Occupational stress among Nigerian construction trade artisans in the building construction sector: An intervention study.

BACKGROUND: Construction work can negatively affect artisans' mental health in the form of stress. This research investigated the effect of cognitive behavioral intervention on occupational stress among Nigerian construction trade artisans in the building construction sector. METHODS: In this randomized controlled study involving 3 waves of data collection, 140 construction trade artisans who presented with high occupational stress symptoms at the study onset were assigned randomly to either a treatment condition (n = 70) or to a waitlist control condition (n = 70). The study involved pre-treatment and post-treatment assessments and a 3-months follow-up. The artisans' occupational stress questionnaire and artisans' dysfunctional thoughts at work scale were the data collection instruments. RESULTS: Results revealed a significant effect of group on artisans' occupational stress and dysfunctional thoughts at work. Also, significant effects of time on artisans' occupational stress and dysfunctional thoughts at work were recorded. Finally, group × time interaction effects on artisans' occupational stress and dysfunctional thoughts at work were significant. CONCLUSION: Cognitive behavioral intervention effectively reduced occupational stress symptoms and dysfunctional thoughts at work among Nigerian construction trade artisans compared with a waitlist control condition.

Nurse practitioner clinical decision-making and evidence-based practice.

Evidence-based practice is key to improving patient outcomes but can be challenging for busy nurse practitioners to implement. This article describes the process of critically appraising evidence for use in clinical practice and offers strategies for implementing evidence-based innovations and disseminating the findings.

Selecting An Open Access Journal for Publication: Be Cautious

Nurse scholars and clinicians seek to publish their research and scholarly findings to strengthen both nursing science and clinical practice. Traditionally subscription-based publications have been the mainstay of knowledge dissemination. However, subscription costs have tended to restrict access to many journals to a small, specialized, academic community, a limitation that has contributed to the development of open access (OA) publications. OA journals have a powerful appeal as they allow greater access to scholars and consumers on a global level. However, many OA journals depend on an author-pays model that may lead to unintended and undesirable consequences for authors. Today, it is easier than ever to share scholarly findings, but authors need to be vigilant when selecting a journal in which to publish. In this article, we discuss the background of open access journals and describe key consideration to distinguish between reputable publications and those that may lead authors astray. We conclude that despite controversy and concerns related to publishing in OA journals, these journals do provide opportunities for researchers and clinicians to raise the profile of their work and ensure a robust, scholarly communication system.

Affordable Care Act: Overview and Implications for Advancing Nursing.

The Affordable Care Act (ACA) confronts nursing with opportunities as well as challenges. The authors provide an overview of the ACA and highlights opportunities for nursing practice, research, and doctoral education. The importance of disciplinary foundations is also addressed as relevant to envisioning the future of practice and education in the context of healthcare reform.

The effects of a community-based, culturally tailored diabetes prevention intervention for high-risk adults of Mexican descent.

PURPOSE: This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. METHODS: The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. RESULTS: There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. CONCLUSIONS: Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.

Challenges and success of recruiting and retention for a culturally tailored diabetes prevention program for adults of Mexican descent.

PURPOSE: The purpose of this article is to describe methods used to recruit and retain high-risk, Spanish-speaking adults of Mexican origin in a randomized clinical trial that adapts Diabetes Prevention Program (DPP) content into a community-based, culturally tailored intervention. METHODS: Multiple passive and active recruitment strategies were analyzed for effectiveness in reaching the recruitment goal. Of 91 potential participants assessed for eligibility, 58 participated in the study, with 38 in the intervention and 20 in the attention control group. The American diabetes association risk assessment questionnaire, body mass index, and casual capillary blood glucose measures were used to determine eligibility. RESULTS: The recruitment goal of 50 individuals was met. Healthy living diabetes prevention presentations conducted at churches were the most successful recruiting strategy. The retention goal of 20 individuals was met for the intervention group. Weekly reminder calls were made by the promotora to each intervention participant, and homework assignments were successful in facilitating participant engagement. CONCLUSIONS: A community advisory board made significant and crucial contributions to the recruitment strategies and refinement of the intervention. RESULTS: support the feasibility of adapting the DPP into a community-based intervention for reaching adults of Mexican origin at high risk for developing diabetes.

The dimensions of nursing surveillance: a concept analysis.

AIM: This paper is a report of an analysis of the concept of nursing surveillance. BACKGROUND: Nursing surveillance, a primary function of acute care nurses, is critical to patient safety and outcomes. Although it has been associated with patient outcomes and organizational context of care, little knowledge has been generated about the conceptual and operational process of surveillance. DATA SOURCES: A search using the CINAHL, Medline and PubMed databases was used to compile an international data set of 18 papers and 4 book chapters published from 1985 to 2009. REVIEW METHODS: Rodger's evolutionary concept analysis techniques were used to analyse surveillance in a systems framework. This method focused the search to nursing surveillance (as opposed to other medical uses of the term) and used a theoretical framework to guide the analysis. RESULTS: The examination of the literature clarifies the multifaceted nature of nursing surveillance in the acute care setting. Surveillance involves purposeful and ongoing acquisition, interpretation and synthesis of patient data for clinical decision-making. Behavioural activities and multiple cognitive processes are used in surveillance in order for the nurse to make decisions for patient safety and health maintenance. A systems approach to the analysis also demonstrates how organizational characteristics and contextual factors influence the process in the acute care environment. CONCLUSION: This conceptual analysis describes the nature of the surveillance process and clarifies the concept for effective communication and future use in health services research.

Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes.

PURPOSE: The purpose of this article is to report the results of a culturally tailored diabetes intervention for Mexican Americans on physical activity and to report the results of a focus group with intervention participants. DATA SOURCES: Seventeen Mexican American subjects with type 2 diabetes participated in the study. The study used a pretest/posttest control group design with 10 subjects in each group (N = 20). Outcome measures included the number of steps walked weekly, weight, and body mass index (BMI). Pedometers were used to measure the daily number of steps in the intervention group. A focus group provided data on participant satisfaction. CONCLUSIONS: Results suggest a positive effect of the intervention on physical activity level, weight, and sense of control over diabetes self-management. Intervention participants had a statistically significant increase in the number of steps walked per day and a statistically significant mean weight loss of five pounds. Focus group results indicate that participants were satisfied with the culturally tailored intervention and that they and their families benefited from the intervention. IMPLICATIONS FOR PRACTICE: A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.

Cultural values and political economic contexts of diabetes among low-income Mexican Americans.

PURPOSE: To explore the political and economic dimensions of diabetes self-management for Mexican American adults. DESIGN: Critical ethnographic analysis of focus group data from caregivers and adults with diabetes. FINDINGS: Three themes were identified: diabetes self-management is tied to other mental and bodily states, family and neighborhood environments cause stress and prevent diabetes solutions, and hassles of the health care environment subvert self-management. DISCUSSION: Cultural constructs about diabetes merge with social-political forces in explaining diabetes. IMPLICATIONS: Cultural competence in diabetes care requires attention to the political economy of the disease and advocacy for healthful political and economic change.

Treatment patterns and outcomes in a low-risk nurse-midwifery practice.

Childbirth, which represents more than 20% of all hospitalizations for women, is often accompanied by technical intervention, and identifying best practices is crucial. This study analyzed data entered into the Nurse-Midwifery Clinical Data Set (ACNM, 1990) to ascertain treatment patterns and associated outcomes, using Kane's Model of Treatment and Outcomes (Kane, R. L. [1997]. Understanding health care outcomes research. Gaithersburg, MD: Aspen Publishers, Inc.). Low-risk women (N = 510) received prenatal care from nurse-midwives and delivered at a university facility. Significant relationships were found between patient characteristics (age) and clinical factors (parity, body mass index, number of prenatal visits, comorbidities) and between treatment interventions (activity, intake, invasive monitoring) and outcomes (infant Apgar scores, complications).

The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire.

BACKGROUND: Translation of data collection instruments, paying careful attention to equivalency between the source and the target language, is important to obtain valid data collection instruments. OBJECTIVE: To translate the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English) into Spanish and to evaluate the reliability and validity of the Spanish version. METHODS: Translation and back-translation were used to develop the Spanish version of the SDSCA. The Spanish version of the SDSCA was reviewed by an expert panel for conceptual and content equivalence to the English version. Psychometric properties were assessed further by combining data from three studies that used the Spanish version as a data collection instrument. RESULTS: Correlation of each item of the Spanish and English version of the SDSCA instrument ranged from .78 to 1.00, with no variability in the responses of 2 of the 12 items. Test-retest correlations for the SDSCA ranged from .51 to 1.00. Internal consistency (Cronbach's alpha) for the Spanish version was .68. Items loaded on three factors, with the factors accounting for 61% of the variance in SDSCA. DISCUSSION: The findings for the psychometric properties of the Spanish version of the SDSCA questionnaire suggest that it has conceptual and content equivalency with the original English version and is valid and reliable. However, further testing with larger samples is required.

A feasibility study of a culturally tailored diabetes intervention for Mexican Americans.

Latinos, the fastest growing minority group in the United States, are among the hardest hit by diabetes. Among Latinos, Mexican Americans have the highest rate (23.9%) of diabetes. Good self-management can improve glycemic control and decrease diabetes complications but can be challenging to achieve. The purpose of this study was to test the feasibility and examine the effects of a culturally tailored intervention for Mexican Americans with type 2 diabetes on outcomes of self-management. The study used a pretest/posttest control group design with 10 participants in each group (N = 17). Feasibility and acceptability of the tailored diabetes self-management program was assessed by examining ease of recruitment and retention rates. The behavioral outcomes of self-efficacy, diabetes knowledge and self-care measures, and the biologic outcomes of weight, body mass index, HbA1C, and blood glucose were used to examine intervention effectiveness. Successful recruitment of participants came from personal referrals from providers or the promotora. Retention rates were 100% for the intervention group and 80% for the control group. Findings suggest that the intervention had a positive clinical and statistical effect on diabetes knowledge, weight, and body mass index. Improvements were also noted in self-efficacy scores, blood glucose, and HbA1C, but these changes did not reach statistical significance. A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.

Getting through birth in one piece: protecting the perineum.

PURPOSE: To identify factors related to perineal trauma in childbirth, replicating the work of . STUDY DESIGN AND METHOD: A retrospective descriptive analysis of pregnancy and birth data recorded into the Nurse Midwifery Clinical Data Set for women (N = 510) with a singleton pregnancy and largely uncomplicated prenatal course. Prenatal care occurred at four prenatal clinics with births at a tertiary care facility during 1996-1997, with care provided by nurse midwifery faculty. Multivariate statistics detailed clinical characteristics associated with perineal trauma. RESULTS: Episiotomy was related to parity, marital status, infant weight, fetal bradycardia, prolonged second stage labor, and lack of perineal care measures. Factors related to laceration were age, insurance status, and marital status. For all women, laceration was more likely when in lithotomy position for birth (p = .002) or when prolonged second stage labor occurred (p = .001). Factors that were protective against perineal trauma included massage, warm compress use, manual support, and birthing in the lateral position. found that ethnicity and education were related to episiotomy and that warm compresses were protective. In this study, use of oils/lubricants increased lacerations, as did lithotomy positioning. Laceration rates were similar in both studies. Episiotomy use was lower in this study. CLINICAL IMPLICATIONS: Side-lying position for birth and perineal support and compress use are important interventions for decreasing perineal trauma. Strategies to promote perineal integrity need to be implemented by nurses who provide prenatal education and care for the laboring woman.

Disparity in prenatal care among women of colour in the USA.

OBJECTIVE: To describe the disparity in prenatal care among women of colour in timing of initiation of prenatal care and total number of prenatal visits. DESIGN: A retrospective, descriptive design. SETTING: A large, urban university midwifery faculty practice. PARTICIPANTS: 439 healthy women at term (37-42 weeks gestation) with a vertex singleton pregnancy, and an essentially uncomplicated prenatal course. One clinic, the university facility, provided full-scope services. The other four community clinics, all outside the university in the larger metropolitan area, were designed to provide care to low-, under-, and uninsured pregnant women. MEASUREMENTS: Timing of initiation of prenatal care and total number of prenatal visits were examined in relation to demographic variables, including race, education, age, marital status, method of payment and clinic sites. FINDINGS: Significant differences in initiation of prenatal care and total number of prenatal visits were documented. The non-Hispanic white women at the university hospital clinic, with high school or college degrees and insurance or Medicaid, were more likely to visit prenatal clinics. Examination of association between timing of initiation of prenatal care and demographic variables showed significant differences in race and education. KEY CONCLUSIONS: This study reflects the difficulty in access to care faced by women of colour. When comparing 1997 national survey findings with those of a 2001 study, about 40% of the 50 States and the District of Columbia showed an increase in the frequency of women receiving late care or no care; additionally, a disparity in access to prenatal care between non-Hispanic white and non-white women was noted in most of these areas. IMPLICATIONS FOR PRACTICE: The number of births to women of colour delivered by midwives has rapidly increased in recent years. Also, the numbers of babies born to women of colour is anticipated to surpass 50% in the next few decades. Considering the increased proportion of births to women of colour, special attention to promote early prenatal care for these populations is needed. Recruitment and retention efforts for non-white midwives, regular education for cultural competence of midwives, and provision of culturally and linguistically appropriate care for women of colour should be considered.

Using focus groups to develop a culturally competent diabetes self-management program for Mexican Americans.

PURPOSE: The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants' preferences and recommendations about the essential components of a culturally competent diabetes self-management program. METHODS: Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. RESULTS: "Being in the dark" emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members' support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. CONCLUSIONS: Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.

Down the rabbit hole: examining outcomes of nurse midwifery care.

Care of the laboring woman and subsequent birth interventions have generally been based on tradition rather than a systematic examination of the cost-effectiveness of the interventions. This retrospective study examined the outcomes of nurse midwifery care at a large metropolitan university clinic setting. Findings suggest that more sensitive cost and quality indicators of nurse midwifery care need to be developed, and the effect of these on outcomes needs to be elucidated.

Translation research in long-term care: improving pain management in nursing homes.

BACKGROUND: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. AIMS: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. METHODS: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. FINDINGS: The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. DISCUSSION: Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. IMPLICATIONS: Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. CONCLUSIONS: Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.