A Review of the Psychology That Underpins the Creation of a Diversity, Equity, and Inclusion Committee.

Although all committee work can be fraught with difficulty and laborious time commitments, committees designed to disrupt the cycle of inequity and bias are particularly fraught with social and emotional land mines that come as baggage to years of unaddressed inequity. As such, leaders must take special care and attend to the complex psychology that underpins the difficult discussions that must be had by these committees as they begin to address topics of inequity within professional medical institutions. The authors describe, in an accessible summary format, how to lay the foundations for a smooth transition into the work of a diversity, equity, and inclusion committee, the best steps to build a team, and the core concepts that should underpin all diversity, equity, and inclusion work, starting from the intrapersonal level and moving toward the organizational level. This is done with the help of available scientific data where they are available, including literature on teamwork, health equity, and psychological safety, among other topics.

Influence of Evidence-Based Design Strategies on Nurse Wellness.

OBJECTIVES: The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness. BACKGROUND: Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness. METHODS: This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses' tasks and documentation, (4) ability to care for patients, and (5) nurses' overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness. RESULTS: Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness. CONCLUSIONS: It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.

Single-family room neonatal intensive care unit design: do patient outcomes actually change?

OBJECTIVE: This study examined outcomes in a single-family room neonatal intensive care unit (NICU) compared to an open bay within a public safety net hospital. STUDY DESIGN: We included 9995 NICU encounters over 5 years pre and post move for a predominantly low SES population. Outcomes were length of stay (LOS), growth, time to first oral feeding, and incidence of sepsis. Analysis included regression models, interrupted time series, and growth models. RESULTS: LOS decreased over time in preterm infants both pre and post move, but increased post move for term/post-term infants (p < 0.001). First oral feeding decreased over time in both periods. A higher incidence of sepsis was found in the post period for term/post-term infants (p = 0.01). CONCLUSION: Our analysis appropriately accounted for time trends. Few differences were observed. Changes in LOS for term/post-term infants should be further explored as well as the impact of NICU care patterns.

Nurse-Led Interventions for Hypertension: A Scoping Review With Implications for Evidence-Based Practice.

BACKGROUND: Hypertension is the leading preventable contributor to cardiovascular morbidity and mortality, affecting 1 billion people globally. Low- and middle-income countries have increasing rates of hypertension, much of it undiagnosed. AIMS: The purpose of the project is to review studies of nurse-led hypertension interventions that have been implemented in East Africa and to inform hypertension interventions in low-resource settings. METHODS: A scoping review was conducted following Arksey and O'Malley's (2005) format. An electronic search in six databases for citations was conducted by the medical librarian author. The parameters for this scoping review were nurse interventions related to hypertension in East Africa. RESULTS: Fourteen full-text articles were identified that met inclusion criteria. Nurse-led interventions for hypertension were found to increase access to care and be cost- effective. Medication Adherence Clubs were an innovative intervention that increased the retention of patients in care. LINKING EVIDENCE TO ACTION: This scoping review provides evidence from studies of nurse-led hypertension interventions in East Africa relevant to implementing or improving hypertension screening, diagnosis, and treatment. Nurses provide 80% of health care in East Africa, and nurse-led hypertension interventions are critically needed to ameliorate the significant hypertension-related increases in morbidity and mortality globally.

HIV and Nurses: A Focus Group on Task Shifting in Uganda.

The HIV prevalence rate is 7.4% in Uganda, where the HIV-related President's Emergency Plan for AIDS Relief and United Nations millennial development goals have not been met. This is partially due to a critical shortage of nurses and other health care providers. Task shifting is a World Health Organization strategy to address the shortage of human resources for health by shifting work from one cadre of health care worker to another, often less-trained, cadre. We conducted three focus groups with nurses in Uganda to better understand perceptions of their preparation for and implementation of task shifting. The focus group included nurses from diverse work settings. Data analysis revealed that nurses were proud of the work they were doing but were challenged by the lack of consistent and appropriate support. We found a need for additional policies, regulations, and consistent preparation for nurses who work in environments with task shifting.

Stigma in HIV-infected health care workers in Kenya: a mixed-method approach.

HIV-related stigma decreases access to HIV testing, prevention, and treatment services. Our mixed methods study explored stigma as perceived, experienced, and managed in a sample of 76 HIV-infected health care workers in Kisumu, Kenya. Stigma was quantitatively measured using the HIV/AIDS Stigma Instrument for People Living with AIDS (HASI-P). Overall, subjects experienced low stigma levels (mean = 7.88, SD = 12.90; range = 0-61), and none of the sociodemographic variables were predictive of stigma. Transcript analysis of 20 qualitative interviews revealed two negative themes (blame, lack of knowledge) and five positive themes (living positively, optimism, empathy, support, changes over time). Three themes emerged on reducing stigma (normalizing, empowerment, leading by example). Disclosure, access to treatment, stigma reduction training, workplace support groups, and awareness of an HIV workplace policy may have contributed to low stigma scores. Qualitative findings corroborated quantitative findings and corresponded to the six domains of the HASI-P.

Conducting international nursing research: challenges and opportunities.

AIM: To describe practical experiences before, during and after gaining entry into research fields in Kenya and Uganda. BACKGROUND: Planning, conducting and implementing international research can be an arduous task. Novice researchers need practical guides to accessing international fields and mitigating challenges met in the field. DATA SOURCES: The researchers conducted three different studies in two developing nations. REVIEW METHODS: This paper reviews challenges encountered when conducting international research. Solutions used to overcome these challenges are discussed. DISCUSSION: Establishing and maintaining effective partnerships is critical to the success of international research efforts. Researchers must be tactful, flexible and creative when handling methodological, ethical and logistical challenges encountered in settings poor in resources. CONCLUSION: International research provides opportunities for increasing dedication, building cross-cultural competence and advancing health professional practice globally. IMPLICATIONS FOR RESEARCH/PRACTICE: This paper contributes to nursing scholarship by highlighting the practical challenges of conducting international research. Illustrations aimed at lending insight and encouraging others to expand their dedication to conducting international research are offered.

Meeting tomorrow's health care needs through local and global involvement.

Strengthened efforts to achieve the United Nations Millennium Development Goals by 2015 are urgently needed. A fundamental step toward achieving these goals is strengthening global partnerships for development. This article describes critical challenges and opportunities in global health and the social responsibility of the nursing profession in this area. Examples and suggestions for nursing action are provided for consideration by those interested in influencing global health. Engaging in global health activities such as study abroad programs, interprofessional exchanges, continuing education workshops, and seminars with a global health focus can have significant implications for nursing education, research, policy, and practice. Equipping nurses with the leadership skills, knowledge, and attitudes needed to advance global health is integral in the delivery of effective, culturally relevant health care.