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OBJECTIVE: The purpose of the study was to describe demographic and health literacy correlates of learning style in older adults with heart failure (HF). METHODS: Cross sectional data on learning styles (VARK Questionnaire, 16 items) and health literacy (S-TOFHLA, 36 items) were collected. Preferred learning style was determined and correlated to health literacy and demographic measures. RESULTS: 116 participants with heart failure (M age = 75.1 (SD 12.5) years, M health literacy of 19 (SD 11.5). Most identified as male (59 %); with inadequate health literacy (67 %). Thirty percent reported a multimodal learning style preference with a kinesthetic (r = .33, p = .03) and not a visual preference (r = -.49, p < .001). Among unimodal learning styles, the most frequent was kinesthetic (26.7 %). Those with lower literacy levels were older (r = -.44, p = <.001), had less education (r = .48, p < .001) and reported a kinesthetic learning preference (r = .37, p = .001). CONCLUSION: Older individuals identifying as male, with low health literacy, preferred a kinesthetic approach to HF education. Future research should consider the linkage between education tailored to learning style, health literacy and outcomes. PRACTICE IMPLICATIONS: Assessment of learning style should be completed prior to an educational encounter.

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BACKGROUND: Recent research has focused on the relationship between heart failure (HF) symptom clusters and outcomes, including mortality, hospitalization, functional status, and quality of life. No known studies to date have explored the role of physical HF symptom clusters and delays in seeking treatment. OBJECTIVES: Describe physical symptom clusters in a population of HF patients and determine if a specific cluster is predictive of delay in seeking treatment for HF symptoms. METHOD: We analyzed combined data from two studies (n = 406) collected during acute HF hospitalization. The Heart Failure Somatic Awareness Scale quantified physical HF symptoms. Delay, measured in days, was collected from the medical record and confirmed by interview. Hierarchical agglomerative clustering techniques determined physical HF symptom clusters. Hierarchical multiple regression analysis was computed to explore predictors of delay. RESULTS: Participants were primarily White, male sex older adults. Three physical HF symptom clusters were identified: discordant, edema-related symptoms, and dyspnea-related symptoms. Hierarchical multiple regression analysis revealed in Step 1 that age was a significant predictor of delay. DISCUSSION: Our findings provide valuable insight into the role of physical symptom clusters on delay in persons with HF. Through agglomerative hierarchical clustering techniques, we found three physical HF symptom clusters that were then used to determine differences in cluster membership by demographic and clinical variables. Significant age differences were noted by cluster membership with youngest older adults in a discordant symptom cluster.

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BACKGROUND: To provide high-quality patient care, heart failure (HF) nurses must comprehend/use best evidence; however, HF nurses' ability to do so are unknown. OBJECTIVES: To describe HF nurses' research interest/involvement, confidence, facilitators/motivators, and barriers to lead/collaborate in research studies. METHODS: A descriptive design with convenience sampling and online data collection (Qualtrics) were used with American Association of HF Nurses members. Recruited/included nurses (n = 145) needed to be of any educational level and currently practicing in any practice setting in the United States. A 30-item, adapted instrument assessed research interest (one-question), involvement (two-questions), confidence (two-questions), facilitators (one-question), motivators (three-questions), and barriers (21-questions). RESULTS: Subjects (n = 145) were Caucasian (n = 124, 86.1 %) females (n = 137, 96.5 %) with an average age of 52.5 ± 10.38 years and 26.90±12.06 years of nursing experience. Nurses were interested in conducting nursing research (7.78/10±2.37) but involvement was low. Most frequently (n = 73, 50.3 %) nurses served as principal/co-investigators. Confidence with research participation was moderate (70.28/100±26.92) and in their ability to understand/apply research findings were low (21.68/100±80.07). The most frequently reported facilitator was the ability to control their own schedule/work (n = 30, 20.7 %) and the strongest motivator (n = 107, 73.8 %) was the perception presenting nursing research/EBP impacts HF care. The greatest reported barrier was the authority to seek research funding (2.39/5 ± 1.14). Nursing experience (p=.034), interest in participating in nursing research (p=.01), and how much presenting nursing research/EBP impacted one's performance review (p<.001) added to the prediction (R2=0.499, p<.001). CONCLUSIONS: The gained knowledge may promote development of innovative programs and educational opportunities to increase HF nurses' research activities.

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BACKGROUND: There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors. OBJECTIVE: The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources. METHODS: This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity. RESULTS: Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support. CONCLUSIONS: The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.

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Heart failure is a chronic, progressively worsening condition afflicting more than 64 million individuals worldwide. Heart failure outcomes are influenced by self-care, a naturalistic patient-centered decision-making process. The situation-specific theory of heart failure self-care addresses how this decision-making process determines actions and outcomes. However, little is known about the impact of socioecological determinants of health on heart failure self-care. A theoretical synthesis could advance the situation-specific theory of heart failure self-care through the inclusion of socioecological determinants of health. Thus, socioecological determinants of health related to heart failure self-care can be better explored, understood, and overcome through research and health promotion.

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BACKGROUND: This integrative review synthesized the findings of studies to determine the uses and outcomes of guided reflection in simulation-based education (SBE) with prelicensure nursing students. METHOD: A search of Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Education Resources Information Center (ERIC), Education Research Complete (ERC), and PsychINFO using the key words reflection, guided reflection, simulation (nursing education or nursing student), traditional, and baccalaureate identified 18 articles. RESULTS: Findings suggest facilitation of guided reflection in SBE has a positive effect on leadership development, clinical judgment, student satisfaction, and critical thought. Development of a tool to accurately measure guided reflection is warranted. CONCLUSION: Current evidence on the use of guided reflection in SBE calls for a major paradigm shift in higher education. Guided SBE experiences enhance participant knowledge, and guided reflection should be used as an innovative teaching strategy in SBE. [J Nurs Educ. 2022;61(2):73-79.].

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A time burden, financial strain, and prioritizing care recipient needs over their own are key barriers preventing informal caregivers from engaging in health-promoting self-care. Primary healthcare providers are well positioned to assess and support informal caregivers. A cross sectional descriptive, correlational study was used to examine the knowledge, attitudes, and practices of healthcare providers regarding assessment and support of older informal caregivers. The Healthcare Professional Facilitated Health Promotion (HPFHP) Model guides this study by depicting the collaborative patient-healthcare professional relationship. The Caregiver Self-Care Survey for Healthcare Providers measured the knowledge, attitudes, and practices of 80 healthcare providers on assessing and supporting older informal caregivers. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 28.0 software. Results indicated that despite positive attitudes, knowledge deficit and system level barriers prevented integration of caregiver assessment in practice. A caregiver identification process, user-friendly assessment tool, and system level changes are overdue.

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INTRODUCTION: There is a lack of lesbian, bisexual and gay (LGB)-focused nursing research, in part, because the population is traditionally difficult to access. This article explores the effectiveness, benefits, and limitations of online recruitment of a distinct population of LGB-identified nurses in a study of substance use and minority stress. METHODOLOGY: A sample of nurses who self-identified as LGB were recruited for an online survey using organic Facebook outreach. A $5 Amazon gift card was offered as an incentive. Facebook insights data and demographic data were analyzed. RESULTS: Within 96 hours, 394 participants had completed the 101-question online survey. The majority (n = 269, 68.6%) reported accessing the survey through Facebook. Email (n = 79, 20.2%) and word of mouth (n = 44, 11.2%) also contributed to recruitment. DISCUSSION: The effectiveness of this Facebook recruitment protocol speaks to the importance of social media, survey incentives, and the "power of visibility" in recruitment of this population.

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BACKGROUND: Research suggests that clinical practicums in hospital-based settings are important, even if condensed, to provide students with the opportunity for real-world learning experiences. Rational dialogue makes learning meaningful and empowers students to learn by reflecting on experiences. PROBLEM: The COVID-19 pandemic minimized availability of traditional one-to-one mentorship practicums. APPROACH: This article describes the use of critical reflection on experiences in an undergraduate senior mentorship course to assess student learning through the thematic analysis of writing assignments. Guided by Mezirow's transformative learning theory, students completed a traditional group clinical practice, written reflective journals and virtual seminars focused on role development, and reflection on concurrent learning in clinical and simulation experiences. OUTCOMES: Transformative learning was evident in their writing. Student journals demonstrated themes of responding to change, discovering resilience, developing confidence, finding gratitude, embracing advocacy, and transforming and becoming. CONCLUSIONS: Through critical reflection, students recognized the opportunities mentorship afforded them, despite challenges.

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BACKGROUND: Metacognitive knowledge and regulation are critical to nursing students who must apply knowledge to rapidly changing and complex conditions. Exam wrappers assist learners to consider past study habits with the goal of improving future exam preparation. However, little is known about use of exam wrappers in nursing education. PURPOSE: The purpose of this integrative review was to describe the disciplines, populations, courses, specific strategies, and outcomes of the exam wrapper strategy. METHODS: A systematic literature search of peer-reviewed publications was completed in any discipline using exam wrappers. RESULTS: Ten academic disciplines of primarily introductory students completed exam wrappers with positive effects on course and exam grades, as well as metacognition, and noted changes in future study habits. CONCLUSIONS: The exam wrapper strategy has been successfully implemented with improvements in course and exam grades, levels of metacognition, and changes in future study habits.

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A theory-guided non-experimental, descriptive, correlational design was used to evaluate how entry and passage variables were related to nursing home adjustment for individuals with dementia. Older adults with dementia may be unable to speak for themselves, therefore proxy responses of Certified Nursing Assistants (CNAs) provided the data for completion of the Nursing Home Adjustment Scale.1 Guided by the Meleis' Theory of Transitions, entry level factors (i.e. age, previous residence, gender, and choice), and passage variables (i.e. length of stay, extent of dementia, functional abilities, and depression) were entered into a regression equation as predictors of nursing home adjustment. Information about extent of dementia, functional abilities and depression was derived from the Minimum Data Set (MDS) maintained for all residents per Medicare and Medicaid guidelines. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 26.0 software. Results indicated an inverse relationship between nursing home adjustment and depression as measured by the PHQ-9. There was no support for relationships among other variables. CNA proxy responses were found to be reliable in that they were significantly correlated with nursing responses on the same measure. This study supports the use of CNA proxy responses as a method to evaluate the experience of individuals with dementia.

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BACKGROUND: Gender differences exist in structure and function of the heart resulting in HF symptom variation. Previous HF symptom cluster research described symptom clusters that were linked to functional status, mortality, quality of life and rehospitalization. Age and gender differences between cluster groups were described in one study. OBJECTIVES: Identify physical HF symptom clusters and explore age and gender differences between clusters. METHODS: Secondary analysis study of adults with HF. Cluster analysis was conducted using hierarchical agglomerative clustering techniques. A pictorial dendrogram output displays clusters. RESULTS: Three symptom clusters were identified in this sample of 133 older HF patients that differed by gender (p = 0.04), age (p = 0.00) and beta blocker use (p = 0.01). Symptom clusters were consistent with worsening HF, acute HF and chronic HF. CONCLUSION: Symptom clusters differ by age and gender. Education should be directed at increasing patient awareness of their individual symptom clusters.

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BACKGROUND: The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF. AIMS: Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster. METHODS: Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group. RESULTS: One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033). CONCLUSIONS: Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.

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PURPOSE: Nurse practitioners (NPs) are in a unique position to address the problem of opioid use disorders (OUDs) because they provide a large percentage of primary care services (Agency for Healthcare Research and Quality, 2014). This study aimed to increase doctoral NP students' beliefs/attitudes about their ability to care for and about individuals with OUDs through a multifaceted educational approach, guided by social cognitive theory. METHODS: Researchers used a quasi-experimental pre/post design. Five doctoral students attended lectures and 16 hours of direct clinical exposure to individuals with OUDs at a medication-assisted treatment center. The 22-item Drug and Drug Problems Perception Questionnaire examined students' attitudes toward individuals with OUDs before and after receiving this multifaceted education. Students completed reflective writings. Descriptive statistics and effect sizes were computed, and reflective writings were reviewed. RESULTS: Changes in Drug and Drug Problems Perception Questionnaire scores before and after intervention showed a fairly large effect size. This suggests that the intervention may have clinical significance for practice and is likely to attain statistical significance with a larger sample size. Greatest changes occurred in students' perceptions of role adequacy and self-esteem scores, indicative of higher self-efficacy. Measured score increases correspond to increases in confidence, knowledge, and skills to therapeutically engage with this population. CONCLUSION: Doctoral NP students had more positive attitudes and beliefs about individuals with OUDs after the multifaceted intervention. Enhancement of self-esteem and adequacy in the caregiver role for this population were promising signals that education can reduce stigma. Further study is warranted with a larger and more diverse sample.

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BACKGROUND: Exam wrapper, a structured self-regulated learning strategy, assists students to review study habits and performance on an exam with the goal of improving future study habits. Little is known about the use of this strategy in nursing students, particularly associate degree students. OBJECTIVES: To describe and compare demographic characteristics, study habits, reasons for getting content wrong on an exam and future study plans between associate degree and baccalaureate nursing students. DESIGN: A cross sectional, descriptive comparative study of exam wrapper use in associate degree and baccalaureate nursing students. SETTINGS: A medium-sized public university and small private college in the northeastern United States. PARTICIPANTS: A convenience sample 102 prelicensure baccalaureate (n = 63) and associate degree (n = 39) nursing students. Mean age of 21.9 ± 5.6, GPA of 3.46 ± 0.38, 7% male, 57% commuter students, 75% employed an average of 14 ± 11.4 h per week. METHODS: Data were collected by course faculty during an in-class exam review following a multiple-choice examination. Students completed a demographic form and exam wrapper that assessed pre-exam study habits, reasons for getting items wrong on an exam and future study habits. RESULTS: Associate degree students had lower GPAs (3.19 vs 3.57, p = .000), were older (27 vs 19.2, p = .000), more often commuted (100% vs 31%, p = .000), were employed (95% vs 65%, p < .001), were more likely to study at home (39.5% vs 13.1%, p = .000) and spent significantly longer on each study activity (p = .000) than baccalaureate students. When comparing reasons for getting a question wrong and intended study habits, baccalaureate and associate degree students did not differ. CONCLUSIONS: Use of the exam wrapper strategy allows nursing students at all levels of prelicensure education to actively reflect upon their learning with the goal of improving future learning.

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A focus group methodology was employed to elicit information from Certified Nursing Assistants (CNAs) about their views of the personality, social, institutional and cultural factors that affect the success or failure of elders' adaptation to nursing home life. The focus group (N = 6) was conducted in one long-term care facility. CNAs identified three themes that represent the process of successful adaptation to the nursing home. Emotional displacement was followed by a period of assimilation and acceptance. Resident personality, social, institutional and cultural characteristics that may affect each stage of the process are described. This study supports previous findings regarding the contribution of social-environmental elements in the adjustment process. CNA perceptions of factors that assist elders during the transition process proved to be a valuable source of information.

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AIM: This study aimed to explore how nursing students define and describe academic and clinical integrity and to identify social and psychological influences on student decisions to act with integrity. BACKGROUD: Nursing students are exhibiting a decline in academic and clinical integrity. Academic dishonesty often correlates to clinical dishonesty, subsequently impacting patient care quality and safety. Student perceptions and understanding of integrity are unknown. METHOD: A qualitative descriptive approach guided this study. A purposive sample of 19 traditional baccalaureate nursing students was recruited to participate in one-hour face-to-face interviews. RESULTS: All participants defined academic and clinical integrity as honest, ethical, and accountable behavior. Additional subthemes of characteristics, facilitators and barriers, and outcomes of acting with integrity emerged. CONCLUSION: Students recognize the positive characteristics of integrity and their effects on personal growth and optimal patient outcomes. These findings can inform faculty in developing and supporting a culture of integrity.

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Social determinants of health (SDH) are known to influence health. Adequate self-care maintenance improves heart failure (HF) outcomes. However, the relationship between self-care maintenance and SDH remains unclear. Explore the relationship between sociodemographic indicators of social position and self-care maintenance in adults with HF. This was a secondary analysis of data from a cross-sectional descriptive study of 543 adults with HF. Participants completed the Self-Care of HF Index and a sociodemographic survey. We used multiple regression with backward elimination to determine which SDH variables were determinants of self-care maintenance. Marital status (p = .02) and race (p = .02) were significant determinants of self-care maintenance. Education (p = .06) was highest in Whites (35.6%). These variables explained only 3.8% of the variance in self-care maintenance. Race, education, and marital status were associated with HF self-care maintenance. SDH is complex and cannot be explained with simple sociodemographic characteristics.

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AIM: Guided by the Individual and Family Self-Management Theory, this study examines demographic and self-management variables that impact the outcome of physical activity. BACKGROUND: Multiple sources indicate relationships between physical activity and reduced incidence of cardiovascular disease. Women engage in significantly less physical activity than guidelines recommend. METHODS: Data collected in women included demographic/situational factors and external influencing level factors including knowledge and beliefs, social facilitation, and outcome expectancy. The outcome behavior physical activity was also assessed. Correlation and hierarchical multiple regression were used to examine the relationship of demographic/situational and external influencing factors to physical activity. RESULTS: The sample included 119 women (mean age 40.96, 89.1% Caucasian, 51.3% Married, 95% high school graduates). Education was positively correlated with exercise benefits (r = 0.235,p = .010). Gross family income (r = 0.191,p = .043), work status (r = 0.238,p = .009), and health insurance(r = 0.228,p = .013) were positively correlated to family participation, and work status was positively correlated to friend participation (r = 0.263.p = .004). In the final model, demographic/situational factors (step 1) explained 12.9% of the variance in physical activity (p < .05). Knowledge and beliefs, social support, and outcome expectancy (step added an additional 0.9% of variance physical activity levels). CONCLUSIONS: Findings suggest that demographic/situational factors contribute more to explaining variability in physical activity levels than external influencing factors. This suggests that in addition to considering demographic variables, further research to explore other demographic/situational and external influencing factors that affect physical activity specifically in women is necessary.

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PURPOSE: The aim of this study was to explore the incidence of problematic substance use (PSU) and the relationship between level of substance use, minority stress, and general stressors in a population of lesbian, gay and bisexual (LGB) identified nurses. Methods: A national, convenience sample of 394 self-identified LGB nurses completed an online survey in March 2019. Using data from the ASSIST V3.1 measurement tool, the incidence of problematic and non-problematic tobacco, alcohol and illicit substance use was described as a percentage of respondents in each group. Hierarchical regression assessed the impact of demographic variables, sexual orientation, gender identity, race/ethnicity, and level of substance use. Multiple regression assessed the impact of general stressors, minority stress processes, including coping and social support and internalized homophobia, on level of substance use. Results: The incidence of PSU was higher in this population of LGB-identified nurses than previously described in either the general population of nurses or the general LGB population. Demographic variables and minority status had variable associations with level of tobacco, alcohol and illicit substance use. Components of Meyer's minority stress model had a stronger and more consistent association with level of tobacco, alcohol and illicit substance use than general stress. Predictors of level of substance use across groups suggest community involvement may be significant. These results have potential implications for public health and the prevention and treatment of substance use in LGB-identified nurses.

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