Secondary Analysis of Diabetes and Psychological Distress in American Indian Women from the California Health Interview Survey (CHIS).

Since European settlers arrived to the United States (U.S.), American Indians (AI) have been separate and unequal members of society. After a long history of discrimination, ethnocide, genocide, and distrust, the AI have become a population with severe disparities, having the highest rates of diabetes, depression, suicide, tuberculosis, and alcoholism than any other minority or majority population in the U.S. The author\u27s purpose for conducting this study was to explore a possible relationship between depression or psychological distress and diabetes in AI women. AI women are the most under studied group in the country; therefore, a secondary analysis of the large established California Health Interview Survey (CHIS) was done. The sample used 1,110 self-identified AI women\u27s data. Even though the literature shows that the AI have the highest rates of diabetes and depression of any population, this analysis revealed no statistically significant relationship between the two diseases. It did reveal many limitations and implications associated with the use of such large databases for the AI woman. Among the limitations were the survey itself, its administration to the AI population, guidelines for self-identifying as AI, and the researcher\u27s limited access to the data. The implications of this study are significant. Large databases provide the basis for social and political decisions such as allocation of federal dollars for health care. Healthcare and health care services are designed according to the health burden of specific populations. If these databases are in error, or not representative of the true population, healthcare decisions will not reflect the true health care needs of the population. The inadequacies of large databases results in less funding, leading to less quality health care, and an increase in AI health disparities. Further research is needed to determine the actual health burden depression and diabetes place on the AI woman

Faculty Development for the Use of High-Fidelity Patient Simulation: A Systematic Review

This is a systematic review of the research data between 1995 and June 2013 concerning faculty development in the use of high-fidelity patient simulation for health professionals and students with a search of the following databases: CINAHL, Nursing and Allied Health Collection: Comprehensive, OVID Medline, ScienceDirect, PubMed, Scopus, and ProQuest Dissertation/Theses Database. The primary search terms were high-fidelity patient simulation and faculty development. Reference lists from relevant articles were also reviewed. Twenty-five studies were included for this review. The majority of the studies were surveys with a few quasi-experimental designs. The themes were similar to those found in the non-research literature: strengths, incentives, barriers, use of faculty champions/simulation coordinator, and faculty development. The validity and reliability differed by study. There are numerous incentives and barriers to the use of high-fidelity patient simulation by faculty. Several examples of faculty development programs have been described in the literature but little evaluation has taken place beyond the end of the program. The goal of the use of high-fidelity patient simulation is to enhance the student’s knowledge, skills, and critical thinking in the care of patients. It is essential that the faculty are competent to provide instruction with high-fidelity patient simulation and therefore, the efficacy of these developmental programs need closer attention

Educating Nursing Students on Pregnancy Smoking Issues to Improve Regional Intervention Efforts

Objective: Rates of pregnancy smoking in the rural South are twice national averages and contribute to poor birth and long term outcomes for affected women and children. Efforts to intervene during prenatal care with pregnant women have been hampered by lack of knowledge, skill, comfort, and commitment from prenatal providers and their nursing staff. Regional community providers and staff have been reluctant to participate in available trainings, and even those who do seldom exhibit attitude and practice change long term. Therefore, efforts to educate health care professionals on the dangers of pregnancy smoking, and to provide necessary skills for intervention efforts, may need to occur before they ever enter practice. Thus, the goal of the current project was to implement and evaluate a pregnancy smoking-related training session for baccalaureate nursing students in rural Southern Appalachia. Design: Nursing students attended training on pregnancy smoking dangers/intervention techniques. Sample: Third year students beginning clinical rotations in obstetrics. Methods: 1.5-hour training including pre- and post-tests. Implementation Strategies: Four months later, follow-up survey assessed gains in knowledge, skill, comfort, and willingness to address smoking. Results: Over seven semesters, 659 nursing students were trained. Substantial gains in knowledge of pregnancy smoking issues were seen from pre- to post-testing, with knowledge retained at four- month follow-up. The percentage of students who felt they lacked skills to intervene with pregnant smokers dropped from 39% at pre-test to 6% at same day post-test. In addition, the percentage who reported they would be uncomfortable talking with pregnant women about smoking dropped from 10% to 1%, while the percentage who indicated they would always make time to address smoking with pregnant women increased from 54% to 87%. While most students did address smoking with multiple pregnant patients encountered during clinicals, and over half felt the patients benefited from their actions, only 58% were confident in their intervention skills at four month follow-up. Finally, 83% felt the training had been beneficial, and over 90% committed to addressing smoking with pregnant patients once they graduated. Conclusion/Implications for nursing practice: Training can increase nursing student knowledge, skill, comfort, and willingness to address smoking with pregnant women. However, it appears ongoing education may be needed to promote skills and confidence long term. In the rural South, where smoking rates are high and provider efforts to address pregnancy smoking are inconsistent, educating future nurses could have substantial impact on pregnancy smoking rates and birth outcomes into the future

Polycystic Ovary Syndrome: Morbidity Issues and the Psychosocial Impact on Infertile Women

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder and the leading female infertility. PCOS is characterized as a clustering of clinical concerns, which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. These characteristics were examined with regard to their impact on women\u27s psychosocial concerns and health related quality of life. Design: Cross-sectional, correlational Setting: Private endocrinology practice in the rural Southeastern U.S. Participants: The study sample consisted of 126 women with PCOS. Methods: Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to conceive had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life