Tappen, Ruth

Transitions in care have been a national priority for decades to promote the safe and timely passage of patients between levels of healthcare and across care settings. Improving hospital discharge processes is an important quality improvement initiative to reduce adverse outcomes, and thirty-day readmission rates and increase patients’ satisfaction after discharge. This qualitative design study explored the perceptions, experiences, and gaps in understanding the needs of the resident and family in the transition from a hospital to a skilled nursing facility (SNF). It is essential to understand the perspective of the residents, families, and healthcare professionals who experience this transitional process to inform future research, and practice initiatives and to effectively prepare the residents and families for this transition. The purposive sample included 15 residents, 13 family members, and 12 SNF staff. The setting was a SNF within a continuing care residential community with an 89-licensed-bed capacity in Palm Beach County, FL. This doctoral research applied a descriptive qualitative methodology to capture the essence of the perceptions of residents, families, and staff participants transitioning from acute care to a skilled nursing facility. Interviews were qualitatively analyzed with an interactive model utilizing open, pattern, and thematic coding, and data (network) display to help organize, inform, and justify conclusions and explanations. Overall, 53% of residents, and 62% of families expressed confusion, frustration, concern, uncertainty, disappointment, and stress.

Chronic pain is highly prevalent in older adults and often negatively
associated with health-related quality of life (HRQoL). This study
compared HRQoL, including physical health and mental health, in
persons of differing ethnicities, and identified factors associated with
pain intensity and HRQoL in ethnically diverse older adults. Older
adults with chronic pain from four ethnic groups (African Americans,
Afro-Caribbeans, Hispanics, and European Americans) were recruited
from the Florida Atlantic University Healthy Aging Research Initiative
(HARI) registry. The Medical Outcomes Study Short Form-36
(SF-36) was used to evaluate HRQoL, including functional status,
emotional well-being, and social functioning. Of 593 persons in the
four ethnic groups in the registry, 174 met the inclusion criteria (pain
level of four or higher on an 11-point scale, lasting 3 months or
longer). Among these 174, African Americans reported the highest
level of pain intensity, followed by Afro-Caribbeans, Hispanics, and
European Americans. Hispanics reported the highest physical health
scores and the lowest mental health scores. In contrast, African
Americans reported the highest mental health scores and the lowest
physical health scores. Multivariate linear regression analysis revealed
that ethnicity, lower physical health scores, and lower mental
health scores were significantly (p # .01) associated with pain intensity.
Understanding ethnic variations in response to pain intensity
may address gaps in knowledge about HRQoL to reduce disparities in
optimal care. Health care providers should consider ethnic norms and
cultural diversity to provide optimal interventions for this population.

The purpose of this study was to explore differences in perceived stress, glucocorticoid receptor (GR), and the expression of histone acetylation (HAT) of the corticotropin-releasing hormone (CRH) gene between non-Hispanic Black and non-Hispanic White women in their 2nd trimester of pregnancy. Black women are 2–3 times more likely to experience preterm birth (PTB) and maternal mortality than White women (Hoyert, 2022; Martin et al., 2019). Researchers have reported chronic stress associated with factors such as experiencing discrimination, financial hardship, and abuse may induce dysregulation of the stress hormones (Kramer et al., 2013; Shapiro-Mendoza et al., 2016). Likewise, the stress hormones glucocorticoid and CRH dysregulation have been linked to early labor, preeclampsia, and maternal death (Kramer et al., 2013; Shapiro-Mendoza et al., 2016; Yu et al., 2013). Additionally, social status, gender, education, and income are recognized as social determinants of health.
This study used an observational, cross-sectional design to analyze the differences in perceived stress, depression, GR, and HAT of the CRH gene between a group of Black and White pregnant women in their 2nd trimester of pregnancy. This study analyzed perceived stress, depression, and peripheral blood monocytes cells (PMBC) using secondary, deidentified data from pregnant women. The Perceived Stress Scale was used to measure stress, the profile in Mood Depression Scale measured depression, a chromatin immunoprecipitation (ChIP) to quantitative Polymerase chain reaction (qPCR) analysis was used to measure GR and HAT of the CRH gene. The data were analyzed using correlation and analysis of covariance (ANCOVA) to examine relationships and the differences between groups.

Heart failure (HF) is a clinical syndrome with various manifestations (Groenewegen, Rutten, Mosterd, & Hoes, 2020). However, self-care for patients with complex illnesses, such as HF, can be very challenging. The Centers for Disease Control and Prevention [CDC] (2020) reported that an estimated 6.2 million adults in the United States had HF. It is generally estimated that between 1% and 2% of adults in developed countries have HF (Groenewegen et al., 2020). Although important advances in managing HF were made before approximately 1990, improvements have been significant since that time (Choi et al., 2019). However, some patients with HF still struggle. The prognosis of HF remains poor for most patients. One estimate suggests 87%, 73%, 57%, and 35% survival rates at 1, 2, 5, and 10 years, respectively (Groenewegen et al., 2020). A radical treatment for HF is a heart transplant, but due to the shortage of donated organs, this option remains out of reach for most patients (McDonagh et al., 2021). Recent success in the transplantation of a porcine heart into a human recipient suggests that some HF patients may benefit from this procedure in the future, but today, patients diagnosed with HF may receive a heart transplant from a diseased human donor (Kotz, 2022).

Service learning is a pedagogy designed to teach democratic skills to prepare students to become civically engaged members of society. One of the challenges in the field of service learning is to demonstrate the effectiveness of this pedagogy. Common methodological problems include small sample sizes, difficulty differentiating correlation from causation, self-selection bias, and use of primarily qualitative and experiential outcome measures. The literature review failed to reveal any quantitative scales designed for the health professions. The purpose of this study was to develop and test a quantitative scale to measure service learning outcomes among health professions students, before and after an academic service learning activity.
Phase 1 of the study, the development phase, involved an extensive review of the literature to develop the conceptual framework and identify the operational indicators to be measured. Items were adapted from existing scales that were consistent with the personal and social responsibility dimensions and found to possess at least minimally acceptable reliability and validity. Items were adapted to add the health professions perspective which resulted in the preliminary twenty-two item scale, divided into four subscales: Civic Responsibility, Self-Efficacy Toward Service, Civic Participation, and Social Justice Attitudes.
Psychometric testing of this preliminary PSR Scale was done in 3 studies. Study 1 involved evaluation of content validity with subject matter experts utilizing a Content Validity Index. The scale was modified based on the results of the CVI and recommendations of the subject matter experts. The S-CVI/Ave for the entire scale was .84 suggesting content validity of the PSR Scale.
Study 2 utilized principal components analysis of the subscales to validate the dimensions and operational indicators. Data was constrained to four factors which accounted for 60.56% of the total variance. Items with factor loadings less than 0.4 were deleted. Cronbach’s alpha coefficient was calculated for internal consistency. Based on these results, the scale was further revised by deleting items that decreased the Cronbach’s alpha. This resulted in a 16 item scale, containing four subscales, each with four items. The Cronbach’s alpha for the entire revised scale PSR Scale was .94.
Study 3 involved testing the final 16 item version for sensitivity. Wilcoxon signed rank analysis revealed statistically significant changes pre and post service learning activity in the Civic Participation Subscale. Civic Participation Subscale items that were significant included “volunteering time to support my community”, “being involved in programs and activities that improve my community”, and “being involved in activities that improve the health of my community”. These findings suggest that participation in a service learning activity can increase civic participation.
Psychometric testing of the Personal and Social Responsibility Scale (PSR) support preliminary validity, reliability and sensitivity of the instrument and the premise, consistent with prior research that changes in civic participation can occur as a result of service learning.