Dr. Blackwell's BLOG

Work based on results from a study conducted by an interdisciplinary research team, which included Dr. Blackwell, will be published in the Journal of Nursing Scholarship, one of the profession’s premiere academic journals. The article, entitled, Provider Cultural Competence and Humility in Healthcare Interactions with Transgender and Nonbinary Young Adults, looks at how transgender individuals perceive care by nurses and other healthcare providers. The abstract appears below:

Abstract

Purpose: Transgender and non-binary patients experience many barriers when seeking quality healthcare services, including ineffective communication and negative relationships with their providers, as well as a lack of provider competence (including knowledge, training, and experience) and humility in treating gender-diverse individuals. The purpose of this qualitative research study involved identifying factors associated with cultural competence and humility that facilitate and impede effective relationships between gender diverse young adults and their healthcare providers.

Methods: Data came from individual interviews with 60 young adults aged 18 to 26 from Florida who self-identified as transgender or non-binary. After developing a codebook, all data were coded. We analyzed the data using thematic and Grounded Theory-based approaches, and a feminist perspective, to identify themes associated with patient-provider relationships. 

Conclusions: We identified 4 themes related to patient-provider relationships: (1) Participants indicated effective patient-provider communication and relationships are facilitated by providers requesting and utilizing gender-diverse patients’ correct names and personal pronouns. (2) Participant narratives conveyed their preferences that providers “follow their lead” in terms of how they described their own anatomy, reinforcing the utility of cultural humility as an approach for interactions with gender-diverse patients. (3) Participants also discussed the detrimental effects of gender-diverse patients having to educate their own providers about their identities and needs, suggesting clinicians’ competence regarding gender diversity is paramount to fostering and maintaining patient comfort. (4) Finally, participants’ responses indicated concerns regarding the confidentiality and privacy of the information they provided to their providers, suggesting a lack of trust detrimental to the process of building rapport between patients and their providers. 

Clinical Relevance: Our findings indicate balancing the use of cultural humility and cultural competence during clinical encounters with gender-diverse young adults can improve providers’ relationships with these young people. Nursing education is often devoid of focus on caring for transgender persons. Additional provider training and education on approaching clinical encounters with gender-diverse young people with cultural humility and competence should improve patient-provider communication and relationships. 

Dr. Blackwell and colleagues will have their original article, “Mpox in the United States: Current Trends and Implications for Public Health Nursing” published in the journal Public Health Nursing. The team behind the work included Drs. Rodney Hicks (Professor & Associate Dean for Research & Administration, Western University College of Graduate Nursing [Pomona, CA, Dr. Humberto Lopez Castillo (UCF College of Medicine and College of Health Professions and Sciences), Dr. Mindi Anderson (UCF College of Nursing) and Dr. Frank Guido-Sanz (UCF College of Nursing). The scientists scoured the data regarding the mpox outbreak in the US, provided close examination of current and past epidemiological prevalence and incidence trends (including vaccination trend data), and provided very important guidance for public health nursing and other clinicians regarding mpox prevention and vaccination. The abstract for the article appears below:

In 2022, mpox, an orthopoxvirus first isolated in 1958 in cynomolgus monkeys, became a global public health threat. While the virus can be communicated through skin-to-skin contact from any infected person to non-infected person, most cases in the United States have been in gay and bisexual men. Consequently, early public health and community-based efforts concentrated on reducing infections in this population. This article explores current mpox case count epidemiologic data and trends. In addition, vaccination indications, contraindications, adverse events, and national administration data are provided along with directions for nurses and other clinicians moving forward in the outbreak.

Earlier this week, Dr. Blackwell’s original article, ” Monthly Injectable Cabotegravir/Rilpivirine to Manage HIV Infection in Adults” was published in the Journal of the American Association of Nurse Practitioners. Written with Dr. Blackwell’s frequent collaborator and colleague, Dr. Humberto Lopez-Castillo, the article explores a new treatment strategy for managing HIV-1 infection in the United States using an injectable antiretroviral combination agent. The abstract appears below:

The FDA recently approved a unique treatment regimen for management of HIV-1 infection in adults. A one-time per month injection of cabotegravir/rilpivirine can replace a current, stable antiretroviral regimen in those with virologic suppression, without history of treatment failure, or known or suspected resistance with cabotegravir or rilpivirine. A one-month oral trial should be initiated before switching to the extended-release injectable formulation. Cabotegravir/rilpivirine showed continued virologic suppression without clinically relevant changes in CD4+ cell counts. Clinicians should understand this new HIV regimen, its indications and suitability for select patients, administration and dosing, interactions, and most reported adverse events.

Findings from a groundbreaking research project supervised by Dr. Blackwell based on the dissertation work of Dr. Jake Bush has been published in the Journal of Transcultural Nursing. Dr. Bush is the primary author of the article, entitled, “Social Media as a Recruitment Strategy with Transgender-Identified Individuals: Using an Ethical Lens to Direct Methodology.” The abstract for the work appears below. Click on the “Research” link at the top of the Web Site to access the article.

Abstract

Introduction: Researchers are limited when using traditional recruitment methods to access hidden and vulnerable populations, including transgender persons. Social media platforms such as Facebook can provide access to the transgender population and facilitate recruitment of a representative sample. There is little regulatory guidance for using social media as a recruitment strategy. Methodology: This article presents recruitment recommendations based on a study that generated a diverse sample of transgender-identified persons using Facebook as the sole recruitment method. Results: Despite taking precautions, computer bots penetrated the initial survey. A second survey distribution collected data from a diverse sample of transgender-identified individuals. Discussion: Researchers should design social media recruitment methods with attention to privacy and transparency. Thus, using social media platforms such as Facebook to recruit transgender participants that otherwise would be challenging to reach is a viable and ethically sound alternative to traditional recruitment methods.

Findings from a recent research project on which Dr. Blackwell participated are going to be published in the journal Clinical Simulation in Nursing. Data from the work suggest pre-briefing exercises conducted in acute care simulations using augmented reality can enhance learners’ retainment of clinical information and skills. The research team was led by Dr. Mindi Anderson, APRN, CPNP-PC, CNE, CHSE-A, ANEF, FAAN, FSSH, the Director of the healthcare simulation graduate programs in the College of Nursing at UCF.

Dr. Frank Guido-Sanz, APRN, ANP-BC, AGACNP-BC, Faculty in the College’s adult-gerontology acute care nurse practitioner programs, also worked closely on the project. The article, entitled, “Clinical Simulation in Nursing Augmented Reality (AR) as a Prebrief for Acute Care Simulation” will be published in the journal later in the year. Other authors on the article include Steven “Steve” Talbert, Ph.D., RN, Mari Dial, PMGT-BC, CHSE, LNC, Ryan McMahan, Ph.D., and Desiree Diaz, Ph.D., FNP-BC, CNE, CHSE-A, ANEF, FAAN. The abstract for the article appears below:

Background: There is sparse literature describing the use of Augmented Reality (AR) as pre-simulation preparation (i.e., prebrief) and how participants are oriented to the technology. Methods: A multi-methods study was piloted with adult-gerontology acute care nurse practitioner learners. Participants were oriented to the AR headset and participated in an AR experience during prebrief followed by a high-technology, manikin-based simulation. Usability, effectiveness, and participant side effect data were gathered. Four open-ended questions were answered, and anecdotal notes were taken.

Results: The AR prebrief activity averaged 22 minutes or less. Side effects that occurred during the experience were mostly oculomotor. Usability was less than average; however, the AR activity during prebrief appeared to be effective in the overall simulation experience.

Conclusions: AR can be utilized during prebrief. There are multiple faculty considerations. Further study for AR during prebrief is needed.

Highlights:

Augmented Reality (AR) can be utilized during prebrief and is effective.

Timing for AR during prebrief should be evaluated.

Faculty considerations must be contemplated when using AR.

Key Points:

Prebriefing is foundational for successfully meeting established simulation outcomes.

Integrating AR technology into the prebrief may enhance simulation learning experiences.

Further research is needed in AR for prebrief learning.

Dr. Blackwell will be giving 3 presentations at the 2022 American Association of Nurse Practitioners (AANP) National Conference in Orlando, Florida in June. These presentations include Preventing HIV in 2022: Integrating Evidence into Practice (6/22: Session 22.2.036), Advanced Practice Care of Patients with HIV and AIDS (6/23: Session 22.3.025), and Evidence-Based Care of LGBTQ Adolescents (6/22: Session 22.2.155). Attendees should plan to register for these sessions during the conference if they’d like to attend. The Preventing HIV in 2022: Integrating Evidence into Practice (Session 22.2.036) and Evidence-Based Care of LGBTQ Adolescents (Session 22.2.155) presentations will also be given at the 2022 AANP National Virtual Conference. Follow the link below to register for the 2022 National AANP Conference:

https://www.aanp.org/events/2022-aanp-national-conference

Dr. Blackwell’s original article, “Monthly Injectable Cabotegravir/Rilpivirine to Manage HIV Infection in Adults” has undergone the rigorous peer review process and has been accepted for publication in the Journal of the American Association of Nurse Practitioners, considered the premier journal of the NP profession. Written with collaborator Dr. Humberto Lopez-Castillo, the article examines the use of a new approach to managing HIV infection in adults using injectable antiretrovirals. The article will appear in a forthcoming issue of the journal. The abstract appears below:

The FDA recently approved a unique treatment regimen for management of HIV type-1 infection in adults. A one-time per month injection of cabotegravir/rilpivirine can replace a current, stable antiretroviral regimen in those with virological suppression, without history of treatment failure or known or suspected resistance with cabotegravir or rilpivrine. A one-month oral trial should be initiated prior to switching to the extended-release injectable formulation. Cabotegravir/rilpivirine showed continued virologic suppression without clinically relevant changes in CD4+ cell counts. Clinicians should understand this new HIV regimen, its indications and suitability for select patients, administration and dosing, interactions, and most reported adverse events.

Dr. Blackwell’s original article, “COVID-19 Vaccination in Adults Living with HIV” has been accepted for publication in the Journal of the American Association of Nurse Practitioners, considered the premier academic journal for the nurse practitioner profession. The article is co-authored by Blackwell’s frequent collaborator and physician Dr. Humberto Lopez-Castillo and provides crucial information for NPs and other clinical providers on the implications of prescribing the COVID-19 vaccination in the population of adults with HV. The abstract appears below:

The Centers for Disease Control and Prevention has recommended use of vaccines manufactured by Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen to prevent COVID-19 infection in the United States. While these vaccines are safe and have been administered to millions of persons nationwide, special populations warrant closer focus. Adults living with HIV may have specific clinical considerations that should be acknowledged when making COVID-19 vaccination prescribing decisions. This article discusses these practice considerations and provides clinical and additional guidance for nurse practitioners and other clinicians responsible for prescribing COVID-19 vaccines in adults living with HIV.

Dr. Blackwell’s original article, “HIV Pre-Exposure Prophylaxis Through Use of Emtricitabine/Tenofovir Alafenamide” has been accepted for publication in the Journal for Nurse Practitioners. The article is co-written by Dr. Humberto López Castillo, an Assistant Professor dually-appointed in the University of Central Florida’s College of Health Professions and Sciences and College of Medicine. The article will be published in mid-2021. The abstract appears below:

Pre-exposure prophylaxis (PrEP) involves use of antiretroviral medication in concert with safer sex practices to significantly reduce risk of HIV-1 infection. In October 2019, daily use of emtricitabine/tenofovir alafenamide (FTC/TAF) 200mg/25mg was approved as a newer agent for PrEP to prevent HIV-1 infection in at-risk adults and adolescents. The purpose of this article is to: 1) Provide an overview of the FTC/TAF regimen and its safety and efficacy profiles; 2) Discuss indications and contraindications of FTC/TAF as PrEP; 3) Provide a focused comparison of FTC/TDF with FTC/TAF; and 4) Examine issues surrounding cost and accessibility in the United States.