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In today's fast-paced, instant-gratification-oriented society, everyone is looking for quick fixes. We want it all and we want it now! This mindset is in conflict with the overall process of education and learning which requires time, reflection, and practice. More and more students are entering colleges and universities with weak academic preparation and deficient life skills. This often leads them to engage in unethical practices in order to compete, get ahead and survive academically. Declining academic integrity is a significant issue on almost all college campuses. The purpose of this study was to gain deeper insight into student nurses' perceptions of the concept of instant gratification in general and in nursing education in particular. The implications of the Trinity Paradigm of Intelligence in developing a culture of integrity were also explored. The emerged data supports the notion of "academic disintegrity" as a social problem with a long history of development.

Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.

Background: One-third of the U.S. population has prediabetes, but 90% remain undiagnosed because healthcare providers are not screening for this condition. Objective: The purpose of this quality improvement project was to monitor prediabetes screening and identification, and implement evidence-based recommendations including registered dietician referral. Methods: This project involved using an evidence-based screening tool to measure individual risk of prediabetes. Aggregate data was collected to evaluate screening implementation, evidence-based recommendations offered by providers, and assess patient risk factors. Results: The percentage of patients at risk for prediabetes was 41.3% (n = 111). The most frequent risks were identified as overweight, history of hypertension, family history of type 2 diabetes mellitus (T2DM), and older age. Providers offered education on weight loss 68.5% (n = 76) and exercise 76.6% (n = 85) but referred 33.3% (n = 37) patients for nutrition education. The screening rates were 52.3% (n = 176) and 72.5% (n = 244) in clinics A and B respectively. Conclusions: A gap remains in using evidence-based recommendations to decrease risk of prediabetes. Prediabetes screening identified a greater percentage of persons in this population. Implications for Nursing: There is a need for consistent practice of evidence-based recommendations. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

Background: The Central Appalachian region of the United States is disproportionately burdened with high prevalence of tobacco use and tobacco-induced diseases. Efforts to address tobacco use in the region have become complicated with uptake of Electronic Nicotine Products (ENPs), including e-cigarettes, among adolescents and young adults. The high prevalence of tobacco use, and the history of tobacco production have created a high-risk environment for the use of tobacco and ENP among adolescents in the region. However, research on how susceptibility to use e-cigarettes among school-going adolescents translates to usage is sparse. This study aimed to explore the association between susceptibility to use e-cigarette and e-cigarette use in school-going adolescents in Appalachian Tennessee. Methods: Data (N=399) was collected from high school students in an Appalachian Regional Commission (ARC)-designated distressed County in Appalachian Tennessee. We ascertain the study’s outcomes (current e-cigarette use), the exposure (susceptibility to use e-cigarette) and co-variates (grade, sex, age at first use of tobacco, perception of the danger of smoking, parental counseling) using validated questions. Descriptive statistics and multi-variable logistics analyses were performed. The Odds Ratios (ORs) along with Confidence Intervals (CI) have been reported. Results: 15.5% of the population were current e-cigarette users and 25.93% were identified as susceptible to use e-cigarettes. Susceptibility to use e–cigarette was associated with increased odds of the current use of e-cigarette (OR=6.40, CI=4.18–9.77). In addition, age at first use of tobacco (OR = 0.42, 95%CI =0.32 – 0.56) was associated with reduced odds of the current use of e-cigarette, while intention to smoke e-cigarette (OR =6.46, CI =3.63 -11.49) was associated with increased odds of the current use of e-cigarette. Conclusion: Susceptibility to use e-cigarette was positively associated with the current use of e-cigarette among school going adolescents. Future longitudinal studies with large sample size are warranted to confirm the association.

This manuscript provides a critical review of the literature on parent–child physiological synchrony—the matching of biological states between parents and children. All eligible studies found some evidence of physiological synchrony, though the magnitude and direction of synchrony varied according to methodological factors, including the physiological system examined (i.e., parasympathetic or sympathetic nervous system activity, adrenocortical functioning) and the statistical approach used (e.g., multilevel modeling, correlation). The review underscores the need to consider the context in which physiological synchrony occurs (e.g., family risk) to best understand its significance. Furthermore, the review delineates vital avenues for future research, including the need to assess synchrony across multiple physiological systems and the importance of documenting continuity/change in physiological synchrony across developmental periods. Such research is crucial for understanding how the parent–child relationship unfolds at a physiological level and, in turn, how this relationship can facilitate or hinder parent, child, and family adjustment.

Studies have addressed the visitation needs of visitors and patients and the impact of visitation policies on nurses, but few studies compare the level of satisfaction between visitors and nurses when visitation policies change. The objectives of this study were to investigate whether a more liberal intensive care unit visitation policy satisfactorily met the needs and expectations of visitors and nurses. © 1999 Lippincott Williams and Wilkins, Inc.

Previous studies have suggested that health care workers may differ with respect to universal precautions knowledge, compliance, practice setting barriers, or exposure to patient body fluids in rural and urban areas. The purpose of this study was to determine whether or not there are rural/urban differences in the degree of precaution taken by health care workers to prevent the spread of blood borne pathogens, specifically human immunodefiency virus (HIV) and hepatitis B virus (HBV). A random sample of rural and urban registered and licensed practical nurses in Tennessee was surveyed. The respondents completed two instruments that assessed self‐reported universal precautions knowledge, precautions, and practice barriers. No measurable differences in universal precautions knowledge, compliance, or barrier scores between the two groups were found; yet rural nurses were 2.7 times as likely to be exposed to patient body fluids than urban nurses (P<0.005). The conclusion was that rural nurses were as experienced and as knowledgeable about universal precaution techniques as their urban peers, but their knowledge was not translated into practice to the same degree. Two possible explanations offered are (1) rural nurses are more likely to be acquainted with, and thus trusting of, their patients, and (2) the lower seroprevalence of human immunodefiency virus and hepatitis B virus in rural areas may lead to complacency.

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