Living With the Aftermath: The Second Victim Experience Among Certified Registered Nurse Anesthetists.

The second victim experience is defined as a healthcare professional who is traumatized by adverse events that have occurred to the patient, the first victim. This traumatization can cause a range of symptoms such as guilt, anxiety, disturbed sleep, and decreased job satisfaction. The purposes of this study were to understand certified registered nurse anesthetists' (CRNAs') second victim distress, perceived support, and the impact of the second victim experience on absenteeism and turnover intention. A survey was administered to CRNAs from the Michigan Association of Nurse Anesthetists, with a total of 172 responses suitable for analysis. Psychological distress was experienced by 20.3% (n = 35) of CRNAs. Additionally, 16.3% (n = 28) and 15.1% (n = 26) of CRNAs experienced physical distress and professional self-efficacy issues respectively where CRNAs doubted whether they were a good healthcare provider and questioned their professional abilities. Turnover intentions and absenteeism were also evaluated with 11.6% of CRNAs wanting to take a job outside of patient care and/or quit their job, and 13% identified that they needed a mental health day and/or time away from work after their experience. Organizations must consider offering peer support and supportive counseling for practitioners who have suffered from traumatic events and identify desired forms of support among staff.

Public Service Announcements: An Innovative Strategy for Introducing Competencies in Population Health.

BACKGROUND: Teaching health concepts using a variety of strategies has been shown to enhance students' critical thinking skills and learning outcomes. Educational strategies highlighting the effects of social determinants of health (SDOH) on communities and populations are considered essential nursing curricula by the American Association of Colleges of Nursing. METHOD: A public service announcement (PSA) assignment was developed and implemented for a community nursing course with approximately 100 students. RESULTS: The PSA assignment was a multifaceted project that incorporated knowledge development (e.g., public health topics, group dynamics, and SDOH factors) as well as skill development (e.g., navigating web-based databases, creating an annotative bibliography, designing developmentally and culturally appropriate educational messages, and conducting self-evaluation and peer-evaluation). CONCLUSION: This assignment allowed faculty to assess 28 subcompetencies of student learning and provided students with the opportunity to explore a population health issue that considered cultural, developmental, and social determinants of health needs. [J Nurs Educ. 2023;62(11):650-652.].

Legacy of the Role of Medicine and Nursing in the Holocaust: An Educational Intervention to Support Nursing Student Professional Identity Formation and Ethical Conduct.

ABSTRACT: Reflecting on history of medicine and nursing in the Holocaust scaffolds professional identity formation. Students grapple with 1) nurses' active participation in identifying/killing patients with mental and physical disabilities, camouflaged as "euthanasia" or "mercy killing" of German citizens and others, preceding mass murder of Jews and others at death camps; 2) involvement in unethical, cruel experiments; 3) resistance narratives; and 4) relevance for contemporary nursing. Impact of a seminar/colloquium on historical knowledge and personal/professional relevance included reported increased historical awareness/knowledge and themes of nurse as patient advocate/judicious obedience, importance of ethics/values adherence, and value of art/reflective writing for processing experience.

Implementation of a Standardized National HIV Curriculum in a Primary Care Nurse Practitioner Program.

BACKGROUND: Although efforts have been made to improve and integrate an HIV curriculum in schools of nursing, little has been done to standardize the integration of competencies related to HIV care in primary care nurse practitioner (NP) programs. PURPOSE: The purpose of this study was to understand the effect of integrating the 6 core competencies from the National HIV Curriculum (NHC) on NP students' perceived knowledge about HIV care. METHOD: This was a quasi-experimental study with a pre/posttest design that measured NP students' self-perceived knowledge of the 6 core competencies from the NHC. RESULTS: A total of 375 student NHC training sessions were implemented across 5 semesters (fall 2019 through fall 2021 academic years). In each of the 3 courses that integrated the NHC, there were statistically significant increases in student knowledge from pre- to posttest for each of the 6 competencies. CONCLUSION: This project supports using a standardized HIV curriculum as part of primary care NP curricula.

A poverty simulation to enhance nursing student knowledge, skills, and attitudes toward people living in poverty.

BACKGROUND: Poverty is a reality for many individuals and families. Unless one has lived in a poverty situation, it can be difficult to understand the challenges people face. METHODS: This study was a quasi-experimental study with a pre- and post-test design (36 select-items from four-established instruments) that measured students' self-perceived knowledge, skills, and attitudes towards people living in poverty. All undergraduate, pre-licensure, senior-level nursing students enrolled in a community nursing course (fall 2018-fall 2019, n = 254) participated in a face-to-face interactive Community Action Poverty Simulation (CAPS) with a focus on the QSEN concept of patient-centered care. The winter 2020 semester, the simulation was not offered because of the coronavirus pandemic; these students (n = 96) served as a comparison group. RESULTS: Paired-samples t-tests revealed knowledge, skill, and attitude mean scores, were improved for all students with the exception of social justice attitudes (improved only for the non-simulation group). Independent-samples t-tests revealed simulation students had higher knowledge, skill, and attitude scores on the Adapted CAPS Assessment and Active Learning Measure. Non-simulation participants had higher Political Awareness scores. CONCLUSION: These results indicated the CAPS appears to be an effective simulation to change students' self-perceived knowledge, skills, and attitudes regarding people whose incomes are low or who are living in poverty.

Nursing Student and Faculty Perceptions of Just Culture.

BACKGROUND: Just culture is essential for quality improvement and patient safety. METHOD: This descriptive study measured perceptions of just culture among nursing students and faculty using the Just Culture Assessment Tool for Nursing Education (JCAT-NE). RESULTS: There were no significant differences in JCAT-NE scores for students (M = 133.43, SD = 19.12) and faculty (M = 136.34, SD = 22.73) (t[159] = 0.82, p = .42); however, there were significant differences in JCAT-NE scores based on level of experience. For students, JCAT-NE scores were significantly higher for sophomores than for seniors (F[2, 114] = 4.9, p = .01). For faculty, advanced beginner and competent faculty had significantly higher scores compared with proficient and expert faculty (t[42] = 2.36, p = .02). CONCLUSION: More needs to be done to establish a fair and just culture in schools of nursing. [J Nurs Educ. 2022;61(5):257-260.].

Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature.

Background: The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients' health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered; interactions between patients and providers; and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias. Objective: To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias. Design: Integrative review. Methods: The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions' students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis. Results: Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment. Conclusions: Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias.

Project REACH: A multi-level, interdisciplinary approach to enhance student retention and success.

BACKGROUND: An escalating nursing shortage brought attention to nursing student retention and success including graduation and licensure. PURPOSE: The purpose of this Health Resources and Services Administration (HRSA) project, Realizing Educational Attainment and Careers in Healthcare (REACH), was to increase nursing progression and graduation rates for undergraduate nursing students from diverse and/or under-resourced backgrounds. METHODS: REACH goals focused on four levels: 1) Individual: Neutralize the impact of economic-environmental factors that are barriers for diverse and under-resourced populations to pursue a BSN, 2) Group: Bridge gaps within a social determinants framework to achieve progression and graduation, 3) Institutional: Broaden the cultural competence of faculty on campus and 4) Community: Expand the knowledge and skills of the social determinants of health and cultural competence for nurses within the largest nursing employer in the community. RESULTS: 92% (35/38) of participants graduated with a BSN and 91% (32/35) of these graduates are employed as registered nurses. Sixty percent (n = 35) of participants are employed in HRSA designated Health Professional Shortage Areas or in Medically Underserved Areas/Populations as compared to 24% (n = 79) of College of Nursing students. CONCLUSION: An interdisciplinary approach to addressing social determinant needs allowed this project to successfully diversify the nursing workforce.

Strengthening Student Nurses' Sense of Belonging Through Attendance at a Professional Nursing Conference.

Nursing faculty members at one midwestern college provided a professional development opportunity for baccalaureate nursing students by organizing a trip to a nursing association conference (ie, the AORN Global Surgical Conference & Expo). Preconference and postconference survey results showed a statistically significant increase in sense-of-belonging scores; and the eta-squared statistic (0.14) indicated a large effect size, suggesting the students' conference attendance enhanced their sense of belonging to the profession. A Pearson's correlation analysis revealed a strong, positive correlation between a student's intention to join a professional organization and his or her belief that membership in a professional organization was important (r = 0.82, n = 26, P < .001). This type of professional experience may improve students' perception of nursing professionalism, sense of belonging, intention to join a professional organization, and confidence in nursing as a career.

Exploratory Factor Analysis of the Strength of the Cultural Affiliation Scale.

BACKGROUND: Within the United States, there are individuals who retain the traditions and beliefs of cultural groups that vary from the general majority population. Both healthcare providers and researchers have reported that many individuals who live in but are less affiliated with the dominant culture tend to have less positive health outcomes. OBJECTIVE: The purpose of this study is to use factor analysis to assess the psychometric properties of Mood's 18-item Strength of Cultural Affiliation Scale (SCAS). METHODS: The SCAS was administered to 604 participants from a randomized clinical trial of cancer patients who were treated with radiotherapy at a large central city hospital located in the Midwest. RESULTS: Confirmatory Factor Analyses using Principal Component Analysis with Oblimin Rotation indicated a 16-item, 4-factor final solution with the following subscales: factor 1, lifestyle (7 items); factor 2, language and cultural-specific holidays (3 items); factor 3, relationships (4 items); and factor 4, cultural health practices (2 items). CONCLUSION: The SCAS demonstrated high reliability and content, construct, discriminant, convergent, divergent, and predictive validity. IMPLICATIONS FOR PRACTICE: The SCAS seems to be a reliable and valid tool for practitioners to use to assess a patient's strength of cultural affiliation to provide the best culturally sensitive care possible for the patient.

Considering a relational model for depression in Navy recruits.

OBJECTIVE: Key variables that have influenced depression in previous research were examined in this study including adult attachment, perceived social support, sense of belonging, conflict in relationships, and loneliness for their relationships in a relational model for depression with U.S. Navy recruits in basic training. METHODS: This theory-testing analysis study was part of a larger cross-sectional cohort study that examined the factors associated with depression in Navy recruits. The sample for this study included 443 recruits. Structural equation modeling was used to test the fit of the theoretical model. RESULTS: The proposed model explained 49% of the variance in depressive symptoms with loneliness and sense of belonging as the strongest indicators of depression. CONCLUSIONS: The Navy should consider interventions that increase sense of belonging in high risk for depression recruits to decrease loneliness and depression and circumvent recruits not completing basic training. The assumption that recruits are in close quarters and contact with other people and therefore are not lonely and receive adequate social support is not supported. This article contributes to advancing the science of mental health in relation to depression by considering predictors that are amenable to intervention.

Utilizing the Intercultural Development Inventory® to develop intercultural competence.

PURPOSE: Health care professional education programs in the United States have been charged to devise strategies to increase the racial and ethnic diversity of the workforce (Health Resources and Services Administration, Nursing Workforce Diversity (NWD) http://bhpr.hrsa.gov/nursing/grants/nwd.html, 2014). The purpose of this charge is to develop a healthcare workforce that can better provide culturally relevant care to meet the needs of diverse communities. The purpose of this study was to assess the cultural competency of students, faculty, and staff from a small Midwest-university college of nursing. METHODS: This study was part of a larger interventional study to enhance the cultural development of the College of Nursing faculty, staff, and students. The sample for this study included 314 participants (students, faculty, and staff) in phase one of the parent study. Phase one included the initial administration of the Intercultural Development Inventory (IDI®) over a two year period with analysis of the pre-test results. Phase two includes the implementation of cultural development interventions with a post-test IDI® survey and is currently in process. RESULTS: IDI® aggregate results were similar for students and faculty/staff in that most participants scored at the Minimization level according to the IDI®. Ninety-eight percent of student participants overestimated their level of cultural competency. Minority students had higher cultural competency scores in terms of developmental orientation (M = 98.85, SD = 14.21) compared to non-minority students (M = 94.46, SD = 14.96). CONCLUSIONS: Overall, the IDI® was a valuable self-reflection tool to assess cultural development. At the individual level, it has allowed for self-reflection and awareness to the reality of cultural development, attitudes, and values. At an institutional level, the aggregate results provided a framework for the examination of department policies, procedures, and curriculum design with the ultimate goal of graduating a more culturally competent nursing workforce to serve the greater community.

Considering a Relational Model for Depression in Women with Postpartum Depression.

PURPOSE: To extend testing of a relational theory that a low sense of belonging, delayed or impaired bonding, and loneliness are salient risk factors for postpartum depression (PPD) in women. METHODS: Data for this theory-testing analysis came from a larger prospective longitudinal cohort study and included women who were retained to the end of the study at the 6 week postpartum interview (n=564). Structural equation modeling was used to test the "fit" of the model and determine significance of direct and indirect paths. RESULTS: The model explained 35% of the variance in postpartum depression with impaired bonding and loneliness as the strongest indicators. Lower sense of belonging, less perceived social support from a healthcare practitioner and a partner, and lower parenting sense of competence were additional predictors. CONCLUSION: Study findings challenge current thinking about the relationship between impaired bonding and PPD as this study raises the possibility that impaired bonding is a risk for PPD as opposed to the reverse relationship. The study provided evidence of the importance of healthcare practitioners' alliance with patients. This paper contributes to advancing the science of women's mental health in relation to depression by considering additional predictors which might be amenable to intervention.

Validation of alternative indicators of social support in perinatal outcomes research using quality of the partner relationship.

AIM: To test alternatives to the current research and clinical practice of assuming that married or partnered status is a proxy for positive social support. BACKGROUND: Having a partner is assumed to relate to better health status via the intermediary process of social support. However, women's health research indicates that having a partner is not always associated with positive social support. DESIGN: An exploratory post hoc analysis focused on posttraumatic stress and childbearing was conducted using a large perinatal database from 2005-2009. METHODS: To operationalize partner relationship, four variables were analysed: partner ('yes' or 'no'), intimate partner violence ('yes' or 'no'), the combination of those two factors, and the woman's appraisal of the quality of her partner relationship via a single item. Construct validity of these four alternative variables was assessed in relation to appraisal of the partner's social support in labour and the postpartum using linear regression standardized betas and adjusted R-squares. Predictive validity was assessed using unadjusted and adjusted linear regression modelling. RESULTS: Four groups were compared. Married, abused women differed most from married, not abused women in relation to the social support, and depression outcomes used for validity checks. The variable representing the women's appraisals of their partner relationships accounts for the most variance in predicting depression scores. CONCLUSIONS: Our results support the validity of operationalizing the impact of the partner relationship on outcomes using a combination of partnered status and abuse status or using a subjective rating of quality of the partner relationship.