Application of the socioecological model to mitigate risks of heat illness.

BACKGROUND: The socio-ecological model (SEM) is a widely used framework that can be applied to heat-related illness (HRI) in the context of multiple influencing factors that exist in society. Leaders and policymakers must intervene to mitigate the deleterious effects of climate change on those at risk. PURPOSE: The purpose is to introduce the SEM as a framework to address the complex factors contributing to the impact of excess heat. METHODS: Conceived through the SEM, the compounding and cumulative impact of excess heat resulting in HRI is operationalized. DISCUSSION: The SEM provides a structure for understanding the complex nature of climate change and HRI and proposed interventions. The prevention of HRI is dependent on actions, related to practice, education, research, and advocacy across multiple levels of the SEM. The SEM has the potential to target HRI at all levels of society to reduce the harm of excess heat.

Educating Pregnant Women About the Dangers of Extreme Heat and Air Pollution.

Climate change poses a serious threat to the health and well-being of pregnant women and their developing fetuses. Certain populations are at greater risk of adverse outcomes from air pollution, a contributing factor to climate change. In addition, heightened exposure to extreme heat, a consequence of climate change, exacerbates the existing health care inequities in the United States. Nurses, midwives, and other health care clinicians are uniquely positioned to reduce the harmful effects of climate change by educating pregnant women and their families and advocating for systems and policies that can decelerate climate change. The purpose of this article is to provide resources for clinicians to use in educating pregnant women about the risks of extreme heat and air pollution, their potential effects on pregnancy and neonatal outcomes, and strategies to help mitigate risk. We conclude with implications for practice, opportunities for advocacy, and areas for future research.

Leadership in Nursing Education for Advancing a School of Nursing-Led Center for Climate Change, Climate Justice, and Health.

BACKGROUND: This article examines innovations in the development and advancement of a school of nursing-led climate change center and innovative leadership related to climate change and health in nursing education. METHOD: The integration of health consequences of climate change in curricula and continuing education is essential to prepare nursing students and nurses for clinical practice. RESULTS: Transformational leadership is a key concept for effective leadership in nursing education to address climate change as the looming public health challenge of the 21st century. Transformational leadership strengthened one nursing program's curricula, dissemination of relevant scholarship, and achievements with public health outreach related to climate change, climate justice, and health. CONCLUSION: Nursing education leaders can influence nursing practice and improve societal health outcomes related to the health consequences of climate change across all levels of education and continuing education for professional nurses. [J Nurs Educ. 2023;62(9):528-531.].

The Future of Nursing 2020-2030: The Critical Role of Nurses and Nurse Leaders in Addressing the Health Impacts of Climate Change.

Climate change represents a looming health challenge and a critical area for nursing leadership at all levels of organizations and settings. With a lens on The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, addressing climate change-related health consequences should be a major focus and spotlight for nurses and nurse leaders with a lens on individuals, communities, populations, and from a national and global perspective.

Development of a screening tool for assessment of climate change-related heat illness in the clinical setting.

ABSTRACT: Extreme heat contributes to heat-related illnesses resulting from heat intolerance, which is the inability to maintain a thermal balance to tolerate heat stress. In the United States, heat-related mortality for older persons has almost doubled in the past 20 years. Other populations at risk for heat-related illness (HRI) include children, pregnant people, those who work outside, young people participating in outdoor sports, and at-risk populations such as Black, indigenous, and populations of color. The classic heat tolerance test used for decades monitoring physiological responses to repetitive motions is impractical across large and potentially health challenged populations and does not identify environmental or social factors or specific vulnerable populations. To address this issue, we developed a heat-related illness screening tool (HIST) to identify individuals at risk for HRI morbidity and mortality based on their physical, environmental, and social vulnerabilities with an emphasis on populations of concern. The HIST has the potential to be used as routine clinical screening in the same way as other commonly used screening tools. Heat intolerance affects patient outcomes and quality of life; therefore, early screening with a simple, easy-to-administer screening tool such as the HIST can identify people at risk and refer them to services that address heat exposure and/or create safety nets to prevent heat-related illnesses.

Screening for Heat Related Illness in Pregnant People: Sample Case Study for Clinician Education.

Climate change has significant implications for pregnant people. The Heat-Related Illness Screening Tool was developed by faculty in the nurse-led Center for Climate Change, Climate Justice, and Health at the MGH Institute of Health Professions. In an effort to integrate content on the health effects of climate change on pregnant people, faculty in the Women's Health/Gender-Related Nurse Practitioner program in the School of Nursing developed a case study that incorporated heat and environmental exposures in pregnancy into an existing module on preterm birth. The case study aims to increase awareness about the intersections between climate change, social determinants of health, structural racism, and potential adverse pregnancy outcomes. Together this case study and screening tool for heat-related illness represent innovations for health professions educators and clinicians to detect intensifying risks to already vulnerable people who are pregnant.

Interprofessional Ambulatory Staff Perceptions of Pandemic Preparedness.

The COVID-19 pandemic forced us to face the growing realization that our expectations of staff redeployed to areas other than their usual role did not fully align with their perceptions of safety, competence, and teamwork. This mixed-methods study assessed perceptions of role, preparedness, and management among staff who were deployed from March through June 2020. Our findings support that the rapid reassignment of interprofessional role groups to respiratory illness clinics in the first wave, albeit necessary at the time, may not be the best response in future infectious disease outbreaks.

Nurse-Sensitive Indicators in the Care of Individuals With Opioid Use Disorder.

ABSTRACT: Patients with opioid use disorder (OUD) seek care in primary care settings where nurses support the provision of medication-assisted treatment. Office-based opioid treatment (OBOT) that includes buprenorphine hydrochloride administration under the supervision of a nurse for stabilization and maintenance therapy has the potential to improve outcomes for patients with OUD in primary care settings. However, the first step is to determine if OBOT nurses provide nurse-sensitive care, which consists of activities that have been shown to make a difference in patient outcomes. Content analysis of 368 nursing notes from 100 patients enrolled in an OBOT program in an urban hospital-based primary care clinic was conducted. Data were analyzed descriptively according to quantity and qualitatively according to the content. Entries indicative of care coordination and transition management were extracted. Seven content categories within care coordination were identified, including harm reduction, medication management, symptom management, communication between providers, promoting adherence, self-management goal setting, and patient education. Four areas within transition management were identified including supporting connections to resources, referrals for care, medication reconciliation, and communication with other facilities. Care coordination was documented more frequently than transition management. The presence of nurse-sensitive indicators provides evidence for and distinguishes the role of the nurse in OUD care.

Leader Influence, the Professional Practice Environment, and Nurse Engagement in Essential Nursing Practice.

OBJECTIVE: The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice. BACKGROUND: There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making. METHODS: A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated. RESULTS: Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC. CONCLUSIONS: Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.

Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams: An Integrative Review.

OBJECTIVES: Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. METHODS: A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1) shared understanding of roles, norms, values, and goals of the team; (2) egalitarianism; (3) cooperation; (4) interdependence; and(5) synergy. RESULTS: Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. CONCLUSIONS: Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes.

Organizational and leadership perceptions assessment: opportunities and challenges using the Baldrige companion surveys.

Combining the use of employee perception surveys with sound analytical techniques and models is critical to capturing high quality data from which effective decisions can be made in complex healthcare settings. This study used the Baldrige Award companion surveys with an analysis of variance (ANOVA) framework to identify discordant perceptions of hospital staff and leadership in the areas of customer focus, knowledge management, and results that were significant at the 0.05 and 0.01 levels. Senior leaders in the organization found the ANOVA framework helpful as they interpreted results from the Baldrige companion surveys and planned future improvement activities. During the execution of our study a number of difficulties and challenges arose that are not uncommon to survey administration in smaller settings, such as community hospitals, or in larger hospital settings with no research staff or research staff with relevant psychometric expertise. Our experience suggests that the Baldrige companion survey process would be enhanced by providing organizations with general guidance and protocols for optimal survey administration and data analysis. The purpose of this article is to outline the ANOVA model we used with the Baldrige companion surveys and to provide guidance related to the administration and analysis of these companion surveys for those that use them.