The Nature of Nursing Competency in Simulation of Adult Medical-Surgical Nursing: Exploratory Factor Analysis.

BACKGROUND AND PURPOSE: Educators, employers, and regulatory agencies face substantive challenges in evaluating nursing competency. Evidence on what competency is and how to measure it can mitigate the challenges. METHODS: Participants (N = 67) completed three high-fidelity simulation tests. Each video-recorded test was scored by three raters using a 41-item instrument. Exploratory factor analysis was used to define the latent structure of the instrument. RESULTS: A five-factor solution accounted for 56% of the variance, minimized negative loadings, and minimized the number of cross-loadings. The factors were minimally correlated (each r < .30). CONCLUSIONS: The factors, Vigilant Action, Role Nuances, Precision, Procedural Skills, and Risk Reduction, represent integrated dimensions of competency that can be linked to specific tasks underlying safe practice.

Testing Nursing Competence: Validity and Reliability of the Nursing Performance Profile.

BACKGROUND AND PURPOSE: There is growing evidence that simulation testing is appropriate for assessing nursing competence. We compiled evidence on the validity and reliability of the Nursing Performance Profile (NPP) method for assessing competence. METHODS: Participants (N = 67) each completed 3 high-fidelity simulation tests; raters (N = 31) scored the videotaped tests using a 41-item competency rating instrument. RESULTS: The test identified areas of practice breakdown and distinguished among subgroups differing in age, education, and simulation experience. Supervisor assessments were positively correlated, r = .31. Self-assessments were uncorrelated, r = .07. Interrater agreement ranged from 93% to 100%. Test-retest reliability ranged from r = .57 to .69. CONCLUSIONS: The NPP can be used to assess competence and make decisions supporting public safety.

Measuring competence: collaboration for safety.

Few options are available to nursing regulatory boards for the evaluation of nursing competency in registered nurses who are reported for practice breakdown. To address this deficiency, the authors conducted funded research through collaboration between their respective institutions: a state nursing regulatory board, a community college nursing program, and a state university nursing program. Through this collaboration, a competency evaluation process that used high-fidelity simulation was developed and was called the nursing performance profile (NPP). The NPP process consisted of evaluation of videotaped performances of registered nurses providing simulated patient care in three successive situations. Nurses who were experienced in both practice and supervision rated the performances according to scoring guidelines developed by the authors. Findings showed that the NPP process has the potential to (1) provide regulators, educators, and employers with a quantitative picture of nurse performance across nine areas essential to safe practice, and (2) establish a basis for recommending a specific remediation plan or continuing professional development.

Preparing clinical preceptors to support nursing students in evidence-based practice.

Staff nurse preceptors contribute importantly to student learning and to academic program outcomes; however, academic-clinical partnerships can offer focused learning opportunities for preceptors as well. This study addressed different interest levels in evidence-based practice across clinical settings by testing the effectiveness of a workshop designed to increase preceptor knowledge and endorsement of evidence-based practice. Nurse preceptor participants (N = 160) recruited from seven hospitals during 2009 to 2011 had an average age of 43.9 (SD = 11.5) and an average of 17.0 (SD = 11.2) years of nursing experience. Participants' scores on the Evidence-Based Practice Beliefs Scale improved significantly from pretest to posttest (M(pre) = 59.0, SD(pre) = 8.4, M(post) = 66.4, SD(post) = 6.8, p < .001), which was confirmed by subgroup analyses. At follow-up (1 to 25 months), 52% of the nurse preceptors reported increased use of evidence-based practice. This study indicates that a short collaborative, content-focused workshop can promote preceptor endorsement of evidence-based practice.

Reliability and validity of an instrument assessing nurses' attitudes about healthy work environments in hospitals.

AIM: To examine the psychometric properties of an instrument used to evaluate the work environment of direct care nurses employed in hospital settings. BACKGROUND: Healthy work environments are associated with increased retention and high-quality patient care. METHODS: Items for the instrument were based on the American Association of Critical Care Nurses' standards for a healthy work environment. Six items measured the individual's contribution to the work environment and six measured co-workers' contributions. Each item was graded on a scale from 'A=well above average' to 'F=failing'. The instrument was administered by nurse leaders to 210 direct care nurses in six hospitals. RESULTS: The Cronbach α was 0.75 for the self-rating subscale and 0.89 for the co-workers rating subscale. Administrators rated their co-workers significantly higher [n=32, mean (M)=2.69, standard deviation (SD)=0.63] than direct care nurses rated theirs (n=209, M=2.31, SD=0.83, P=0.03). Direct care nurses intending to stay in nursing rated co-workers significantly higher (n=170, M=2.35, SD=0.81) than those not intending to stay (n=22, M=1.87, SD=0.81, P=0.01). CONCLUSION: The instrument is a feasible, reliable and valid method for assessing the work environment. IMPLICATIONS FOR NURSING MANAGEMENT: The instrument can be used to assess the relationship of the work environment to nurse retention in hospitals.

Culturally focused wellness intervention for American Indian women of a small southwest community: associations with alcohol use, abstinence self-efficacy, symptoms of depression, and self-esteem.

PURPOSE: This study examined the influence of a culturally focused wellness intervention on alcohol consumption, alcohol abstinence self-efficacy, depression, and self-esteem among women of a small American Indian community in the southwestern United States. Participation in two intervention approaches was compared: a curriculum-based health promotion­only approach and health promotion combined with cognitive-behavioral skills building (CBSB). DESIGN: The wellness intervention was tested in a prospective, randomized, two-group design with repeated measures. There was no control group. SETTING: An American Indian community in the Southwest. SUBJECTS: American Indian women, ages 18 to 50 (N = 268). INTERVENTION: A 10-session culturally focused curriculum-based health promotion intervention, with a CBSB component, was developed using a community-based participatory research process. Comparisons were made between those who attended the health promotion plus CBSB intervention and those who attended the intervention without the CBSB component. MEASURES: Information regarding demographics, substance use, alcohol consumption, alcohol abstinence self-efficacy, depressive symptoms, and self-esteem was collected through a structured interview. ANALYSIS: Regression was used to evaluate the effect of the intervention on alcohol consumption, alcohol abstinence self-efficacy, depressive symptoms, and self-esteem in CBSB and non-CBSB groups. RESULTS: Although there were no significant differences between the CBSB and non-CBSB groups, the results indicate a significant decrease in alcohol consumption and symptoms of depression, and a significant increase in alcohol abstinence self-efficacy and self-esteem, from baseline to the 6-month follow-up for both groups. CONCLUSION: Evidence suggests that this culturally focused health promotion intervention has a positive impact on alcohol use, alcohol abstinence self-efficacy, depressive symptoms, and self-esteem among American Indian women.

Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study.

STUDY OBJECTIVES: To compare health-related quality of life (HR-QOL) across subgroups defined by sleep disturbances and ethnicity. METHODS: Men (47%) and women (53%) Sleep Heart Health Study participants age 40 and older (N = 5237) underwent overnight polysomnography and completed self-report questionnaires on symptoms of sleep disturbances. The physical and mental composite scales (PCS and MCS) of the Medical Outcomes Study 36-item short form survey assessed HR-QOL and were compared to sleep data. RESULTS: Participants self-identified as Caucasian/White (n = 4482, 86%), African American/Black (n = 490, 9%), or Hispanic/Mexican American (n = 265, 5%). The prevalence of obstructive sleep apnea (OSA) was 17%, frequent snoring was 34%, difficulty initiating or maintaining sleep (DIMS; insomnia symptoms) was 30%, and excessive daytime sleepiness (EDS) was 25%. African American participants with frequent snoring, insomnia symptoms, or EDS had significantly poorer physical health compared to Caucasians (p < 0.001). Hispanics with frequent snoring, insomnia symptoms, or EDS had significantly poorer mental health than Caucasian participants (p <0.001). Neither PCS nor MCS scores differed significantly across ethnic subgroups for participants with moderate to severe OSA (respiratory disturbance index > 15, 4% desaturation). CONCLUSIONS: Across ethnic/racial subgroups, sleep disturbances are associated with worse physical and better mental HR-QOL than the U.S. norm, but this relationship may be moderated by comorbid health conditions. This study replicates and extends prior research indicating differences among minority and non-minority participants and highlights the need for future studies of sleep disturbances with larger samples of minorities that control for comorbid health conditions.

The relationship of perceived and actual weight in minority adolescents.

The prevalence of overweight in adolescents with its associated outcomes continues to be a major public health concern. The purpose of this study was to assess whether adolescents perceived their weight accurately and to determine the relationships among perceived and actual weight, depression, anxiety, anger, disruptive behavior, and self-concept in minority adolescents. A descriptive, correlational design was conducted with 33 adolescents. Questions regarding weight perception, depression, anxiety, anger, disruptive behavior, and self-concept were correlated with body fat percentile, body mass index (BMI), and BMI percentile. Findings indicated that adolescent perception of overweight was positively related to actual weight and negatively related to self-esteem and disruptive behavior. Adolescents who were overweight identified their weight accurately and tried to lose weight.

Improving the mental health, healthy lifestyle choices, and physical health of Hispanic adolescents: a randomized controlled pilot study.

BACKGROUND: Obesity and mental health disorders are 2 major public health problems in American adolescents, with prevalence even higher in Hispanic teens. Despite the rapidly increasing incidence and adverse health outcomes associated with overweight and mental health problems, very few intervention studies have been conducted with adolescents to improve both their healthy lifestyles and mental health outcomes. Even fewer studies have been conducted with Hispanic youth. The purpose of this study was to evaluate the preliminary efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, and Nutrition) program, a manualized educational and cognitive behavioral skills-building program, on Hispanic adolescents' healthy lifestyle choices as well as mental and physical health outcomes. METHODS: A cluster randomized controlled pilot study was conducted with 19 Hispanic adolescents enrolled in 2 health classes in a southwestern high school. One class received COPE and the other received an attention control program. RESULTS: Adolescents in the COPE program increased their healthy lifestyle choices and reported a decrease in depressive and anxiety symptoms from baseline to postintervention follow-up. A subset of 7 overweight adolescents in the COPE program had a decrease in triglycerides and an increase in high-density lipoproteins. In addition, these overweight adolescents reported increases in healthy lifestyle beliefs and nutrition knowledge along with a decrease in depressive symptoms. CONCLUSION: The COPE TEEN program is a promising school-based strategy for improving both physical and mental health outcomes in adolescents.

Self-reported health status of students in-processing into military medical advanced individual training.

It is important to be aware of the health and injury status of students in military training settings in order to adequately plan for their progression through required physical training and provision of health care to meet their needs. This paper describes the self-reported health status of students arriving in two medical training Battalions at Ft. Sam Houston. The results revealed that 43% of arriving soldiers had musculoskeletal symptoms and 35% had symptoms that interfered with their ability to accomplish the normal daily activities required as students. The most common sites of symptoms were knee (17 and 18%), foot/toe (16 and 13%), ankle (9 and 10%), and lower leg (9 and 12%) for the 232nd and 187th Medical Battalions respectively. Risk factors for those with musculoskeletal injury (MSI) symptoms that interfere with their abilities to do their jobs include gender, past history of injury, and self-reported stress and fitness levels. Other risk factors for medical specialties other than combat medic include being older (over 24 yrs of age), active duty status, being overweight, and use of smokeless tobacco. This information can help identify soldiers considered at risk of incurring a MSI during AIT. With this knowledge, physical training can be designed to help soldiers achieve fitness without additional injury and health care facilities can be designed to provide appropriate staffing of the health care professionals needed for evaluation and treatment.

The evidence-based practice beliefs and implementation scales: psychometric properties of two new instruments.

BACKGROUND: Implementation of evidence-based practice (EBP) by health professionals is a key strategy for improving health care quality and patient outcomes as well as increasing professional role satisfaction. However, it is estimated that only a small percentage of nurses and other health care providers are consistently using this approach to clinical practice. AIM: The aim of this study was to report on the development and psychometric properties of two new scales: (1) the 16-item EBP Beliefs Scale that allows measurement of a person's beliefs about the value of EBP and the ability to implement it, and (2) the 18-item EBP Implementation Scale that allows measurement of the extent to which EBP is implemented. METHODS: Nurses (N= 394) attending continuing education workshops volunteered to complete the scales. Data were analysed to evaluate reliability and validity of both instruments. RESULTS: Cronbach's alpha was > .90 for each scale. Principal components analysis indicated that each scale allowed measurement of a unidimensional construct. Strength of EBP beliefs and the extent of EBP implementation increased as educational level increased (p < .001) and as responsibility in the workplace increased (p < .001). CONCLUSION: In this study, initial evidence was provided to support the reliability and validity of the EBP Beliefs and Implementation Scales in a heterogeneous sample of practicing nurses. EVIDENCE TO ACTION: Use of the scales in future research could generate evidence to guide EBP implementation strategies in practice and education. Results could establish the extent to which EBP is being implemented and its effect on clinician satisfaction and patient outcomes.

Back to the future: personal digital assistants in nursing education.

This article provides an overview of the current state of the art for incorporating personal digital assistants (PDAs) into nursing education. The development of PDA technology and the lessons learned by educators integrating PDA technology into nursing curricula are described. The current cycle of PDA evolution is discussed and contrasted with a proposed model for maximizing the impact of PDAs on technological innovation in nursing education and practice.

Association of adolescent physical and emotional health with perceived severity of parental substance abuse.

PURPOSE: This study aims to examine the association between adolescent health, including physical complaints, mood, and social adjustment, and perceived severity of parental substance abuse. DESIGN AND METHODS: Baseline data from a study of school-based support groups for adolescents with substance-abusing family members (n = 121) were used to examine the relationship between the severity of substance abuse and adolescent health. RESULTS: Participants were divided into three groups on the basis of severity of parental substance abuse. The high-severity group had significantly more medical conditions, physical symptoms, and negative moods than those in the low- or moderate-severity groups (p < .02). PRACTICE IMPLICATIONS: Nurses can use the Children of Alcoholics Screening Tool to assess severity of parental substance abuse and its impact on adolescents' physical and emotional health.

A comparison of bioabsorbable and metallic suture anchors in a dynamically loaded, intra-articular caprine model.

Little is known about the in vivo behavior of bioabsorbable suture anchors. A goat model was used to biomechanically and histologically test bioabsorbable and metallic suture anchors in an intra-articular environment at 0, 6, and 12 weeks. Significantly greater force was required to break the bioabsorbable construct than the metallic construct at 0 and 6 weeks. Failure of the metallic anchor constructs occurred at the eyelet. Histological analysis of both bone-anchor interfaces demonstrated equally good osteointegration without evidence of osteolysis. The bioabsorbable suture anchor tested is safe for use in clinical practice without concerns for the strength of the construct or bony reaction to the material.

School-based support groups for adolescents with a substance-abusing parent.

BACKGROUND Adolescents with substance-abusing parents need interventions to reduce their risk for a variety of problems. School-based support groups (SBSGs) have been proposed to increase resilience in this population. OBJECTIVE The purpose of this study was to evaluate a SBSG for adolescents with substance-abusing parents. STUDY DESIGN The randomized, controlled study was conducted with high-school students (n = 109) to evaluate the impact of SBSGs on resiliency. Resiliency was operationalized as positive physical health, mental health, and risk behaviors in the presence of adverse life events. Data were collected pre- and postintervention. RESULTS Significant improvements in knowledge of substance abuse were noted. Findings suggested gender differences in coping and health outcomes and positive trends in substance use. CONCLUSIONS SBSGs may increase resilience in this at-risk population. However, there were gender differences in response to the intervention, and group facilitators should be aware that participants' gender may influence response to the groups. J Am Psychiatr Nurses Assoc, 2008; 14(4), 297-309. DOI: 10.1177/1078390308321223.

Effectiveness of a screening tool to detect injuries during Army Health Care Specialist training.

The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.

Differences in Mexican American and Non-Hispanic White veterans' homocysteine levels.

PURPOSE: To compare homocysteine (Hcy) levels and possible modulatory factors, such as nutrient or supplement intake, between Mexican American and Non-Hispanic White (NHW) male military veterans scoring at high- versus low-risk for stroke. DESIGN: A cross-sectional survey with a high and low stroke risk biomarkers substudy. METHODS: Voluntary participants were Mexican American (n=109) and NHW (n=120) veteran outpatients 54 to 85 years of age at a Southwestern Veterans Administration (VA) medical center. Measures included food frequency, health history, and stroke risk scale derived from the Framingham Study. Biomarker subgroups, 30 Mexican American and 30 NHW, half of each group scoring high or low on stroke risk, who were tested for morning fasting blood levels of Hcy, B12, and folate. FINDINGS: In the cross-sectional study (n=229), nutrient intake was comparable between ethnic groups. In the substudy, Mexican Americans (n=30) with high or low stroke risk scores and NHW (n=30) with high stroke risk scores had elevated Hcy levels (12.5; 11.9; 11.4 micromol/L respectively) compared to NHW veterans with low stroke risk scores (7.8 micromol/L) even after controlling for age, education, folate, diabetes, and smoking pack-years (p=.001). Mexican Americans compared to NHW were significantly more likely to be in the preclinical (17% versus 3% >10 micromol/L) and clinical ranges (69% versus 35% >15 micromol/L) for Hcy. CONCLUSIONS: Mexican Americans showed higher levels of Hcy whether they scored high or low for stroke, and greater representation in clinical and preclinical Hcy ranges compared to NHW veterans. The Framingham-derived, predominantly NHW population-based stroke risk measure might require ethnically relevant stroke risk factors for Mexican Americans.

Who are health influencers? Characterizing a sample of tobacco cessation interveners.

OBJECTIVES: To describe characteristics of health influencers (HIs) prior to training in brief tobacco cessation interventions (BI). METHODS: HIs (n=910) in Arizona were recruited for a randomized controlled trial comparing training modalities. RESULTS: Typically middle-aged (M=43, SD=14), non-Hispanic white (68%), female (77%), non-tobacco users (93%), most identified personal (89%) rather than job-related (3%) motivators for becoming cessation interveners. Confidence about intervention ability was high (93%); knowledge scores, however, were low (M=55%, SD=13%). CONCLUSIONS: HIs exhibiting high motivation to intervene but lacking knowledge about BI strategies may be an untapped resource for tobacco cessation and a variety of other health promotion interventions.

Heat fatalities in Pima County, Arizona.

The most common cause of heat fatalities is environmental exposure during heat waves. Deserts of the southwestern USA are known for temperatures that exceed 32 degrees C for 30 days or more; yet, heat-related fatalities are rare among residents of the region. We compiled data from the National Weather Service and the Office of the Medical Examiner in order to determine the relationship between temperature and occurrence of heat fatalities in Pima County, AZ. Logistic regression indicated that for each degree of increase in temperature (degrees C), there was a 35% increase in the odds of a heat fatality occurring (p<0.001).