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BACKGROUND: Colorectal cancer (CRC) is a leading cause of death from cancer in the United States, despite the availability of high-quality screening options. Multiple barriers to CRC screening have been identified, including cost (noninsured), younger age, racial or ethnic minority, recent immigration to the United States (non-English speaking), fear or distrust of the health care system, and rural residence. LOCAL PROBLEM: The mean CRC screening rate for the designated Federally Qualified Health Center (FQHC) was 33.7% for the 5 months preceding this quality improvement (QI) project. The benchmark target for CRC screening was 60.1%. METHODS: The Model for Improvement and Plan-Do-Study-Act cycle created the framework for the CRC screening targeted interventions used in this FQHC patient population. INTERVENTIONS: Multiple targeted interventions were implemented over a 4-month period that emphasized a strong provider recommendation, a team-based approach to identify and offer CRC screening options to the overdue patient. A chart audit was followed by a mailed fecal immunochemical test (FIT) and colonoscopy reminder letter initiative. RESULTS: The performance metric for CRC screening reached 40% within 4 months. A second chart audit confirmed the CRC screening rate improved to 41.5% among patients aged 50-75 years. An overall 55% return rate was achieved with the mailed FIT initiative within 2 months. CONCLUSIONS: Continued quality improvement initiatives are needed to achieve the benchmark target for this FQHC. These team-based interventions can be used by the primary care nurse practitioner to improve health equity for CRC screening in other underserved populations.

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In this paper, we describe the development and psychometric properties of the Fogg Intent-to-Screen for HIV questionnaire (ITS HIV), which measures peoples' beliefs and intentions toward HIV screening. The ITS HIV was developed using the Theory of Planned Behavior as the framework for a developmental process that included qualitative interviews, a validation phase, two pilot tests, and a field test of the final 55-item questionnaire. The field test involved 312 homeless persons from five New England states. Cronbach alphas of the direct measures scales ranged from .72 to .90. Findings from a path analysis verified the construct validity. The psychometric estimates from these analyses suggest the ITS HIV questionnaire is appropriate for use in clinical practice or to evaluate the effectiveness of interventions.

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HIV screening is the first step in identifying HIV infection; however, the HIV screening rates remain low. Homeless people in the United States are at risk for HIV infection, yet their acceptance of HIV screening remains poorly understood. The purpose of this study was to investigate beliefs and intentions of the homeless toward HIV screening. Using a survey design, this study applied the Theory of Planned Behavior to investigate attitudes, social norms, and perceived behavioral control and their relationship to intention to screen for HIV. Homeless people (N = 323) from 12 different shelters participated in this study. The final path analysis explained 60% of homeless people's intentions to screen for HIV. Significant predictors included: attitude toward HIV screening, prior screening, age, and subjective norms. Implications include health provider recommendations for screening and increasing awareness of HIV risk behaviors for this vulnerable population.

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Injection drug users and their sexual partners and children represent an increasing proportion of Americans living with HIV or AIDS. Syringe-exchange programs (SEPs), which are based on the theory of harm reduction, are effective in preventing the transmission of HIV and other pathogens through injection drug use. Most programs also serve as gateways to other vital medical services. Yet SEPs remain controversial. This article describes the controversy, considers the evidence, and discusses the nursing implications.

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This article describes a qualitative study that explored the perceptions of graduating students from a northeast baccalaureate nursing program regarding their life experiences with cultural diversity. Thirteen students were interviewed using an interview guide, and interviews were recorded on audiotape. Information obtained included participants' cultural heritage, life experiences before entering a nursing program, educational and clinical experiences in the nursing program, knowledge about cultural competence, and the students' reflections on their ability to provide culturally competent care. Primarily qualitative methods were used to gather and analyze data. This article focuses on one of the major themes that emerged: defining life experiences related to cultural diversity. Data were reanalyzed focusing on this theme, and three life patterns emerged: positive, neutral, and conflicted. These patterns affected the students' interest and desire to provide culturally competent care. Implications for further research and nursing education are discussed.

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Are policies allowing family into the trauma room humane and necessary--or just asking for trouble?

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Are policies allowing family into the trauma room humane and necessary--or just asking for trouble?

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