Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future.

OBJECTIVE: The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave. BACKGROUND: Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed. METHODS: This cross-sectional correlational study was conducted in a Magnet® hospital. RESULTS: Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic. CONCLUSIONS: Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.

Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products.

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires-one focusing on pharmacists and the other focusing on pharmacy students-were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area.

Translation and validation of the medication management patient satisfaction survey: The Lebanese Arabic version.

Background: No Arabic translation exists for the medication management patient satisfaction survey (MMPSS), a 10-item psychometrically valid patient satisfaction survey tool developed to assess patient satisfaction for comprehensive medication management. The objective of this study is to translate the medication management patient satisfaction survey into Lebanese Arabic while culturally adapting and assessing the psychometric properties of the translated survey in the outpatient setting. Methods: Guidelines for translation, adaptation, and validation of instruments for cross-cultural healthcare research were followed. The process included forward translation, expert panel review, back-translation, pretesting, and cognitive interviewing. Participants were approached after picking up their medications from the pharmacy at a primary care facility. The medication management patient satisfaction survey was administered verbally by two trained data collectors. Instrument psychometric analyses included testing both for reliability using Cronbach's alpha (α) and McDonald's omega (ω) and for construct validity using exploratory factor analysis (EFA). Pearson correlations between items were calculated. Results: During the translation process, the term "clinical pharmacist" was changed to "pharmacist today" for improved understanding. Four items were adapted through minor linguistic modifications. Data were collected from 143 patients. The mean age of participants was 72 years. Participants were mostly females (69%) and had an average of four comorbidities and eight daily medications. Findings from Cronbach's α and McDonald's ω indicated that the internal consistency among items from one to nine was very strong (α = 0.90; ω = 0.90). Exploratory factor analysis indicated that all items are strongly influenced by one factor, except for item six, "My clinical pharmacist is working as a team member with my other healthcare providers" which was the least influenced (loading = 0.44) with the highest uniqueness (0.81). The latent factor captured over 50% of the variance originally observed between variables. Items four and five "My clinical pharmacist helped me find easier ways to take my medicines" and "My clinical pharmacist helped me understand the best ways to take my medicines", had the strongest correlation (0.77), while the weakest correlation was seen between item six "My clinical pharmacist is working as a team member with my other healthcare providers" and other items. Conclusion: The Lebanese Arabic version of the medication management patient satisfaction survey was produced as a brief tool to serve as a valid and reliable instrument for measuring patient satisfaction with comprehensive medication management services.

Mechanistic Research for the Student or Educator (Part I of II).

Many discoveries in the biological sciences have emerged from observational studies, but student researchers also need to learn how to design experiments that distinguish correlation from causation. For example, identifying the physiological mechanism of action of drugs with therapeutic potential requires the establishment of causal links. Only by specifically interfering with the purported mechanisms of action of a drug can the researcher determine how the drug causes its physiological effects. Typically, pharmacological or genetic approaches are employed to modify the expression and/or activity of the biological drug target or downstream pathways, to test if the salutary properties of the drug are thereby abolished. However, experimental techniques have caveats that tend to be underappreciated, particularly for newer methods. Furthermore, statistical effects are no guarantor of their biological importance or translatability across models and species. In this two-part series, the caveats and strengths of mechanistic preclinical research are briefly described, using the intuitive example of pharmaceutical drug testing in experimental models of human diseases. Part I focuses on technical practicalities and common pitfalls of cellular and animal models designed for drug testing, and Part II describes in simple terms how to leverage a full-factorial ANOVA, to test for causality in the link between drug-induced activation (or inhibition) of a biological target and therapeutic outcomes. Upon completion of this series, students will have forehand knowledge of technical and theoretical caveats in mechanistic research, and comprehend that "a model is just a model." These insights can help the new student appreciate the strengths and limitations of scientific research.

Mechanistic Research for the Student or Educator (Part II of II).

This two-part series describes how to test hypotheses on molecular mechanisms that underlie biological phenomena, using preclinical drug testing as a simplified example. While pursuing drug testing in preclinical research, students will need to understand the limitations of descriptive as well as mechanistic studies. The former does not identify any causal links between two or more variables; it identifies the presence or absence of correlations. Parts I and II of this educational series encourage the student to 1) ensure the sensitivity and specificity of their measurements, 2) establish or optimize an appropriate disease model, 3) find pharmaceutical drug doses/concentrations that interfere with experimental disease processes, 4) leverage the literature and exploratory datasets to craft a mechanism-oriented hypothesis on drug binding and downstream effects, 5) and design a full-factorial experiment to test the hypothesis after sketching potential outcomes and imagining their interpretations. These creative goals facilitate the choice of the appropriate positive and negative controls to avoid false data interpretations. Here, Part II describes in detail how to test for a causal link between drug-induced activation of biological targets and therapeutic outcomes. Upon completion of this two-part series, the new student will have some of the tools in hand to design mechanistic studies, interpret the outcomes of their research, and avoid technical and theoretical pitfalls, which can otherwise decelerate scientific progress and squander human and financial resources.

Exploring Screening Practices for Child Sexual Abuse in School Settings: An Integrative Review.

Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.

A Pediatric-Specific View on Improved Nurse-Sensitive Indicators Related to Increased BSN or Higher Rates Over Time.

BACKGROUND: Nurses obtaining higher levels of education has been recommended nationally for more than a decade to support improved patient outcomes. LOCAL PROBLEM: Organizational strategies were implemented to achieve a highly educated workforce at the project site over 14 years. However, there was no evaluation of relationship with increasing education levels and pediatric patient outcomes. METHODS: A quality improvement project explored the relationship of Bachelor of Science in Nursing (BSN) or higher prepared nurses with 9 different nurse-sensitive indicators (NSIs). Educational preparation and NSI data were retrieved retrospectively from hospital databases from up to 14 years. RESULTS: Moderate to moderately strong correlations were noted between the proportion of BSN or higher prepared nurses and 2 NSIs (central line-associated bloodstream infections, r = -0.55 and surgical site infections, r = -0.71). Four of the 9 indicators were approaching moderate correlation. CONCLUSIONS: Increasing the proportion of highly educated nurses at the project site correlated with improvements in select NSI outcomes.

Impact of a Digital Intervention on Perceived Stress, Resiliency, Social Support, and Intention to Leave Among Newly Licensed Graduate Nurses: A Randomized Controlled Trial.

BACKGROUND: The nursing shortage has been deemed a public health crisis as the turnover rate of newly licensed graduate nurses (NLGNs) continues to grow. One of five NLGNs are leaving the profession due to work dissatisfaction and feelings of inadequacy, risking patient safety. METHOD: A prospective, randomized controlled trial evaluated the impact of a 6-week digital intervention (text messaging) on NLGNs' self-reported stress, resiliency, sense of support, and intention to leave their jobs, organization, and profession. Messages to the experimental group (n = 10) conveyed emotional, esteem, and networking support, and messages to the control group (n = 11) were medical facts. RESULTS: The digital intervention in the form of medical facts increased the control group's sense of social support. Stress, resilience, and intention to leave their jobs, organizations, or profession did not change for either the control or experimental group. CONCLUSION: A digital intervention, such as text messaging, potentially can increase NLGNs' sense of support during their first year of hire. [J Contin Educ Nurs. 2021;52(8):367-374.].

Issues and recommendations for exploratory factor analysis and principal component analysis.

This commentary provides a brief mathematical review of exploratory factor analysis, the common factor model, and principal components analysis. Details and recommendations related to the goals, measurement scales, estimation technique, factor retention, item retention, and rotation of factors. For researchers interested in attempting to identify latent factors, exploratory factor analysis, the common factor model, is the appropriate analysis. For surveys with Likert-type scales weighted least squares with robust standard errors is recommended along with oblique rotation. Alternative techniques for analyzing the data, e.g., item response theory and machine learning, are briefly discussed. Finally, a basic check list for researchers and reviewers is provided.

An integrative review of nurse practitioner practice and its relationship to the core competencies.

BACKGROUND: Competency based education (CBE) has been suggested for nurse practitioner (NP) education reform. For this to occur, competencies should reflect the knowledge, skills, and attitudes that NPs need for independent practice. PURPOSE: This integrative review examined the general practice activities of NPs across all population foci to determine the extent to which these activities are reflected in current NP competencies. METHOD: Using the Whittemore and Knafl (2005) integrative review method, 17 studies that focused on NP practice between 2008 and 2018 were retrieved from three electronic databases. These studies were evaluated, analyzed and synthesized for themes. Afterwards the themes were compared with seven sets of current NP core competencies. RESULTS: The themes for NP practice activities were direct and indirect patient care activities with a majority of NP time spent performing direct patient care activities. However, only 14% of the NP core competencies reflected these direct care activities. CONCLUSION: In order to successfully implement CBE, a need exists for the NP core competencies to reflect current NP practice.

Determining nurse practitioner core competencies using a Delphi approach.

BACKGROUND: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined. PURPOSE: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable. METHODS: A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data. RESULTS: Consensus was reached after 3 rounds and resulted in 49 final core competencies. IMPLICATIONS FOR PRACTICE: This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.

Cracking the Code for Quality: The Interrelationships of Culture, Nurse Demographics, Advocacy, and Patient Outcomes.

OBJECTIVE: The aim of this study was to describe the complex relationships among patient safety culture, nurse demographics, advocacy, and patient outcomes. BACKGROUND: Why has healthcare lagged behind other industries in improving quality? Little nursing research exists that explores the multifactorial relationships that impact quality. METHODS: A convenience sample of 1045 nurses from 40 medical/surgical units was analyzed using a correlational cross-sectional design with secondary data analysis. Data sources included survey results for patient safety culture, nurse perceptions of patient advocacy, and patient experience and fall and pressure ulcer rates. RESULTS: Significant findings included a positive correlation between patient safety culture and advocacy and a negative correlation between safety culture, advocacy, and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. CONCLUSIONS: Newer nurses were more positive about safety culture and advocacy, whereas experienced nurses were overall less positive.

New paradigms for considering statistical significance: A way forward for health services research journals, their authors, and their readership.

This commentary discusses the new American Statistical Association forty-three article issue in The American Statistician. I cover some history of p-values, misunderstandings, along with NHST and the Neyman-Pearson model. Special focus is placed on Student [W. Gosset] and Fisher's work. Finally, a list of recommendations is provided.

Touchscreen tablet-based cognitive assessment versus paper-based assessments for traumatic brain injury.

BACKGROUND: Electronic cognitive assessment tools present potential benefits for clinical practice; however, they warrant examination before use with clinical populations such as people with traumatic brain injury (TBI). OBJECTIVE: The primary study purpose was to compare results from a tablet-based, electronic cognitive assessment to two paper cognitive assessments when administered to adults with TBI. We also explored the effect of iPad comfort on performance. METHODS: We employed a quasi-experimental, correlational study design. Forty adults between 18 to 615 months post TBI completed the Standardized Touchscreen Assessment of Cognition (STAC), the Montreal Cognitive Assessment (MoCA), and the Cognitive Linguistic Quick Test (CLQT) in a systematically, counterbalanced order. We compared participants' performance on these tools and examined the effect of iPad comfort. RESULTS: Three STAC subtests had a good relationship with CLQT subtests: orientation, generative naming category, and generative naming first letter. A good relationship was also identified between two STAC and two MoCA subtests: orientation and generative naming first letter. People who were very comfortable using the iPad performed statistically better on the STAC first letter fluency item than participants who were not comfortable. CONCLUSIONS: Moderate correlations suggest validity for some STAC items; however, modifications and further testing are needed.

A pilot study: Resistive behavior in the context of informal caregiver-assisted activities of daily living.

Providing care for people with dementia is difficult when resistive behaviors displayed by people impede caregiving efforts. PURPOSE: To examined the frequency of resistive behaviors during informal caregiver-assisted activities of daily living and the impact of these occurrences. DESIGN: A cross sectional design was used to recruit 17 caregivers from Alzheimer's support group meetings in 2010. METHOD: Self-report surveys were used to obtain participants' report of resistive behaviors. FINDINGS: A positive correlation was found between caregivers reported frequency of bathing behaviors and their reported upset with dressing behaviors. Gender differences emerged in caregiver reported frequencies of the resistive behaviors. Caregivers reported behaviors occurring between two and six times per week but rated the not frequent behaviors as somewhat to very upsetting when they occurred. CONCLUSIONS: When informal caregivers provide assisted care, resistive behaviors occur. Future research is needed to identify interventions to help caregivers manage their upset when resistiveness occurs.

Validation of the Standardized Touchscreen Assessment of Cognition with neurotypical adults.

BACKGROUND: Portable electronic devices are increasingly being used for clinical assessment of individuals with cognitive deficits. Prior to implementation of tablet-based assessments, comparison with other standard measures is needed. OBJECTIVE: The study purpose was to compare an iPad administered cognitive assessment known as the Standardized Touchscreen Assessment of Cognition (STAC) to the Cognitive Linguistic Quick Test (CLQT) and the Cognitive Assessment of Minnesota (CAM). METHODS: Eighty-eight neurotypical participants completed the STAC, CAM, and CLQT in a randomized order. The researchers compared the participants' responses across similar subtests. Performance across iPad comfort levels was also explored. RESULTS: Findings revealed moderate correlations in some areas of assessment: generative naming and immediate visual memory. The correlations varied across age groups within each area of assessment with no consistent pattern. Additionally, people with comfort using an iPad performed significantly better on three areas of STAC assessment (generative naming category and first letter, and auditory working memory) compared to people who reported no iPad comfort. CONCLUSIONS: Initial testing of the STAC in a neurotypical population identified moderate correlations with standard measures in some subtests; however, additional testing of the STAC is needed to determine the clinical utility and validity of assessing populations with cognitive impairments.

Latent Class Analysis: An example for reporting results.

OBJECTIVE: The purpose of this paper is to provide a brief non-mathematical introduction to Latent Class Analysis (LCA) and a demonstration for researchers new to the analysis technique in pharmacy and pharmacy administration. LCA is a mathematical technique for examining relationships among observed variables when there may be collections of unobserved categorical variables. Traditionally, LCA focused on polytomous observed variables, but recent work has extended the types of data that can be utilized. Included in this introduction are basic guidelines for the information that should be part of a manuscript submitted for review. For the analysis, LatentGold is used, but I also include basic R code for running LCA and LC Regressions with the poLCA package.

Update to core reporting practices in structural equation modeling.

This paper is a technical update to "Core Reporting Practices in Structural Equation Modeling."1 As such, the content covered in this paper includes, sample size, missing data, specification and identification of models, estimation method choices, fit and residual concerns, nested, alternative, and equivalent models, and unique issues within the SEM family of techniques.

The relation of parenting, child temperament, and attachment security in early childhood to social competence at school entry.

A wealth of research demonstrates the importance of early parent-child interactions on children's social functioning. However, less is known about the interrelations between child and parent characteristics and parent-child interactions in early childhood. Moreover, few studies have broadly examined the longitudinal relations between these constructs and social competence. This study is an examination of the relations between parent responsiveness, negativity, and emotional supportiveness, attachment security, and child temperament, and their impact on children's social competence from infancy to kindergarten entry. The sample was derived from the Early Childhood Longitudinal Study--Birth Cohort and included 6850 parent-child dyads. Observational and rating scale data were used. The proposed model was nearly fully supported by path analysis, and it provides insight into the complex relations between early parenting behaviors, child characteristics, and parent-child interactions in the development of social competence.

Core reporting practices in structural equation modeling.

BACKGROUND: Structural equation modeling (SEM) is a popular analysis technique because of the wide range of questions that it can help answer. There are several pieces of information specific to SEM that should be reported when this technique is used. OBJECTIVES: To demonstrate a basic framework for reporting SEM analyses, to provide definitions of key terms readers will encounter, and to illustrate 2 examples for reporting SEM results. METHODS: Data from 650 participants who completed 3 self-report surveys were used to test a confirmatory factor analysis and a structural model as examples of information to be reported. RESULTS: The results displayed are requisite information for any SEM analysis. CONCLUSIONS: It is important for investigators to provide this information so that readers can properly evaluate the results and conclusions based on the analyses.