Sue & Bill Gross School of Nursing

AIMS: This study aimed to determine the effect of a multi-component mHealth intervention on patient activation and examine its predictors among older adults at risk of cardiovascular disease (CVD). METHODS AND RESULTS: This pilot randomized controlled trial compared two groups: Get FIT (control), who received healthy lifestyle counselling from a licensed health coach, a mHealth app (MyFitnessPal) with push alerts, and an activity tracker, and Get FIT + (intervention), who received the same interventions and had personalized text messages with 3- and 6-month follow-up periods. Patient activation was measured using the 13-item Patient Activation Measure; higher scores indicated better activation. Linear mixed-effects models were used to investigate between-group changes in outcomes across time. The participants (n = 54) mean age was 65.4 ± 6.0 years; 61% were female; and 61% were married. Baseline characteristics were comparable between groups. Significant improvements in mean patient activation scores were observed in the Get FIT + group at 3 months [mean 3.53 points, 95% confidence interval (CI) 0.11, 6.96; P = 0.043] and 6 months (mean 4.37 points, 95% CI 0.91, 7.83; P = 0.014), whereas improvements in the Get FIT group were non-significant. Adjusting for age, gender, education, employment, marital status, social support, smartphone confidence, and self-perceived health, we found that only social support was associated with higher patient activation overall (B = 5.14, 95% CI 1.00, 9.27; P = 0.015). CONCLUSION: The findings indicate that personalized text messaging can improve the self-care of older adults at risk of CVD. Findings also emphasize the importance of social support in the success of mHealth interventions for older adults. REGISTRATION: The study is registered in ClinicalTrials.gov (NCT03720327).

BACKGROUND: The importance of assessing out-of-hospital cardiac arrest (OHCA) risk in cancer patients is increasing as cancer incidence rises in aging populations. OBJECTIVE: This study aimed to investigate the association between newly diagnosed cancer and OHCA risk using a metropolitan cohort from South Korea. METHODS: A population-based retrospective cohort study was conducted, linking the nationwide OHCA registry with the National Health Information Database. The study included adults aged 40 years or older, residing in Seoul between 2015 and 2018, with no history of cancer or OHCA. The main exposure was cancer development. The primary outcome was the occurrence of OHCA with medical cause. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using a cause-specific hazard model considering death as a competing risk. Analyses stratified by age group and cancer type were also conducted. RESULTS: During a follow-up period of up to 4 years for 5,450,438 individuals, 174,785 participants developed cancer. The incidence rates of OHCA per 100,000 person-years were 54.0 in non-cancer and 145.0 in cancer groups, respectively. The aHR (95% CI) for OHCA associated with cancer development was 3.18 (2.97-3.41). The aHR (95% CI) for OHCA was highest in the 40-49 years of age group (7.52 [5.52-10.25]), followed by 50-59 years old (6.66 [5.56-7.97]) compared to older age groups. By cancer type, pancreatic, lung, biliary tract, and liver cancer were associated with a significantly increased risk of OHCA. CONCLUSION: We found an association between newly diagnosed cancer and the occurrence of OHCA. Our findings underscore the importance of tailored risk assessments and proactive care planning for patients with cancer.

There is an urgent need for improved school-based mental health services to address students increasing mental health needs. School nurses are often at the frontlines of youth mental health, but report feeling unprepared to manage student needs due to limited training. We conducted a rapid review to identify evidence-based mental health educational interventions for school nurses and evaluate program characteristics. Eleven studies met the inclusion criteria. While the literature evaluating mental health training programs for school nurses is limited, it suggests that training may improve school nurse knowledge, confidence, and preparedness to address student mental health needs and improve the management of student mental health. Additionally, it highlighted the importance of support, resources, and policies that foster mental health promotion. Future research should focus on obtaining a current assessment of school nurse mental health education needs, evaluating existing interventions, and developing more evidence-based mental health training programs for school nurses.

BACKGROUND AND OBJECTIVES: Culturally diverse informal caregivers of community-dwelling persons with dementia face challenges in accessing dementia care resources due to language barriers and cultural stigmas surrounding dementia. This study presents the perceived intervention experiences of a home-based approach which considers the cultural and linguistic needs of diverse family caregivers in dementia care. The intervention model includes home visits by trained bilingual, non-licensed community health workers (CHWs) whose cultural histories and understandings reflect that of the caregivers. The purpose of the present study was to understand family caregivers experience in caregiving and their feedback on the intervention, which includes caregiver support through education and skill development. METHODS: The present study thematically analyzed qualitative data from exit interviews with caregivers who participated in a CHW-led, 12-week home visit-based intervention program. RESULTS: Among 57 caregivers (mean age = 63.5, SD = 14.3) who participated in the 3-month home-visit intervention and completed the exit interviews, 33% were Korean Americans, 28% Vietnamese Americans, 21% non-Hispanic Whites, and 17.5% Latino/Hispanic. The majority were females (81%) and spouses (51%). Main themes include, (a) Individual Level: Improvements in Caregiving Self-efficacy and Self-care Awareness, (b) Relational Level: Enhanced Communications and Relationships with Persons with Dementia, and (c) Community Level: Connection and Access to Community Resources and Support. CONCLUSION: Interview data show that the culturally and linguistically tailored program supported diverse caregivers by increasing self-care awareness, improving knowledge about dementia and dementia care, strengthening communication skills, and facilitating access to community resources. Strong rapport between CHWs and caregivers enhanced the effectiveness of the intervention. Future approaches can focus on supporting caregivers with especially limited resources.

Youth experiencing homelessness (YEH) face challenges that increase their susceptibility to HIV/STIs. Nurse case management is effective in managing the complex needs of populations experiencing homelessness and reducing HIV risk. A randomized wait-list control study conducted between September 2019 to May 2023 evaluated the CAYA Come As You Are intervention. This nurse-led HIV prevention for YEH aged 16-25 years focused on the uptake of HIV prevention methods: pre- and post-HIV exposure prophylaxis (PrEP, nPEP), HIV/STI testing and treatment, sober sex, and condom use. Secondarily, we examined intervention impact on housing stability. Descriptive statistics were calculated by study arm. Multiple imputation (m = 10) was used for missing values and intervention effects were estimated from Bayesian multilevel models with noninformative priors. Participants (N = 450) were 21.1 years old on average, 62% Black, 11% Hispanic, 11% White, and 10% other race and reported being homeless for an average of 3 years. An intervention effect was found for PrEP use, which showed a larger increase from baseline to first follow-up (OR = 3.27; 95% Cr.I.: 1.13 to 10.14). No intervention impact was found for nPEP use, HIV and STI cases, sober sex, or condom use. Sheltering arrangements improved from baseline to the first follow-up in both groups with increase in shelter stability (OR = 3.85; 95% Cr.I.: 1.61 to 10.30) and decreased shelter transiency (OR = 0.29; 95% Cr.I.: 0.14 to 0.60). This study demonstrates that a personalized, nurse-led HIV prevention approach increased uptake of some but not all HIV prevention strategies among YEH. CLINICAL TRIAL REGISTRATION NUMBER: NCT03910218.

As a practicing clinical nurse, a phenomenon I experienced at times was the sudden acute sense that something was going wrong with a person in care at the sub-critical unit in the hospital where I worked. In fact, many hospital nurses have their story of somethings not right in relation to a person they were caring for/with, in that the day started with them on a coherent path to healing and then suddenly the nurse feels something is going very wrong, and yet there is nothing observable that would justify such a feeling. This feeling would be called intuition by many nurses, a concept most notably theorized in nursing by Patricia Benner in her extensive program of scholarship. Benner defines intuition as understanding without rationale. Benner opposes embodied intuition and rational abstract reasoning and creates criteria for the use of each by nursing depending on whether the clinical situation is familiar or novel. The philosophical idea is that the new must be reasoned with a different mode of thought than the familiar. Charles Sanders Peirce was a philosopher of reasoning. He defined logic as the theory of reasoning, which by the end of his career he was declaring was only another name for semiotic. Peirce argued that all reasoning/semiosis is done through signs, or more accurately sign-activity. Semiotic is the philosophical schema providing the concepts and methods by which semiosis - reasoning - happens. Importantly, semiotic does not oppose different modes of thought, and conceptualizes reasoning as a process that functions in familiar as well as novel situations. In this paper I describe Peirces philosophy of semiotic. I then provide an example relevant to nursing by conducting a semiosis of the nursing scenario above to show how nursing works chance, or novelty, in a way that doesnt need to resort to rational abstract reasoning and yet is different than Benners notion of intuition.

INTRODUCTION: We used an implementation science framework to investigate perceived health inequities in preventive health care initiatives in rural communities in the Philippines. We also identified health equity-focused quality improvement strategies. METHODS: Three health care providers and 12 barangay clinic patients were interviewed. RESULTS: Patient interviews showed that social determinants of health, respect, and attitudes toward health care providers affected patient empowerment to engage in self-management for noncommunicable diseases (NCDs). Health care providers identified six challenges in managing NCDs: (a) inefficient work processes; (b) staffing shortages; (c) insufficient access to low-cost medications; (d) inadequate primary preventive health education from the schools; (e) health care not considered a priority; and (f) lack of local government support. DISCUSSION: Inadequate preventive health care and education intensify health access and resource inequities in rural communities in the Philippines. A multi-sectoral plan may improve rural health infrastructure and education toward improving health care access and decreasing care disparities.

Chronic hepatitis B remains a substantial global health challenge, impacting approximately 254 million people worldwide. A cure for this condition is yet to be discovered. Early identification and effective treatments coupled with vigilant monitoring can help alleviate associated morbidity and mortality due to potential complications such as liver cirrhosis and hepatocellular carcinoma.

PURPOSE: The aim of the study was to develop a prediction model using deep learning approach to identify breast cancer patients at high risk for chronic pain. DESIGN: This study was a retrospective, observational study. METHODS: We used demographic, diagnosis, and social survey data from the NIH All of Us program and used a deep learning approach, specifically a Transformer-based time-series classifier, to develop and evaluate our prediction model. RESULTS: The final dataset included 1131 patients. We evaluated the deep learning prediction model, which achieved an accuracy of 72.8% and an area under the receiver operating characteristic curve of 82.0%, demonstrating high performance. CONCLUSION: Our research represents a significant advancement in predicting chronic pain among breast cancer patients, leveraging deep learning model. Our unique approach integrates both time-series and static data for a more comprehensive understanding of patient outcomes. CLINICAL RELEVANCE: Our study could enhance early identification and personalized management of chronic pain in breast cancer patients using a deep learning-based prediction model, reducing pain burden and improving outcomes.