Enhancing Nurse Roles in Community Health (ENRICH): The Impact of a Primary Care-Based Undergraduate Nursing Fellowship.

BACKGROUND: Low numbers of new graduate nurses entering careers in primary care settings are insufficient to meet the demand of the current nursing shortage. The Enhancing Nurse Roles in Community Health (ENRICH) Fellowship is aimed at increasing undergraduate nursing students' exposure to population health concepts by providing opportunities to practice in primary care settings. PURPOSE: The purpose of this study was to implement and evaluate an undergraduate nursing fellowship program to enhance competency development in the primary care setting. METHODS: Fellows received targeted exposure to population health content and immersive primary care experiences through participation in 150 dedicated clinical hours in primary clinics, coupled with up to 250 hours of dedicated curriculum. RESULTS: Students who participated in the ENRICH Fellowship showed increased knowledge, improved perception of skills performance, and changed attitudes about population health and primary care nursing. CONCLUSION: Participation in a population health-based fellowship that includes targeted curricular content and primary care-based clinical experiences during an undergraduate nursing program improves knowledge, attitudes, and competency-based skills related to primary care and population health.

"Ditch the white coats": What LGBTQ+ patients prefer in their primary care provider.

BACKGROUND: Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population. PURPOSE: The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals. METHODOLOGY: In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results. RESULTS: Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: "Ditch the white coats"; "Meet me where I am"; "The relationship is key"; and "Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs." CONCLUSIONS: The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population. IMPLICATIONS: These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.

Incorporating climate change into Doctor of Nursing Practice curricula.

Climate change is a global crisis with major impacts on planetary health and quality of life. Nurses are well positioned to recognize the major health consequences of climate change on health. Therefore, highlighting nurses' active engagement in mitigating climate change impact and resilience efforts is essential. However, there is little evidence of climate change content in nursing curricula. Climate change/planetary health content could be integrated into existing Doctor of Nursing Practice programs so that graduates, as influential leaders, are equipped to meet the challenges ahead. The domains, competencies and sub-competencies outlined in the Essentials: Core competencies for professional nursing education (American Association of Colleges of Nursing (AACN), 2021) are proposed as a curricular scaffold to integrate climate change content in DNP curricula. Climate change content matched to the AACN domains and competencies could be included in many existing DNP courses. Climate change would become a consistent concept throughout all DNP curricular programs rather than a specified course addressing climate change. The curricular structure presented would provide a foundation for enhancing DNP students' knowledge, attitudes and skills related to climate change. These students and future graduates would be well prepared to introduce changes in practices and policies at the local, national, and global levels.

Effects of Postpartum Fatigue and Depressive Cognitions on Life Satisfaction and Quality of Life in Arab Postpartum Women: The Intervening Role of Resourcefulness.

The purpose of this study is to explore the relationships among postpartum fatigue (PPF), depressive cognitions, resourcefulness, quality of life, and life satisfaction in Arab postpartum mothers. A conceptual framework is used in this study based on the middle range theory of resourcefulness, which Zauszniewski developed in 2006. The study is a cross-sectional descriptive design with 123 postpartum women who had given birth within the past six months. used WhatsApp and Facebook for recruitment. developed the self-administered online survey in Qualtrics and collected data from 6 January 2017, to 6 February 2017. Correlation analysis is used to address the research aim and used the P value of 0.05 to determine the significance of the results. There were significant correlations among depressive cognitions and resourcefulness, life satisfaction, and quality of life; there were also significant correlations between PPF and life satisfaction, as well as among resourcefulness, quality of life, and life satisfaction. The results of this study emphasized the importance of assessing depressive symptoms and PPF in mothers early in the postpartum period. The results may contribute to designing future intervention studies aimed toward decreasing the risk of mothers with PPF developing more serious depressive symptoms.

The Role of Skin-to-Skin Contact and Breastfeeding on Atonic Postpartum Hemorrhage.

Objectives: were to (a) determine incidence of postpartum hemorrhage (PPH) in all women delivering between 2009 and 2015, and (b) determine the amount of Estimated Blood Loss (EBL) and duration of the third stage of labor in each subgroup for women with or without PPH, and (c) compare EBL and duration of 3rd stage of labor between subgroups in groups of women with or without PPH. Design: A retrospective chart review conducted using codes for atonic PPH. Setting: Records from a University based tertiary setting, 264 charts were reviewed and data from 154 charts were analyzed. One-way ANOVAs followed with post-hocs and a 2-way ANOVA were conducted. Results: PPH rate increased by 47.50% from 2009-2015. For women with PPH, EBL was lower in skin to skin contact (SSC) + Breastfeeding (BF) subgroup. For women without PPH, EBL was lower in SSC only subgroup. Third stage of labor duration was longer in women with PPH. Conclusions: Study confirmed the increasing trends of PPH due to uterine atony and proposed role of SSC and BF in decreasing EBL and shorten the duration of the 3rd stage of labor for PPH women, usefulness of SSC and BF as physiologic practices merit further study.

Nursing Student Perceptions of Faculty Advising.

AIM: The aim of the study was to determine student perceptions of faculty advising and the most effective method of faculty advising. BACKGROUND: The nursing faculty advisor is important in facilitating the timely completion of the program. Faculty members have initiated synchronous electronic methods of advising to facilitate advising. METHOD: A descriptive study was conducted with a convenience sample of members of a student nurses' association. The Faculty Advisor Evaluation Questionnaire was used for data collection via online survey. RESULTS: With 106 respondents, results demonstrated high levels of student-perceived effectiveness of the advising session, advocacy/accountability, faculty advisor knowledge, and availability. The majority of nursing students reported that face-to-face advising (58.5 percent, n = 62) was the most helpful method. CONCLUSION: This study is one of the first to examine nursing students' perceptions of faculty advising. As nursing faculty implement online methods of advising, it is important to evaluate the evidence.

Staff Nurses' Perceptions of Their Nurse Managers' Transformational Leadership Behaviors and Their Own Structural Empowerment.

OBJECTIVE: The aim of this study was to investigate staff nurses' perception of their nurse managers' transformational leadership behaviors and their own structural empowerment. BACKGROUND: Transformational leadership behaviors in nurse managers have been linked to increased staff nurse satisfaction and decreased turnover and burnout. Perception of nurse managers' leadership behaviors by staff nurses and the relationship to the staff nurses' structural empowerment is important to advance our understanding of the leadership role of nurse managers. METHODS: A descriptive correlational design was used to examine the relationship between staff nurses' perception of their nurse managers' transformational leadership behaviors and their own structural empowerment. Staff nurses at a conference were offered an opportunity to participate in the study. RESULTS: The transformational leadership behaviors of nurse managers were moderately correlated to staff nurses' structural empowerment. Transactional leadership behaviors were associated with staff nurses' structural empowerment to a lesser degree. CONCLUSION: Nurses who perceived their nurse managers as demonstrating transformational leadership behaviors experienced higher structural empowerment.

Transformational Leadership Practices and Work Engagement Among Nurse Leaders.

OBJECTIVE: The aim of this study was to develop better understanding of the leadership characteristics of clinical nurse leaders. BACKGROUND: Transformational leaders are the essential to support nursing in taking control of patient and family care coordination. One prior study of leadership and work engagement among clinical nurse leaders was identified. METHODS: This descriptive correlational study explored the relationship between transformational leadership practices and work engagement among nurse leaders in the United States. Sample consisted of clinical nursing leaders attending the 2016 Magnet® Conference. RESULTS: A significant positive relationship was identified between leadership practices and work engagement. Differences were noted in areas of select leadership practices and work engagement among nurse leaders based on different levels of education. Nurse leaders underperform in inspiring a shared vision, support for innovation, and taking risks, while also showing relatively weak levels of engagement in areas of vigor and absorption. CONCLUSION: There is a need for additional research to better understand the characteristics of clinical nurse leaders to promote the principles of transformational leadership.

Emotional Intelligence and Transformational Leadership in Nurse Managers.

OBJECTIVE: This study describes the relationship between emotional intelligence (EI) and transformational leadership (TL) in nurse managers (NMs). BACKGROUND: Effective NM leadership is important as they have direct influence over RN performance and patient outcomes. Research has demonstrated that a TL style generates greater commitment from followers than other leadership styles. EI is 1 potential characteristic of TL. METHODS: A descriptive exploratory research study was conducted to correlate EI and TL practices of NMs. RESULTS: EI was significantly positively correlated with TL and outcome measures of extra-effort, effectiveness, and satisfaction and significantly negatively correlated with laissez-faire leadership. A positive relationship was found between TL and NMs with advanced education and administrative certification. CONCLUSION: Nursing administrators should consider EI characteristics when hiring NMs and lead efforts to advance education to align with organization needs for business and strategic essentials necessary for NM effectiveness.

Resilience and professional quality of life among military healthcare providers.

The retention of qualified military healthcare providers is a top priority for Department of Defense (DoD) leaders. The purpose of this study is to examine the relationship between resilience and professional quality of life and to explore differences among providers who had been deployed and those who had never been deployed. Results indicated high resilience scores among all providers, and significant relationships between dimensions of professional quality of life and resilience. There were significant differences in professional quality of life based on deployment. Recommendations for future research are included, particularly as retention is an important issue for the DoD.

Job satisfaction and turnover intention among Jordanian nurses in psychiatric units.

Psychiatric nursing has been identified as a stressful occupation, and this stress could affect individuals' health, well-being, and job satisfaction. The stress of nurses might also affect the organization in terms of absenteeism and quality of care. The purpose of this study was to examine the relationship between job satisfaction and turnover intention among Jordanian nurses in the psychiatric units of the Jordanian National Mental Health Center. A descriptive, correlational, cross-sectional design was used. Nurses were asked to complete a demographic data sheet and questionnaires regarding job satisfaction and turnover intention. Of the 179 questionnaires distributed, 154 were completed, with an 86% response rate. The results revealed a statistically-significant negative relationship between job satisfaction and turnover intention. The findings of the study are consistent with previous research regarding the negative relationship between job satisfaction and turnover intention. The findings provide new information about Jordanian nurses who work in government hospital psychiatric services.

Perceptions of empowerment among ED nurses.

BACKGROUND: Nurses' perceptions of empowerment have been linked to a number of variables in the hospital workplace, including job satisfaction, autonomy, and work effectiveness. Yet there have been no previous studies of perceptions of empowerment specifically among emergency department (ED) nurses. METHODS: Registered nurses (RNs) employed in the EDs of 6 hospitals in a major health care system in the eastern United States were surveyed regarding their perceptions of empowerment. Of the 240 RNs eligible to participate, there were 167 usable surveys. RESULTS: There was a moderate level of empowerment among the RNs who participated, consistent with the level of empowerment reported in several other studies of staff nurses and nurses in other positions. DISCUSSION: The moderate level of empowerment in this sample may be attributed to the many opportunities for RN involvement in the hospitals within this health care system. Nurse leaders can initiate programs focused on enhancing RN perceptions of empowerment. In addition, there is a need for further research among RNs with different specialty preparation.

Cardiovascular genomics: implications for acute and critical care nurses.

As genomic health care becomes commonplace, nurses will be asked to provide genomic care in all health care settings including acute care and critical care. Three common cardiac conditions are reviewed, Marfan syndrome, bicuspid aortic valve, and hypertrophic cardiomyopathy, to provide acute care and critical care nurses with an overview of these pathologies through the lens of genomics and relevant case studies. This information will help critical care nursing leaders become familiar with genetics related to common cardiac conditions and prepare acute care and critical care nurses for a new phase in patient diagnostics, with greater emphasis on early diagnosis and recognition of conditions before sudden cardiac death.

Structural empowerment and anticipated turnover among behavioural health nurses.

AIM: The aim of this pilot study was to examine the relationship between structural empowerment and anticipated turnover among behavioural health nurses. BACKGROUND: There have been several studies relating structural empowerment to a range of organizational characteristics and personal attributes of nurses themselves. There are also previous studies linking the key variables in the present study, but no previous research of behavioural health nurses was available. METHODS: A quantitative design was used for this cross-sectional pilot study. All registered nurses (RN) working on inpatient units in the study facility were invited to participate (n = 97). An anonymous survey was sent to all potential participants. RESULTS: The response rate was 53% (n = 50). The majority of participants perceived themselves as moderately empowered. There was a significant negative correlation between empowerment and anticipated turnover. CONCLUSION: The results of this pilot study among behavioural health nurses are similar to the results among nurses working in other clinical areas. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should be cognizant of the factors that enhance nurses' perceptions of empowerment, particularly related to issues of retention and anticipated turnover among behavioural health nurses.

The level of importance and level of confidence that midwives in the United States attach to using genetics in practice.

INTRODUCTION: The clinical application of genetic advances has the potential to transform preconception and pregnancy care and improve pregnancy outcomes. The study aim was to evaluate the level of importance and level of confidence that midwives in the United States attach to using genetics in practice. METHODS: The study was a descriptive, cross-sectional, online survey with a convenience sample of certified nurse-midwives who were active members of the American College of Nurse-Midwives (ACNM) and provided midwifery care in the United States. The survey contained genetic case studies and questions related to genetic activities that occur in clinical practice. Participants were asked to rate how important each genetic activity is to midwifery practice generally and their personal level of confidence in carrying out the stated activity at the present time; questions were rated on a Likert-type scale of 1 (not at all important, not at all confident) to 4 (essential, confident to teach). RESULTS: There were 612 survey responses from among the 4244 active members of ACNM (14.42%). Most midwives believed that genetics-related activities were very important or essential to their clinical practices, but they were only moderately confident in their abilities to perform these activities. The average importance survey score was 88%, and the average confidence survey score was 70%. Some midwives (17.5%) thought that taking a 3-generation family history was essential, and some midwives (20.9%) were extremely confident in their abilities to perform this activity. Almost all midwives (98.5%) indicated that they wanted to learn more about genetics and genomics. DISCUSSION: Genetics education programs need to be developed and made available to midwives to increase their confidence levels in using genetics in clinical practice.

Perceptions of structural empowerment: differences between nationally certified perinatal nurses and perinatal nurses who are not nationally certified.

BACKGROUND: Although there has been previous research linking perceptions of empowerment to specialty certification among critical care nurses, no research in this area has been conducted among nationally certified perinatal nurses. METHODS: A comparative quantitative survey design was used. Participants included 80 perinatal registered nurses from one community hospital in New York. RESULTS: Registered nurses who were nationally certified in a perinatal specialty had higher total empowerment scores and higher scores on five of the six subscales. CONCLUSION: This study supports the results of previous studies focused on differences in empowerment among nationally certified nurses and nurses without national certification. Because much of the preparation for certification is done within continuing education, nurse leaders must be cognizant of the value of certification and must develop and implement programs to support certification in the workplace.

Integrating genomics into undergraduate nursing education.

PURPOSE: To prepare the next generation of nurses, faculty are now faced with the challenge of incorporating genomics into curricula. Here we discuss how to meet this challenge. ORGANIZING CONSTRUCT: Steps to initiate curricular changes to include genomics are presented along with a discussion on creating a genomic curriculum thread versus a standalone course. Ideas for use of print material and technology on genomic topics are also presented. Information is based on review of the literature and curriculum change efforts by the authors. CONCLUSIONS: In recognition of advances in genomics, the nursing profession is increasing an emphasis on the integration of genomics into professional practice and educational standards. Incorporating genomics into nurses' practices begins with changes in our undergraduate curricula. Information given in didactic courses should be reinforced in clinical practica, and Internet-based tools such as WebQuest, Second Life, and wikis offer attractive, up-to-date platforms to deliver this now crucial content. CLINICAL RELEVANCE: To provide information that may assist faculty to prepare the next generation of nurses to practice using genomics.

Structural empowerment and anticipated turnover among critical care nurses.

AIM: This study examines the relationship between perceptions of structural empowerment and anticipated turnover among critical care nurses. BACKGROUND: The literature revealed that work environments that provide access to information, resources, support and opportunity create an environment of more satisfied employees, ultimately reducing turnover. METHOD: A sample of 257 nurses completed a background data questionnaire, the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) and the Anticipated Turnover Scale (ATS). RESULTS: Nurses in five critical care units perceive themselves to be moderately empowered. Structural empowerment was inversely related to anticipated turnover; those who were more empowered had a lower anticipated turnover score. CONCLUSION: Nurses who perceive themselves as empowered have higher levels of organizational commitment. Organizations that support and recognize these characteristics may experience improved retention rates. IMPLICATIONS FOR NURSING MANAGEMENT: This study is the first to demonstrate a relationship between structural empowerment and anticipated turnover among critical care nurses. Research has demonstrated that workplace behaviours and attitudes are determined by social structures within the workplace. Nurses are responsible for a large portion of health care provided in this country. A serious nursing shortage is expected in the future and will exert pressure on both the supply and the demand of nurses.

Collaboration and autonomy: perceptions among nurse practitioners.

PURPOSE: This descriptive study was designed to investigate the relationship between nurse practitioners' (NPs) perceptions of collaboration with physician colleagues and level of autonomy NP practice. DATA SOURCES: A convenience sample of 99 NPs attending a national clinical conference completed the Dempster Practice Behavior Scale (DPBS) and the Collaborative Practice Scale modified for advanced practice nurses. CONCLUSIONS: NPs rated both their perceptions of collaboration with physician colleagues and levels of autonomy as high. Yet, there was no significant correlation between these variables. IMPLICATIONS FOR PRACTICE: Collaboration between NPs and physician colleagues is said to improve the quality and cost of health outcomes and also leads to professional satisfaction. Further research into the relationships between collaboration and autonomy are necessary to understand these complex concepts.

Self-transcendence and spiritual well-being in the Amish.

Self-transcendence, the ability to expand one's relationship to others and the environment, has been found to provide hope which helps a person adapt and cope with illness. Spiritual well-being, the perception of health and wholeness, can boost self-confidence and self esteem. The purpose of this descriptive correlational study was to describe the relationship between self-transcendence and spiritual well-being in adult Amish. A random sample of Old Order Amish was surveyed by postal mail; there were 134 respondents. Two valid and reliable questionnaires were used to measure the key variables. The participants had high levels of self-transcendence and spiritual well-being and there was a statistically significant positive relationship between the two variables. The findings from this study will increase nurses' awareness of the holistic nature of the Amish beliefs and assist nurses in serving this population. Additional research is needed to develop further understanding of the study variables among the Amish.