White Counselor Trainees\u27 Racial Identity and Working Alliance Perceptions

Racial identity has been theorized to significantly affect cross-racial counseling relationships (Helms, 1984, 1995). This study examined the direct impact of White racial identity of 124 counselor trainees on working alliance formation in a same-racial and cross-racial vicarious counseling analogue. Regardless of the race of the client, disintegration and reintegration attitudes negatively affected working alliance ratings, and pseudoindependent and autonomy attitudes positively affected working alliance ratings. Implications for counseling, supervision, training, and research are discussed

White Counselor Trainees\u27 Racial Identity and Working Alliance Perceptions

Racial identity has been theorized to significantly affect cross-racial counseling relationships (Helms, 1984, 1995). This study examined the direct impact of White racial identity of 124 counselor trainees on working alliance formation in a same-racial and cross-racial vicarious counseling analogue. Regardless of the race of the client, disintegration and reintegration attitudes negatively affected working alliance ratings, and pseudoindependent and autonomy attitudes positively affected working alliance ratings. Implications for counseling, supervision, training, and research are discussed

African American and European American Therapists’ Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads

Using Consensual Qualitative Research, 12 licensed psychologists’ overall experiences addressing race in psychotherapy were investigated, as were their experiences addressing race in a specific cross-racial therapy dyad. Results indicated that only African American psychologists reported routinely addressing race with clients of color or when race was part of a client’s presenting concern. European American psychologists indicated that they would address race if clients raised the topic, and some reported that they did not normally address race with racially different clients. When discussing a specific cross-racial dyad, African American therapists more often than European American therapists addressed race because they perceived client discomfort. Only European American therapists reported feeling uncomfortable addressing race, but therapists of both races perceived that such discussions had positive effects

Improving HPV Vaccine Series Compliance with Text Message Reminders in Military Women

Project Purpose: The purpose of the project was to improve the rate of Human Papillomavirus (HPV) vaccination compliance among military women aged 18-26 years utilizing clinical reminder via text messages. Background: Specific populations have been particularly effected by low HPV vaccine completion rates including active duty military women. The incidence of high risk sexual behavior in this population is noted to be higher than the general public and sexually transmitted infection (STI) rates are seven times higher in active duty military women compared to the general public. In addition, HPV is the most prevalent STI in this population with an incidence rate of 333.9 per 10,000 person-years. In 2011, research at the Naval Medical Center San Diego (NMCSD) found that the vaccine series completion rate in active duty military members was only 16%. The use of reminders for multi-dose vaccine series has demonstrated effective increases in compliance rates since the 1980s. Practice Change: Clinical reminders via text message were sent out to each woman who received her first dose of HPV vaccine in November or December 2014 and January 2015. The text was sent to all women who had not yet returned to the clinic to receive the second or third dose. The reminder notified them that their next vaccine dose was due and to obtain it within the next month. The Iowa model was used as a framework for this project. Project effectiveness was evaluated based on changes in HPV immunizations series compliance rates before and after the text message intervention. Outcomes: There was an increase in vaccination rates among the women receiving the text message reminders for both the second and third dose. This project followed an initial effort three months before to educate patients about need for the HPV vaccine and the provider to offer a strong recommendation for obtaining the vaccine. An increase from the previously reported rate of HPV vaccine series compliance among active duty military women was achieved. However, even with the education and provider recommendation, the rates were below the national averages. With the implementation of the clinical reminders via text message, there was an increase from 50% to 65% for the 2nd dose after the text message reminder with 17 out of 26 women receiving at least 2 HPV vaccine doses. In addition, the completion rate for all 3 doses increased from 34% to 42% (11 out of 26 women) exceeding the national average of 39.7% for HPV vaccine completion by U.S. girls according to the CDC (2015). Implications and Conclusions: Clinical reminders, specifically text message reminders, increased HPV vaccination rates for active duty military women in addition to patient education and provider recommendation. Long-term benefits will include a decrease in HPV infection rates, a decrease in HPV-related medical costs, and a decrease in the incidence of cervical cancer in this population

Improving Advance Directive Completion Rates Through Advance Care Planning

Purpose: The purpose of this evidence-based practice (EBP) project is to assess the effectiveness of a multimodal intervention to increase advance care planning discussions (ACP) and advance directive (AD) completion rates. Background: Advance care planning (ACP) and advance directives (AD) is the ongoing discussion and recording of patient preferences and goals of care in the event they lose the capacity to speak for themselves. The Center of Disease Control and Prevention (CDC) estimates that 70% of Americans are without ADs. Centers for Medicare and Medicaid Services (CMS) reimburses for advance care planning consultations. ACP has improved multiple outcomes including higher rates of AD completion and patient satisfaction. Project Process: Patients were identified based on AD completion status, age, and history of at least one chronic illness. These charts were flagged indicating the need for ACP and AD education and completion. Participants were mailed a letter of intent addressing the need for AD completion two weeks prior to their scheduled appointment with their primary care provider. A 30-minute face to face discussion focusing on ACP was conducted for each agreeable patient. Weekly follow up phone calls were conducted for patients unable to complete documentation during the encounter. The data collected measured AD completion and ACP discussions. Outcomes: Interventions significantly improved completion of advance directives on average 23 AD ’s, from 55 to 78 (95% confidence Interval, 21, 34) and was statistically significant at p \u3c .001. This was proven to be clinically significant improving completion of advanced directives by 20%. Conclusions: Multimodal interventions have shown to increase completion rates. Through this evidence-based quality improvement project, providers will be encouraged to initiate and guide advance care planning discussions

Nurse Practitioner-Led Obstructive Sleep Apnea Screening in Patients with an Implantable Cardiac Monitor, and Confirmed or Suspected Atrial Fibrillation

Background: Obstructive sleep apnea (OSA) has been linked to heart disease and vice versa. Millions of Americans suffer from this chronic sleep condition, and a great number of those affected are unaware they have it. According the American Sleep Apnea Association, 80% of patients who fall in the moderate to severe OSA category are undiagnosed. Evidence suggest that untreated OSA can lead to atrial fibrillation (AF), and other cardiovascular problems. These cardiovascular complications can increase the mortality and morbidity of patients who suffer from this sleep syndrome. Purpose of Project: The goal of the project was to provide OSA screening to patients with implantable cardiac monitors who were observed due to confirmed or suspected AF. The aim of this study was to identify the prevalence of those at high risk. Our overall purpose was to establish early screening protocols, that could potentially lead to early detection and treatment. The screening tool used was the STOP-BANG OSA screening tool due to its high sensitivity and specificity for detecting moderate to severe cases. Methods: Patients were screened for OSA risk by using the STOP-BANG tool. The phone screening calls were conducted between the hours of 9:00 am to 5:00pm on week days over a period of six months. The scores of 100 patients were obtained, and analyzed by using Microsoft Excel software. Evaluation/Results: The results showed that 63% of patients screened, scored as high risk for OSA. Of those who scored as high risk, 61.90% were males, 38.10% were female, 25.39% had previously been diagnosed with OSA, 4.76% were previously referred for sleep studies, and 69.84% have never been screened for OSA or referred for a sleep study. These findings suggested that the majority of patients at high risk for OSA are neither screened nor referred for sleep studies. The patients found to be at highest risk were males, older than 50y/o, obese, with a history of hypertension and syncope. Discussion: This project has the potential to provide information regarding the prevalence of OSA in patients who are diagnosed or are suspected to have AF. The prevalence of OSA in this patient population can give us knowledge regarding their health care needs. It can also help providers focus interventions that can potentially improve health care outcomes. Early screening can lead to early referral and treatment. This in turn may lead to decrease exacerbation of AF, and improved overall quality of life for patients who have coexisting AF and OSA

Establishment of Best Practice Skills for Advanced Practice Nurses

Over the past two decades, nursing researchers have defined nurses’ perceptions of evidence-based practice as well as facilitators and barriers to its implementation . This project seeks to take the next step through a current assessment of registered and advanced-practice nurses’ assimilation of evidence-based practice as well as a current literature review of the research to clinical use gap. This is a cross-sectional, retrospective project. Through analysis of two self-administered questionnaires to both registered and advanced-practice clinical nurses as well as literature review findings, five recommendations for advanced-practice nurses were created. Ultimately, the goal of this project seeks to establish evidenced-based practice implementation strategies for advanced-practice nurses to effectively bridge research to the bedside. Areas of evidence-based practice implementation that remain unanswered or weakly executed provide a direction for research moving forward

Prospective Minority Students\u27 Perceptions of Application Packets for Professional Psychology Programs: A Qualitative Study

This article reports the results of a qualitative study designed to determine issues salient in Black and Hispanic American students\u27 review and evaluation of program-application packets in professional psychology. The study served as an extension to the Yoshida et al. (1989) quantitative investigation. Students interested in pursuing doctoral studies in counseling or school psychology (N = 22) served as the sample. The qualitative methodology incorporated a think-aloud procedure and semistructured interviews. A theme analysis of transcribed interviews identified both major and minor themes central to participants\u27 evaluation of the packets. Major themes included financial aid, program requirements and course descriptions, demography of the student body, and the quality and clarity of application material. Specific suggestions on developing an application packet to send to inquiring prospective students are put forth. It is recommended that such a packet could serve as a cost-effective minority-recruitment strategy