Using Cognitive Rehearsal to Address Faculty Incivility in Nursing Academe.

BACKGROUND: Faculty-to-faculty incivility is a national and global problem. Recent studies examining faculty incivility in nursing academe found that respondents expressed emotional and physical distress stemming from workplace incivility, and most avoid dealing with the problem. A top strategy for improving workplace civility includes providing ongoing education to improve communication skills. PROBLEM: Faculty and academic nurse leaders require evidence-based strategies to prevent and address the range of uncivil behaviors occurring in academic work environments. APPROACH: Cognitive Rehearsal (CR) is a primary prevention and intervention communication strategy used to address incivility in health care and educational settings. Working with a skilled facilitator, participants practice addressing stressful situations in a non-threatening environment. This is the first known publication using CR to address faculty-to-faculty incivility. CONCLUSIONS: The author uses real-life situations derived from faculty-to-faculty incivility research studies and in-person conversations to describe each step of the CR process.

Professional Identity in Nursing Scale 2.0: A national study of nurses' professional identity and psychometric properties.

BACKGROUND: Professional identity is a relatively new concept in the nursing and health care literature. Using the definition of Professional Identity in Nursing (PIN) as its main construct, the authors developed and tested the second iteration of the Professional Identity in Nursing Scale (PINS 2.0) used to measure PIN from two perspectives, self and environment. PURPOSE: The purpose of this study was to evaluate the psychometric properties of the PINS 2.0. METHODS: To assess psychometric validity and reliability, a split-sample analysis was conducted. An exploratory factor analysis (EFA) was conducted on one half of the sample (n = 322) and a confirmatory factor analysis (CFA) was conducted on the other half of the sample (n = 312). Descriptive statistics were also performed and analyzed. RESULTS: According to the EFA pattern of parameter coefficients and CFA fit statistics (PINS-self: χ2(399) =1059.495, p < .001, CFI = 0.934, RMSEA = 0.072, SRMR = 0.032; PINS-environment: χ2(399) =929.019, p < .001, CFI = 0.946, RMSEA = 0.065, SRMR = 0.029), the PINS 2.0 shows adequate psychometric properties for measuring the concept of PIN with the following 4 constructs: 1) values and ethics, 2) knowledge, 3) leadership, and 4) professional comportment. Cronbach's alpha coefficients were: PINS 2.0-self = 0.97 and PINS 2.0-environment =0.98. CONCLUSION: We further advance the assessment of the psychometric properties of the PINS 2.0 to measure PIN from the perspective of self and environment.

Cerebellar deep brain stimulation for chronic post-stroke motor rehabilitation: a phase I trial.

Upper-extremity impairment after stroke remains a major therapeutic challenge and a target of neuromodulation treatment efforts. In this open-label, non-randomized phase I trial, we applied deep brain stimulation to the cerebellar dentate nucleus combined with renewed physical rehabilitation to promote functional reorganization of ipsilesional cortex in 12 individuals with persistent (1-3 years), moderate-to-severe upper-extremity impairment. No serious perioperative or stimulation-related adverse events were encountered, with participants demonstrating a seven-point median improvement on the Upper-Extremity Fugl-Meyer Assessment. All individuals who enrolled with partial preservation of distal motor function exceeded minimal clinically important difference regardless of time since stroke, with a median improvement of 15 Upper-Extremity Fugl-Meyer Assessment points. These robust functional gains were directly correlated with cortical reorganization evidenced by increased ipsilesional metabolism. Our findings support the safety and feasibility of deep brain stimulation to the cerebellar dentate nucleus as a promising tool for modulation of late-stage neuroplasticity for functional recovery and the need for larger clinical trials. ClinicalTrials.gov registration: NCT02835443 .

An Analysis of the Nutritional Adequacy of Mass-Marketed Vegan Recipes.

The popularity of plant-based and vegan diets has grown in recent years. While following a vegan diet has been associated with various health benefits, the intake of certain vitamins and minerals including vitamins B12 and D, calcium, and iron, are likely to be inadequate in an exclusively plant-based diet. Low nutrient intake over time can lead to nutritional deficiencies and potentially increased risk of adverse health outcomes. In this study, we analyzed a one-week meal plan comprised of vegan recipes from Forks Over Knives (FOK), an organization that promotes a low-fat, whole-food, vegan diet to prevent or reverse chronic disease. A detailed analysis of the meal plan found that it was deficient in several nutrients. It did not meet at least 90% of the daily value (DV) for the following: biotin (56% DV), calcium (58% DV), choline (30% DV), iodine (1% DV), niacin (75%), selenium (68%), vitamin B12 (82% DV), vitamin D (5% DV), vitamin E (7% DV), and zinc (64% DV). Based on evidence from this analysis, vegans and their healthcare providers should be aware of potential nutrient deficiencies and health consequences that may result from this type of diet.

Integrating Trauma-Informed Teaching and Learning Principles Into Nursing Education.

BACKGROUND: Trauma-informed teaching and learning (TITL) considers the effect of trauma on learners stemming from sources such as political tensions, racial and gender inequities, health disparities, poverty, community violence, bullying, and most recently, the coronavirus disease 2019 (COVID-19) pandemic. METHOD: TITL is an inclusive, learner-centered teaching methodology that has evolved during the past two decades to become more relevant in times of crisis. The foundation for effective TITL practice is the educator's grasp of how trauma affects learner behavior, performance, relationships, and coping. RESULTS: The principles of TITL are described as well as how each principle can be implemented to enhance learner engagement, strengthen relationships, and foster an inclusive learning environment aimed at facilitating learning and enhancing personal and professional growth. CONCLUSION: Nursing faculty can implement TITL learner-centered, inclusive, inquiry-based, and adaptive strategies to promote learner engagement and empowerment, improve academic performance, and foster stronger faculty-learner connections. [J Nurs Educ. 2023;62(3):133-138.].

Benefits and barriers to engagement of mental health caregivers in advisory roles: Results from a cross-sectional survey.

Background and Aims: Mental health institutions and community organizations have had difficulty recruiting patients and caregivers onto their Patient, Family, and Community Advisory Committees (PFACs). Previous research has focused on barriers and enablers of engaging patients and caregivers who have advisory experience. This study acknowledges the experiential difference between patients and caregivers by focusing only on caregivers; further, we compare the barriers and enablers between advising versus non-advising caregivers of loved ones with mental illness. Methods: Data from a cross-sectional survey codesigned by researchers, staff, clients, and caregiver affiliated with a tertiary mental health center were completed by n = 84 caregivers (n = 40 past/current PFAC advising caregivers; n = 44 non-advising caregivers). Results: Caregivers were disproportionately female and late middle-aged. Advising and non-advising caregivers differed on employment status. There were no differences of the demographics of their care-recipients. More non-advising caregivers reported being hindered from PFAC engagement by family-related duties and interpersonal demands. Finally, more advising caregivers considered being publicly acknowledged as important. Conclusions: Advising and non-advising caregivers of loved ones with mental illness were similar in demographics and in reporting the enablers and hindrances that impact PFAC engagement. Nevertheless, our data highlights specific considerations that institutions/organizations should consider when recruiting and retaining caregivers on PFACs. Patient or Public Contribution: This project was led by a caregiver advisor to address a need she saw in the community. The surveys were codesigned by a team of two caregivers, one patient, and one researcher. The surveys were reviewed by a group of five caregivers external to the project. The results of the surveys were discussed with two caregivers involved directly with the project.

Pilot Study Using Cognitive Rehearsal, Simulation, and Biomarker Data to Address Workplace Incivility.

BACKGROUND: Workplace incivility poses a threat to patient safety. This intervention pilot study used simulation and biomarker data with newly graduated nurses to explore the impact of incivility on patient care and tested whether cognitive rehearsal could mitigate the effects of workplace incivility. METHOD: A clinical scenario and script were used by actors to deliver either an uncivil or a hurried but not uncivil handoff report to participants before they conducted a focused patient assessment and administered medications to a standardized patient. RESULTS: Participants identified gaps in understanding of both handoff reports that resulted in compromised patient care. Quantitative trends showed lower resilience scores and higher stress appraisal scores for participants who received the uncivil handoff report. CONCLUSION: Although participants expressed confidence using cognitive rehearsal as an intervention before the simulation, responses indicated that a 60-minute session was insufficient to adequately prepare them to effectively address an uncivil nurse encounter. [J Contin Educ Nurs. 2023;54(2):79-88.].

Civility: A concept analysis revisited.

BACKGROUND: Nurses have an ethical obligation to create cultures of civility, treat others with respect and dignity, and foster healthy, inclusive work environments that protect worker and patient safety. PURPOSE: Because concepts are known to change over time, this concept analysis compares the original concept of civility published in 2008 with the current concept analysis of civility. METHODS: The Walker and Avant method of concept analysis was utilized. FINDINGS: Antecedents, defining attributes, ideal and unintended consequences, relevant cases, and an operational definition of civility are presented. A conceptual model illustrates antecedents, defining attributes, consequences of civility, and the role perception plays when assessing, interpreting, experiencing, and responding to incivility. DISCUSSION: Authentic civility, rather than "mere civility," is urgently needed to build meaningful relationships, create healthy, productive work and learning environments, and foster organizational cultures of inclusivity and belonging.

National Study of Nursing Faculty and Administrators' Perceptions of Professional Identity in Nursing.

BACKGROUND: Establishing a professional identity in nursing is integral to professional development, yet this area of inquiry remains understudied. PURPOSE: This segment of a multiphased national study measured nursing faculty's perceived level of importance regarding key components of professional identity in nursing using the newly developed Professional Identity in Nursing Survey (PINS). METHODS: Fifty subject matter experts from nursing education, practice, and regulation utilized the DeVellis scale development process to develop the PINS over the course of 2 years. Nearly 1200 nurse educators evaluated the importance of a 34-item scale relating to professional identity in nursing. RESULTS: At endorsement of 95% or greater, 28 items were found to be important components of nursing identity. Effective communication, integrity, and being trustworthy and respectful were reported as most important to nursing identity. CONCLUSIONS: Nurse educators identified the important items to assess professional identity in nursing. Item refinement and psychometric evaluation of the survey are the next phase of the multiphased study.

Faculty development workshop on gender-associated incivility in nursing education.

BACKGROUND: Men comprise the minority of entry-level baccalaureate nursing students and are at increased risk of experiencing gender-associated incivility. PROBLEM: Uncivil peer-to-peer behavior can negatively affect students' mental and physical well-being, and learning experience. Nursing faculty must be able to identify and address gender-associated incivility among students. AIM: The purpose of this quality improvement program was to train nursing faculty to prevent, identify, and manage gender-associated incivility in the educational environment. METHODS: A day-long interactive workshop utilizing trigger films, small group discussions, and interactive theater was developed to train nursing faculty to implement proactive and reactive techniques to address uncivil behavior which will enhance the learning environment for all students. Utilizing Kirkpatrick's Model of Evaluation, participants were surveyed at the conclusion of the workshop and four months postworkshop to evaluate their learning and its implementation. RESULTS: Participants gained greater understanding of the impact of gender-associated incivility and felt both empowered and better prepared to manage gender-associated conflict. CONCLUSION: Similar approaches may be useful for schools of nursing that wish to empower their nursing faculty to support an equitable nursing education environment free of gender-associated incivility.

Assisting Learners to Understand and Incorporate Functions of Clinical Judgment Into Nursing Practice.

BACKGROUND: Mastering clinical judgment (CJ) skills is an essential competency for nurses in all health care environments. PROBLEM: Complexities of the health environment combined with the intricacies of nursing practice can pose potential risks to client safety. APPROACH: Over a 2-year period, a 3-phased approach using (1) survey results from nurses in education and practice, (2) discussion forums, and (3) a series of think tanks that comprised nurse educators resulted in the development of the Guide for CJ. OUTCOMES: The Guide for CJ provides nurse educators with an evidence-based resource to promote CJ skills in nursing students. The environmental and individual factors and expected nurse responses and behaviors contained in the Guide are well-aligned with the cognitive operations contained in the National Council of State Boards of Nursing Action Model. CONCLUSIONS: Educators may use the Guide to support faculty development and operationalize CJ to develop a variety of learning strategies for use in multiple learning environments.

National Study on Faculty and Administrators' Perceptions of Civility and Incivility in Nursing Education.

BACKGROUND: Incivility among nursing faculty and administrators lowers morale, damages relationships, and threatens workplace health and productivity. PURPOSE: This national study examined nursing faculty and administrators' perceptions of civility and incivility in nursing education, ways to address the problem, and psychometric properties of the Workplace Incivility/Civility Survey (WICS). METHODS: A convergent mixed-methodological study was used to conduct the study. A factor analysis and other reliability analyses were conducted on the WICS. RESULTS: Respondents included 1074 faculty and administrators who identified types and frequency of incivility, severity and contributors to the problem, reasons for avoiding incivility, and strategies to improve civility. Eight themes of uncivil behaviors were garnered. The WICS was shown to be a psychometrically sound instrument to measure civility and incivility. CONCLUSION: This study reported faculty and administrators' perceptions of civility and incivility in nursing education and provided evidence-based strategies to prevent and address the problem.

Genetic ablation of serotonin receptor 2B improves aortic valve hemodynamics of Notch1 heterozygous mice in a high-cholesterol diet model.

Calcific aortic valve disease (CAVD) is a deadly disease that is rising in prevalence due to population aging. While the disease is complex and poorly understood, one well-documented driver of valvulopathy is serotonin agonism. Both serotonin overexpression, as seen with carcinoid tumors and drug-related agonism, such as with Fenfluramine use, are linked with various diseases of the valves. Thus, the objective of this study was to determine if genetic ablation or pharmacological antagonism of the 5-HT2B serotonin receptor (gene: Htr2b) could improve the hemodynamic and histological progression of calcific aortic valve disease. Htr2b mutant mice were crossed with Notch1+/- mice, an established small animal model of CAVD, to determine if genetic ablation affects CAVD progression. To assess the effect of pharmacological inhibition on CAVD progression, Notch1+/- mice were treated with the 5-HT2B receptor antagonist SB204741. Mice were analyzed using echocardiography, histology, immunofluorescence, and real-time quantitative polymerase chain reaction. Htr2b mutant mice showed lower aortic valve peak velocity and mean pressure gradient-classical hemodynamic indicators of aortic valve stenosis-without concurrent left ventricle change. 5-HT2B receptor antagonism, however, did not affect hemodynamic progression. Leaflet thickness, collagen density, and CAVD-associated transcriptional markers were not significantly different in any group. This study reveals that genetic ablation of Htr2b attenuates hemodynamic development of CAVD in the Notch1+/- mice, but pharmacological antagonism may require high doses or long-term treatment to slow progression.

Fostering Civility in Learning Conversations: Introducing the PAAIL Communication Strategy.

BACKGROUND: Civility, psychological safety, and effective stress management are essential for meaningful learning conversations. PROBLEM: Incivility triggers fear and humiliation, impairs clinical judgment and learning, reduces psychological safety, and increases cognitive load. These factors converge to make learners less likely to incorporate feedback, speak up when there is a problem, and discuss practice errors and patient safety issues. APPROACH: The authors combined the Basic Assumption and the PAAIL (Preview, Advocacy1, Advocacy2, Inquiry, and Listen) conversational strategy to help surface (rather than obscure) both educators' and learners' thinking. The synergy of these 2 strategies allows educators to identify individual learning needs and develop the learners' clinical judgment skills. This process improves learning by reducing incivility and cognitive load, improving psychological safety, and strengthening clinical judgment skills. CONCLUSION: This conversational strategy can minimize stress and anxiety in learners and optimize learning.

Civility Mentor: A Virtual Learning Experience.

BACKGROUND: Incivility and disrespect in health care weaken teamwork and collaboration, diminish communication, and can impact an individual's ability and willingness to speak up and advocate for patient care. PROBLEM: Evidence-based teaching strategies are needed to prepare nursing students to address incivility in academic and practice settings. APPROACH: The authors describe a virtual learning experience designed to prepare students to prevent and address incivility in academic and health care environments and report preliminary assessment data from student users. OUTCOMES: More than 90% of 22 000 student respondents indicated they were satisfied with the learning experience, were made aware of the consequences of incivility and its effects on patient safety, and planned to apply techniques for addressing incivility into their nursing practice CONCLUSION: Civility mentor is effective in educating students about the consequences of incivility, developing skills to foster civility, communicating more assertively, and addressing incivility in academic and health care environments.

Cognitive Rehearsal, HeartMath, and Simulation: An Intervention to Build Resilience and Address Incivility.

BACKGROUND: The detrimental impact of incivility in health care is well documented. Nursing students and new graduate nurses are particularly vulnerable to its effects. Evidence-based civility education strategies are urgently needed to address incivility, which can protect patient safety. METHOD: Using a mixed methodology, 188 incoming, upper division, prelicensure nursing students participated in an intervention study that combined cognitive rehearsal, HeartMath, and simulation using TeamSTEPPS™ Concerned, Uncomfortable, and Safety model to address acts of incivility that threaten patient safety. RESULTS: Student evaluations immediately following the intervention and 6 months postintervention rendered positive results. Eight themes emerged describing uncivil experiences occurring in the patient care environment. CONCLUSION: This intervention provided nursing students with evidence-based tools to build resilience to effectively address incivility in the patient care environment. Nurse educators are urged to provide civility education in conjunction with tested techniques to build resilience and address uncivil encounters in health care. [J Nurs Educ. 2019;58(12):690-697.].