Skilled home health care (HH) is the largest and fastest growing long-term care setting in the United States. Patients in HH are served by an interprofessional team, and may have little direct contact with physicians, when discussing their progress, prognosis, and goals of care. Such conversations are part of primary palliative care communication. Evidence on primary palliative care communication training in the non-physician HH interprofessional team is lacking. The objectives of this study were to assess the feasibility, acceptability, and preliminary effectiveness of using a palliative care communication model known as COMFORT© to provide palliative care communication training to HH staff. A randomized controlled trial was conducted at a regional health system in the southeastern U.S. to test online training modules (n = 10) (Group 1) and online training modules plus face-to-face training (n = 8) (Group 2). Measures included training completion rates, staff acceptability ratings, comfort with palliative and end-of-life communication (C-COPE) and moral distress (MMD-HP). Results showed that COMFORT© training was feasible (92%), highly acceptable (>4 on a 6-point scale), and positively correlated with improved C-COPE scores (P = .037). There was no significant difference in moral distress scores pre- and post-intervention or in effectiveness between the groups. However, acceptability of COMFORT© was positively correlated with history of leaving or considering leaving a job due to moral distress ( χ 2 = 7.6, P = .02). Preliminary findings from this pilot study suggest that administration of COMFORT© training was feasible, and it was correlated with increased HH staff comfort with palliative care communication.

Since 2021, some state legislators have passed laws that limit what public institutions can teach about discrimination. The number of these laws, also called gag orders, is increasing despite a national outcry against racism, homophobia and transphobia, and other forms of discrimination. Many nursing and other professional healthcare organizations have recognized and published statements decrying racism in healthcare and calling for an increased focus on health disparities and advancing health equity. Similarly, national research institutions and private grant funders are funding health disparities research. Nursing and other faculty in higher education, however, are being gagged by laws and executive orders which prevent them from teaching and conducting research about historic and contemporary health disparities. This commentary seeks to highlight the immediate and long-term impact of academic gag orders and to encourage action in opposition of such legislation. Supported by professional codes of ethics and discipline-specific education, we present concrete activities readers can use to address gag order legislation and in doing so, protect patient and community health outcomes.

PURPOSE: The purpose of this study was to explore an association between e-cigarette use and Quality of Life (QOL) among college students. METHODS: During February 2016, 1,132 students completed an online survey that included measures of tobacco use and the WHOQOL-BREF instrument. Differences were tested using Chi-square, Fisher's exact test, and ANOVA, and regression was used to assess possible relationships. RESULTS: E-cigarettes were used by 6.97% of the participants, either solo or along with traditional cigarettes. Bivariate analyses suggest that male college students are more likely than females to use e-cigarettes, either solo or in combination with traditional cigarettes (χ =19.4, < .01). Lesbian, gay, and bisexual students are more likely than heterosexual students to use traditional cigarettes, either solo or in combination with e-cigarettes (χ = 32.9, < .01). Multivariate models suggest that for every 10-unit increase in overall QOL, psychological well-being, social relations or environmental health the adjusted odds of being a sole cigarette user were significantly lower (all, < .01), respectively. For every 10-unit increase in psychological well-being the adjusted odds of being a dual user was significantly lower (OR = .83, = .026). CONCLUSIONS: Findings indicate that lower quality of life appears to be connected to tobacco use.

BACKGROUND: E-cigarette use has grown in popularity, especially as the devices have been touted as smoking cessation tools. In an exploratory study, we sought to compare dual users (i.e., users of both combustible tobacco and e-cigarettes) to e-cigarette only users. METHODS: The Electronic Cigarette Opinion Survey (ECOS) was employed to assess users' (n=78) perceptions and consumption of e-cigarettes and combustible cigarettes. Quantity of e-juice and nicotine used and time of initial nicotine exposure were assessed. Multivariable logistic regression was used to evaluate the association between e-cigarette use behaviors and being an e-cigarette only user compared to a dual user. RESULTS: Compared to dual users, e-cigarette only users consumed higher levels of nicotine in e-juice (p=0.0009) and more nicotine per month (p=0.03). For dual users, the time of first nicotine exposure after waking was significantly earlier than for e-cigarette only users (mean= 9.6 minutes (SD= 8.0) and mean= 26.6 minutes (SD= 22.0), respectively; p=0.0056). Results from the regression models suggest the amount of e-juice consumed and time of first nicotine exposure after waking are significantly associated with being an e-cigarette only user. CONCLUSIONS: These findings shed light on the perceptions and use patterns of e-cigarette only users compared to dual users. As regulation of e-cigarettes is considered, understanding the impact of e-cigarettes and dual use is imperative. Despite frequent marketing claims that e-cigarettes are completely safe, health campaigns need to convey emerging and mixed findings on safety as well as current scientific uncertainty to the public.

Rationale: An inter-professional education (IPE) masterclass symposium titled, ‘The journey to team-based healthcare’, was jointly hosted by the School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), the Irish Institute of Pharmacy and the Bill Gatton College of Pharmacy in East Tennessee State University in May 2017. The masterclass provided a comprehensive overview of IPE initiatives based on the extensive experience of senior academics from the host institutions, which included staff from pharmacy, nursing and medicine. The masterclass was attended by healthcare professionals, policy makers and educationalists working in Ireland. As part of the symposium, focus groups were conducted with a sample of symposium attendees to determine their opinions and perceptions, as key stakeholders, regarding the development, implementation and future direction of IPE in Ireland. Methods: Focus groups were conducted with symposium attendees using a topic guide that was developed based on previous literature. Questions explored participants’ views and experiences on a range of topics including development and implementation of IPE activities, and key priorities for developing future IPE initiatives. Thematic analysis was conducted to identify key themes. Findings: Three focus groups were conducted each involving five to six participants (total 16 participants: nine female). Preliminary themes have been identified and further analysis is ongoing. Discussion/conclusion: The research findings will help to inform the future development and direction of IPE initiatives at both undergraduate and postgraduate level within the host institutions and could help in the development of an IPE strategy for undergraduate and post-graduate teaching across Ireland.

Community health workers are projected to grow in number by 17 percent by 2030. A baccalaureate degree in nursing (BSN) provides a foundation for public health nursing practice. The Competencies for Public Health Nursing Practice instrument was distributed to BSN students at a Midwestern university before and after an educational intervention. Students completed a pretest (n = 269) and posttest (n = 154). All four subscales and total score indicated a significant increase in competence (p < .001). There is a need to develop interactive public health nursing simulations with an interprofessional venue to help students improve teamwork and communication competencies [...]

Background: Telepresence robots provide real-time audio, video, and mobility features, allowing faculty and students to engage in learning experiences without being physically present. Problem: With multiple students and faculty members needing to quarantine due to the COVID-19 pandemic, a flexible learning environment was essential. Approach: The telepresence robots were used as an innovative approach for both faculty and students to engage in learning experiences offered in a variety of settings. Outcome: Feedback was obtained from faculty and students about the use of and satisfaction with telepresence robots. The robots were easy to use and posed only a few technological challenges, which were easily overcome. Conclusions: Telepresence robots were effective tools in overcoming teaching and learning barriers caused by the COVID-19 pandemic. The telepresence robots have many applications, including use in clinical and community settings.

Objective. To examine the relationship between the NAPLEX and Pre-NAPLEX among pharmacy graduates, as well as determine effects of pre-pharmacy, pharmacy school, and demographic variables on NAPLEX performance. Methods. A retrospective review of pharmacy graduates' NAPLEX scores, Pre-NAPLEX scores, demographics, pre-pharmacy academic performance factors, and pharmacy school academic performance factors was performed. Bivariate (eg, ANOVA, independent samples t-test) and correlational analyses were conducted, as was stepwise linear regression to examine the significance of Pre-NAPLEX score and other factors as related to NAPLEX score. Results. One hundred fifty graduates were included, with the majority being female (60.7%) and white (72%). Mean NAPLEX score was 104.7. Mean Pre-NAPLEX score was 68.6. White students had significantly higher NAPLEX scores compared to Black/African American students. NAPLEX score was correlated to Pre-NAPLEX score, race/ethnicity, PCAT composite and section scores, undergraduate overall and science GPAs, pharmacy GPA, and on-time graduation. The regression model included pharmacy GPA and Pre-NAPLEX score. Conclusion. The findings provide evidence that, although pharmacy GPA is the most critical determinant, the Pre-NAPLEX score is also a significant predictor of NAPLEX score.

Pediatric obesity has become a major health care concern over the last several decades. This condition can lead to detrimental life-long physical and mental comorbidities. Pediatric primary care providers have a unique opportunity to both prevent and treat pediatric obesity in their clinics. However, discussing this topic with families can be uncomfortable and time consuming. Time efficient resources to educate and increase confidence are needed to improve the management of pediatric obesity. This quality improvement project integrated the Healthy Care for Healthy Kids by the National Institute for Children's Healthcare Quality (2014) into the electronic medical record at a pediatric primary care office in rural East Tennessee. This toolkit included handouts, management algorithms, and provider education for pediatric obesity. After an 8-week implementation period, improvements in lab draws and evaluation of a family's readiness to change were noted. Overall, providers reported the toolkit was helpful and improved patient interaction. Currently, the clinic is still utilizing the integrated resources and handouts.

Purpose: The purpose of this qualitative study was to highlight the lived experiences of Hispanic migrant workers seeking healthcare at a community care clinic in rural Appalachia with participation from student nurses learning about qualitative research methods. Design/method: A phenomenological qualitative study was approved by the institutional IRB. Senior BSN nursing students, community care clinic staff and interpreters, and nurse educators participated in structured interviews during healthcare visits from Hispanic migrant workers at a local community care clinic in rural Appalachia. An audit trail provided the process to highlight common themes on health from the lived experiences of the Hispanic migrant worker population. Results: Several barriers on healthcare viewed by the Hispanic migrant workers included transportation, financial resources, medication prescriptions, and language. Positive lived experiences included; resources, quality care, and trust. Discussion/conclusion: Surprisingly, this research highlighted strengths of the interpersonal connection between the rural clinic staff and the Hispanic migrant workers. Participants vocalized their satisfaction when trust was established through the clinic’s efforts in providing interpreters, extended hours after normal field work hours, and personnel’s attitudes toward the promotion of health. The Hispanic Worker Study findings parallel similar lived experiences of the culture among people from rural Appalachia. Implications: Healthcare members must establish ‘trust’ as one of the interpersonal relationship strategies with multiple and diverse populations in order to create holistic culturally competent healthcare.