Competence and Confidence With Quality and Safety Education for Nurses Competencies by Newly Licensed Registered Nurses.

Understanding newly licensed registered nurses' perceived confidence in the Quality and Safety Education for Nurses (QSEN) competency domains and corresponding knowledge, skills, and attitudes will help inform clinical leaders to develop successful transition-to-practice programs. Newly licensed registered nurses and prelicensure nursing students had confidence in their understanding of QSEN competencies as they began their transition to practice. Online learning and virtual practicums were effective for attaining QSEN competencies, offering support for using these interventions in academic settings and transition-to-practice programs.

Perceived Stressors and Support in Family Caregivers of Individuals With Opioid Use Disorder.

ABSTRACT: Stress experienced by family caregivers of individuals with opioid use disorder (OUD) contributes to caregiver burden. To understand the stressors experienced by family caregivers of individuals with OUD and the factors that influence their personal resiliency, data were collected from a convenience sample of family caregivers who answered two open-ended questions about sources of stress and factors that affect their personal resilience as part of an online survey. Yin's thematic analysis revealed five objective and two subjective burden themes and four resilience themes. Results indicate OUD places significant burden on families and may contribute to decreased physical and mental well-being in caregivers. Caregivers who perceived adequate support were able to use their experience and innate knowledge to cope and emerge with more resilience. Results of this study support the need for translational research to increase resilience and coping in this population of caregivers.

Nurse Disrespect and Abuse Toward Laboring and Child-Birthing Women.

BACKGROUND: Disrespect and abuse of laboring and child-birthing women in healthcare is a global problem that violates a woman's right to respectful care. The abuse can be life-threatening and jeopardizes their rights to health, bodily integrity, and freedom from discrimination. This study aimed to understand the factors influencing nurse and midwife disrespect and abuse of child-birthing women in healthcare settings. METHODS: An exploratory, nonexperimental, cross-sectional design was used to identify correlates and predictors of disrespect and abuse of child-birthing women by nurses/midwives. Pearson product-moment correlation and hierarchical multiple regression analyses were used to explore the relationships between nurse intrapersonal, interpersonal (Nursing Incivility Scale), organizational/structural factors (Professional Practice Work Environment Inventory), and disrespect and abuse (Disrespect and Abuse Scale) toward women during labor and childbirth.An online electronic survey was used to collect data from an international nursing and midwifery population from May 2021 to September 2021. Data were collected from 231 nurses and midwives. RESULTS: The standardized regression coefficients showed that gender, number of hours worked per week, and organizational/structural factors were all predictors of disrespect and abuse. Organizational/structural factors were the strongest predictor of disrespect and abuse, accounting for 20% of the variance in the regression model. DISCUSSION: These findings support the patient abuse in healthcare model, where researchers hypothesized that nurse/midwife intrapersonal, interpersonal, and organizational/structural factors contribute to patient abuse in healthcare settings. Work environment, gender, and number of hours worked per week were significant predictors of disrespect and abuse. The results of this study support future research that addresses unhealthy work environments and develops policies to transform the values and norms of labor and delivery.

e-Delphi Study: Expert Consensus on the Needs and Resources Available to Family Caregivers of Individuals with Substance Use Disorder.

Family caregivers of individuals with substance use disorder (SUD) experience a significant burden and have few evidence-based resources available.To obtain a consensus of expert views on the needs, and resources available, to family caregivers of individuals with SUD given the COVID-19 pandemic and other sociopolitical factors.Quantitative design using the Classic e-Delphi method of multiple iterations of questioning to reach a consensus among expert panelists. Purposive sampling was used to recruit a multidisciplinary, nationwide panel of SUD experts from professional contacts, professional organization list servers, websites relevant to support groups for family caregivers, flyers, and word of mouth. In round 1 panelists (n = 96) responded to open-ended questions about the support provided to family caregivers, and the additional needs of family caregivers. In subsequent rounds, the panel rated collated responses in terms of agreement (n = 54) and importance (n = 48).Thematic content analysis identified ten needs in the resources available to family caregivers. Consensus was obtained across thematic categories and the remaining items were ranked according to importance.Participatory-based SUD research that includes the expertise of healthcare providers, support leaders, and family caregivers is necessary to develop evidence-based interventions to increase caregiver resilience and facilitate coping. Several clear conclusions that address social and structural determinants of health emerged, including the need for increased access to healthcare and community services, more self-care strategies for families, and focused public advocacy to reduce SUD-related stigma.

Perceived stigma, barriers, and facilitators experienced by members of the opioid use disorder community when seeking healthcare.

INTRODUCTION: Healthcare professionals, particularly nurses, have negative attitudes towards individuals with opioid use disorder (OUD) and these attitudes can contribute to suboptimal care. The aim of this study was to identify stigma, barriers and facilitators experienced by members of the OUD community when interacting with the healthcare system. DESIGN: A qualitative exploratory design used semi-structured focus group interviews to address the study aim. METHODS: Following IRB approval, purposive sampling was used to recruit participants with a history of OUD, family caregivers of individuals with OUD, and support group leaders from regional recovery groups to provide a broad perspective of stigmatizing issues and barriers to care. Focus group discussions were conducted, and video recorded using web-based conferencing software. Transcripts from the focus groups and field notes were analyzed and coded into themes. RESULTS: Both structural and social determinants of health were identified by participants as stigmatizing and/or barriers to care. Thematic content analysis resulted in eight themes: stigmatizing language, being labeled, inequitable care, OUD as a chronic illness, insurance barriers, stigma associated with medications for OUD (MOUD), community resources, and nursing knowledge and care. CONCLUSION: Members of the OUD community are challenged by both internal and external stigma when seeking healthcare. Stigma negatively affects public support for allocation of resources to treat OUD. Interventions aimed at reducing stigma are critical to support effective OUD treatment and prevent barriers to OUD care. CLINICAL RELEVANCE: Understanding the complex relationships between stigma and structural determinants of health will allow nursing science to develop educational interventions that provide the next generation of nurses with the knowledge, skills, and attitudes needed to advance health equity for individuals with OUD.

Model of Family Caregiver Resilience and Burden in Opioid Use Disorder: A Theoretical Framework.

This theory synthesis provides a theoretical model for nursing researchers to examine factors that influence resilience and burden in family caregivers of individuals with opioid use disorder. Two frameworks, the Resiliency Model and the Conceptual Framework for Family Involvement with Adults with Co-occurring Substance and Mental Disorders, were synthesized and modified by incorporating concepts and conceptual relationships from recent research studies and experiential knowledge from clinical practice to develop a new model. The model predicts the impact of caregiver characteristics, caregiver support, stressors, and caregiver-care recipient dyad characteristics on caregiver well-being.

Predictors of Burden and Resilience in Family Caregivers of Individuals With Opioid Use Disorder.

BACKGROUND: Family caregivers are an essential resource for individuals with opioid use disorder (OUD). Overburdened caregivers often experience detrimental effects to their emotional and physical well-being. METHOD: A cross-sectional, nonexperimental, correlational study was used to identify correlates and predictors of burden and resilience in caregivers of care recipients with OUD. Pearson product-moment correlation and multiple regression analysis were used to explore the relationships between caregiver characteristics, care recipient characteristics, the caregiver-care-recipient dyad characteristics, and burden and resilience among caregivers of individuals with OUD and to determine the best predictive model. Participants ( N = 152) completed the study using an online electronic survey. RESULTS: The standardized regression coefficients indicated that supervision of care recipient behavioral problems (ß = .29), dyadic interaction (ß = .29), caregiver stress (ß = .28), and care recipient opioid use (ß = .12) were the strongest predictors of caregiver burden, whereas caregiver mental health (ß = -.31) and physical health (ß = .30) were the strongest predictors of caregiver resilience. CONCLUSIONS: Caregiver and care recipient characteristics, and their dyadic interaction, directly influence the degree of burden and resilience reported by family caregivers. Caregivers experiencing increased stress who are tasked with supervising problematic care recipient behaviors are more likely to experience higher levels of burden. In contrast, caregivers with good physical and mental health and adequate resources showed higher levels of resilience.

Patient Abuse in Healthcare: A Theoretical Synthesis.

Patient abuse in healthcare is an emerging phenomenon in need of explanation and further analysis. Preventing abusive incidents in healthcare requires identifying structural imbalances that make mistreatment of vulnerable individuals possible. A theory synthesis of the vicious violence triangle and the socioecological model provides a framework to investigate factors that influence nurses' abusive behavior toward patients in hospitals. Concepts include direct violence, structural violence, cultural violence, and intrapersonal, interpersonal, and organizational factors. The patient abuse in healthcare theory supports empowerment and transformation of nursing and nursing science and offers a blueprint for research that promotes health equity.

Examination of Factors Affecting Therapeutic Attitude and Empowerment of Perianesthesia Nurses Who Care for Patients With Opioid Use Disorder.

PURPOSE: Patients with opioid use disorder (OUD) and associated complexities are presenting to hospitals in increasing numbers. Preparation of perianesthesia nurses caring for this patient population has lagged, with noted deficits in continuing education, resources, and role support. Previous research found education without considering therapeutic attitude (TA), empowerment and factors that influence nursing practice does not translate into feelings of competence in nursing care. The purpose of this study was to identify correlates and predictors that affect TA and empowerment among perianesthesia nurses caring for patients with OUD. DESIGN: A cross-sectional, correlation design was used to identify correlates and predictors of TA and empowerment in a national sample of perianesthesia nurses (N = 215) METHODS: A national survey collected data from perianesthesia nurses. The Perianesthesia Nurse Empowerment and Therapeutic Attitude Model was the guiding framework. Pearson product-moment correlation and hierarchical multiple regression analyses were used to examine relationships between personal factors, the professional practice environment and societal factors of perianesthesia nurses. FINDINGS: The standardized regression coefficients indicated the professional practice environment (ß = -0.28), drug user stigma (ß = 0.27), access to a pain specialist (ß = 0.25), and exposure to drug users (ß = 0.25) were the strongest predictors of TA. Access to a pain specialist (ß = -0.15) and the professional practice environment (ß = 0.72) were the strongest predictors of empowerment. CONCLUSIONS: The professional practice environment directly influenced the degree of empowerment and TA reported by perianesthesia nurses. Exposure to persons with OUD and personal stigmatization of persons who misuse drugs decreased TA but had no association with empowerment. Access to a pain specialist was moderately predictive of empowerment and negatively associated with TA suggesting a lack of role legitimacy and the need for further research into perianesthesia nurses' perceptions of their role when caring for this population.

Internet Recruitment of a Diverse Population of Lesbian, Gay, and Bisexual Nurses in a Study of Substance Use and Minority Stress.

INTRODUCTION: There is a lack of lesbian, bisexual and gay (LGB)-focused nursing research, in part, because the population is traditionally difficult to access. This article explores the effectiveness, benefits, and limitations of online recruitment of a distinct population of LGB-identified nurses in a study of substance use and minority stress. METHODOLOGY: A sample of nurses who self-identified as LGB were recruited for an online survey using organic Facebook outreach. A $5 Amazon gift card was offered as an incentive. Facebook insights data and demographic data were analyzed. RESULTS: Within 96 hours, 394 participants had completed the 101-question online survey. The majority (n = 269, 68.6%) reported accessing the survey through Facebook. Email (n = 79, 20.2%) and word of mouth (n = 44, 11.2%) also contributed to recruitment. DISCUSSION: The effectiveness of this Facebook recruitment protocol speaks to the importance of social media, survey incentives, and the "power of visibility" in recruitment of this population.

A theoretical framework to promote minority PhD and DNP student success in nursing education.

BACKGROUND: Nursing PhD and DNP programs lack diversity and cultural responsiveness and, as a result, minority students are underrepresented in these programs. Stressors specific to being a member of a minority population, defined as minority stress, contribute to a range of barriers for ethnic/racial minority, male and LGBTQ PhD and DNP students. There is an urgent need for faculty and administrators to support minority doctoral student success by taking proactive steps to identify and begin to deconstruct these barriers. Doctorally-prepared nursing faculty serve as mentors and role models for doctoral students, provide exemplars for how to use scientific humility to research health inequities, implement evidence-based practice and develop the next generation of nurse scientists. Combating educational inequities for minority doctoral students is a first step in advancing health equity beyond academia. PURPOSE: The purpose of this paper is to develop a theoretical synthesis to promote minority PhD and DNP student success in academia. THEORETICAL FRAMEWORK: The minority doctoral student success (MDSS) framework was developed using Schneider's attraction-selection-attrition framework, key concepts from the literature, and professional and personal experience to capture the minority doctoral student experience. A systems approach was used to identify multi-level influences on the minority student experience, including antecedents at each stage of the academic journey, and how minority stress and opportunity inherently affect the process. CONCLUSIONS: Diversity is essential to reimagine nursing doctoral education. This theoretical framework provides an approach to understanding the minority PhD and DNP student experience and the role of faculty and the academic organization in mediating barriers and creating opportunities to enhance diversity, equity, and inclusion.

Using Board Games to Foster Clinical Reasoning Among New Graduate Nurses.

Gamification has gained popularity among clinical nurse educators as a method to engage novice and experienced nurses in higher-level thinking. Classic board games can be cost-effectively transformed into educational games; however, it is important to use a clinical reasoning framework to ensure that learning outcomes focus on stimulating higher-level thinking. This article describes the development of a game as an innovative approach to designing new methods that better prepare new graduate nurses for current nursing practice. [J Contin Educ Nurs. 2021;52(9):413-416.].

Nursing Science, Mental Illness, and the Family: A Conceptual Framework to Break the Cycle of Suffering.

Mental illness is an epidemic in the United States, and there is a gap in care due to minimal integrated programs and transitional community resources. This paper reports the development of a conceptual framework to identify challenges facing families living with mental illness and the integral role nursing plays to positively impact health. An inductive, bottom-up approach was used to develop the Nursing Science, Mental Illness and Family model. Concepts clustered around family health, cycle of suffering, improving outcomes, healthcare policy, and nursing science. Successful, goal-directed interprofessional collaborations are essential for individual-, family-, and system-level interventions to be effective.

Substance Use and Minority Stress in a Population of Lesbian, Gay and Bisexual Nurses.

PURPOSE: The aim of this study was to explore the incidence of problematic substance use (PSU) and the relationship between level of substance use, minority stress, and general stressors in a population of lesbian, gay and bisexual (LGB) identified nurses. Methods: A national, convenience sample of 394 self-identified LGB nurses completed an online survey in March 2019. Using data from the ASSIST V3.1 measurement tool, the incidence of problematic and non-problematic tobacco, alcohol and illicit substance use was described as a percentage of respondents in each group. Hierarchical regression assessed the impact of demographic variables, sexual orientation, gender identity, race/ethnicity, and level of substance use. Multiple regression assessed the impact of general stressors, minority stress processes, including coping and social support and internalized homophobia, on level of substance use. Results: The incidence of PSU was higher in this population of LGB-identified nurses than previously described in either the general population of nurses or the general LGB population. Demographic variables and minority status had variable associations with level of tobacco, alcohol and illicit substance use. Components of Meyer's minority stress model had a stronger and more consistent association with level of tobacco, alcohol and illicit substance use than general stress. Predictors of level of substance use across groups suggest community involvement may be significant. These results have potential implications for public health and the prevention and treatment of substance use in LGB-identified nurses.

An Integrative Review of Measuring Caregiver Burden in Substance Use Disorder.

BACKGROUND: Family caregivers contribute to engagement in treatment and adherence, reduced substance misuse and relapse, and increased well-being of recipients with substance use disorder. However, providing care has also been associated with negative emotional and physical health outcomes for caregivers. The purpose of this integrative review was to determine what instruments are used to measure caregiver burden in informal caregivers of individuals with substance use disorder. METHODS: An integrative review framework was applied to examine empirical and theoretical literature to answer the guiding research question, "How is caregiver burden measured in caregivers of individuals with substance use disorder?" PubMed, CINAHL, and APA PsychINFO were searched using a combination of search terms. The initial 1,198 articles were narrowed to 32 that fit the search criteria and purpose of the review. RESULTS: A variety of scales have been used to measure caregiver burden. Caregiver burden is operationalized as objective or subjective burden. Objective burden refers to changes in the home, finances, employment, social life, and leisure, whereas subjective burden refers to the emotional reaction of the caregiver in coping with providing care. Caregiver burden was most often reported as moderate to severe in populations with substance use disorder. Attributes measured included anxiety, depression, stress, worry, displeasure, care recipient behavioral problems and substance abuse, stigma, relationship strain, financial expenses, social support, family disruption, and the effect on caregiver physical and emotional health. CONCLUSIONS: Specific instruments that can accurately evaluate objective and subjective caregiver burden are needed to measure the quality of caregiver health. More research is necessary to better understand the physical and emotional health of caregivers of persons with substance use disorder and the factors that contribute to increased quality of life. Understanding the relationship between outcomes and protective factors could help nurses to develop prevention strategies and treatment interventions aimed at decreasing the psychosocial trauma and stress associated with caregiver burden.

The Post-caregiving Health Model: A Theoretical Framework for Understanding the Health of Former Family Caregivers of Persons with Dementia.

Presently, there is a dearth of theoretical models to guide research on the population of former dementia caregivers. The purpose of this article is to describe the development of the Post-caregiving Health Model and its potential for generating a more nuanced understanding of the health of family caregivers following the death of a care recipient with dementia. The model highlights the impact of personal and environmental characteristics, appraisal, coping, and emotion on long-term health outcomes in this population and offers a viable framework for studying long-term health outcomes among caregivers following the care recipient's death.

Using Consensus Testing to Enhance Genomic Understanding and Teamwork in Doctoral Advanced Practice Nursing Students.

Nurse educators are challenged to develop effective strategies to teach genomic content, increase communication skills, and encourage teamwork among doctoral advanced practice nursing students. Consensus testing is a collaborative learning strategy where students work together in small groups using communication and teamwork to solve problems. This descriptive survey study evaluated consensus testing as a strategy to increase doctoral students' understanding of genomic content and provide practical experience with teamwork and collaboration in a blended course. Findings from 38 doctoral students indicated that understanding of genomic content increased as students gained practical experience with strategies for collaboration, effective teamwork, and leadership skills.

Predictors of psychological distress and sleep quality in former family caregivers of people with dementia.

Objectives: The stress-related psychological symptoms experienced by informal family caregivers do not always improve or resolve after the death of the care recipient. The purpose of this study was to explore the independent associations of sociodemographic variables, personality and coping, environmental variables, and caregiver guilt with the sleep quality and psychological distress of former family caregivers of individuals with dementia following care recipient's death.Method: A cross-sectional, correlational study was conducted with a sample of 171 former family caregivers of people with dementia. Participants completed an online survey comprised of six instruments and demographic items. Caregiver personal variables (e.g. personality and coping), environmental variables, guilt, psychological distress (depressive and anxiety symptoms), and sleep quality were evaluated using psychometrically validated measures.Results: In bivariate analysis, post-caregiving guilt was significantly associated with depressive and anxiety symptoms (p < 0.01). After controlling for covariates, dysfunctional coping and neuroticism explained 32% of the variance in depressive symptoms (R2 = .52, ΔR2 = .32, F(5, 165) = 36.24, p < .001) and 24% of the variance in anxiety symptoms (R2 = .41, ΔR2 = .24, F(5, 165) = 22.65, p < .001), while dysfunctional coping, pre-loss depression, and extraversion accounted for 16% of the variance in sleep quality (R2 = .30, ΔR2 = .16, F(6, 164) = 11.44, p < .001).Conclusion: This study demonstrates the critical role of personal variables, including personality traits, coping strategies, and pre-loss depression, in explaining psychological distress and sleep quality in this sample of former dementia caregivers.

Testing the Nursing Quality and Safety Self-Inventory.

The Nursing Quality and Safety Self-Inventory (NQSSI) is a valid and reliable instrument for measuring self-assessment of confidence in attaining Quality and Safety Education for Nurses competencies in student nurses. This article reports on the psychometric analysis of the NQSSI for newly licensed registered nurses. Findings support NQSSI as a valid and reliable instrument for nursing professional development practitioners to use to evaluate newly licensed registered nurses' competency attainment and the effectiveness of transition to practice programs.

The Effect of Transition to Practice Programs on the Self-Assessment of Newly Licensed Registered Nurses' Confidence in Quality and Safety Competency Attainment.

AIM: The aim of the study was to evaluate effectiveness of transition to practice programs (TPPs) on self-assessment of quality and safety competency development in newly licensed registered nurses (NLRNs). BACKGROUND: TPPs are innovative strategies to promote quality and safety competencies. Hospital-based TPPs support and facilitate transition to practice. METHOD: A pretest-posttest design was used to determine if NLRNs' self-assessment of quality and safety knowledge, skills, and attitudes changed significantly over time and by TPP type as measured by the Nursing Quality and Safety Self-Inventory. RESULTS: Sixty-four NLRNs from three TPPs participated. A statistically significant increase in confidence in knowledge and skills was found with no significant changes in confidence attitudes. No significant changes were found based on TPP type or prelicensure program. CONCLUSION: The Nursing Quality and Safety Self-Inventory was a valid and reliable instrument for measuring changes in quality and safety knowledge, skills, and attitudes in NLRNs. TPPs are effective strategies to advance confidence in quality and safety competencies.