Sallie Porter

Background: Individuals who identify as sexual and gender minorities often experience high rates of adverse childhood experiences and encounter discrimination and stigma in their interactions with healthcare providers, leading to low utilization of healthcare services. However, the relationship between adverse childhood experiences, preventive care utilization, and trust in nurses among sexual and gender minority individuals remains unclear. Purpose: This study explored the relationship between adverse childhood experiences and preventive care use and assessed the potential interaction effects of trust in nurses between adverse childhood experiences and preventive care use among individuals from sexual and gender minorities. Methods: A cross-sectional design was used. A sample of 160 self-reported individuals from sexual and gender minorities completed an electronic online survey. Multiple linear regression and moderation analyses were conducted to examine the association between adverse childhood experiences, preventive care utilization, and nurse trust. Results: There was a significant negative relationship between adverse childhood experiences and preventive care utilization. There was also a significant positive relationship between trust and preventive care utilization. The results also indicated that trust in nurses moderated the relationship between adverse childhood experiences and preventive care utilization among sexual and gender minority individuals. Discussion: A significant relationship was found between a high prevalence of adverse childhood experiences and low healthcare service utilization. Strengthening the trust relationship between nurses and sexual and gender minority individuals could serve as a potential intervention point, leading to improved health outcomes for this vulnerable population. Hence, enhancing trust in nurses could be a key factor in increasing healthcare service utilization and overall health outcomes.

The significance of trauma on the nursing workforce is of utmost importance in graduate nursing education. Competing roles of graduate nursing students, such as the demands of nursing practice and advanced education, can increase vulnerability to trauma and chronic stress. Stressors associated with graduate nursing education can significantly impact student and program outcomes. Incorporating a trauma-informed approach to graduate-level education can be an essential component to support the needs of this student population. Creating and sustaining a trauma-informed academic setting requires awareness, open-mindedness, empathy, and incorporating educational practices that promote healing and mitigate harm. Nurse faculty can play a pivotal role in restructuring curriculum design to include principles of a trauma-informed approach. This article reviews what is known about trauma informed care and considers strategies to apply a trauma-informed framework to graduate nursing education.

Purpose: To assess the psychometric properties of a newly developed instrument patient-nurse trust scale (PNTS) among sexual and gender minorities (SGM). Design: Secondary data analysis. Methods: Reliability and construct validity of the PNTS were assessed. Findings: The PNTS showed high internal consistency (Cronbach’s alpha= 0.96). It also demonstrated a good fit to the data and confirmed construct validity. Conclusions: PNTS is a reliable and valid instrument to measure trust in the nurse-patient relationship with SGM youth. Clinical Evidence: PNTS is a valid and reliable tool that quantifies patient-nurse trust relationship and can predict patient satisfaction, health behaviors and health outcomes.

Historically, sexual and gender minority populations may have faced multiple Adverse Childhood Experiences (ACEs) and their utilization of preventive healthcare is low. However, sociocultural changes in attitudes and policies affecting sexual and gender minority populations signal their broader societal acceptance. We examined the prevalence of ACEs among sexual and gender minority populations belonging to Generation Z (those born between 1990-early 2000s) and their utilization of preventive healthcare to identify areas for health promotion. We used the Philadelphia Expanded ACEs questionnaire as well as questions about demographics and preventive healthcare use in a cross-sectional online survey design. The participants (n = 160) were chiefly female (n = 105, 65.6%) and bisexual (n = 51, 31.9%), while gender non-binary comprised 10.6% (n = 17). Most (93.75%, n = 150) participants reported three or more ACEs. ACEs were significantly associated with preventive healthcare use (p = 0.02). Higher prevalence of ACEs was associated with a 0.05 reduction in preventive healthcare utilization. Despite protective factors such as a comparatively advantaged background (based on their annual household income), health insurance, and college education, high ACEs, sexual orientation, and gender identity remained significantly associated with low utilization of preventive healthcare.

Background: Diaper need is a lack of reliable access to a sufficient quantity of diaper supplies. It is an essential pediatric social determinant of health measure that is useful for exploring the effects of the COVID-19 pandemic on families of young children. Objective: This study aimed to identify the predictors of diaper need and the associations between diaper need and psychosocial outcomes among underresourced families with neurodiverse children. Methods: This cross-sectional study included 129 caregivers of children aged 0–36 months who completed an online survey in early 2021, during the height of the COVID-19 pandemic. Participants completed a diaper need assessment, the Hunger Vital Signs Food Insecurity Screener, the Perceived Stress Scale, and the Infant Behavioral Questionnaire subscale. Relationships were explored using independent-samples t-tests, chi-square tests, and multiple regression analyses. Results: Seventy-six percent of caregivers reported some diaper need, and 87.6% reported food insecurity. Greater than one third (39.5%) reported high diaper need. Common mitigation strategies included using a towel or other cloth like a diaper, not using a diaper, and keeping the child in the same diaper for longer than usual. In multivariate modeling, food insecurity, household size, and parent age were significantly associated with high diaper need. Families experiencing food insecurity were 4.24 times more likely to experience high diaper need than food-secure families. High diaper need compared to low or no diaper need was associated with increased parent perceived stress. Discussion: We found high levels of diaper need and food insecurity for families during the COVID-19 pandemic. The association of high diaper need and stress indicates an inadequate supply of diapers adversely affects parent stress. Nurses may consider including diaper need in social determinants of health screening and prioritize connecting families to appropriate resources.

The incidence of infants with congenital syphilis (CS) has been accelerating in the United States and remains an issue of global concern. Infants with CS often experience poor birth, health, and developmental outcomes. These poor outcomes (e.g., prematurity, bone changes, neurodevelopmental impairment) may be exacerbated by social vulnerabilities (e.g., housing instability, incarceration) experienced by their mothers and families. As such, infants with CS may benefit from neurodevelopmental assessments offered early in life, comprehensive in scope, and repeated over time; developmental intervention, as well as family support services that acknowledge the co-occurring health, developmental, and social challenges they may face.

Background. Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. Objective. To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. Study Design. Systematic review. Method. Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. Results. Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. Conclusions. Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.