Impact of a Gardening and Physical Activity Intervention in Title 1 Schools: The TGEG Study.

Background: The purpose of the Texas!Grow!Eat!Go! (TGEG) study was to assess individual and combined effects of school-based gardening and physical activity (PA) interventions on children's eating and PA behaviors and obesity status. Methods: Using a 2 × 2 design, 28 low-income schools in Texas were randomized to 1 of 4 conditions: (1) School Garden intervention (Learn!Grow!Eat!Go! [LGEG]), (2) PA intervention (Walk Across Texas [WAT!]), (3) both Garden and PA intervention (Combined), or (4) neither Garden nor PA intervention (Control). Participants included 1326 third grade students and parents (42% Hispanic; 78% free/reduced lunch). Student and parent data were collected at the beginning and end of the school year. Two different sets of analyses measuring pre-post changes in outcomes within and across conditions were estimated by factorial ANOVAs using mixed models adjusted for demographics. Results: Main effect analyses indicate that relative to children at schools that did not receive LGEG, children at schools that received LGEG, either individually or in combination with WAT!, showed significant increases in Nutrition knowledge, Vegetable preference, and Vegetable tasted (p < 0.001 in all cases). Within-group analyses show that compared to Comparison, children in the WAT! group significantly increased in the amount of time parents and children were active together (p = 0.038). In addition, children in LGEG and WAT! schools significantly decreased BMI percentile (p = 0.042, p = 0.039, respectively), relative to children in Comparison schools. Conclusions: Both the garden and PA interventions independently produced significant changes related to healthy lifestyle behaviors. However, combining the two interventions did not show greater impact than the single interventions, underscoring the need for more research to determine how to better implement comprehensive interventions at schools.

The Association Between Child Cooking Involvement in Food Preparation and Fruit and Vegetable Intake in a Hispanic Youth Population.

BACKGROUND: Cooking interventions have been linked to reductions in obesity and improvements in dietary intake in children. OBJECTIVE: To assess whether child cooking involvement (CCI) was associated with fruit intake (FI), vegetable intake (VI), vegetable preference (VP), and vegetable exposure (VE) in children participating in the Texas, Grow! Eat! Go! (TGEG) randomized controlled trial. METHODS: Baseline data from TGEG included 1231 3rd grade students and their parents. Conducted in 28 low-income, primarily Hispanic schools across Texas, TGEG schools were assigned to: 1) Coordinated School Health (CSH) only (control group), 2) CSH plus gardening and nutrition intervention (Learn, Grow, Eat & Go! or LGEG group), 3) CSH plus physical activity intervention (Walk Across Texas or WAT group), and 4) CSH plus LGEG plus WAT (combined group). Height, weight, dietary intake, VE, VP, and CCI were collected at baseline and postintervention. Linear regressions were used to assess the relation between baseline CCI and fruit and vegetable (FV) intake, VE, and VP. A priori covariates included age, sex, race/ethnicity, and TGEG treatment group. RESULTS: Children who were always involved in family cooking had higher VP and VE when compared with children who were never involved in family cooking (ß = 3.26; 95% CI: 1.67, 4.86; P < 0.01 and ß = 2.26; 95% CI: 0.67, 3.85; P < 0.01, respectively). Both VI and FI were higher for children who were always involved in family cooking compared with children who never cooked with their family (ß = 2.45; 95% CI: 1.47, 3.44; P < 0.01 and ß = 0.93; 95% CI: 0.48, 1.39; P < 0.01, respectively). VI and fruit consumption were higher for children who reported being sometimes involved in family cooking compared with children who were never involved in family cooking, (ß = 1.47; 95% CI: 0.51, 2.42; P < 0.01, and ß = 0.64; 95% CI: 0.20, 1.08; P < 0.01, respectively). CONCLUSIONS: Results show a positive relation between family cooking and FV intake and preference in high-risk, minority children.

The Influence of Organizational Culture on School-Based Obesity Prevention Interventions: A Systematic Review of the Literature.

BACKGROUND: Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school-based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school-based obesity prevention interventions. METHODS: Fourteen studies examining the impact of organizational-level characteristics on school-based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus. RESULTS: Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school-based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate. CONCLUSIONS: Organizational culture can greatly influence the success of school-based obesity interventions. The collection of data related to organizational-level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.

Examining the Role of Income Inequality and Neighborhood Walkability on Obesity and Physical Activity among Low-Income Hispanic Adults.

Obesity is a major public health issue affecting rising medical costs and contributing to morbidity and premature mortality. We aimed to identify factors that may play a role in obesity and physical activity at the individual and environmental/neighborhood levels. We analyzed data from an adult sample who were parents of students enrolled in a school-based health and wellness program. The sample was restricted to those who were Hispanic and whose children were on free/reduced lunch (n = 377). Dependent variables: body mass index (BMI); neighborhood walkability. Walk Score® was used to assess neighborhood walkability. Overall, 46% of participants were obese and 31% were overweight. The median age of respondents was 34 years, and the majority were female (88%) and married (59%). Participants who resided in a census tract with a higher relative income inequality (high, OR 2.54, 90% CI 1.154-5.601; moderate-high OR 2.527, 90% CI 1.324-4.821) and those who were unmarried (OR 1.807, 90% CI 1.119-2.917) were more likely to be obese versus normal weight. Overweight individuals that resided in areas that were walkable versus car-dependent averaged more days engaging in walking for at least 30-min (p <.05). Identifying individual and neighborhood factors associated with obesity can inform more targeted approaches to combat obesity at multiple ecological levels. The importance of understanding how neighborhood characteristics influence health-related and behavioral outcomes is further reinforced with the current findings. Identifying effective strategies to engage communities and organizations in creating, implementing, adopting, evaluating, and sustaining policy and/or environmental interventions will be needed to combat the obesity epidemic.

Association of parental social support with energy balance-related behaviors in low-income and ethnically diverse children: a cross-sectional study.

BACKGROUND: Parents play an important role in providing their children with social support for healthy eating and physical activity. However, different types of social support (e.g., instrumental, emotional, modeling, rules) might have different results on children's actual behavior. The purpose of this study was to assess the association of the different types of social support with children's physical activity and eating behaviors, as well as to examine whether these associations differ across racial/ethnic groups. METHODS: We surveyed 1169 low-income, ethnically diverse third graders and their caregivers to assess how children's physical activity and eating behaviors (fruit and vegetable and sugar-sweetened beverage intake) were associated with instrumental social support, emotional social support, modeling, rules and availability of certain foods in the home. We used sequential linear regression to test the association of parental social support with a child's physical activity and eating behaviors, adjusting for covariates, and then stratified to assess the differences in this association between racial/ethnic groups. RESULTS: Parental social support and covariates explained 9-13% of the variance in children's energy balance-related behaviors. Family food culture was significantly associated with fruit and vegetable and sugar-sweetened beverage intake, with availability of sugar-sweetened beverages in the home also associated with sugar-sweetened beverage intake. Instrumental and emotional support for physical activity were significantly associated with the child's physical activity. Results indicate that the association of various types of social support with children's physical activity and eating behaviors differ across racial/ethnic groups. CONCLUSIONS: These results provide considerations for future interventions that aim to enhance parental support to improve children's energy balance-related behaviors.

Previous Gardening Experience and Gardening Enjoyment Is Related to Vegetable Preferences and Consumption Among Low-Income Elementary School Children.

OBJECTIVE: To examine if gardening experience and enjoyment are associated with vegetable exposure, preferences, and consumption of vegetables among low-income third-grade children. DESIGN: Cross-sectional study design, using baseline data from the Texas! Grow! Eat! Go! SETTING: Twenty-eight Title I elementary schools located in different counties in Texas. PARTICIPANTS: Third-grade students (n = 1,326, 42% Hispanic) MAIN OUTCOME MEASURES: Gardening experience, gardening enjoyment, vegetable exposure, preference, and consumption. ANALYSIS: Random-effects regression models, adjusted for age, sex, ethnicity, and body mass index percentile of child, estimated means and standard errors of vegetable consumption, exposure, and preference by levels of gardening experience and enjoyment. Wald χ2 tests evaluated the significance of differences in means of outcomes across levels of gardening experience and enjoyment. RESULTS: Children with more gardening experience had greater vegetable exposure and higher vegetable preference and consumed more vegetables compared with children who reported less gardening experience. Those who reported that they enjoyed gardening had the highest levels of vegetable exposure, preference, and consumption. CONCLUSIONS AND IMPLICATIONS: Garden-based interventions can have an important and positive effect on children's vegetable consumption by increasing exposure to fun gardening experiences.

Using Family-Focused Garden, Nutrition, and Physical Activity Programs To Reduce Childhood Obesity: The Texas! Go! Eat! Grow! Pilot Study.

BACKGROUND: The TEXAS! GROW! EAT! GO! (TGEG) randomized, control trial is a 5-year study to measure the impact of a nutrition and gardening intervention and/or physical activity (PA) intervention on the weight status of third-grade students. This article describes the results of the pilot study to test the feasibility of two interventions and test the measures to be used in the main trial. METHODS: The pilot study was conducted in one school with third-grade students and their parents or guardians. The Junior Master Gardner (JMG) and Walk Across Texas (WAT) interventions were implemented over a 5-month period in three third-grade classrooms during spring 2012. The respective interventions focused on improving healthy eating and PA behaviors of children and their families. Baseline and immediate post-test data were collected from students and parents/guardians to measure four child, four parent, and four parent-child interaction behaviors. Process data regarding implementation were also collected from teachers and school administration. RESULTS: Forty-four students and 34 parents or guardians provided both pre- and post-test data. Paired-sample t-tests showed statistically significant changes in student knowledge, vegetable preferences, vegetable consumption, and home food availability (all p < 0.05). At baseline, participants' weight status categories included 57% obese, 10% overweight, and 31% normal weight. Postintervention, weight status categories included 39% obese, 16% overweight, and normal 45%. Data collected from teachers indicated high levels of implementation fidelity. CONCLUSIONS: Implementation of both interventions occurred at a very high fidelity level, which led to positive changes in BMI status, and several dietary and PA behaviors. Although the pilot study indicated feasibility of the two interventions for school implementation, results guided revisions to the TGEG program and its survey instruments.

Nursing Knowledge: Big Data Science-Implications for Nurse Leaders.

The integration of Big Data from electronic health records and other information systems within and across health care enterprises provides an opportunity to develop actionable predictive models that can increase the confidence of nursing leaders' decisions to improve patient outcomes and safety and control costs. As health care shifts to the community, mobile health applications add to the Big Data available. There is an evolving national action plan that includes nursing data in Big Data science, spearheaded by the University of Minnesota School of Nursing. For the past 3 years, diverse stakeholders from practice, industry, education, research, and professional organizations have collaborated through the "Nursing Knowledge: Big Data Science" conferences to create and act on recommendations for inclusion of nursing data, integrated with patient-generated, interprofessional, and contextual data. It is critical for nursing leaders to understand the value of Big Data science and the ways to standardize data and workflow processes to take advantage of newer cutting edge analytics to support analytic methods to control costs and improve patient quality and safety.

A national action plan for sharable and comparable nursing data to support practice and translational research for transforming health care.

BACKGROUND: There is wide recognition that, with the rapid implementation of electronic health records (EHRs), large data sets are available for research. However, essential standardized nursing data are seldom integrated into EHRs and clinical data repositories. There are many diverse activities that exist to implement standardized nursing languages in EHRs; however, these activities are not coordinated, resulting in duplicate efforts rather than building a shared learning environment and resources. OBJECTIVE: The purpose of this paper is to describe the historical context of nursing terminologies, challenges to the use of nursing data for purposes other than documentation of care, and a national action plan for implementing and using sharable and comparable nursing data for quality reporting and translational research. METHODS: In 2013 and 2014, the University of Minnesota School of Nursing hosted a diverse group of nurses to participate in the Nursing Knowledge: Big Data and Science to Transform Health Care consensus conferences. This consensus conference was held to develop a national action plan and harmonize existing and new efforts of multiple individuals and organizations to expedite integration of standardized nursing data within EHRs and ensure their availability in clinical data repositories for secondary use. This harmonization will address the implementation of standardized nursing terminologies and subsequent access to and use of clinical nursing data. CONCLUSION: Foundational to integrating nursing data into clinical data repositories for big data and science, is the implementation of standardized nursing terminologies, common data models, and information structures within EHRs. The 2014 National Action Plan for Sharable and Comparable Nursing Data for Transforming Health and Healthcare builds on and leverages existing, but separate long standing efforts of many individuals and organizations. The plan is action focused, with accountability for coordinating and tracking progress designated.

Ambient Findability: Developing a Flowsheet Ontology for i2B2.

The process of moving from the locally defined flowsheet ontology containing redundancy and jargon to one understandable by researchers is described. Over 250 million nursing flowsheet observations were imported into a data repository that uses the i2b2 framework. Focus groups were used to derive a new ontology model--18 templates were identified. One hundred measures, 50% of all patient observations over 36 months, were encoded in SNOMED CT(©). 78% of the concepts were mapped.

Development of the nursing problem list subset of SNOMED CT®.

OBJECTIVE: To create an interoperable set of nursing diagnoses for use in the patient problem list in the EHR to support interoperability. DESIGN: Queries for nursing diagnostic concepts were executed against the UMLS Metathesaurus to retrieve all nursing diagnoses across four nursing terminologies where the concept was also represented in SNOMED CT. A candidate data set was retrieved and included the nursing diagnoses and corresponding SNOMED CT concepts from the UMLS Metathesaurus. The team members identified the concepts that met the semantic selection criteria for inclusion in the nursing problem list. RESULTS: 1320 concepts were returned in the initial UMLS Metathesaurus query of nursing diagnostic concepts. Further analysis was conducted to identify those nursing diagnostic concepts mapped to SNOMED CT and duplicate concepts were removed resulting in 591 unique UMLS Metathesaurus concepts. The query extracted all concepts from two of the nursing terminologies that contained interventions and outcomes. After cleaning the dataset, the final count of SNOMED CT concepts in the nursing problem list subset is 369. CONCLUSIONS: The problem list is a key component of the patient care and has been acknowledged as critical by the EHR Meaningful Use criteria. Nursing diagnoses on the problem list are foundational for constructing a nursing care plan. A multidisciplinary patient problem list will facilitate communication and evaluation of the contribution of nursing care to the patient's clinical care experiences and outcomes.

Expressing observations from electronic medical record flowsheets in an i2b2 based clinical data repository to support research and quality improvement.

While nursing documentation in electronic medical record (EMR) flowsheets may represent the largest investment of clinician time with information systems, organizations lack tools to visualize and repurpose this data for research and quality improvement. Incorporating flowsheet documentation into a clinical data repository and methods to reduce the flowsheet ontology's redundancy are described. 411 million flowsheet observations, derived from an EMR predominantly used in inpatient, outpatient oncology, and emergency room settings, were incorporated into a repository using the i2b2 framework. The local flowsheet ontology contained 720 "templates" employing 5,379 groups (2,678 distinct), 37,836 measures (13,659 distinct) containing 226,666 choices for a total size of 270,641. Aggressive pruning and clustering resulted in 150 templates, 743 groups (615 distinct), 6,950 measures (4,066 distinct) with 22,497 choices, and size of 30,371. Making nursing data accessible within i2b2 provides a new perspective for contributing clinical organizations and heightens collaboration between the academic and clinical activities.

Quality and safety education for advanced nursing practice.

The Quality and Safety Education for Nurses (QSEN) project is a national initiative to transform nursing education to integrate quality and safety competencies. This article describes a two-year process to generate educational objectives related to quality and safety competency development in graduate programs that prepare advanced practice nurses in clinical roles. Knowledge, skills, and attitudes for each of 6 competencies are proposed to stimulate development of teaching strategies in programs preparing the next generation of advanced practice nurses.

Educating a health terminologist.

An overview of competencies and suggestions for educating healthcare terminologists is presented. This new role in healthcare informatics requires formal and informal education that pays particular attention to the adult learner. Knowledge of terminology and informatics standards development is critical, as well as knowledge about the use of terminology management servers.

Creating experiential learning activities using Web 2.0 tools and technologies: a case study.

Learning is no longer an internal individual activity but occurs through networks and connections. The aim of this project was to teach online health informatics students to use Web 2.0 tools and technologies to form networks and connections through experiential learning assignments. Web 2.0 tools and technologies were evaluated using a criteria checklist prior to implementation for students enrolled in health informatics classes at the University of Kansas School of Nursing. Health informatics students have developed competencies using an instant message service, blogging, concept mapping, social bookmarking, and interacting a virtual environment. In the future, health care professionals will have to work in rapidly changing environments and keep abreast of new innovations and tools, learn to use those tools, and to teach others about the tools.

Second life: not your conventional simulation.

Second Life is a massive, multiuser, virtual environment. The University of Kansas School of Nursing has introduced SL into the health informatics curriculum as a virtual environment for students and faculty to interact and communicate. Students have successfully completed course activities in SL. Informatics faculty continue to develop simulations in SL.

Visualizing simulated learning experiences through the use of informatics tools.

High-fidelity simulation technology is a growing educational technology. Designing effective simulations requires the use of informatics tools such as UML modeling. This poster demonstrates the steps in modeling a simulation exercise.

Using a modified electronic health record to develop nursing process skills.

In our study, we described the experiences and behaviors of beginning nursing students learning the nursing process using a modified electronic health record. Eight students led by an experienced nursing instructor from a midwestern university comprised the criterion purposive sample. Data were obtained from observations of the group, interviews with students and the teacher, and evaluation of care plans that were generated using the technology. Two foundational themes were identified through qualitative content analysis: Techno-Savvy Students and Teacher, Simulated Technology, and Data-Rich Case Studies--a valuable hybrid "SEED" for learning. Seeing, Hearing, and Doing--a catalyst for application and spontaneous interaction. The concluding theme emerged: Honing the Data Gatherer and Data User Roles with a Modified Electronic Health Record--an authentic, learner-centered experience. Further study is needed to measure learning outcomes with similar technology-based, learner-centered activities.