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Introduction & Background Black infant mortality rate is 122% higher than that of non-Hispanic white infants. In a 2021 CDC study, Black women’s maternal mortality rate was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White women. Purpose Statement & Research Question The purpose of our research was to explore reasons why Black maternal mortality is higher than White and non-Hispanic populations and what contributing health disparities are causing higher mortality rates in black infants and mothers compared to their non-Hispanic white counterparts, in the United States. Literature Review: We found articles under 5 years old from Cinhal database. Findings Examples of inclusion and exclusion criteria in our studies included: ages between 18-39, whether they had hypertension during pregnancy, or were between 22-43 weeks of gestation. Main findings from our studies include mistrust between health providers and the black pregnant women negatively impacted their adherence to safe sleep practice, and 32% of women in another study reported that they were not able to initiate their first prenatal care visit as early as preferred due to a myriad of barriers. Conclusions & Nursing Interventions The take-home message of our studies was that disparities are multifactorial. Some major nursing implications we found are that perinatal nurses should assess the psychological wellbeing in Black women throughout pregnancy and advocate for Black women who report high levels of stress, depressive symptoms, or psychological distress.

Background People with type 1 diabetes make up approximately two million of the American population. Every day, these two million people struggle to fight this lifelong, sometimes life threatening disease. While type 1 diabetes currently has no cure, there are technologies that can make diabetes management more effective. This study surveyed the type 1 diabetes (T1D) young adult population aged 18-30, to evaluate what technologies and tools are most often associated with achieving optimal glycemic control (OGC). Methodology The instrument is a 35 question, investigator developed survey that is designed to measure how often a participant utilizes the technology identified in each question, with the response choices ranging from 0 (never) to 5 (multiple times daily). In addition, there were some yes/no and fill-in-the-blank questions to identify demographic variables. The technology topics that were explored are 1) mode of insulin therapy, 2) mode of blood glucose monitoring therapy, 3) mode of communication with designated care provider, 4) electronic applications used, 5) demographic variables, and 6) pertinent comorbidities. This information was used to evaluate variables that assist T1Ds in achieving optimal glycemic control. Participants were invited to participate in this study via email using the Students with Diabetes email listserv. The email contained the IRB approved explanation of research letter, which informed participants of the study and the research being conducted. If the student chose to participate, they checked a box that served as an electronic signature, and they continued on to the 35-question survey. All responses to the survey will be kept confidential; as the survey and research did not require any personal identifying information. Data regarding the specific demographics, technologies used for diabetes control, and hemoglobin A1C levels were recorded and analyzed. The results of the survey will be shared with the participants via the same email list-serv by which they were originally recruited. Results There were 59 participants. A total of 21 out of 59 respondents had optimal glycemic control (A1C less than 7.0, per American Diabetes Association guidelines). Eighty eight percent of those with OGC wore their CGMs all the time, while only 66% of those with IGC wore their CGMs all the time. Ninety five percent of those with OGC used their insulin pumps all the time, while 89% of those with IGC did. It is likely that the combination of both CGMs and insulin pumps worn all the time are the most powerful tools to achieving OGC. Students that were employed, enrolled in classes, and still under their parent’s insurance plans had a higher incidence of optimal glycemic control. Discussion It was hypothesized that those with OGC would have a higher incidence of diabetes technology use. This PI found that even though almost all participants had access to the diabetes technology, still only 37% of the participants had optimal glycemic control. There are many components to diabetes care that impact glycemic control that were not explored within this scope of this diabetes technology study. Conclusions It is likely that both CGMs and insulin pumps worn all the time are the most powerful tools to achieving OGC. Students who graduate from college and transition to adulthood are vulnerable as they may encounter added stressors such as employment, and financial responsibility that cause them to deviate from the recommendations for diabetes technology use. Care providers need to be cognizant that young adulthood is a vulnerable time in terms of OGC and optimal diabetes management. Providers need to work with young adults, and encourage them to adhere to the recommended diabetes care regime.

Women with gynecological (GYN) cancer experience a wide spectrum of physical, emotional and social effects after diagnosis and treatment of their cancer. The insufficient availability of local support groups, limited transportation for the rural Chinese population and a shortage of oncologists make it difficult to have face-to-face support groups for Chinese GYN cancer patients. However, the wide access of Internet has provided an opportunity for people to have online support groups. The purpose of this study was to observe and describe the types of support given to and by Chinese GYN cancer survivors in a QQ chat group. This was a qualitative study that used the directed content analysis approach. A QQ group was observed for two weeks between March 10th (12:01am) and March 24st (11:59pm) 2018 Beijing time. Observed online posts were copied and pasted into a WORD ™ document for analysis. There were 4 themes observed: sharing experience, information exchange, emotional support and Guardian Against Cancer group member benefits. The results of the study suggested that women supported each other but little evidence-based support was observed. Healthcare providers should be monitoring and engaging in conversations with group members. Well-planed and organized information sessions should also be beneficial for members. Further research on understanding members’ needs on online support groups and the effectiveness of intervention should be conducted.

The lesbian, gay, bisexual, and transgender (LGBT) community is a unique population that has specific health issues and health care needs associated with lifestyle behaviors that increase risk for certain diseases. Health concerns include mental and behavioral health, issues associated with gender identity and relationships (i.e. intimate partner violence), sexually transmitted infections, and chronic illnesses. The research suggests poorer health outcomes for the LGBT population compared to heterosexual and/or cisgender counterparts. Most research conducted with LGBT populations occurred in more populated urban settings with very few studies focusing on this population in the rural context. Consequently, there is a paucity of information on the health care concerns of the rural LGBT population. Considering the information gap, this integrative review of 14 research articles focused on health-related issues of the LGBT population in rural regions. The findings revealed rural LGBT persons experience disparities in accessing health care and support services; coupled with health care providers who often were not culturally competent; and, sometimes, unfamiliar with evidence-based health care protocols when caring for the LGBT patient. Implications for nursing research, education, practice, and policy and study limitations are highlighted.

Adults aged 65 years and above have grown substantially over with past decade. However, the chance of developing multiple comorbidities only increases with age. Because elderly residents of rural Appalachia often encounter barriers to healthcare, rural nurses, providers, and policy makers must overcome physical and structural barriers, but also gain a more in-depth understanding of the personal and cultural attitudes impacting the use of new and innovative forms of healthcare delivery. With a slow and variable uptake of telehealth adoption in rural Appalachia, and in the presence of well-documented medical mistrust, this study was designed to better understand the degree of medical mistrust existing in the elderly of rural Appalachia and to assess if medical mistrust may be inhibiting efforts related to telehealth acceptance. A correlational design was utilized administering the Medical Mistrust Index (MMI) and Technology Acceptance Model (TAM) questionnaire via electronic survey to those age 65 years and above living in rural Appalachia. Deemed well-established and validated, the MMI measures medical mistrust from a broader perspective, while TAM assesses telehealth acceptance in terms of perceived usefulness, perceived ease of use, and overall attitude towards telehealth as a technology. Demographics of gender, income, education, and previous telehealth experience were compared to MMI and TAM scores. The study revealed a moderate level of medical mistrust and telehealth acceptance among the elderly of rural Appalachia. A statistically significant negative relationship was found between MMI and TAM for those reporting previous telehealth experience, and among all demographics, with the strongest correlations found among females and participants of lower education. Elderly rural Appalachians have a rich social and cultural history, but past experiences and long-held beliefs have resulted in medical mistrust and slow telehealth uptake. Stakeholders have a responsibility to meet individuals where they are understanding that elderly residents of rural Appalachia may not be ready or fully prepared to incorporate telehealth into their management of care. However, quality rural nursing practice and continued research has the ability to evolve to meet the needs that exist among those of advancing age with limited healthcare resources such as those found in rural Appalachia.

External and internal funding is a way that nurse scholars can support research and scholarship activities. Often, programs are supported by a combination of internal and external funding to support projects. External funding through competitive grants is a valuable way to fund initiatives and to expand services. However, these applications commonly require a detailed and complete budget that will provide a framework to fiscally plan for program activities – which can be daunting to novice grant seekers. There is a scarcity of information in the literature on the framework for the development of a program budget or how to begin, which can be a challenge to those new to this process. A well-prepared and developed budget supports the success of an external funding application and serves as the framework to fiscally support and optimize activities. The purpose of this presentation is to provide nurses the basic information on how to develop a budget for external and internal funding applications.

No / By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.

Yes / Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods: To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012–June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013–April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Results: Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Conclusions: Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision, which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice. / This study was funded by a grant from the Assisted Living Innovation Platform, with support from the Technology Strategy Board and the Economic and Social Research Council.

No / Ex-offenders re-enter their communities with limited pre-release preparation for the continuity of access to health care once outside prison. Once released, these individuals become hard to reach, do not consider health a priority and consequently use services to address their health and social care needs in a crisis-led way. Nevertheless, how nurses can best support these health-excluded group of individuals in the community remains vague and requires discussion. It is argued that current dominant discourses around equity of care are contradicted in the provision of health and social care services to ex-offenders in the community. Effective engagement with community interventions may be achieved if ex-offenders maintain contact with frontline providers who can support both their structural and health needs. Nurses are uniquely positioned to initiate and sustain contact with ex-offenders, intervening at points of greatest need in the community to address the socially significant health and social care issues that plague them. The use of nurses in the provision of health and social care interventions to ex-offenders is a strategy, which could increase equity in access to health care, reduce reoffending and improve both the health and life chances of these individuals.