Breastfeeding interventions and programmes conducted in Portuguese-speaking sovereign states: A scoping review.

AIM: This scoping review aimed to identify and appraise the effectiveness and impact of breastfeeding promotion interventions conducted across Portuguese-speaking sovereign countries. METHODS: Using the PRISMA-ScR guidelines, we searched 14 electronic databases for publications published through 31 July 2023. The search terms were designed to find studies promoting breastfeeding or exclusive breastfeeding in pre-defined Portuguese-speaking countries. RESULTS: Of the 5263 papers initially retrieved, 30 interventional studies on breastfeeding met the inclusion criteria across three countries: Brazil (N = 26), Portugal (N = 2) and Guinea Bissau (N = 2). Participants ranged from pregnant women, mothers, mother-infant pairs, healthcare professionals, and school children. Overall, the interventions increased exclusive breastfeeding and better breastfeeding practices, such as a higher duration of breastfeeding. The interventions positively affected maternal breastfeeding self-efficacy, knowledge and perception. Only four studies used a theoretical framework. CONCLUSION: While the results were often statistically significant, no study had an outcome close to the recommended UNICEF and WHO goal of 70% breastfeeding at six months. The need to determine what works for the recommended six months postpartum period is critical for maximising children's health in Portuguese-speaking countries.

A Qualitative Inquiry Exploring Clinical Faculty Transition to a Concept-Based Curriculum.

AIM: This study explores the transition process clinical faculty experience when changing to teaching in a concept-based curriculum. BACKGROUND: Literature related to faculty support during curricular change is sparse and offers little guidance to assist clinical faculty. METHOD: A qualitative study was conducted with participants from nursing programs in a statewide consortium. Semistructured interviews were transcribed to identify themes that linked participants' experiences to transition stages. Additional research included review of clinical assignments and observation of faculty while teaching at a clinical site. RESULTS: Nine clinical faculty from six nursing programs participated in the study. Five themes linked to the stages of the Bridges Transition Model were identified: Collaboration, Communication, Coordination, Coherence, and Futility. CONCLUSION: The identified themes revealed that clinical faculty varied in their transition process. These results add to the knowledge of transitional change for clinical faculty.

COVID-19 Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors.

COVID-19 vaccination hesitancy has become a major concern around the world. Recent reports have also highlighted COVID-19 vaccination hesitancy in healthcare workers. Despite media reports and scientific publications, little is known about the extent and predictors of COVID-19 vaccination refusal among nurses. Thus, the purpose of this study was to assess COVID-19 vaccine refusal rates among nurses globally and to explore the reasons for refusal and factors associated with the uptake of the vaccines. A scoping review of the published literature was conducted, and a final pool of 51 studies (n = 41,098 nurses) from 36 countries was included in this review. The overall pooled prevalence rate of COVID-19 vaccine refusal among 41,098 nurses worldwide was 20.7% (95% CI = 16.5-27%). The rates of vaccination refusal were higher from March 2020-December 2020 compared to the rates from January 2021-May 2021. The major reasons for COVID-19 vaccine refusal were concerns about vaccine safety, side effects, and efficacy; misinformation and lack of knowledge; and mistrust in experts, authorities, or pharmaceutical companies. The major factors associated with acceptance of the vaccines were: male sex, older age, and flu vaccination history. Evidence-based strategies should be implemented in healthcare systems worldwide to increase the uptake of COVID-19 vaccines among nurses to ensure their safety and the safety of their patients and community members.

Office-Based Buprenorphine Treatment: Identifying Factors That Promote Retention in Opioid-Dependent Patients.

Opiate addiction is a serious global health issue that profoundly impacts the welfare of populations around the world. Opioid addiction affects an estimated 1.9 million individuals in the United States alone, stimulating a rise in treatment options such as medication-assisted treatment with buprenorphine. When combined with counseling and relapse prevention groups, medication-assisted treatment has proven to be an effective office-based opioid treatment for opiate dependence. Office-based opioid treatment has broadened access to treatment of opioid dependence, has decreased the risk for overdose, and is effective for reducing cravings and opioid use at proper dosing levels. However, treatment retention and relapse remain significant challenges. The purpose of this study was to identify characteristics predictive of retention in treatment time of opioid-dependent individuals receiving office-based buprenorphine treatment. The records of individuals enrolled in a public health office buprenorphine clinic (n = 350) were analyzed to determine retention time in treatment and whether retention time varied by selected individual variables. Participants in the study had a cumulative predicted retention time on buprenorphine of 65% at 30 days, 35% at 6 months, 25% at 12 months, and 18% at 18 months.

Charting Cognitive Growth of Nursing Students Using Linguistic Software.

BACKGROUND: Students' word choice when writing in a reflective journal may reveal their emotional development, sense of belonging, cognitive processing, and ability to appraise their own growth and understanding. New linguistic analysis software can scan and categorize these journals for the use of pronouns, positive and negative emotions, and cognitive keywords. METHODS: A retrospective study design evaluated student journaling from a psychiatric clinical course. Journal entries from weeks 1 and 12 were compared by z-score analysis. FINDINGS: Significant increases were found in the use of "we" (P = .001), positive emotions (P < .001), inclusion words (P < .001), and insight words (P = .004), whereas the use of cause and self-discrepancy words were not significantly different. CONCLUSION: Identification of learning as expressed in words could have an impact on how student assignments are designed by including the use of the Linguistic Inquiry and Word Count software to assess changes in student cognition.

Answering the Call for a Bachelors-Prepared Nursing Workforce: An Innovative Model for Academic Progression.

Forces that have produced national reform of a fragmented, inefficient, and expensive health care services sector have also set the stage for reform of a fragmented, inefficient, and expensive system for nursing education. Changes in health care, health policy, education policy, and funding for public higher education have led to the development of new nursing education models designed to increase the number of baccalaureate-prepared nurses entering the workforce. This article describes the development and implementation of one such model that features a common concept-based curriculum and university-community college partnerships at its core. This plan increases access for nursing students across the state to earn a prelicensure bachelor of science in nursing degree and preserves the integrity and accessibility of associate degree nursing education.

Autonomy and empowerment in advanced practice registered nurses: lessons from New Mexico.

PURPOSE: The purpose of this study was to determine the association between autonomy and empowerment of advanced practice registered nurses (APRNs) and predictor variables of physician oversight, geographical location, and practice setting. As the Patient Protection and Affordable Care Act (PPACA) is implemented, these characteristics are vital to understanding how APRNs practice and the relationship of APRNs to other healthcare team members, including physicians. DATA SOURCES: This was a descriptive, correlational survey of APRNs in New Mexico exploring autonomy and empowerment in relation to variables of physician oversight, geographical location, and practice setting. CONCLUSIONS: New Mexico's APRN Nurse Practice Act supports independent practice and prescriptive authority. Results indicated that APRNs are highly empowered and autonomous. However, nearly 40% of respondents identified practicing with physician oversight. Further investigation of subscales of empowerment also provided insight of relationships among healthcare team members, particularly physicians. IMPLICATIONS FOR PRACTICE: This research provides additional knowledge for policy changes that support APRNs assuming more responsibility for primary care. However, understanding the APRN role within the healthcare team is necessary for effective implementation of primary care in New Mexico.

Strategies for success: crisis management model for remediation of at-risk students.

Student success is a concern for all nursing schools. Accountability for NCLEX(®) pass rates, along with accountability for student attrition and progression, compel nursing schools to carefully select applicants and then actively manage their progress. One of the strategies of managing student progression is to use standardized, nationally normalized exit examinations to identify students at risk for NCLEX-RN failure. This article describes the response of one baccalaureate nursing program to an unacceptable number of exit examination failures among senior students preparing to graduate. As a unique approach to this matter, a crisis management process was used to assess the problem, to develop and implement an intervention for at-risk students, and to revise program policies to better support ongoing student success.

Promotores and the Chronic Care Model: an organizational assessment.

Although promising research is developing related to promotores and the Chronic Care Model (CCM), studies of the effectiveness of the integration of these two system innovations in addressing health disparities are limited. This article reports on an organizational assessment and analysis of promotores working in a system of federally-sponsored community health clinics along the United States-Mexico border where the CCM has been operationalized. The work of promotores was found to be largely invisible within the CCM. This highlights the need for further investigation if the potential of these combined system innovations to address health disparities among Hispanics is to be realized.

Implementing interdisciplinary practice change in an international health-care organization.

The current emphasis on adopting evidence-based practice often results in the need to change interdisciplinary practice. This article describes the successful system-wide change to evidence-based wound care practices in a large, Middle-Eastern health services organization using a multinational workforce. Elements within this change initiative are identified that stimulated experimentation and collaboration among members of this organization's workforce while also preserving culturally determined expectations for authority and decision-making. The result was a system-wide practice change accomplished through consensus-building and interdisciplinary learning while also utilizing the strengths to be found in an established organizational hierarchy. This description of practice change among the members of a multicultural, multinational workforce provides lessons for managing a diversity of perspectives, creating consensus and accomplishing change in an environment where multiple cultural values intersect.

A differentiated practice model for school nursing.

School nursing is notable for autonomous practice and independent decision-making. School nurses practice within a complex school health services environment that is subject to constant change, the influence of multiple stakeholders, and a chronic state of uncertain resources. Other professional challenges faced by school nurses are a lack of standardized entry education requirement, inadequate theoretical research with practice application, and expanding role responsibilities. Administrative restructuring of school nursing services using a differentiated practice model could be a method to address the challenges of school nurse practice. A model of differentiated school nursing practice is proposed as a starting point for the national school nurse audience to consider this alternative to the master's entry requirement. School nurse role responsibilities are divided among three levels of practitioners: generalist, master's prepared, and school nurse policy analyst. Each level features an increased scope of responsibility based on higher educational attainment. Research regarding how differentiated practice has been implemented in other health care settings is described. Implications for the implementation of differentiated practice in school health services are discussed, including the need for cooperation among stakeholders, possible cost considerations, and how school nurse education might be affected.

Data speak: influencing school health policy through research.

School nurses occupy a unique position in relation to school health policy. In addition to facing the demands of promoting and maintaining the health of students, they collect the information that is used to document the implementation of school health policy. Effective school health policy is guided by reliable, credible data regarding what interventions achieve desired results. Research data that truly reflect school nurses' contributions to student health and educational outcomes enhance the visibility of professional school nurses. School nurses can learn to use data as a policy tool by knowing data collection methods, when to select a particular method, and how outcomes research can benefit school nurse practice.