Abstract available in the Journal of the Academy of Nutrition and Dietetics.

Background: Disadvantaged social, economic, and environmental factors create Adverse Childhood Experiences (ACEs), which can harm a child’s developing brain and have lasting effects on health. These experiences range from physical, emotional, or sexual abuse to parental divorce or substance abuse. Afflicted children have a significantly increased risk of behavioral and health issues later in childhood, as well as adult onset chronic health problems. We hypothesize that primary care ACEs screening, intervention by a primary care-behavior health care integrated care team, and referrals for parenting support and resources will be feasible, acceptable, and beneficial from parent and provider perspectives. Methods: Parents with an ACE score of four or higher at the one-month checkup will be offered The Incredible Years interactive video intervention during checkups through 9 months of age. Parents or children with an ACE score of four or higher at the 1-4 year well child visits will be referred to participate in Nurturing Parenting group visits provided by a partnering community agency. Both programs are evidence-based, family-centered trauma-informed programs supporting positive child rearing practices. Process and outcome variables will be assessed using surveys administered after patient screening and following each program session, and primary care providers will be surveyed at the end of the project period. Process and outcome measures include; number of families screened for ACEs, number referred to parenting programs, the number of program sessions completed and attendance and changes in selfassessed parenting competence. This study will demonstrate the feasibility of integrating traumainformed practices into primary pediatric care, document an increase in referrals to community support services and document an increase in self assessed parenting competence among parents who have suffered 4 or more ACEs. Results: Preliminary survey results show that families evaluate the process of undergoing ACEs screening and follow up discussion with providers in a favorable manner. Additionally, families with elevated ACEs scores that meet criteria for additional interventions, received the corresponding program in as acceptable and appropriate. Provider surveys are forthcoming, however the additional screening, intervention provided by the Behavioral Health Team, and feasibility survey collection has not affected the clinic’s productivity or delayed patient care. Upon initially starting screening and survey administration at clinic, an error was noted in the reporting of ACEs screening results in the EMR. Data collection was delayed while the EMR function was edited by IT administrator. Conclusions: Our multidisciplinary team will continue to collect data and continue to evaluate and streamline all aspects of the project in order to enhance the care of our patients and families. Additionally, will evaluate concerns and recommendations noted with provider administration survey at conclusion of data collection.

Yes / Introduction: Mobile phones are used the world over, including in healthcare settings. This study aimed to investigate the viable microbial colonisation of mobile phones used by healthcare personnel. Methods: Swabs collected on the same day from 30 mobile phones belonging to healthcare workers from three separate paediatric wards of an Australian hospital were cultured on five types of agar plate, then colonies from each phone were pooled, extracted and sequenced by shotgun metagenomics. Questionnaires completed by staff whose phones were sampled assisted in the analysis and interpretation of results. Results and discussion: All phones sampled cultured viable bacteria. Overall, 399 bacterial operational taxonomic units were identified from 30 phones, with 1432 cumulative hits. Among these were 58 recognised human pathogenic and commensal bacteria (37 Gram-negative, 21 Gram-positive). The total number of virulence factor genes detected was 347, with 1258 cumulative hits. Antibiotic resistance genes (ARGs) were detected on all sampled phones and overall, 133 ARGs were detected with 520 cumulative hits. The most important classes of ARGs detected encoded resistance to beta-lactam, aminoglycoside and macrolide antibiotics and efflux pump mediated resistance mechanisms. Conclusion: Mobile phones carry viable bacterial pathogens and may act as fomites by contaminating the hands of their users and indirectly providing a transmission pathway for hospital-acquired infections and dissemination of antibiotic resistance. Further research is needed, but meanwhile adding touching mobile phones to the five moments of hand hygiene is a simple infection control strategy worth considering in hospital and community settings. Additionally, the implementation of practical and effective guidelines to decontaminate mobile phone devices would likely be beneficial to the hospital population and community at large.

The prevalence of diabetes mellitus (DM) continues to be a global concern among health care practitioners. Without collaboration and interventions, this chronic disease, which poses a significant financial burden for health care institutions, will continue to be problematic. Promoting the use of glycemic control measures among diabetic patients is an intervention, which has the potential to reduce diabetic complications and improve outcomes. The purpose of this doctoral project was to explore available evidence through a systematic review of the best practices for glucose management. The chronic care model served as the theoretical framework. The evidence based practice question was, What is the current evidence supporting the utilization of a computer-based glucose management system (CBGMS) for inpatient diabetic adults in acute and critical care settings? A systematic review was conducted, yielding 532 studies in which 3 of the studies related to CBGMSs published from 2008 to 2017 were critically appraised. The John Hopkins Nursing Evidence Appraisal Tool with specific inclusion and exclusion criteria was utilized. Participants were adult patients (aged 18 and over) with DM in inpatient care settings who were English speaking. Interventions included the traditional paper-based sliding scale regimen versus the utilization of a CBGMS. Outcome measures included decreased length of stay, reduced cost, and glucose optimization. A conclusion was the implementation of a CBGMS has the potential to improve patient outcomes with additional research that exhibits overall benefits and implement into practice. Thus, implementation of a CBGMS can lead to positive social change by aiding in a change in practice that will ultimately ameliorate patient health outcomes.

The general intention of recent Swedish legislation concerning adults with intellectual disabilities has been to provide care and support for this group in small settings in the community. It has been shown that adults with intellectual disabilities are better equipped to exert influence over their own care and support when living in group homes in the community and other forms of independent living as opposed to large institutional settings. Recent research on this group has to a great extent concerned the study of how life is in small group homes for this group and has highlighted obstacles preventing them from participating in society. Previous research has indicated that living in institutional settings makes it difficult for them to exert influence on their lives. A small number of large institutional care settings still exist, however, in Sweden and there is a dearth of research that focuses on how adults with intellectual disabilities experience everyday life in such settings. In addition, little research has been carried out on the role of the care workers who work in such settings. The aim of this research has thus been to describe the experiences of adults with intellectual disabilities and care workers of living and working in an institutional care setting in Sweden.   An ethnographic approach including participant observation and in-depth interviews was used to gain a deeper understanding of how adults with intellectual disabilities and staff experience their everyday life in an institutional care setting. The result showed that the residents experienced;  I) a sense of belonging, which was connected to having access to a private sphere and being part of social togetherness;  II) a feeling of insecurity in relation to other residents and care workers;  III) a longing for independence and a desire to get away. The study of the staff revealed three main themes that represent their approach; I) creating a family-like atmosphere; II) making the everyday life ordered and structured; III) being exposed to stress factors.   The results revealed the importance of paying close attention to what adults with intellectual disabilities and their care workers have to say about their everyday lives when living and working in an institutional care setting. It may be concluded that adults living in an institutional care setting experience their everyday lives in existential terms such as belonging, insecurity and longing. For caring science and in caring practices of people with intellectual disabilities, it is not satisfactory that residents experience such an insecure existence in a care setting. In order to provide individual care and support, staff need to be more open and vigilant as to the residents’ vulnerability and be able to guide them in matters  concerning emotional aspects. It was seen that care workers in their everyday work with residents in an institutional care setting used experiences from their personal lives in situations where they lacked formal care training. Such experiences may have helped to create meaningfulness but at the same time risked preserving inequality and gender stereotyping. In order to avoid these risks care workers should receive clear directives from the management about the care objectives, and guidelines about how best to care for adults with intellectual disabilities and offer them individualized care. Furthermore, it also became evident that care workers need additional support, training and opportunities for reflection to cope with their complex work situation. The results of this research can contribute to a greater insight and deeper knowledge of what adults with intellectual disabilities experience in an institutional care setting in the 2000’s , enabling the staff and management to further enhance the well-being for this group of individuals. The findings can provide feedback to staff, managers and researchers working in the intellectual disabilities field.   Keywords: adults with intellectual disabilities, care, care workers, ethnography, institutional care setting, Sweden

No description available.

Introduction: Breastfeeding has numerous benefits for babies, mothers, and families. It is well established that mothers perceptions of embarrassment, convenience, and social support related to breastfeeding affect whether they choose to breastfeed and for how long . Tennessee falls well below national statistics and goals for breastfeeding initiation and continuation. Effective and efficient promotional tools that can be incorporated into clinical care are needed. Objectives: This study evaluated the effectiveness of a video intervention to improve perceptions of breastfeeding among pregnant women presenting for a prenatal visit in an obstetrics and gynecology (OB/GYN) clinic in northeast Tennessee. Specifically, the project sought to determine whether watching the video with the babys father, a friend, or family member (supportive others) would be more beneficial than watching it alone, a previously unanswered question. Methods: The investigative team established a relationship with an OB/GYN clinic that serves a high volume of pregnant women. A 15 minute video addressing issues of embarrassment, convenience and support related to breastfeeding was shown in the clinic waiting room. The video had been previously developed and evaluated by the Mississippi Department of Health. Pregnant women visiting the clinic during 8 days in 2009 were invited to complete an anonymous written survey immediately before and after viewing the video. The survey included items on demographics, perceptions of breastfeeding, and intention to breastfeed. Descriptive statistics were calculated. The proportion of women reporting improved perceptions of breastfeeding was compared between subgroups using chi-square testing. Mean breastfeeding perception scores were compared between subgroups and changes in womens intention to breastfeed were evaluated. Results: Of the 77 participants, 38.9% reported previously breastfeeding a child, 51.3% planned to breastfeed, and 25% were undecided. After viewing the video, perceptions of embarrassment, convenience, and social support related to breastfeeding improved in a range of 39-44.2%, 37-40%, 39-63% of women, respectively. Mothers who watched the video with a supportive other were more likely to report improved perceptions of embarrassment than mothers who watched the video alone (chi2 = 12.01, p = .002). Of the mothers who reported being undecided about breastfeeding prior to watching the video, 57.9% reported being more likely to breastfeed after watching the video (chi2=10.22, df=2, p=0.006). Discussion: The findings suggest this video intervention is an effective means of addressing barriers to breastfeeding in the clinical setting. Furthermore, this study addressed previously unanswered questions about the impact of pregnant mothers watching the video with supportive others; results indicate that its efficacy is significantly improved if pregnant women view it with a supportive other.

Polypharmacy entails the use of multiple drugs taken at the same time to manage the various comorbidities common among elderly patients. Polypharmacy is associated with increased health care spending due to drug duplication, adverse drug events, and medication noncompliance. Medication reconciliation has been shown to reduce the problems seen with polypharmacy. The purpose of this project was to review published evidence to develop a staff education program on medication reconciliation in a primary care setting and determine the efficacy of the program in relation to staff confidence and knowledge levels concerning medication reconciliation. The project was guided by Nola Pender's health promotion model. The education program was modeled after a medical staff education program on medication reconciliation and included a medication assessment questionnaire and its use when evaluating a patient's medications. The pretest and posttest questionnaire obtained from the education materials was administered to clinical staff at the practice site before and after presenting the education material. Data were analyzed for statistical changes after the education program using a t test. Results showed that participants increased their confidence and knowledge of medication reconciliation from an average score of 2.19 (SD 0.20) before the education to 4.37 (SD 0.12) (p < 0.001) on a 5-point confidence scale after the education. This staff education program will promote positive social change by increasing nurses' knowledge and confidence of medication reconciliation and potentially reducing the incidence of polypharmacy and its negative effects among the elderly patients.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.