Stress Management in a Corporate Setting

Abstract The purpose of this evidence-based project was to implement a sustainable stress management program in a corporate setting, utilizing company stress management resources. A three-step program was initiated to include a 30-minute stress education session, followed by a 30-minute one-on-one session with a nurse practitioner student utilizing aspects of motivational interviewing to develop a goal oriented stress management plan. An individual one-month follow up was also performed. Of the 30 employees who attended the educational session, 15 signed up for a one-on-one session. Eight out of the 15 employees completed the one-month follow up. Employees completed a pre and post Perceived Stress Scale during the initial and follow-up one-on-one sessions, demonstrating lower perceived stress after one month

Children with HIV: How they Feel About What Parents Say

With improvements in diagnosis and care, children with HIV infection are living long enough to reach school age, a stage when they are capable of perceiving the stigmatizing, life-threatening nature of their illness. Many parents desire to protect them from this knowledge by avoiding an open dialogue about their disease, even though pediatric professionals advocate disclosure. Research-based guidelines about the risks and benefits of telling, however, have not been available in the literature. Using an innovative, qualitative approach through the use of grounded theory and projective drawing techniques, this investigation sought to explore what parents said about the illness and how children responded socially and emotionally. Data were obtained from 13 parents and 12 school age children with HIV. Although most of the children were informed about the illness by the time of the study, their drawings and conversations suggest they did not perceive that communication and support were available within their families. Instead, signs of social isolation, poor self-esteem, and severe emotional distress were found. The parents\u27 readiness to tell determined the interval between diagnosis and disclosure, which was typically 4 years. These findings have implications for nursing practice, research, and education

Improving HPV Vaccine Series Compliance with Text Message Reminders in Military Women

Project Purpose: The purpose of the project was to improve the rate of Human Papillomavirus (HPV) vaccination compliance among military women aged 18-26 years utilizing clinical reminder via text messages. Background: Specific populations have been particularly effected by low HPV vaccine completion rates including active duty military women. The incidence of high risk sexual behavior in this population is noted to be higher than the general public and sexually transmitted infection (STI) rates are seven times higher in active duty military women compared to the general public. In addition, HPV is the most prevalent STI in this population with an incidence rate of 333.9 per 10,000 person-years. In 2011, research at the Naval Medical Center San Diego (NMCSD) found that the vaccine series completion rate in active duty military members was only 16%. The use of reminders for multi-dose vaccine series has demonstrated effective increases in compliance rates since the 1980s. Practice Change: Clinical reminders via text message were sent out to each woman who received her first dose of HPV vaccine in November or December 2014 and January 2015. The text was sent to all women who had not yet returned to the clinic to receive the second or third dose. The reminder notified them that their next vaccine dose was due and to obtain it within the next month. The Iowa model was used as a framework for this project. Project effectiveness was evaluated based on changes in HPV immunizations series compliance rates before and after the text message intervention. Outcomes: There was an increase in vaccination rates among the women receiving the text message reminders for both the second and third dose. This project followed an initial effort three months before to educate patients about need for the HPV vaccine and the provider to offer a strong recommendation for obtaining the vaccine. An increase from the previously reported rate of HPV vaccine series compliance among active duty military women was achieved. However, even with the education and provider recommendation, the rates were below the national averages. With the implementation of the clinical reminders via text message, there was an increase from 50% to 65% for the 2nd dose after the text message reminder with 17 out of 26 women receiving at least 2 HPV vaccine doses. In addition, the completion rate for all 3 doses increased from 34% to 42% (11 out of 26 women) exceeding the national average of 39.7% for HPV vaccine completion by U.S. girls according to the CDC (2015). Implications and Conclusions: Clinical reminders, specifically text message reminders, increased HPV vaccination rates for active duty military women in addition to patient education and provider recommendation. Long-term benefits will include a decrease in HPV infection rates, a decrease in HPV-related medical costs, and a decrease in the incidence of cervical cancer in this population

Beyond the informed consent procedure: continuing consent in human research

An ethnographic field study about informed consent in hepatitis C clinical trials provides insight into how changes in protocol requirements and patient health status triggered the actions and decisions of researchers and human subjects during the conduct of these trials. U.S. federal guidelines recommend that informed consent should be conceptualized as more than a one-time event. Rather, a process of continuing consent should be the standard but little is understood about how exactly this process should unfold. We used a proposed typology of continuing consent to frame our analysis and were able to document that only some of the proposed types took place at the site of our study. The most frequent practice involved the researchers' re-consent of their subjects for major protocol revisions. Only one subject dissented and chose to withdraw even though he was technically eligible to continue in the study. Two other types of continuing consent were not observed. We discovered an additional type of continuing consent not described in the typology whereby subjects gave implied consent through their cooperation and adherence to the on-going requirements of the protocols. Implications for the informed consent process and the need for further research are presented