Publications by authors named "Madeline Fernandez-Pineda"

5 Publications

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Development and evaluation of a telehealth-based simulation to improve breastfeeding education and skills among nursing students.

Nurse Educ Pract 2021 Oct 2;57:103226. Epub 2021 Oct 2.

Palm Beach Atlantic University, 901 S Flagler Dr, West Palm Beach, FL 33401, USA. Electronic address:

Aim: The aim of this study was to evaluate undergraduate nursing students' perceptions of using telehealth-based simulations for practicing their breastfeeding education skills.

Background: Telehealth can help bridge the gap between the high need for healthcare services and the limited access to these services, such as breastfeeding mothers in rural settings. However current literature suggests that there is lack of telehealth education among healthcare providers, as well as, a shortage of adequately trained nurses on breastfeeding, making it difficult to provide new mothers with the support they need to successfully breastfeed. Telehealth simulation has shown to be acceptable and helpful in teaching clinical reasoning, increasing exposure to telehealth experiences, and preparing nursing students for real interaction experiences with patients.

Design: For this cross-sectional descriptive study, two breastfeeding telehealth simulation scenarios were developed and delivered through Zoom for Bachelor of Science in Nursing students in a high-level institution in Florida. Selected students interacted over Zoom as healthcare providers with a female simulated patient who played as a mother with a breastfeeding concern. Students in their role of healthcare providers assessed the breastfeeding needs of the mother and conducted breastfeeding education as appropriate. After debriefing, students received feedback from faculty and students who observed the simulation and completed an optional evaluation about their telehealth simulated experience.

Results: A total of 205 students completed the evaluation. Most students (n = 136, 66.3%) were not familiar with telehealth prior to the simulation. Most students (n = 199, 97.1%) also found the simulation helpful for supporting breastfeeding mothers and wanted more telehealth simulations in the future (n = 162, 79%). Feedback for improving the simulations included: improving the technical setup (n = 17, 8.3%), increasing the time that students interacted with the mother (n = 16, 7.8%), and observing the correct performance of the simulation after debriefing (n = 16, 7.8%).

Conclusion: Telehealth simulation is a promising modality for clinical competency assessment, thus it is essential to integrate telehealth education into nursing curriculum. It is evident that telehealth-based breastfeeding simulations can be used to address the exposure/knowledge gap among nursing students who are missing or have limited exposure to breastfeeding content and telehealth use in their nursing curriculum.
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http://dx.doi.org/10.1016/j.nepr.2021.103226DOI Listing
October 2021

Preferred HPV and HPV Vaccine Learning Methods to Guide Future HPV Prevention Interventions Among Rural Hispanics.

J Pediatr Nurs 2021 Sep-Oct;60:139-145. Epub 2021 May 4.

University of North Carolina at Chapel Hill School of Nursing, NC, USA. Electronic address:

Purpose: HPV vaccination among United States's rural Hispanic youth is suboptimal to the Healthy People 2030 goal. Rural Hispanic parents' HPV vaccine (HPVV) perceptions have influenced these low rates. Furthermore, few effective interventions for increasing HPV vaccination among rural Hispanic populations exist. This study aimed to determine rural Hispanic parent's preferred HPV and HPVV learning methods to guide future HPV prevention interventions.

Design And Methods: A descriptive qualitative design was used. A total of 23 rural Hispanic parents from South Florida participated in four focus groups. Conventional content analysis was used to analyze the transcripts.

Results: Three overcharging themes were identified: 1) Learning method preferences for parents, 2) Learning method preferences for youth, and 3) Learning method preferences for families. Sub-themes included participants' preferences on their interest for an intervention, target audiences, teaching methods, availability of community members, intervention facilitators, and content.

Conclusions: Addressing HPV vaccination by developing culturally tailored programs for rural Hispanic parents is urgently needed to prevent HPV and HPV-related cancers among this disproportionately affected population. Findings highlight essential elements that should be considered when designing an intervention for increasing HPV vaccination among Hispanics in rural settings.

Practice Implications: Pediatric nurses must offer culturally appropriate HPVV education and literature and proactively recommend the HPVV at every opportunity. Pediatric nurses can administer the HPVV at schools and community health fairs while clinics can play educational clips in waiting and examination rooms.
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http://dx.doi.org/10.1016/j.pedn.2021.04.026DOI Listing
October 2021

Salient factors among Hispanic parents in South Florida rural communities for vaccinating their children against human papillomavirus.

J Pediatr Nurs 2020 Sep - Oct;54:24-33. Epub 2020 Jun 7.

University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA. Electronic address:

Purpose: Few studies have tried to understand the factors related to HPV vaccination among Hispanics living in rural communities in the United States (US). Nationally, HPV vaccination among Hispanics is suboptimal (26.1%) compared to the HealthyPeople 2020 goal of 80% and even more suboptimal in rural communties. This study aimed to determine the salient factors among Hispanic parents for vaccinating their children against HPV and for designing a future HPV prevention intervention for Hispanics.

Design And Methods: A descriptive qualitative design was used. Saturation was reached after conducting four focus groups with 23 Hispanic parents from rural communities in South Florida. Directed content analysis using the Theory of Planned Behavior (TPB) constructs was used to analyze the transcripts.

Results: All TPB constructs were identified as salient factors for HPV vaccination including background factors, attitudes towards the behavior, perceived norms, perceived behavioral control, actual control, intention, and behavior.

Conclusions: Addressing HPV vaccination by developing educational programs based on the TPB and tailored to meet the needs of Hispanic parents is urgently needed to prevent HPV among Hispanics in rural US communities. This approach can also serve as a directive to target HPV vaccination among Hispanics in other rural areas in the US.

Practice Implications: Pediatric nurses must proactively promote and recommend the HPV vaccine (HPVV), educate parents on having sex-related discussions with their children, include children in the HPVV education and decision, bundle the HPVV with other child vaccines, and utilize reminder systems to ensure completion of the vaccine series.
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http://dx.doi.org/10.1016/j.pedn.2020.05.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484143PMC
April 2021

Anal Cancer Prevention Perspectives Among Foreign-Born Latino HIV-Infected Gay and Bisexual Men.

Cancer Control 2018 Jan-Mar;25(1):1073274818780368

2 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.

This study explores understanding of primary and secondary prevention of anal cancer among human immunodeficiency virus (HIV)-infected foreign-born Latino gay and bisexual men (GBM). Between August 2015 and December 2016, researchers conducted 33 in-depth, semi-structured interviews with HIV-infected foreign-born Latino GBM. Interview questions sought to determine participants' knowledge and perceived barriers and facilitators to primary and secondary prevention of anal cancer. Researchers analyzed interview transcripts using a qualitative content analysis approach. For primary prevention, men reported a lack of knowledge about the human papillomavirus (HPV) vaccine. However, for secondary prevention, roughly 60% of participants had previously screened for anal dysplasia via anal Papanicolaou (Pap) smear. However, participants reported willingness to screen, and provider recommendation was the most common screening facilitator. Men reported stigma related to their HIV status, sexual orientation, and anal Pap smear procedures as anal cancer screening barriers. Participants reported willingness to use a self-screening anal Pap smear test if it was commercially available. Health providers continue to be the leading source of health information. Therefore, provider recommendation for HPV vaccination and anal cancer screening among age-eligible foreign-born Latino HIV-infected GBM is critical. More work is needed to destigmatize HIV and sexual orientation to influence positive health behaviors among this population. Future intervention research could test the effects of provider-led interventions and also media campaigns aimed at influencing HPV vaccine uptake and anal cancer screening among this population.
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http://dx.doi.org/10.1177/1073274818780368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028166PMC
December 2018

Human Papillomavirus Vaccine Awareness Among HIV-Positive Gay and Bisexual Men: A Qualitative Study.

LGBT Health 2018 Feb/Mar;5(2):145-149. Epub 2018 Feb 7.

2 School of Nursing and Health Studies, University of Miami , Coral Gables, Florida.

Purpose: This study explores HIV-positive gay and bisexual men's (GBM) understanding of human papillomavirus (HPV) and the HPV vaccine.

Methods: Researchers conducted 15 in-depth interviews with HIV-positive GBM between the ages of 18-30 years old.

Results: Two participants had received a single dose of the HPV vaccine. Otherwise, the majority of participants had either never heard of the HPV vaccine or they perceived it as a resource for women only. Other commonly cited barriers to getting the vaccine included lack of provider recommendation to complete the vaccine series and vaccine costs.

Conclusions: Future provider-driven interventions should focus on increasing HPV vaccine among age-eligible HIV-positive GBM.
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http://dx.doi.org/10.1089/lgbt.2017.0109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833245PMC
April 2019
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