12 weeks of shelf life during which time personal protective equipment was used during endoscope storage cabinet access. We stored four colonoscopes and two gastroscopes in a cabinet for 12 weeks after liquid chemical sterilization and the cabinet was only accessed during the 12-week period wearing personal protective equipment (gown and gloves). Scopes were tested for bacteria and fungus at the end of 12 weeks. No bacteria or fungus grew on any of the scopes. This study provides further support that contaminated endoscopes may be related to either inadequate disinfection or contamination during storage, not shelf life.

Objective To explore the relationship between well-child visit (WCV) attendance during early childhood and age at autism spectrum disorder (ASD) diagnosis using data drawn from a statewide all-payer claims database. Study design We used a correlational study design with longitudinal data drawn from the Virginia All-Payer Claims Database. All children born in 2011 with a diagnosis of ASD were included (n = 253). Survival analysis determined the impact of WCV attendance on ASD diagnosis at each American Academy of Pediatrics-recommended early childhood visit, and the 5-year visit. Results Survival analysis revealed a significant impact of WCV attendance at the 24-month, 3-, and 4-year visits on earlier ASD diagnosis. Children who attended the 24-month visit were diagnosed nearly 10 months earlier than those who did not. Overall, children with ASD attended fewer than 50% of visits during early childhood. Conclusions Promoting consistent WCV attendance during early childhood is an actionable strategy for improving early identification of ASD. Further exploration is needed to determine barriers to visit attendance and the impact of patterns of early childhood WCV attendance on age of ASD diagnosis. Development and implementation of interventions to promote adherence to the American Academy of Pediatrics-recommended visits is needed.

Diagnosing delirium in hospice patients is challenging owing to the multifactorial causes and symptoms of delirium that can mimic natural end-of-life processes. When delirium goes unrecognized in hospice patients, preventable causes can be left untreated, leading to sequelae that are misaligned with the principles of hospice care. We conducted an evidence-based quality improvement project on a 10-bed inpatient hospice unit aimed at increasing nursing staff knowledge about assessing delirium, with a focus on preventable causes. Nurses were trained in use of the Nursing Delirium Screening Scale, which was implemented over a 5-week period. Increases in knowledge were evaluated with a pretest and posttest. We used a paired t test to determine knowledge improvement. Use of the tool was evaluated using a survey. Nurses demonstrated significantly improved knowledge after the educational session (P = .009). Survey results indicated overwhelmingly that nurses valued having an easy-to-use tool to assess delirium in their patients. Because we used a paper-based tool during the project, which was found to be cumbersome by staff, our next steps are to determine the feasibility of implementing the tool into the electronic medical record.

The pediatric population is at a unique and increased risk of immediate and long-term health effects of asthma from air pollution. The years 2012-16 marked the worst drought in California, USA, in ...

Purpose To determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns. Methods We used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors receiving the intervention and a control group (N = 60). We evaluated the impact of the intervention on the number and type of referrals offered and whether or not the participant accepted the referral. CRD was measured using a modified version of the National Comprehensive Cancer Network Distress Thermometer and Problem List. Results Overall, 30% of participants received a referral for further post-treatment supportive care. Supporting the benefits of the intervention, the odds of being offered a referral were 13 times higher for those who received the intervention than those in the control group. However, even among the intervention group, only 28.6% of participants who were offered a referral for further psychosocial care accepted. Conclusions A nursing telemedicine visit was successful in identifying areas of high distress and increasing referrals. However, referral uptake was low, particularly for psychosocial support. Distance to care and stigma associated with seeking psychosocial care may be factors. Further study to improve referral uptake is warranted. Implications for Cancer Survivors Screening for CRD may be inadequate for cancer survivors unless patients can be successfully referred to further supportive care. Strategies to improve uptake of psychosocial referrals is of high importance for rural survivors, who are at higher risk of CRD. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01052-4.

The Imperial Valley region of Southeastern California has become one of the most productive agricultural regions in the state and has the highest rates of childhood asthma in California. Lack of precipitation in the Imperial Valley has caused the water level of the Salton Sea to recede to a record low since its formation in the early 1900s. Previous studies of wind and dust deposition conducted in other regions have shown how reduced precipitation, ground heating, and the diminishing water level in an arid climate pose a risk of exposing previously sequestered toxic chemicals to open air, adversely affecting lung health. The purpose of this study is to draw historical parallels between the Aral Sea and Salton Sea in the context of geomorphology, ecology, human health, economics, and human migration, to inform an assessment of environmentally related health impacts of those living in the Imperial Valley region. Future droughts and heatwaves are expected to rise in frequency and severity, disproportionately affecting those impacted by financial and health disparities. Future research must include the implications of population health in the context of GeoHealth as a result of the most recent drought and the receding water levels of the Salton Sea., Key Points Comparisons between the Imperial Valley in Southern California and the Aral Sea environmental disaster in central Asia may be drawn to identify the potential human health hazardsFinancial and health disparities among local residents who live near the Salton Sea may be exacerbated due to the exposure to airborne toxinsA GeoHealth lens of analysis is warranted in the evaluation of human health and sustainable resource allocation measures within the Imperial Valley region

In the U.S., those who lack broadband internet have limited ability to connect to care providers over a telemedicine video visit (VV). During the coronavirus disease pandemic, VVs have become increasingly common, but are not equitably accessible, which may exacerbate existing health disparities. Widening health disparities are of particular concern in the rural U.S. where broadband is lacking. We term this inequity in healthcare access due to limited internet access the “digital health divide.” Because public libraries typically offer free use of broadband internet to patrons, they can help bridge the digital health divide and assist patrons with VVs. However, no guidelines currently exist for care providers and libraries to implement this needed, but potentially complex undertaking. Individual programs in which community members have used public libraries as a place from which to connect to a VV may offer insight into guidance needed. Thus, we conducted a scoping review to explore interventions reporting use of public libraries for community members to connect to a healthcare provider via telemedicine. One article was found describing the use of a public library for community members to connect to a telemedicine VV. The use of public libraries as spaces from which patrons can participate in VVs with providers is promising, but research is urgently needed to guide implementation.

PurposeChildren should attend well child visits (WCVs) during early childhood so that developmental disorders may be identified as early as possible, and if indicated treatment can begin. The aim of this research was to determine if rurality impacts access to WCV during early childhood, and if altering rurality measurement methods impacts outcomes.Design and MethodsWe utilized a longitudinal correlational design with early childhood data gathered from the Virginia All Payer Claims Database, which contains claims data from Medicaid and the majority of Virginia commercial insurance payers (n=6349). WCV attendance was evaluated against three rurality metrics: a traditional metric using Rural-Urban Commuting Area codes, a developed land variable, and a distance to care variable, at a zip code level.ResultsTwo of the rurality methods revealed that rural children attend fewer WCVs than their urban counterparts, (67% vs. 50% respectively, using a traditional metric; and a 0.035 increase in WCV attendance for every percent increase in developed land). Differences were attenuated by insurance payer; children with Medicaid attend fewer WCVs than those with private insurance.ConclusionsYoung children in rural Virginia attend fewer WCVs than their non-rural counterparts, placing them at higher risk for missing timely developmental disorder screenings. The coronavirus disease pandemic has been associated with an abrupt and significant reduction in vaccination rates, which likely indicates fewer WCVs and concomitant developmental screenings. Pediatric nurses should encourage families of young children to develop a plan for continued WCVs, so that early identification of developmental disorders can be achieved.

IntroductionIn the United States, access to home-based telemedicine is inequitably distributed due to the limited reach of fixed broadband in rural areas. Public libraries typically offer patrons free access to broadband. Libraries, particularly those in rural regions, need to be evaluated as a site for patients to connect to a health care provider over a video visit. The purpose of this research was to evaluate the technological readiness of public libraries to provide telemedicine support and to determine differences in readiness between rural and urban public libraries.MethodsWe distributed a survey to members of the Virginia Library Association to evaluate technological readiness of Virginia public libraries to support telemedicine use in their facilities. The survey evaluated each library’s availability and speed of fixed broadband internet access, physical equipment, and private space.ResultsRespondents from 39 libraries completed the survey, approximately one-third of which were in rural or small urban areas. All respondents reported fixed broadband, at least four computers, and available staff to assist who technology in their libraries. Eighty-five percent of surveyed libraries reported sufficient broadband speed and a private room available to patrons. There were no significant differences between rural and urban status for any of the library characteristics.DiscussionPublic libraries in Virginia are technologically ready to support patrons connecting to health care providers over telemedicine. Systematic guidelines for library-practice collaborations are needed to support implementation across geographic and socioeconomically diverse areas.

The Imperial Valley region of Southeastern California has become one of the most productive agricultural regions in the state. It also has the highest rates of childhood asthma in California. Lack ...

Despite the known developmental benefits of early intervention for autism spectrum disorder (ASD), diagnosis before age 5 years is often not achieved. Research suggests that lack of health insurance and living in rural areas and areas of severe provider shortages contribute significantly to these delays. The purpose of this project was to conduct a geospatial evaluation of potential gaps in early ASD diagnosis of uninsured children in Virginia. A secondary purpose was to show the use of geospatial analysis by pediatric nurse practitioners for policy advocacy. We mapped data from a statewide provider of ASD evaluative services associated with the Virginia Department of Health and found several communities with high numbers of uninsured children where children may not be receiving early diagnostic services. Pediatric nurse practitioners can help address community-level gaps in early identification of ASD for uninsured young children living in rural areas by conducting outreach programs to providers and families within rural communities and concurrently partnering with nurse–scientists to develop visually impactful geospatial analyses to educate legislators and further advocate for policy positions.

Background Gains in cancer detection and treatment have meant that more patients are now living with both cancer and other chronic health conditions, which may become burdensome. We used the Patient Experience with Treatment and Self-Management (PETS) framework to study challenges in self-management and its impact on health among survivors of women’s cancers who are caring for other chronic health conditions. Methods Applicability of the PETS domains among survivors of women’s cancers with comorbidities was assessed in focus groups to create the study survey. Women surviving primary breast, cervical, ovarian, or endometrial/uterine cancer treated between 6 months and 3 years prior at two large healthcare systems in Virginia were mailed study invitation letters to complete a telephone-based survey. The survey included questions on cancer treatment history, comorbid conditions prior to cancer, treatment and self-management experiences, health literacy, financial security, and items on self-management activities, self-management difficulties and self-management impact (i.e., role/social activity limitations and physical/mental exhaustion). Additionally, general health was assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Hierarchical regression models and path analysis were used to examine correlates of self-management impact on general physical health (GPH) and mental health (GMH). Results Of 1448 patients contacted by mail, 274 (26%) returned an interest form providing their consent to be contacted. Of these, 183 completed the survey. Reasons for non-completion included ineligibility (42), unable to be reached (33) and refusal (6). The majority were survivors of breast (58%) or endometrial/uterine cancer (28%), and 45% resided in non-urban locations. After adjusting for age, race, and cancer type, survivors with higher self-management difficulty reported higher self-management impact, which was associated with lower perceived general health. Reports of higher self-management impact was associated with being single or unmarried, white race, fulltime employed, higher financial insecurity, lower health literacy and more comorbidities. In path analysis, self-management impact was a significant mediator in the association of comorbidity and financial insecurity on GPH and GMH. Conclusions Among survivors of women’s cancer, pre-diagnosis comorbidity, health literacy, and financial security are associated with psychosocial impact of self-management and general physical and mental health in the 6 month to 3-year period after cancer treatment has ended. The impact of self-management on psychosocial functioning is an important factor among cancer survivors caring for multiple chronic health conditions. This study provides evidence on the importance of assessing cancer survivors’ self-management difficulties such as in future interventions to promote health and wellness.

Purpose To explore built and natural environment barriers and facilitators to walking for exercise in cancer survivors. Participants & setting Cancer survivors (N = 7) living in rural, suburban, and small urban neighborhoods in central Virginia. Methodologic approach The authors used a qualitative descriptive design with photovoice to explore the cancer survivors' experience with residential walkability. Findings The following three themes were identified from the data. Implications for nursing Clinicians should consider an evaluation of the built and natural environment to support walking in cancer survivors. These findings may be used in conjunction with known individual-level barriers to physical activity to develop guidance for oncology nurses to help survivors safely achieve physical activity goals.

Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on tobacco retailer density and proximity in relation to adolescent smoking, published in peer-reviewed journals between 2004 and 2014. The tobacco retailer density and proximity were correlated with adolescent lifetime smoking, past 12-month smoking, past 30-day smoking, and susceptibility to smoking. School nurses or other school health professionals may need to include the density and proximity of tobacco retailer factors around schools in school-based tobacco-use prevention programs. Health policy makers may need to consider zoning or licensing restrictions of tobacco retailers around schools for adolescent smoking prevention.

The purpose of this research is to explore donors' perspectives on support of nursing excellence in a community hospital.Philanthropic support is rapidly becoming critical to support nursing excellence in hospitals, including continuing education, nursing research, and professional development. However, no research has examined the experience of private donors who support nursing programs in community hospitals.Structured interviews were conducted with individuals with a history of providing significant financial support (gifts$50 000) targeted specifically for nursing in a 176- bed community hospital in the southeastern United States. Analysis was performed using descriptive content analysis.Four themes emerged that centered around making a difference, helping nurses meet new challenges, an existing foundation of service, and valuing excellent nursing care received.This research provides specific information that nursing administrators can use when seeking philanthropic gifts to support nursing excellence programs in US community hospitals.

Purpose Current evidence-based research suggests that early evaluation, comprehensive care plans, and appropriate referrals for childhood and adolescent behavioral and development needs is critical for successful family-centered outcomes. The overall purpose of this study was to conduct an assessment of a state public health program that offers diagnostic evaluation and coordination for children with behavioral and developmental disorders in the state of Virginia (Child Development Center programs, or CDC). A secondary purpose was to provide translational policy and advocacy targets based on key findings. Design and method The evaluation of the scope of services of the CDC programs was done using qualitative interviews with a focus group interview (n = 23), interviews from representatives from individual centers ( n = 5 centers), and descriptive quantitative data elements for the fiscal year 2015. Results After conducting the state public health evaluation, several translational health policy priorities emerged, including: (a) the need for integrated data standards, (b) Lack of developmental pediatric workforce, particularly in rural sectors of the state, and (c) Need for enhanced program support for care coordination. Conclusion Academic nurse and public health partnerships can aid in translation from research to policy among vulnerable populations and assist in communication to key stakeholders and legislators for iterative action and reassessment.

The new Commission on Cancer (CoC) accreditation standards encompass palliative care (PC) and a patient-centered approach, including specific quality measurements and outcomes. However, cancer centers differ in their interpretation of the CoC standards for PC in level of integration in the care trajectory and services provided.The aim of this study was to identify existing barriers in accessing PC services for cancer patients at a National Cancer Institute (NCI)-designated academic cancer center with a rural catchment area, using the CoC guidelines as a point of reference.This study utilized a cross-sectional qualitative design and conventional content analysis. Subjects were faculty/staff from the cancer center or from community affiliates located outside the main campus. Measurement was by semistructured qualitative interviews. Forty-two interviews were included in the final sample: clinicians, administrative support staff, and service support personnel.Four themes were developed from the analysis focusing on barriers to PC integration: (1) fragmentation of services, (2) unclear pathways and triggers for referral, (3) demand exceeds available practitioners, and (4) insufficient or inadequate education for patients and oncology providers.This study highlights aspects of integration of PC that can be enhanced from a process, education, and systems perspective with a particular focus on the care coordination of a rural cancer population.

Researchers interested in measuring neighborhood-level effects should understand how "neighborhood" is defined within nursing sciences and other sciences, and the inherent strengths and weaknesses of current research methodologies. This concept analysis provides clarity around the concept of neighborhood within the context of health, analyzes the current state of development of the neighborhood concept, and proposes areas for future nursing research. Using the Rodger's Method of analysis, the concept of neighborhood within nursing and public health research is described based on existing literature. The concept's attributes, related concepts, antecedents, and consequences are given from the literature. Comparisons of the use of neighborhood are made between nursing, public health, sociology, and other sciences. The evolution of the concept of neighborhood throughout history is described, and important implications for future research are discussed.

Background Despite increasing implementation of survivorship care plans (SCPs), cancer survivors still experience unmet needs post-treatment. Rural, low-income survivors experience less planning for supportive care during treatment, which is difficult to overcome after patients complete treatment. . Objectives This pilot study explores post- treatment survivorship care planning execution, perception, and needs among rural, low-income cancer survivors. . Methods A longitudinal, descriptive, qualitative design with semistructured interviews was used. . Findings Rural survivors' responses reflected lack of knowledge about post-treatment care, including how to assess for cancer recurrence. Delivery of the SCP during the final treatment appointment was inadequate for knowledge retention. Individualized assessment of survivorship needs and education post-treatment may improve long-term health outcomes for this population.

Jessica Keim-Malpass,1,2 Emma M Mitchell,1 Pamela B DeGuzman,1 Mark H Stoler,3 Christine Kennedy,1,2 1School of Nursing, 2Department of Pediatrics, 3Department of Pathology, School of Medicine, University of Virginia, Charlottesville, VA, USA Abstract: State-based policies to mandate HPV vaccination are politically challenging and have received broad criticisms. There is a critical need to understand the legislative activities that underpin subsequent policy implementation. The objective of this policy analysis was to analyze state legislation that focused on HPV vaccination from 2006–2015. A content analysis was conducted among primary sources of legislative data from HPV vaccine-related bills, including using the National Conference of State Legislatures as a search-source. Findings reveal that much of the legislative activity occurred early after the HPV vaccination was introduced, and focused on increased information for parents, public financing, awareness campaigns, etc. Far fewer states focused on voluntary or mandatory vaccination. Understanding the barriers to achieving mandatory vaccination policy and implementation of such policies for HPV vaccines remains a public health priority. Keywords: HPV vaccine, adolescent, policy, legislation

Background In 2009, our facility established the goal that 70% of patients with discharge orders would be discharged by noon. The orthopaedic unit was not meeting this goal but saw an opportunity to standardize the discharge process for total joint replacement patients. Purpose The purposes of this article were (1) to describe the implementation of a discharge brunch and (2) to determine whether the implementation of this discharge brunch led to an earlier discharge time. Methods A discharge brunch with group discharge instruction was implemented on an inpatient orthopaedic unit for patients who had a total joint replacement. Patient data from our electronic medical record, March-December 2012, were used to compare discharge time of patients who attended the brunch with those who did not. Results A total of 392 joint replacement patients were discharged between March and December 2012. Of those, 234 attended the discharge brunch. Patients who attended the brunch were discharged by 11:20 a.m., compared with a discharge time of 1:10 p.m. for those who did not attend the brunch, and more patients who attended the brunch were likely to be discharged by noon than those who did not attend the brunch (76% vs. 39%, p Conclusion Nursing units with standardized discharge teaching should consider implementing a discharge brunch for groups of patients to help achieve goals of discharging patients before noon.

Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on tobacco retailer density and proximity in relation to adolescent smoking, published in peer-reviewed journals between 2004 and 2014. The tobacco retailer density and proximity were correlated with adolescent lifetime smoking, past 12-month smoking, past 30-day smoking, and susceptibility to smoking. School nurses or other school health professionals may need to include the density and proximity of tobacco retailer factors around schools in school-based tobacco-use prevention programs. Health policy makers may need to consider zoning or licensing restrictions of tobacco retailers around schools for adolescent smoking prevention.

Black Americans have disproportionately higher incidence and mortality rates for many cancers. These disparities may be related to genomic changes that occur from exposure to chronic toxic stress and may result from conditions associated with living in racially segregated neighborhoods with high rates of concentrated poverty. The purpose of this article is to present a nursing research framework for developing and testing neighborhood-level interventions that have the potential to mitigate exposure to neighborhood-associated chronic toxic stress, improve individual-level genomic sequelae and cancer outcomes, and reduce cancer health disparities of Black Americans. Public health nursing researchers should collaborate with local officials to determine ways to reduce neighborhood-level stress. Intermediate outcomes can be measured using genomic or other stress biomarkers, and long-term outcomes can be measured by evaluating population-level cancer incidence and mortality.

Purpose: The purpose of this article is to present a framework for nurses to study the impact of built environment on health, particularly in vulnerable populations. Organizing Construct: The framework is adapted from Social Determinants of Health and Environmental Health Promotion, a framework describing how physical and social environments interact to influence individual and population health and health disparities via macro, community-level, and interpersonal factors. Methods: The original framework was modified for public health nursing using nursing research evaluating built environment and health, and supplemented with Nightingale's theory of nursing and health. Findings: The built environment affects health through regional-, neighborhood-, and individual-level factors. Nursing can affect the health of patients by evaluating the neighborhood built environment where patients reside, and by advocating for changes to the built environment. Conclusions: Through development of built environment research, nurses can provide valuable insight into the pathways linking built environment to health of vulnerable populations, providing evidence for public health nurses to advocate for these changes on a neighborhood, state, and federal level. Clinical Relevance: This framework can be used by public health clinicians to understand the pathways by which the built environment may be affecting the health of their patients, and by researchers to investigate the pathways, and to design and test community interventions.

Guidelines recommend aggressive goals for lipid and blood pressure reduction for high risk patients with diabetes mellitus and atherosclerotic coronary disease. However, it remains unclear how many patients achieve treatment goals versus the number of people merely placed on treatment. We conducted an observational study in an academic cardiology clinic. A total of 926 patients with atherosclerotic cardiovascular disease and concomitant diabetes mellitus met criteria. Mean age was 68.4 ± 10.2, 65.6% were male, and 86.8% were Caucasian. By the last visit a high percentage of patients were receiving recommended medications. Mean LDL-cholesterol achieved was 80.4 mg/dl with 40.9% reaching ≤ 70 mg/dl, and 61.7% reaching SBP ≤ 130 mmHg. Many patients with diabetes mellitus and atherosclerotic cardiovascular disease are prescribed recommended medications; however, few achieve guidelines-specified therapeutic goals for LDL-cholesterol and blood pressure. Studies evaluating performance improvement should include percentage of patients reaching treatment goals. Mechanisms underlying the treatment gap need to be identified and addressed.

Health disparities for racial and ethnic minorities have been present in the United States and persist today. NMHCs (Nurse-Managed Health Center), which can serve as “Medical Homes,” are one mechanism by which nurses can attempt to overcome these disparities within communities. In the mid-1960s, Nancy Milio developed and found funding for a NMHC to address disparities in Detroit, Michigan. History shows that the center was so valued by community members that it remained untouched during the Detroit riot of 1967, despite all buildings surrounding it having been burned down or destroyed. This article uses traditional historic methods to describe the establishment of the center in inner-city Detroit in the 1960s in historical context and analyze factors that led to Milio’s success. To address disparities via NMHCs, nurses must be persistent in acquiring funding and should involve a racially and culturally diverse group representative of community members in the development, planning, and ongoing operation of the enterprise.

Despite focused attention on hospital-acquired infections, ventilator-associated pneumonia (VAP) infections and deaths continueto be a problem in U.S. hospitals. Research indicates that protocols are in place across hospitals but actual implementationlags behind. The inconsistencies in protocol implementation may be due to workarounds created during the process of dailyinterruption of sedation (DIS), which is the process of stopping the ventilated patient’s sedation at a prescribed time each day toevaluate the patient’s ability to wean. The purpose of this thematic synthesis of the literature was to understand how nursing andorganizational barriers may affect adherence to DIS protocols in U.S. hospitals. We conducted a search using the CumulativeIndex of Nursing and Allied Health Literature, using terms related to sedation and mechanical ventilation, then coded andcategorized the study findings, and developed themes. Three themes emerged: (1) organizational structure does not influenceDIS at either the hospital or unit level, (2) a collaborative, multidisciplinary culture may be needed to influence changes insedation practices, and (3) the gap between evidence and practice may be due to lack of nursing education and experience. Toimprove outcomes, intensive care units should evaluate the impact of multidisciplinary ventilator rounding teams that includenursing, on DIS adherence and VAP rates, and ensure that nurses are up-to-date on the evidence around all aspects of sedationmanagement.

In 1965, Nancy Milio established a prenatal and family planning clinic in Detroit, Michigan, to address health disparities and limited access to care among low-income, African American, urban women. Women's health disparities persist today nationally and internationally. Using historical methods, this research analyzes how Milio provided women's health services in the context of the social and political environment. Milio empowered neighborhood women to direct, plan, and participate in the care they received. Successful methods to address disparities in access to family and planning and prenatal care should include empowered participation from the women these programs are intending to serve.

The last decade has brought about a synergy of influences for registered nurses to advance their academic preparation. Literature indicates that there is correlation between self-efficacy and goal establishment and success. The purpose of this project was to evaluate the relationship between self-efficacy and advancing academic aspirations of registered nurses. Findings indicated that there was a trend toward a difference in the self-efficacy of nurses who began their career with a diploma or associate degree and went on for academic advancement and those who did not.

OBJECTIVES: The purpose of this research was to determine the impact of two neighborhood walkability (the extent to which the built environment is pedestrian friendly) metrics on health outcomes of women living in low-income urban neighborhoods, both before and after accounting for individual and neighborhood factors. DESIGN AND SAMPLE: A cross-sectional, retrospective design was used. The sample of 1800 low-income women was drawn from Welfare, Children and Families: A Three-City Study (a study of low-income women from three U.S. cities). MEASURES: Using multilevel modeling and geographic information systems, the study sought to determine the effect of distance to public transportation and residential density on health status, mental health symptoms, and health-related limitations. RESULTS: No significant relationship was found between the two walkability metrics and health outcomes. Instead, neighborhood problems that affect crime and safety impacted health status and mental health symptoms. CONCLUSIONS: As cities make changes to the built environment with the hope of affecting residents' health outcomes, public health nurses need to be aware that changing walkability characteristics in a neighborhood may not affect the health of residents of high crime, low-income neighborhoods. Without first addressing neighborhood crime, efforts to improve walkability in low-income neighborhoods may fail. Language: en