The Limits of 'Social Determinants of Health' Language.

A less restrictive term allows more room for our shared humanity.

Population health in a global society: Preparing nurses for the future.

BACKGROUND: The COVID-19 pandemic has reinforced awareness that the health of populations is inextricably linked around the globe. Nurses require increased knowledge and preparation in global health. Nursing educators need examples of how to improve content in the curriculum. AIMS: The purpose of this paper is to describe reconceptualization of a master's level nursing course entitled "Population Health in a Global Society" to include global health competencies. METHODS: We identified four global health competencies within the following three domains: globalization of health and healthcare; collaboration, partnering, and communication; and sociocultural and political awareness. IMPLEMENTATION: We utilized guest lectures, a panel discussion, discussion forums and an independent research assignment. The methods used were well received by students, and the content delivered improved their perceived knowledge in global population health. DISCUSSION: The global health domains and competencies provided a roadmap for improving our course to focus on population health from a global perspective. CONCLUSION: In order to prepare nurses to contribute to global population health, population health courses should integrate global health competencies. The content of the revised course will better prepare nurses who will practice in a wide variety of settings and is designed for interdisciplinary education.

Cultural Awareness: Ensuring High-Quality Care for Limited English Proficient Patients.

BACKGROUND: Cancer hospitals throughout the United States have seen an increase in the number of adults who are considered limited English proficient (LEP); such individuals do not speak English as their primary language and have a limited ability to read, speak, write, or understand the language. This population requires nurses who are responsive to their language and cultural needs. OBJECTIVES: The purpose of this study was to assess cultural awareness among inpatient oncology nurses and to identify areas for cross-cultural training and educational development. METHODS: 44 inpatient oncology nurses from an oncology unit that admits a large number of Spanish-speaking patients responded to an online survey containing 23 Likert-type questions and 4 open-ended questions. FINDINGS: Despite survey results indicating a moderate to high level of cultural awareness, nurses expressed a need for tools and resources to provide equitable and safe care to LEP adults diagnosed with cancer. To improve the care of LEP patients, nurses suggested the use of resources such as an assigned unit interpreter, an increase in bilingual nursing staff, dual language materials, and free language lessons.

Encouragement: The key to increasing the number of nurses serving on boards.

Nurses have a lot of knowledge about health and health systems but are not yet adequately represented on boards and commissions that influence health and healthcare in our country. The majority of nurses are women and the hesitancy of women to seek board and elected positions are well documented. The purpose of this statewide survey of nurses was to ascertain the political engagement of nurses and their identified barriers to service. The nurses in our sample were more politically engaged than the state as a whole and 40% reported willingness to consider or pursue a board or elected position. The primary barrier was a lack of confidence that their appointment would be supported. While there were some differences by age of the respondents, time, money, and family responsibilities were also identified as barriers to seeking board and elected positions. Our results underscore the need to socialize and encourage nurses to serve in positions that influence health and healthcare in our country.

How to Join a Board: A Practical Guide.

In October 2010, the Institute of Medicine and the Robert Wood Johnson Foundation released The Future of Nursing report. One way that "Recommendation 7: Prepare and enable nurses to lead change and advance health" has been operationalized has been placing nurses on boards, and nursing organizations have urged their constituents to serve in this capacity. This article outlines steps for obtaining an invitation to join a board. [J Contin Educ Nurs. 2018;49(12):559-562.].

Engaging outreach workers in the development of a farmworker health research agenda.

Farmworker health outreach workers have not traditionally been involved in the prioritization and design of research studies. This report from the field shares the results of a survey administered to outreach workers providing health services to farmworkers in North Carolina. Priority areas of research and best practices for engaged research are presented from the perspective of the outreach worker community. The purposeful involvement of outreach workers can make farmworker health research more meaningful and solution-oriented.

Benefits, Facilitators, Barriers, and Strategies to Improve Pesticide Protective Behaviors: Insights from Farmworkers in North Carolina Tobacco Fields.

Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino farmworkers perceive little control over their occupational health. Using the Health Belief Model as a theoretical guide, we explored the perceptions of Latino farmworkers working in tobacco in North Carolina (n = 72) about benefits and facilitators of pesticide protective behaviors as well as barriers, and strategies to overcome barriers to their use. Interviews were conducted with participants at farmworker housing during non-work time. Qualitative data were analyzed using ATLAS.ti. Farmworkers recognized pesticide protective behaviors as helping them to not get sick and stay healthy. Farmworkers perceived work experience as facilitating protective behaviors. Wetness in the field was the most commonly cited barrier to protective behavior use. To overcome this barrier, farmworkers suggested use of water-resistant outerwear, as well as packing a change of clothes for mid-day, with space and time to change provided by employers. Examination of the efficacy and feasibility of farmworkers' suggestions for addressing barriers is warranted. Training and behavior modeling by experienced peers may improve behavior adoption and perceived control.

Workplace Hazards Faced by Nursing Assistants in the United States: A Focused Literature Review.

Nursing assistants (NAs) make up a large share of the healthcare provider workforce and their numbers are expected to grow. NAs are predominantly women who earn a low wage and report financial, work, and family demands. Working as a NA is hazardous; this manuscript specifically examines the biological/infectious, chemical, enviromechanical, physical and psychosocial hazards that appear in the literature to date. A focused search strategy was used to review literature about hazards that fell into each of the five aforementioned domains. While some hazards that were documented were clear, such as exposure to influenza because of close contact with patients (biological/infectious), or exposure to hazardous drugs (chemical), literature was limited. The majority of the literature we reviewed fell into the domain of psychosocial hazards and centered on stress from workplace organization issues (such as mandatory overtime, lack of managerial support, and feeling rushed). More research is needed to understand which hazards NAs identify as most concerning and tailored interventions are needed for risk mitigation.

Pesticides: Perceived Threat and Protective Behaviors Among Latino Farmworkers.

OBJECTIVES: The purpose of this study was to assess the knowledge and beliefs of 72 Latino farmworkers in North Carolina about the threat of health effects of pesticides, including cancer. It sought to explore relationships between threat perceptions and pesticide protective behaviors observed in the field. METHODS/RESULTS: Utilizing stepwise multiple regression, the authors found that years worked in agriculture in the United States was associated with decreased use of protective clothing. CONCLUSION: Pesticide protective behaviors in the field may be improved by utilizing moderately experienced farmworkers (<10 years) as lay advisors to reinforce training.

Observed and self-reported pesticide protective behaviors of Latino migrant and seasonal farmworkers.

Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agency's (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, although they are not required to be taught by the WPS. Farmworkers reported more long-sleeve (p=.028) and glove use (p=.000) than what was observed. It was uncommon to observe washing behavior before eating or drinking, even when washing supplies were available. Washing behaviors were significantly overreported for hand (p=.000; p=.000) and face (p=.000; p=.058) washing before eating and drinking in the field. This study documents that protective clothing behaviors that the WPS requires be taught, plus a few others are commonly practiced by Latino migrant and seasonal farmworkers, but washing behaviors in the field are not. Targeted strategies to improve washing behaviors in the field are needed.

Cancer-related fatigue: scientific progress has been made in 40 years

Cancer-related fatigue (CRF) is a distressing, persistent symptom that is experienced by survivors during and after treatment. Unsurprisingly, many early CRF studies were conducted by nurses. These studies included a look at patients receiving localized radiation treatment (Haylock & Hart, 1979); an exploration of fatigue as a conceptual approach to a clinical problem (Aistars, 1987); the development of a nursing theory focused on fatigue mechanisms (Piper, Lindsey, & Dodd, 1987); an examination of fatigue mechanisms (St Pierre, Kasper, & Lindsey, 1992), as well as of fatigue in advanced cancer (Bruera & MacDonald, 1988) and in non-small cell lung cancer (Sarna, 1993); and a description of fatigue and potential nursing interventions (Nail & King, 1987). Winningham et al. (1994) wrote a state-of-the-science article about fatigue in the cancer experience for the Oncology Nursing Forum, and Mock et al. (1997) was one of the first to conduct an exercise study regarding the effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Nurse scholars from the 1970s-2000s were pivotal in advancing the science of fatigue in various cancers and have provided a scientific foundation for those four decades. 
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Voices of Oncology Nursing Society members matter in advocacy and decisions related to U.S. Health Policy

The Oncology Nursing Society (ONS), a member of the Nursing Organizations Alliance, invests in advocating for health and public policy decisions by sending members to the Nurse in Washington Internship (NIWI) program annually. NIWI provides a forum to educate nurses on the legislative process, giving attendees a better understanding of political, legislative, and regulatory issues facing nurses. The 2014 ONS delegation participated in training and lobbying focused on federal funding issues, nursing education, workforce oversight, and funding for nursing research. The three-day program ended with a Capitol Hill visit where nurses met with their respective legislators or their staff, using skills learned at NIWI briefings to influence policy for nurses and the patients they serve. Critical health and public policy decisions affecting nurses, their practice, and their patients require participation in and understanding of the legislative process. This article provides a glimpse into the three-day experience of the delegates attending the 2014 NIWI.

Implementing survivorship care plans for colon cancer survivors

PURPOSE/OBJECTIVES: To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis. DESIGN: Prospective, descriptive, single-arm study. SETTING: A National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE: 28 nonmetastatic colon cancer survivors within the first year of diagnosis and their primary care physicians (PCPs). METHODS: Regular screening identified potential participants who were followed until treatment ended. An oncology certified nurse developed the JourneyForward™ SCP, which then was delivered to the patient by the oncology nurse practitioner (NP) during a routine follow-up visit and mailed to the PCP. MAIN RESEARCH VARIABLES: Time to complete, time to deliver, usability, and satisfaction with the SCP. FINDINGS: During one year, 75 patients were screened for eligibility, 34 SCPs were delivered, and 28 survivors and 15 PCPs participated in the study. It took an average of 49 minutes to complete a surgery SCP and 90 minutes to complete a surgery plus chemotherapy SCP. Most survivors identified that before treatment ended or within the first three months was the preferred time to receive an SCP. CONCLUSIONS: The SCPs were well received by the survivors and their PCPs, but were too time and labor intensive to track and complete. IMPLICATIONS FOR NURSING: More work needs to be done to streamline processes that identify eligible patients and to develop and implement SCPs. Measuring outcomes will be needed to demonstrate whether SCPs are useful or not.