DNP-PhD Collaboration in NINR-Funded Physical Activity Trials: A Series of Case Studies.

Collaboration between Doctor of Nursing Practice (DNP) scholars and Doctor of Philosophy (PhD) scholars is crucial to efficiently advance and disseminate nursing science. Also, DNP-PhD collaboration can help achieve priorities outlined in the recent National Institute of Nursing Research (NINR) Strategic Plan. The purpose of this series of case studies is to describe exemplars of ongoing DNP-PhD collaborations across three NINR-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. In our three physical activity intervention trials for women, we categorized examples of DNP-PhD collaboration by the four phases of the team-based research model (development, conceptualization, implementation, and translation). Across all three trials, DNP and PhD scholars contributed successfully to all phases of research in an iterative manner. Future work should focus on expanding DNP-PhD collaboration in behavioral trials, which can inform adapted, contemporary models of iterative DNP-PhD collaboration.

Development of the Doctor of Nursing Practice Nurse Practitioner Minimum Data Set (DNP NP MDS).

BACKGROUND: While the number of Doctor of Nursing Practice (DNP) programs has grown steadily, there is limited data on how national organizations are collecting data on DNP-prepared nurse practitioners (NPs) and no standard instrument exists to collect data on DNP-prepared NPs. PURPOSE: The purpose of this study was to develop a universal minimum data set (MDS) for the DNP-prepared NP population. METHOD: Instrument development consisted of several sequential stages, including conceptualization and item generation, preliminary evaluation of items, field testing the survey, and analysis of scale development data. FINDINGS: A set of 16 core variables and 19 additional variables were developed to collect standardized data on the demographics, education, and practice patterns of DNP-prepared NPs. Pilot testing revealed high correlations between the activities DNP-prepared NPs are prepared for and typically participate in a typical workweek and in their career. The MDS demonstrated high reliability in our sample. DISCUSSION: The DNP NP MDS can be used for data collection by various stakeholders, including national organizations, to facilitate improved tracking of outcome data for the DNP-prepared NP workforce. It can also provide data-driven support for the need and significance of the DNP degree for NPs.

Physical Activity and Cardiovascular Risk Factor Outcomes in Women with a History of Hypertensive Disorders of Pregnancy: Integrative Review.

BACKGROUND: Hypertensive disorders of pregnancy increase a woman's risk for developing cardiovascular disease, with risk factors manifested as early as one year postpartum. Researchers are examining how physical activity may help to mitigate cardiovascular risk factors in this population. AIM: Review the existing scientific literature on the impact of physical activity in women with a history of hypertensive disorders of pregnancy related to physical activity and cardiovascular risk factor outcomes. METHODS: This integrative review examined research studies addressing physical activity in women with a history of preeclampsia or other hypertensive disorders of pregnancy. Using four databases, the search strategy included published studies through December 31, 2019. Identified studies were assessed using Joanna Briggs Institute critical appraisal tools. RESULTS: The initial search identified 1,166 publications. Seven studies including two observational, four quasi-experimental, and one experimental study were included in the review. Although the studies had limitations, none of these limitations were deemed significant enough to eliminate a study from the review. Studies were conducted in four countries, and participants were predominantly White. Physical activity interventions primarily consisted of delivery of educational content, and data were primarily obtained by self-report. Of the five studies utilizing intervention strategies, three reported positive findings including increased physical activity, enhanced physiologic adaptations, and decreased physical inactivity. One study reported mixed findings of improved physical fitness in both groups, while another reported no change in intent to change exercise behavior associated with the intervention. LINKING EVIDENCE TO ACTION: Physical activity promotion among women with a history of hypertensive disorders of pregnancy has been studied by a small group of researchers. Current literature on the topic is characterized by limited sample diversity, lack of exercise-based interventions, and over reliance on self-report to measure physical activity. It is imperative that further research be conducted to facilitate improved cardiovascular outcomes.

Improving Stage of Change in an Employee Wellness Program.

Physical activity readiness of front-line employees caring for adults with disabilities (N = 381) improved during a two-phase project based on stages of change (SOC) theory. In Phase 1, we assessed barriers to, and readiness for, participation in an employee wellness program. We collected data from workers using focus groups and a preintervention physical activity readiness survey. Focus groups (N = 14) identified barriers, including lack of communication about the employee wellness program. With respect to their SOC (N = 82), 7% were in precontemplation, 16% in contemplation, 52% preparation, 5% in action, and 20% in maintenance SOC. In Phase 2, we aimed to improve readiness for participation in the program. We used SOC-based employee Facebook group messages, a health education fair, and measurement through a postintervention physical activity readiness survey. The mean number of "views" in which the workers saw the 16 theory-based messages was 12.2 (range = 0-27). Fourteen adults and 17 children attended the fair. Postintervention survey results (N = 125) indicated physical activity readiness improvement with 1% in precontemplation, 21% in contemplation, 33% in preparation, 33% in action, and 12% in maintenance SOC.

Improving Patient Education at a Large Midwest Urban Orthopaedic Center.

A large Midwest urban orthopaedic center sought to improve dissemination and documentation of its education information given to its patients. A new electronic, partially automated patient education delivery system was implemented that disseminates and documents targeted patient education modules. The program triggers automatic dissemination of general education based on patient demographics. Surgical education modules are disseminated manually. The semiautomated electronic education program successfully placed the center in compliance with Stage 2 Meaningful Use and showed improved dissemination of educational materials. The orthopaedic center and patients would benefit from further review and intervention to increase patient compliance with education materials.

Bilingual Text4Walking Food Service Employee Intervention Pilot Study.

BACKGROUND: Half of all adults in the United States do not meet the level of recommended aerobic physical activity. Physical activity interventions are now being conducted in the workplace. Accessible technology, in the form of widespread usage of cell phones and text messaging, is available for promoting physical activity. OBJECTIVE: The purposes of this study, which was conducted in the workplace, were to determine (1) the feasibility of implementing a bilingual 12-week Text4Walking intervention and (2) the effect of the Text4Walking intervention on change in physical activity and health status in a food service employee population. METHODS: Before conducting the study reported here, the Text4Walking research team developed a database of motivational physical activity text messages in English. Because Hispanic or Latino adults compose one-quarter of all adults employed in the food service industry, the Text4Walking team translated the physical activity text messages into Spanish. This pilot study was guided by the Physical Activity Health Promotion Framework and used a 1-group 12-week pre- and posttest design with food service employees who self-reported as being sedentary. The aim of the study was to increase the number of daily steps over the baseline by 3000 steps. Three physical activity text messages were delivered weekly. In addition, participants received 3 motivational calls during the study. RESULTS: SPSS version 19.0 and R 3.0 were used to perform the data analysis. There were 33 employees who participated in the study (57.6% female), with a mean age of 43.7 years (SD 8.4). The study included 11 Hispanic or Latino participants, 8 of whom requested that the study be delivered in Spanish. There was a 100% retention rate in the study. At baseline, the participants walked 102 (SD 138) minutes/day (per self-report). This rate increased significantly (P=.008) to 182 (SD 219) minutes/day over the course of the study. The participants had a baseline mean of 10,416 (SD 5097) steps, which also increased significantly (P=.017) to 12,540 (SD 5149). They significantly improved their performance on their aerobic fitness test (P<.001). The participants had a baseline mean systolic blood pressure of 120 mm Hg and diastolic blood pressure of 76 mm Hg, a mean body mass index of 29.29 kg/m2, and a mean waist circumference of 36.95 inches, without significant changes seen at 12 weeks. CONCLUSIONS: We were able to conduct a motivational physical activity text messaging intervention within the workplace setting. Both physical activity and aerobic fitness improved. However, at baseline, participants were more active than they perceived themselves to be. Although there is insufficient evidence to draw strong conclusions about the study findings, it would be useful to test this physical activity text messaging intervention in a sedentary sample within a larger workplace intervention study trial conducted over a longer time frame.

Bilingual Text Messaging Translation: Translating Text Messages From English Into Spanish for the Text4Walking Program.

BACKGROUND: Hispanic adults in the United States are at particular risk for diabetes and inadequate blood pressure control. Physical activity improves these health problems; however Hispanic adults also have a low rate of recommended aerobic physical activity. To address improving physical inactivity, one area of rapidly growing technology that can be utilized is text messaging (short message service, SMS). A physical activity research team, Text4Walking, had previously developed an initial database of motivational physical activity text messages in English that could be used for physical activity text messaging interventions. However, the team needed to translate these existing English physical activity text messages into Spanish in order to have culturally meaningful and useful text messages for those adults within the Hispanic population who would prefer to receive text messages in Spanish. OBJECTIVE: The aim of this study was to translate a database of English motivational physical activity messages into Spanish and review these text messages with a group of Spanish speaking adults to inform the use of these text messages in an intervention study. METHODS: The consent form and study documents, including the existing English physical activity text messages, were translated from English into Spanish, and received translation certification as well as Institutional Review Board approval. The translated text messages were placed into PowerPoint, accompanied by a set of culturally appropriate photos depicting barriers to walking, as well as walking scenarios. At the focus group, eligibility criteria for this study included being an adult between 30 to 65 years old who spoke Spanish as their primary language. After a general group introduction, participants were placed into smaller groups of two or three. Each small group was asked to review a segment of the translated text messages for accuracy and meaningfulness. After the break out, the group was brought back together to review the text messages. RESULTS: A translation confirmation group met at a church site in an urban community with a large population of Hispanics. Spanish speaking adults (N=8), with a mean age of 40 (SD 6.3), participated in the study. Participants were engaged in the group and viewed the text messages as culturally appropriate. They also thought that text messages could motivate them to walk more. Twenty-two new text messages were added to the original database of 246 translated text messages. While the text messages were generally understood, specific word preferences were seen related to personal preference, dialect, and level of formality which resulted in minor revisions to four text messages. CONCLUSIONS: The English text messages were successfully translated into Spanish by a bilingual research staff and reviewed by Hispanic participants in order to inform the use of these text messages for future intervention studies. These Spanish text messages were recently used in a Text4Walking intervention study.

Nurse practitioner faculty research: Results from the 2012 National Organization of Nurse Practitioner Faculties Survey.

PURPOSE: To better understand the research capacity and productivity of nurse practitioner (NP) faculty, a study was conducted to describe the types of research that have been and are being completed by National Organization of Nurse Practitioner Faculties (NONPF) members. DATA SOURCES: A web-based survey was developed with input from members of the NONPF Research Special Interest Group and the NONPF Board. This 23-question survey included demographic, academic degree, NP population focus, and research-related questions. Three e-mails were sent to NONPF members over a 10-week period of time (late December 2012 to early February 2013). CONCLUSIONS: Respondents (N = 344) in the sample were Advanced Practice Registered Nurses with either a Masters, Doctor of Nursing Practice, DNS or PhD as their highest academic degree. Study results demonstrated that current NP faculty research includes a wide breadth of clinical areas studied, types of methodologies used, variety of funding mechanisms, and successful publication records. IMPLICATIONS FOR PRACTICE: Because NP faculty conduct a wide array of research on clinically relevant topics, and demonstrate successful funding and publication track records, they are poised to continue to be leaders in healthcare research.

DNP and PhD Collaboration: Bringing Together Practice and Research Expertise as Predegree and Postdegree Scholars.

A deliberate course of predegree intraprofessional DNP and PhD student collaboration can yield relationships that will facilitate postdegree teamwork. Working together, DNP-prepared nurses can use their practice expertise, and PhD-prepared nurses can use their research expertise to improve and change health care. This article presents 3 contexts in which predegree collaboration can occur between DNP and PhD students. Postdegree DNP and PhD collaboration can occur in 2 contexts.

Prehabilitation interventions for older adults: an integrative review.

Prehabilitation aims to increase physical activity and improve physical fitness prior to elective surgery to improve postoperative outcomes. This integrative review examined the effect of prehabilitation randomized clinical trial (RCT) interventions on physical activity behavior and physical fitness in older adults. Seven studies met the search criteria. In two studies, effect sizes from baseline to the preoperative period exceeded d = .2, specifically in physical activity and in the physical-fitness dimensions of strength, cardiorespiratory fitness, and flexibility. For the effect sizes between baseline and the postoperative period, five studies had positive effects greater than d = .2 in strength, flexibility, balance, and speed. This review demonstrated that prehabilitation continues to be important to physical activity and physical-fitness research because it may improve physical-fitness measures and have implications for multiple dimensions of health in older adults.

Preparing practice scholars: teaching knowledge application in the Doctor of Nursing Practice curriculum.

PURPOSE: The purpose of this article is to explore the scholarship role of the Doctor of Nursing Practice (DNP) and the associated knowledge and skills required for success. DATA SOURCES: There are excellent competencies provided by national organizations that present guidelines for design and application of this practice scholar's contributions. Although evidence-based research translation is known to be essential for the DNP scholar, a consensus does not exist about the required research knowledge and skill levels that are needed. CONCLUSIONS: A model was developed to depict the scholarship roles of the DNP and the Doctor of Philosophy (PhD). This model indicates both DNP and PhD scholars are alike in their enactment of active scholarship but have different areas of expertise. They are different in their major roles that lead to the development of practice science; the DNP is the expert in knowledge application while the PhD is the expert in knowledge generation. IMPLICATIONS FOR PRACTICE: A nurse practice scholar needs to have a fundamental and strong understanding of research design and interpretation in order to appraise and implement research-based evidence into practice and conduct clinical projects.

Using photos to develop text messages to promote walking.

PURPOSE: Sending text messages (TMs) is a promising global intervention to help adults increase their engagement in walking as a form of physical activity (PA). But, little is known about how effective and acceptable TMs are developed. DESIGN: Our study was designed to (a) determine the acceptability, among low-income adults, of receiving TMs to increase their walking and (b) develop, using photos to prompt discussion, a participant-generated database of TMs to promote walking. METHODS: In 2011, three focus groups (low-income, sedentary adults) met at community clinics (one focus group at each of three clinics). To promote dialogue to help develop TMs, we created a discussion guide and a set of 40 photos depicting barriers to increasing PA or showing people walking. A content analysis of TMs developed was done using audiotaped transcripts, photo page notes, flip chart notes, and field notes. FINDINGS: Twelve TM themes emerged, including 172 TMs developed by the 23 study participants (age 50 ± 6.3 years). CONCLUSIONS: Using TMs to help achieve walking goals is an acceptable method of promoting PA with adults. Using culturally relevant photos to prompt discussion, focus groups can develop a database of PA-related TMs to promote walking. CLINICAL RELEVANCE: Physical inactivity is a significant contributor to adult health problems worldwide, and walking is a realistic method of increasing PA. Using focus groups and photos, individuals can generate acceptable, personalized and innovative TMs to promote walking.

Physical activity text messaging interventions in adults: a systematic review.

BACKGROUND: Physical inactivity is a leading health risk factor for mortality worldwide. Researchers are examining innovative techniques including the use of mobile technology to promote physical activity. One such technology, text messaging, is emerging internationally as a method to communicate with and motivate individuals to engage in healthy behaviors, including physical activity. AIM: Review the existing scientific literature on adult physical activity text messaging interventions. METHODS: This systematic review examined research papers that addressed physical activity text messaging intervention studies in adults. Using multiple databases, the search strategy included published English language studies through October 1, 2011. An author-developed data collection tool was used independently by two reviewers to extract and examine the selected study variables. RESULTS: The initial search resulted in the identification of 200 publications. Eleven publications representing 10 studies were included in the final review. Studies were conducted in seven countries with over half the studies being randomized controlled trials. Participants of the studies were predominantly young to middle aged women. Physical activity data were mainly obtained by self-report although three studies used pedometers or accelerometers. Interventions ranged from only sending out text messages to combining text messages with educational materials, staff support, and/or Internet technology. Minimal information was given regarding development or number of text messages used. The median effect size for the studies was 0.50. CONCLUSIONS: To date, using text messaging as a method to promote physical activity has only been studied by a small group of researchers. Current physical activity text messaging literature is characterized by small sample sizes, heterogeneous but positive effect sizes, and a lack of specificity as to the development of the text messages used in these studies. Further research in this area is imperative to facilitate the expansion of mobile technology to promote physical activity.

Overweight and obese low-income women: restorative health behaviors under overwhelming conditions.

In this grounded theory study we used semistructured interviews to explore how 16 low-income uninsured Midwestern United States women who were overweight or obese felt about their condition. Using grounded theory, we identified a central problem-overwhelming conditions exemplified by numerous stressors in the lives of the participants. Despite these overwhelming conditions, the participants identified numerous restorative health behaviors in five dimensions: health, economics, environment, knowledge, and commitment. Health care providers should be cognizant of their patients' complex lives and support them in identifying, adopting, and maintaining health-restoring behaviors that work for them.

An office-based health promotion intervention for overweight and obese uninsured adults: a feasibility study.

BACKGROUND AND RESEARCH OBJECTIVE: Obesity continues to put more than two-thirds of the American adult population at risk for cardiovascular disease and other health problems. For the obese who are also medically uninsured, obtaining primary healthcare is very difficult. Engaging in no- or low-cost health promotion behaviors such as physical activity and diet modification can help to reduce the effects of obesity. The purpose of this study was to assess the feasibility and initial efficacy of a nurse-delivered tailored physical activity intervention (health intervention promotion) to uninsured, overweight or obese adults seen in a free clinic. Feasibility was assessed by examining their adherence (attendance) to a visit with a registered nurse once a month for 6 months, and initial efficacy was assessed by examining weight loss over the 6-month intervention, as well as compliance with the measures of step counts and dietary log. SUBJECTS AND METHODS: This mainly female (89%), white (70%) sample had a mean age of 46.65 (SD, 10.48) years. RESULTS AND CONCLUSIONS: Of the 123 participants who began the study, 23 (19%) completed all 6 months, although 49% came for 3 or more visits. Although the partial adherers in the study did have a decrease in body mass index (BMI) from 39.64 to 39.29 kg/m(2), it was not a significant decrease. The full adherers to the study had a significant decrease in BMI from 37.27 to 36.67 kg/m(2) (P = .027). This feasibility study demonstrated that a nurse counseling intervention was effective in decreasing BMI in those participants who fully adhered to the visits.