Introduction to Rivera's Gender Affirming Nursing Care Model: A Middle-Range Theory.

Purpose: Currently, standards for transgender care guide surgical, hormonal, cosmetic and psychological care, yet do not include the domain of nursing care and nursing sensitive care outcomes. In response, the purpose of this project was to create a middle-range nursing theory to guide transgender nursing care. Methods: Rivera's Gender Affirming Nursing Care (GANC) Model was developed using a community informed iterative process, combining and modifying two existing theories. Each theory was evaluated, construct templates were created, modified, and expanded to create the proposed gender transcendent model. Face validity was established through expert and community review. Findings: Concepts identified include: Relationship (Join With), Knowledge (Learn With) and Engagement (Partner With). Action within the model is propelled by drivers, including ongoing learning, ongoing research, ongoing self-assessment, and leadership. The model operates within the recognized domains of nursing, to support gender affirming nursing care. Conclusions: The middle-range theory was tested and found to stimulate gender neutral thinking; however, the model would benefit from additional testing to determine impact on nursing and patient outcomes. The model allows the nurse, through self-reflection and other internal growth mechanisms, to identify personal implicit and explicit bias. It is through these actions and shifting paradigms that nurses develop a personal gender affirming nursing practice.

Evaluating Survivorship Experiences and Needs Among Rural African American Breast Cancer Survivors.

Disparities in cancer survivorship exist among specific populations of breast cancer survivors, specifically rural African American breast cancer survivors (AA-BCS). While effective survivorship interventions are available to address and improve quality of life, interventions must be culturally tailored for relevance to survivors. Here, we report the results of our formative research using focus groups and in-depth interview to better understand unique rural AA-BCS survivorship experiences and needs in the Alabama Black Belt. Surveys were used to gather sociodemographic and cancer treatment data. Fifteen rural AA-BCS shared their experiences and concerns about keeping their cancer a secret, lack of knowledge about survivorship, lingering symptoms, religion and spirituality, cancer surveillance, and general lack of survivorship education and support. Rural AA-BCS were unwilling to share their cancer diagnosis, preferring to keep it a secret to protect family and friends. Quality-of-life issues like lymphedema body image and sexuality were not well understood. They viewed spirituality and religion as essential in coping and accepting cancer. Participants also discussed the importance of and barriers to maintaining health through regular check-ups. They needed social support from family and friends and health care providers. Overall, rural AA-BCS expressed their need for knowledge about survivorship self-management by providing a vivid picture of the realities of cancer survival based on shared concerns for survivorship support and education within the context of culture.

A Team Approach to Enhance Scholarship Among Honors Students in Nursing.

Honors programs within schools of nursing have the potential to enhance young nurses' interest in developing programs of research early in their careers and can thus contribute to the successful development of nursing knowledge. Such programs also provide opportunities to enhance knowledge and skill in leadership and teamwork at a critical time during the development of their professional nurse identity. This article presents the successful approach one organization took when revising its honors program to meet the current needs of students, society, and the profession.

Professional development needs of nurse managers.

BACKGROUND: Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today's complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. METHOD: We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. RESULTS: Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. CONCLUSION: Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role.

Attention and memory deficits in breast cancer survivors: implications for nursing practice and research.

Breast cancer survivors (BCSs) commonly report deficits in attention and memory, cognitive functions crucial for daily optimal functioning. Perceived deficits are reported before, during, and after adjuvant therapy and affect quality of life throughout survivorship. Deficits of attention and memory are particularly disruptive for BCSs working or attending school who report that subtle impairment diminishes their confidence and their performance at all levels of occupation. Chemotherapy and endocrine therapy contribute to attention and memory deficits, but research findings have not fully established the extent or timing of that influence. Fortunately, potential interventions for attention and memory deficits in BCSs are promising. These include cognitive remediation therapies aimed at training for specific areas of deficit, cognitive behavioral therapies aimed at developing compensatory strategies for areas of deficit, complementary therapies, and pharmacologic therapies.

Creating innovative clinical nurse leader practicum experiences through academic and practice partnerships.

INTRODUCTION: The new Clinical Nurse Leader (CNL) nursing role was developed to meet the complex health care needs of patients, families, and health care systems. CASE PRESENTATION: This article describes the process used by nurse leaders at the University of Alabama at Birmingham School of Nursing and Hospital to develop Model C CNL practicum courses, recruit and prepare clinical preceptors, prepare clinical microsystems for CNL students, and develop additional practice partnerships throughout the region. MANAGEMENT AND OUTCOME: Critical to the success of the CNL role is a dynamic partnership between academic and practice leaders.The partnership allows faculty to develop curricula that are relevant and responsive to the rapidly changing health care system. Clinical leaders become more aware of trends and issues in nursing education. DISCUSSION: Continued growth and success of the CNL role is largely dependent on the ability of faculty and practice partners to collaborate on innovative educational programs and models of care delivery.

Incorporating quality and safety education into a nursing administration curriculum.

The Quality and Safety Education for Nursing initiative is aimed at developing student competences in quality and safety. Because practicing nurses have not been exposed to this initiative, nurse leaders must be aware of these competencies to develop these competencies in existing staff members. This article provides a roadmap to curriculum development in a nursing administration graduate program focused on quality and safety.

Developing a standardized tool to improve nurse communication during shift report.

Standardization of communication has been suggested as an effective approach to improve communication during patient handoffs such as shift report. Using the clinical microsystem framework, unit leaders and nursing staff developed and pilot tested the medical intensive care unit communication tool. Findings from the pilot study indicated that perceived communication among nurses in general and communication specific to shift report improved significantly following implementation of the tool.

Readability and usefulness of the clinical microsystem assessment tool.

Using an instrument such as the Clinical Microsystem Assessment Tool (CMAT) to examine microsystem performance can provide valuable guidance for the development of quality and safety initiatives within the microsystem. However, instruments developed for this purpose must take into account diverse literacy levels. Perceptions of health care professionals of the usefulness and readability of the CMAT were examined. Readability was determined with the Flesch Reading Ease scale, in which the CMAT was rated as "very difficult" to read, and a Simple Measure of Gobbledygook analysis revealed that 14.71 years of education would be needed to understand the content. Although the majority of the participating health care professionals identified the tool as useful, the high level of reading ability required to understand the content may create limitations for use, given the educational diversity of the health care workforce.

Self-assessed knowledge of treatment and fertility preservation in young women with breast cancer.

Young women with breast cancer do not identify themselves as knowledgeable about the effect of cancer treatment on fertility or fertility preservation treatments and resources. These women need access to high-quality health information to support their participation in medical decision making about fertility preservation.

Development of the Fertility and Cancer Project: an Internet approach to help young cancer survivors.

PURPOSE/OBJECTIVES: To describe the development of the Fertility and Cancer Project (FCP), an Internet approach to supplement information about fertility; describe FCP study participants' characteristics, fertility, cancer knowledge, and Internet use; and assess perceived information and support from the oncology team. DESIGN: Descriptive. SETTING: Internet, international. SAMPLE: 106 young survivors of breast cancer from eight countries. METHODS: FCP content was developed from the literature and interviews with breast cancer survivors, oncology professionals, and young women without cancer who were having fertility problems. Participants learned about the FCP through advocacy groups, cancer care providers, and Web searches. After enrollment, they completed five surveys: sociodemographic, breast cancer and health status, knowledge of fertility, Internet use, and the Medical Outcomes Study-Social Support Survey. MAIN RESEARCH VARIABLES: Sociodemographics, breast cancer, health status, fertility knowledge, Internet use, and social support. FINDINGS: Prior to diagnosis, most survivors had no fertility concerns, but more than 14% reported fertility problems. Following breast cancer diagnosis and treatment, 23 reported fertility problems. About half reported receiving little information about fertility options from the oncology team and were referred to a reproductive endocrinologist. Internet use to obtain support and health information was common. Most reported frequent computer use and Internet access in their homes. Participants were most knowledgeable of the general and treatment-related factors that could affect fertility; they were least knowledgeable of infertility treatment. CONCLUSIONS: Results provide preliminary evidence about the demographic, cancer treatment, and support characteristics of young survivors of breast cancer who seek online information about fertility. IMPLICATIONS FOR NURSING: The Internet is a promising format for engaging young cancer survivors who seek information about fertility and cancer. Future studies can evaluate FCP effectiveness in delivering education and support interventions.

Evaluation of the Fertility and Cancer Project (FCP) among young breast cancer survivors.

OBJECTIVE: Fertility and childbearing issues are the major quality of life concerns among young breast cancer survivors. Practical approaches are needed to convey reproductive health information. The Fertility and Cancer Project (FCP) is a dedicated research project that provides online reproductive health and fertility education. We report FCP participants' (a) changes in mood and functioning and (b) changes in knowledge of fertility and cancer from baseline to 6-month follow-up. METHODS: Participants completed five self-report baseline measures, accessed FCP content and participated in online discussions. At 6 months post FCP study entry, participants were asked to complete follow-up self-reports. RESULTS: One hundred and six breast cancer survivors from 8 countries participated in the FCP. Mean age at diagnosis was 34.3 years; mean time since diagnosis was 22 months. Significant change was detected in improved physical functioning (p=0.019) and social functioning (p=0.02). Significant changes were also noted in improved fertility knowledge (p=0.011). CONCLUSION: Preliminary evidence shows that young breast cancer survivors derive improved mood and knowledge benefit from FCP participation. Internet-based approach may be a viable format for engaging this population of cancer survivors.

Breast cancer survivors and fertility preservation: ethical and religious considerations.

OBJECTIVES: To review religious and ethical considerations for health care professionals when discussing fertility preservation with young survivors. DATA SOURCES: Published research reports and articles, published guidelines, and web sites. CONCLUSION: Although advances in assisted reproductive technology have increased fertility preservation options, not all treatments are acceptable or available for all young survivors. IMPLICATIONS FOR NURSING PRACTICE: The ongoing provision of information from health care professionals allows young survivors to make high-quality decisions about fertility across the survivorship continuum. Knowledge of the influence that religious beliefs and economics have on decisions help nurses to better understand and support patients during this difficult time.

Challenges faced in providing safe care in rural perinatal settings.

PURPOSE: To examine and describe neonatal resuscitation preparedness, presence of connections to wider systems of care, continuing education activities, presence of trained staff, and other indicators of high performance in rural perinatal microsystems. STUDY DESIGN AND METHODS: A nonexperimental, retrospective, descriptive, cross-sectional design was utilized. Rural hospitals (n = 124) providing perinatal services in five southern states were invited to participate. Nurse managers completed the Hospital Neonatal Resuscitation Survey, describing policies, healthcare team members, educational activities, organizational culture, system connections, and process improvement. Descriptive data were also collected. RESULTS: A total of 44 (35.1%) hospitals participated. Annual birth volume ranged from 22 to 1,614 (M = 515.53; SD = 336.27). Low birth volume hospitals (<125 births per year) had significantly lower levels of preparedness than high volume hospitals (>125 births per year). Preparedness was not influenced by rurality. One-third (34.1%) did not identify relationships with Level III NICUs. Support of continuing education was universal. Efforts to increase interdisciplinary teamwork were common. Medical provider shortages were prevalent (n = 25: 56.8%), and the presence of midwifery services was infrequent (n = 12; 27.2%). Hospital nursing shortages (n = 35; 81.8%) were widespread. CLINICAL IMPLICATIONS: Challenges faced by rural hospitals and healthcare professionals in the delivery of perinatal care emphasize the importance of creating and maintaining high performance microsystems that are responsive to the changing needs of providers and the populations they serve. Lower levels of preparedness and the lack of established relationships with level III NICUs is concerning.

Knowledge of limited health literacy at an academic health center.

BACKGROUND: Health care providers' awareness and knowledge of the impact that limited health literacy has on the health care system and the individual patient was measured. In addition, the usefulness of the Limited Literacy Impact Measure (LLIM) was examined. METHODS: Two hundred forty providers and students attending a university-sponsored presentation on health literacy were invited to participate. RESULTS: Participants were most knowledgeable about the impact on patients and less knowledgeable about the impact on the health care system. CONCLUSIONS: Health care provider knowledge and awareness of limited health literacy continues to be a challenge. Educational programs developed for providers and patients are needed to address the health literacy crisis. Improving health literacy will improve health outcomes while reducing the use of unnecessary health care services.

Provider readiness for neonatal resuscitation in rural hospitals.

OBJECTIVE: To describe nurse and physician readiness for neonatal resuscitation in rural hospitals. DESIGN: Descriptive, correlational, and comparative. SETTING: Twenty-six rural hospitals in two Midwestern states. PARTICIPANTS: Rural providers of care to newborns (165 nurses and 59 physicians). INSTRUMENTS: Neonatal Resuscitation Index (knowledge about neonatal resuscitation) and Neonatal Resuscitation Experience Index (comfort and recent skill performance). RESULTS: The average Neonatal Resuscitation Index (knowledge) score of 69% was low. Many skills needed for full resuscitation had not been performed by rural providers during the previous year. Nurses reported lower levels of comfort with skills needed for full resuscitation (t=-4.68; p<.01). Correlation between frequency of skill performance and comfort was higher for nurses than physicians (r=.50 vs. .34). Nurses who were current Neonatal Resuscitation Program providers had significantly higher average levels of comfort (3.67 vs. 3.11; p<.01), knowledge (72.18 vs. 60.71; p<.01), and recent experience (0.94 vs. 0.51; p<.01) with resuscitation skills than nurses who were not current Neonatal Resuscitation Program providers. CONCLUSIONS: Maintaining high levels of readiness for neonatal resuscitation in rural hospitals is challenging. Nurses and physicians should make special effort to obtain continuing neonatal resuscitation education to ensure optimal outcomes when newborn emergencies arise in rural hospitals. Teamwork training for neonatal resuscitation readiness is an important topic for future rural health research.

Rural perceptions of continuing professional education.

BACKGROUND: This study describes rural health care professionals' perceptions about professional isolation and the availability, accessibility, and relevance of continuing education. METHODS: Registered nurses (n = 165) and physicians (n = 59) providing health care services in 26 rural hospitals in two Midwestern states participated in the study. RESULTS: Rural health care providers experience barriers to accessing relevant continuing education. Although physicians reported higher levels of professional isolation than their nurse counterparts, professional isolation was identified as a concern by both provider groups. CONCLUSIONS: To ensure an adequate supply of knowledgeable and skillful rural health care professionals, continuing education specific to the delivery of care in rural settings is necessary. Once developed, the continuing education must be delivered in a manner that is acceptable and accessible to isolated rural providers.

Rural hospital preparedness for neonatal resuscitation.

CONTEXT: Neonatal resuscitation is a critical component of perinatal services in all settings. PURPOSE: To systematically describe preparedness of rural hospitals for neonatal resuscitation, and to determine whether delivery volume and level of perinatal care were associated with overall preparedness or its indicators. METHODS: We developed the 15-point Hospital Neonatal Resuscitation Survey to examine institutional preparedness for neonatal resuscitation in 4 areas: policy and procedure, resuscitation team membership, continuing education, and connections with a wider system of perinatal care. All 58 rural hospitals with perinatal services in 2 upper Midwestern states (North Dakota and Minnesota) were asked to provide information describing preparedness for neonatal resuscitation. Nursing administrators responded to the survey. FINDINGS: A total of 26 hospitals took part. Annual delivery volume ranged from 4 to 958. Preparedness scores ranged from 4 to 12. Hospitals with more than 125 deliveries each year reported significantly higher levels of preparedness than lower volume hospitals (9.50 vs 5.83, P < .001). Overall preparedness was not associated with level of perinatal care. Most rural hospitals did not identify a formal collaborative relationship with a regional level III perinatal center. CONCLUSIONS: Substantial variation in hospital preparedness for neonatal resuscitation was identified. Preparedness was associated with delivery volume. Lack of collaborative agreements between rural hospitals and level III perinatal centers was pervasive. Additional research into the measurement of hospital preparedness for neonatal resuscitation as a component of quality rural perinatal care is needed to optimize outcomes for rural-born neonates.

Readiness for neonatal resuscitation: measuring knowledge, experience, and comfort level.

Neonatal resuscitation is a complex procedure that requires the use of specialized knowledge and skills in an emotionally charged and stressful situation. Knowledge about neonatal resuscitation, frequent performance of skills, and comfort level with skill performance are dimensions of quality implementation of neonatal resuscitation. The Neonatal Resuscitation Index and Neonatal Resuscitation Experience Index are self-report instruments designed to measure these important variables. Information about nurses' responses to the Neonatal Resuscitation Index and Neonatal Resuscitation Experience Index, psychometric properties, and implications for research and practice are discussed in this article.