Sande Gracia Jones

ENHANCING KNOWLEDGE AND SELF-CONFIDENCE of Novice Nurses: The “SHADOW-A-NURSE” ICU Program

The nursing shortage in the United States has resulted in a need for newly graduated novice nurses to rapidly transition into the nursing workforce. Although some nursing schools provide clinical experience in the intensive care unit (ICU), many novice nurses are not confident about their skills in providing critical-care nursing. To assist novice nurses in rapidly transitioning into the ICU nurse role, an innovative internship program for novice nurses was designed and implemented. A pilot study was conducted to determine if working with experienced nurses in the ICU environment, in addition to formal education and skills training in critical-care nursing, enables novice nurses to effectively transition into the role of ICU nurse. Qualitative and quantitative results of the program after the second year are discussed.

Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions

In 2006, the Centers for Diseases Control and Prevention (CDC) released recommendations calling for routine HIV testing to be offered to those ages 13 to 64 as a standard of general health care. This recommendation included a plan to conduct HIV testing as part of a general consent. The reasoning and evidence for this recommendation is supported by experts, patients, and sponsored screenings by the CDC. The rationale behind this approach includes that knowledge of ones HIV status helps (1) infected individuals adopt risk-reduction behaviors and access to life-prolonging treatment and (2) uninfected individuals maintain behaviors that reduce their risk of becoming infected. This article discusses the perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions that can be part of a nurse-led contribution to develop and adopt innovative, patient-centered care models that can address the need for screening.

SENORITAS: an HIV/sexually transmitted infection prevention project for Latina college students at a Hispanic-serving university.

Few HIV prevention projects have specifically targeted Latina college students. These young women may be at risk for HIV infection because of developmental issues, normative behaviors, gender roles, and cultural beliefs that affect their sexual practices. The SENORITAS project (an acronym for Student Education Needed in Order to Reduce Infection and Transmission of AIDS/HIV and STIs [sexually transmitted infections]) is an innovative program designed for Latina college students at an urban Hispanic-serving institution in South Florida. The project has two major aims: (a) to provide age-appropriate, gender-specific, and culturally tailored HIV/STI prevention education for Latina college students through the use of a theoretically based, single-session peer education program: and (b) to improve the competence, comfort level, and skills of multiethnic nursing students as HIV prevention educators. This article discusses project development and design using the information-motivation-behavioral skill model for HIV prevention, describes implementation with peer educators, and concludes with progress to date and future directions.

Life in a Pill Bottle: The Experience of Taking HIV Medications

The purpose of this phenomenological study was to describe the experience of taking HIV medications (HAART) and identify factors affecting adherence. Participants were 10 middle-aged and older (35 to 58) HIV-positive adults (four homosexual men and six women with a history of substance abuse) who were asked to describe the daily experience of taking HAART. The metaphor that emerged from the data was Life In a Pill Bottle, which reflected the central focus of HAART in participants’ lives and also described the complex relationships that evolved between and among the person, the medications, and the virus. Three themes comprised the experience: commitment versus perseverance, feeling bad, and healing helpers. Similarities and differences were noted between men and women.

Taking HAART in the fight against HIV/AIDS.

Drug therapy for HIV/AIDS has come a long way since the 1980s when the focus was treating opportunistic infections that often accompany HIV. Today, caregivers target HIV itself with highly active (or highly aggressive) antiretroviral therapy (HAART) that interrupts viral replication.

Evaluation of a Human Immunodeficiency Virus Rule Out Tuberculosis Critical Pathway as an Intervention to Decrease Nosocomial Transmission of Tuberculosis in the Inpatient Setting

Nosocomial transmission of Mycobacterium tuberculosis (TB) is a recognized risk in health care settings, and is a particular concern in settings where human immunodeficiency virus (HIV)-infected persons receive care. TB control guidelines have been effective in prevention of nosocomial TB outbreaks and protection of patients and health care workers. In 1993 a South Florida academic medical center noted an increase in TB cases, particularly in HIV-infected persons who had been inpatients. A multidisciplinary team developed an HIV Rule Out TB Critical Pathway as an intervention to deter nosocomial transmission of TB. The pathway was implemented in 1995 on the Special Immunology/Infectious Disease (SI/ID) inpatient unit. This paper describes an evaluation study conducted to determine the effectiveness of the pathway as an intervention to deter nosocomial TB in relation to two areas: (1) early identification of HIV-infected patients with potential TB, followed by immediate placement in respiratory isolation and (2) protection of SI/ID unit personnel from occupational TB exposure. A retrospective review was conducted in June 1999 on the medical records of all patients who had been placed on the HIV Rule Out TB Critical Pathway from 1995-1998. A review was also done of the medical centers confirmed TB cases, and employee health records for tuberculin skin testing (TST) of employees during this time period. The review demonstrated that all HIV-infected patients with confirmed TB had been identified, placed on the pathway and admitted to respiratory isolation at the onset of hospital admission, deterring the potential for a nosocomial TB outbreak. However, in 1998 two SI/ID staff converted from a nonreactive to a reactive TST. Although the pathway was only partially successful in TB protection for staff members, other factors may have caused the TST conversions. A study recommendation is that institutions develop an HIV Rule Out TB Critical Pathway, along with a Rule Out TB Pathway for patients who are not HIV-infected but present with symptoms that may be indicative of TB infection.

Lessons From the Viagra Study: Methodological Challenges in Recruitment of Older and Minority Heterosexual Men for Research on Sexual Practices and Risk Behaviors

Although all sexually active persons may be at potential risk for HIV and other sexually transmitted diseases (STDs), there is a common misperception that older heterosexual adults are not at risk (Smith & Christakis, 2009). HIV is a continuing concern among persons older than 50 years (Goodroad, 2003; Savasta, 2004). Therefore, research with this population is warranted. However, little literature addresses the recruitment of middle-aged and older heterosexual men, particularly minority men, into research studies on sexual behaviors and practices. The purpose of this article is to discuss the challenges that arose during the recruitment and data collection stages of a study on health and sexual practices of older heterosexual men using drugs prescribed for treating erectile dysfunction (ED), and the strategies that were used to meet these challenges. Lessons learned from this study will be discussed, as will be implications for HIV/STD researchers and clinicians.

The Perceived Effects of Condoms on Sexual Experience: A Comparison of Older Hispanic and Non-Hispanic Men.

Heterosexual transmission of HIV and other sexually transmitted diseases (STDs) is increasing in older adult populations around the world. This study compares Hispanic and non-Hispanic men ages 50 years and older currently using prescribed erectile dysfunction medications in relation to their perception of the effect of condoms on sexual experience. A sample of 86 men (40 Hispanic and 46 non-Hispanic men) ages 50-79 years completed the 10-item Effect on Sexual Experience (ESE) subscale. Although there was no difference between the 2 groups on the subscale mean score, t(84) = 1.449, p = .151, analysis of the subscale items found 1 item that was significantly different (p = .005) between the 2 groups, although this difference could have been related to different perceptions of the word disgusting. Hispanic men were also less concerned than non-Hispanic men about condom-related loss of erection. This study adds to the literature on HIV and STD prevention for older Hispanic/Latinos.

Condom Attitudes of Heterosexual Men Ages 50 and Older Using Prescribed Drugs (Viagra Cialis Levitra) to Treat Erectile Dysfunction.

The purpose of this study was to explore attitudes about condoms that may affect condom use by heterosexual men ages 50 and older who were sexually active and currently using prescribed oral phosphodiesterase type 5 inhibitor medications (Viagra®, Cialis®, or Levitra®) for treatment of erectile dysfunction. The study was part of a larger study that explored the need for safer-sex health promotion and education for these men. Fifty men completed factor subscales of the Condom Attitude Scale. Subscales were scored and analyzed. Positive factors were found with regard to the Interpersonal Impact, Inhibition, Perceived Risk, Perceived Seriousness, and Global Attitudes subscales. Factors with negative or neutral responses included the Effect on Sexual Experience, Relationship Safety, and Promiscuity subscales. Independent t tests revealed no differences between married and nonmarried men for the mean score on any of the subscales, but there was a difference on the Global Attitude Scale, with younger men having a more positive global attitude than older men. Study findings can be used in the development of health promotion educational activities on condom use as a safer-sex practice.

Using nursing research projects to meet Magnet Recognition Program standards.

The American Nurses Credentialing Center Magnet Recognition Program recognizes facilities that demonstrate excellence in nursing services, development of a professional milieu and growth and development of the nursing staff. The Magnet program is based on the American Nurses Association’s Scope and Standards for Nurse Administrators, which serves as the evaluation framework for determination of Magnet recognition. The role of research and its impact on nursing practice is an important criterion. The authors describe how one medical center successfully used ongoing nursing research projects to highlight how the institution met the Magnet standards.