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BACKGROUND: Pressure injury (PI) development in the critical care population is multifactorial. Despite the application of evidence-based prevention strategies, PIs do occur and may be unavoidable in some patients. OBJECTIVES: To describe the risk factors associated with PI development in a sample of medical-surgical intensive care unit patients and determine whether these risk factors were congruent with the risk factors proposed in the work of the National Pressure Ulcer Advisory Panel on unavoidable PIs. METHODS: A retrospective, descriptive design was used to determine the PI risk factors present in a sample of 57 critically ill patients admitted to the medical-surgical intensive care unit for more than 24 hours and who acquired a PI during their admission. RESULTS: The most frequently identified risk factors were immobility (n = 57 [100%]), septic shock (n = 31 [54%]), vasopressor use (n = 37 [65%]), head-of-bed elevation greater than 30° (n = 53 [93%]), sedation (n = 50 [87.7%]), and mechanical ventilation for more than 72 hours (n = 46 [81%]). The most common PI location was the sacrum (n = 32 [56%]), and the most common stage reported was deep-tissue PI (n = 39 [68%]). The mean number of days to PI development was reported at 7.5 (SD, 7.2) days. CONCLUSIONS: Results of this descriptive study were congruent with the literature surrounding the clinical situations that predispose patients to unavoidable PIs. While the implementation of aggressive PI prevention strategies is essential to reducing PI rates, it is important to recognize that in certain populations, such as the critically ill, exposure to certain risk factors may potentially escalate PI risk beyond the scope of prevention and result in an unavoidable PI. Recognizing these risk factors is significant in the journey to differentiate PIs that result from a lack of preventive care from those that may be prevention immune.

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BACKGROUND: Police-community relations have catapulted onto the national stage after several high-profile instances of alleged police brutality. Blame and hostility can be barriers to positive police-community relations. Playback is a form of audience-inspired, improvisational theater designed to promote connectivity and empathy through storytelling. OBJECTIVES: We tested the feasibility and acceptability of an arts-based intervention, bringing together police officers and formerly incarcerated individuals from the same community in Memphis, Tennessee. METHODS: We collected pre/post quantitative data from five police officers and five ex-offenders who took part in the intervention, as well as qualitative data to provide contextual information. RESULTS: The project was feasible and acceptable to participants. Participants showed gains in their ability to make meaning of stressful life experiences. The officers and ex-offenders showed parallel gains in their increased positive attitudes toward the other group. CONCLUSIONS: This study demonstrates that creating contexts of safety and understanding necessary to address relational problems is both feasible and acceptable to law enforcement and ex-offenders.

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BACKGROUND: Colorectal cancer (CRC) incidence and mortality are highest among African Americans. African Americans lag behind whites in CRC screening rates. Research has examined the role of CRC screening knowledge and beliefs and their relationship to CRC screening adherence. However, studies have not examined the effect cultural identity, social support, CRC beliefs, an informed decision, and having a chronic disease has on CRC screening among African Americans. OBJECTIVES: This study examined CRC screening adherence among African Americans within the context of sociocultural variables, an informed decision, and health factors. METHODS: A secondary data analysis was performed on survey data collected from 129 African American men and women. RESULTS: Social support and family influence were related to having a colonoscopy. Having diabetes was negatively related to having a colonoscopy. There was no relationship between having a primary care provider and making an informed decision about CRC screening. Religiosity and having a primary care provider predicted colonoscopy. CONCLUSIONS: The results indicate that certain sociocultural variables are related to colonoscopy. However, those same variables may not be related to or predictive of fecal occult blood test adherence. The diagnosis of diabetes may present a challenge to CRC screening adherence. IMPLICATIONS FOR PRACTICE: The results of the study suggest that social support and family influence concerning CRC screening be assessed to provide additional support to colonoscopy adherence. The results also suggest that diabetic patients may require additional intervention to increase colonoscopy adherence rates.

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Amyotrophic lateral sclerosis (ALS) often is associated with a particularly intensive caregiving experience, and the well-being of caregivers impacts that of patients. Thus, identification of factors leading to distress in caregivers may provide avenues for intervention that will help both the caregiver and the patient. We prospectively examined caregivers' social problem solving skills, the quality of the patient-caregiver relationship, caregivers' spirituality and religiousness, and the ways in which these impact caregivers' quality of life (QoL) and psychological morbidity in 75 caregivers of ALS patients. Data were analyzed through correlational and hierarchical multiple regression analyses. Social problem solving and spirituality were the best predictors of caregivers' QoL, accounting for 15.6% and 7.8% of the variance in QoL, respectively (F (2, 69) = 11.83, p<.001). Social problem solving also predicted and accounted for 25.4% of the variance in psychological morbidity (F (1, 71) = 25.571, p<.001). Level of care provided did not predict either QoL or psychological morbidity in caregivers. In conclusion, the problem-solving skills of ALS caregivers are an important determinant of caregiver well-being. Developing interventions to teach ALS caregivers effective methods of problem solving would probably be beneficial to this population.

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