Implementation of a Transcultural Nursing Education Program to Improve Nurses\u27 Cultural Competence

The exponential growth of culturally diverse populations in the United States has led to a multicultural patient population while the nursing workforce remains predominantly White. At the project site, managers identified that staff nurses struggled to deliver culturally competent care. The purpose of this project was to improve the cultural competence of registered nurses (RNs) through a transcultural nursing education program. Leininger\u27s transcultural nursing theory guided the project. Sources of evidence used to develop a face-to-face educational program included peer-reviewed journals, credible websites, and the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-R tool. Aggregate pretest and posttest scores were used to determine RNs\u27 competency levels. The Statistical Package for the Social Sciences software was used for data analysis, and a paired t test was used to determine the impact of the program. Of the 22 participants, 4 (18%) scored within the culturally competent range on the pretest, compared to 17 (77%) on the posttest. These findings were statistically significant (p \u3c 0.000) and demonstrated a positive outcome from the educational project. Key recommendations are to continue this education for other RNs in the facility and at other facilities in the network. The implications of this project for positive social change include raising the cultural competency of nurses, which has the potential to improve patient outcomes

Factors that influence development of speech pathology skills required for videofluoroscopic swallowing studies

Background Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. Aims This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts’ VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self-efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts’ skill development. Methods & Procedures Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected—the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing—Adults, self-reported the number of dysphagia cases they managed on placement, and self-rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. Outcomes & Results Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. Conclusions & Implications Novice analysts vary in the acquisition of beginner-level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS What is already known on the subject • The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds • This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work? • Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images

Developing novice analysts’ videofluoroscopic swallowing study skills in speech-language pathology : a randomised control trial comparing blended and online training approaches

Purpose. This research investigates the relative effectiveness of independent online and blended learning approaches for novice analysts’ development of videofluoroscopic swallowing study (VFSS) analytical skills. The secondary aims were to explore the impact of training on decision-making and to describe learners’ perspectives of training outcomes. Method. Undergraduate speech-language pathology students (n = 74) who had completed the dysphagia academic curriculum in an undergraduate speech-language pathology program were recruited for a randomised control trial. The ability to identify swallowing impairments in adults was compared pre- and post-training across three conditions: independent online (n = 23), peer-supported (n = 23), and expert-facilitated training (n = 28). The training comprised online VFSS training and practice with a commercially available digital video disc (DVD). Result. The three training approaches were equal in improving novice analysts’ identification of impairments on VFSS. Participants’ analysis improved pre- to post-training (p = <.001), with no statistical difference amongst training conditions (p = .280). However, the expert facilitation condition resulted in better decision-making skill for novice analysts, as well as higher levels of confidence and greater engagement in the learning. Conclusion. Well-designed independent online methods are appropriate to prepare novice analysts for VFSS analytical training. Expert facilitation and peer-supported environments may have benefits for more advanced skill development and engagement, and should be investigated in future studies

A Proposed Role for Pro-Inflammatory Cytokines in Damaging Behavior in Pigs

Sickness can change our mood for the worse, leaving us sad, lethargic, grumpy and less socially inclined. This mood change is part of a set of behavioral symptoms called sickness behavior and has features in common with core symptoms of depression. Therefore, the physiological changes induced by immune activation, for example following infection, are in the spotlight for explaining mechanisms behind mental health challenges such as depression. While humans may take a day off and isolate themselves until they feel better, farm animals housed in groups have only limited possibilities for social withdrawal. We suggest that immune activation could be a major factor influencing social interactions in pigs, with outbreaks of damaging behavior such as tail biting as a possible result. The hypothesis presented here is that the effects of several known risk factors for tail biting are mediated by pro-inflammatory cytokines, proteins produced by the immune system, and their effect on neurotransmitter systems. We describe the background for and implications of this hypothesis.Peer reviewe

Factors that influence development of speech pathology skills required for videofluoroscopic swallowing studies

Background. Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. Aims. This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts’ VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self-efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts’ skill development. Methods & Procedures. Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected—the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing—Adults, self-reported the number of dysphagia cases they managed on placement, and self-rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. Outcomes & Results. Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. Conclusions & Implications. Novice analysts vary in the acquisition of beginner-level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development

African American community, Rockingham County: an action-oriented community diagnosis: findings and next steps of action

In October 2007, a team of five graduate students from the University of North Carolina at Chapel Hill School of Public Health began an Action-Oriented Community Diagnosis (AOCD) with the African American community in Rockingham County. An AOCD is a community-based process by which the resources, strengths, needs, and challenges of a community are identified. After identification, the process transitions to generating dialogue and creating action steps to build on community strengths and address challenges. Guided by preceptors Debbie Mason of Rockingham County Healthy Carolinians and Katrina White of the Rockingham County Department of Public Health, the student team spent the next seven months attending community events, examining data about Rockingham County from websites and government documents, and conducting interviews and focus groups with both service providers and community members regarding community strengths and community challenges. After analyzing the responses, the team identified thirteen common themes. With the help of a community advisory committee (CAC), the team planned and held a public forum, “Community Dialogue for Change,” on April 14, 2008. The CAC selected five of the original thirteen themes for focused discussion at the forum based on their importance to the community and how easily they could be addressed. Five themes were chosen so that the five student team members could each lead a discussion group on one theme..At the forum, the team highlighted the community‟s strengths such as churches and spirituality, caring people, and leadership capacity as well as challenges related to the five themes chosen for discussion. The approximately 70 people in attendance broke into smaller discussion groups and generated action steps to address each theme. The following challenges and action steps were presented at the forum: Employment- The lack of job opportunities for African Americans within the county is a concern. This affects both adults who have lost jobs and youth seeking jobs. Develop a mentoring program that would place youth in government, corporate, and small business environments. Survey students to determine their career interests so that job fairs and career programs would be more appealing. Create a resource listing of employers willing to hire ex-offenders. Attitudes Towards Education- There is concern that education is not a priority in the county, as seen by high drop-out rates and not enough students going to college. Approach the school board about offering diversity training to teachers and other employees. Approach local colleges that train teachers about offering diversity training in their curricula. Guidance for Youth- Too many African American youth, especially young men, lack positive guidance for their futures. Set up a forum for youth-adult conversation as a starting point for better understanding. Use the media, church newsletters, and organizations to spread the word about the need to come together for better guidance for youth. Find out what mentoring programs churches currently have in place, and increase the number and quality of these programs. Include volunteering for school mentoring programs in regular church service projects, with an emphasis on peer mentors. Establish programs to re-train parents and include professionals in the community with different skill sets for parenting. Racial Discrimination- Community members noted various ways in which racial discrimination happens in the county, such as differences in pay, ability to get loans, and treatment of students. Create a forum to increase dialogue between parents of school children to address issues such as racial discrimination in schools. Increase parental and community involvement in volunteer opportunities in schools. Create guidelines for fair treatment of students for use by teachers and administrators. Preventive Health Care- Low use of preventive health care services for conditions such as diabetes and high blood pressure leads to an increased need for treatment and poor health. Form a group in charge of developing educational flyers with health messages to be placed in grocery stores, doctors‟ offices, daycares, churches, schools, and recreational facilities. This education campaign would also incorporate the use of nutritionists to develop health messages for church newsletters. Form a “take a friend to the doctor” program to assist those without their own personal transportation in getting to preventive health care appointments. This would build upon existing resources available in the community such as Caregivers of Rockingham County and Pelham Transportation in order to make transportation to medical appointments more convenient for community members. The purpose of this final report is to give the African American community of Rockingham County and other concerned individuals a tangible resource that presents the findings of the community assessment as well as a report of the discussions and action steps which emerged at the community forum. It is divided into six sections: Introduction; Background on Rockingham County; Primary Data Findings; Methods; The Forum; and Recommendations and Conclusions. This document should be a tool which all community members can continuously refer to as they address various challenges and work towards progress.Master of Public Healt

Community pharmacy interventions for health promotion: effects on professional practice and health outcomes (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective To assess the effectiveness of health promotion interventions in community pharmacy practice settings on pharmacy workers and pharmacy clients (including diagnosed patients) when compared to i) No treatment controls ii) Usual treatment controls iii) Other active intervention Secondary objectives To assess whether there are differences in effectiveness of health promotion interventions in community pharmacy practice settings on i) Pharmacy worker ii) Client (patient) with regard to: i) Ethnicity of patients ii) Country income level (World Bank Group 2009) iii) Extent of adverse health behaviour (defined according to national guidelines where available) iv) Type of pharmacy worker delivering the intervention (e.g. pharmacist versus pharmacist technician) v) Theoretical constructs/components and behaviour change techniques employed in the intervention vi) Costs of health car

What is the diagnostic accuracy of novel urine biomarkers for urinary tract infection?

Background: Urinary tract infection (UTI) affects half of women at least once in their lifetime. Current diagnosis involves urinary dipstick and urine culture, yet both methods have modest diagnostic accuracy, and cannot support decision-making in patient populations with high prevalence of asymptomatic bacteriuria, such as older adults. Detecting biomarkers of host response in the urine of hosts has the potential to improve diagnosis. Objectives: To synthesise the evidence of the diagnostic accuracy of novel biomarkers for UTI, and of their ability to differentiate UTI from asymptomatic bacteriuria. Design: A systematic review. Data Sources and Methods: We searched MEDLINE, EMBASE, CINAHL and Web of Science for studies of novel biomarkers for the diagnosis of UTI. We excluded studies assessing biomarkers included in urine dipsticks as these have been well described previously. We included studies of adult patients (≥16 years) with a suspected or confirmed urinary tract infection using microscopy and culture as the reference standard. We excluded studies using clinical signs and symptoms, or urine dipstick only as a reference standard. Quality appraisal was performed using QUADAS-2. We summarised our data using point estimates and data accuracy statistics. Results: We included 37 studies on 4009 adults measuring 66 biomarkers. Study quality was limited by case-control design and study size; only 4 included studies had a prospective cohort design. IL-6 and IL-8 were the most studied biomarkers. We found plausible evidence to suggest that IL-8, IL-6, GRO-a, sTNF-1, sTNF-2 and MCR may benefit from more rigorous evaluation of their potential diagnostic value for UTI. Conclusions: There is insufficient evidence to recommend the use of any novel biomarker for UTI diagnosis at present. Further evaluation of the more promising candidates, is needed before they can be recommended for clinical use

'To live and die [for] Dixie': Irish civilians and the Confederate States of America

Around 20,000 Irishmen served in the Confederate army in the Civil War. As a result, they left behind, in various Southern towns and cities, large numbers of friends, family, and community leaders. As with native-born Confederates, Irish civilian support was crucial to Irish participation in the Confederate military effort. Also, Irish civilians served in various supporting roles: in factories and hospitals, on railroads and diplomatic missions, and as boosters for the cause. They also, however, suffered in bombardments, sieges, and the blockade. Usually poorer than their native neighbours, they could not afford to become 'refugees' and move away from the centres of conflict. This essay, based on research from manuscript collections, contemporary newspapers, British Consular records, and Federal military records, will examine the role of Irish civilians in the Confederacy, and assess the role this activity had on their integration into Southern communities. It will also look at Irish civilians in the defeat of the Confederacy, particularly when they came under Union occupation. Initial research shows that Irish civilians were not as upset as other whites in the South about Union victory. They welcomed a return to normalcy, and often 'collaborated' with Union authorities. Also, Irish desertion rates in the Confederate army were particularly high, and I will attempt to gauge whether Irish civilians played a role in this. All of the research in this paper will thus be put in the context of the Drew Gilpin Faust/Gary Gallagher debate on the influence of the Confederate homefront on military performance. By studying the Irish civilian experience one can assess how strong the Confederate national experiment was. Was it a nation without a nationalism