Stoicism and Cognitive Strategies for Nursing Professional Development.

BACKGROUND: Nurse educators are experiencing a vocational crisis, and the unsustainable rate at which nurses are leaving the profession impacts the health of the nation. Nurse educators, including academic and professional development faculty and preceptors, need skills to manage the complex academic and clinical environments. This article describes the development of a course for nurse educators and preceptors around Stoicism and cognitive strategies, describes the perceived takeaways of one group of learners who experienced the course, and offers recommendations for the use of this content. METHOD: This course was evaluated with survey data from 23 nurse educators for demographic information and use of strategies after an educational course. RESULTS: Participants identified several specific takeaways from the training that could be incorporated into their personal, teaching, and clinical practices. Themes included emotional regulation, using the cognitive triangle, and managing stress in emotionally charged situations with patients and colleagues through creating a healthy emotional distance to better evaluate situations. CONCLUSION: Stoicism and cognitive strategies are important additions to nurse educator personal and professional development. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Mobile App Use in Adults with Comorbid Type 2 Diabetes and Depression.

The purpose of this preliminary study was to determine smartphone usage, expressed level of interest, and intent to use mHealth apps among adults with comorbid type 2 diabetes (T2D) and depression. A convenience sample of adults (N=35) completed a Demographic and Mobile App Survey and the CESD-R-10. A majority reported using mobile apps (n=23, 65.7%) and felt comfortable or very comfortable using mobile apps (n=14, 46.7%). However, few respondents used a health app (n=6, 17.1%) or a diabetes-specific app for diabetes management (n=3, 8.6%). Adjusted, age and education were the two variables that independently impacted app use; those aged less than 55 years as well as those with a graduate degree were more likely to use apps. Being younger and having an advanced degree increased the odds of using a diabetes-specific app. The findings suggest that adults with T2D are amenable to using mHealth apps to manage diabetes.

The Relationship Between Culture of Safety and Rate of Adverse Events in Long-Term Care Facilities.

OBJECTIVE: The aim of the study was to assess the relationship of culture of safety dimensions and the rate of unanticipated care outcomes in long-term care facilities (LTCFs) using the Agency for Healthcare Research and Quality framework of resident safety culture. METHODS: Cross-sectional survey data were collected on 13 dimensions of culture of safety in five LTCFs from registered nurses, licensed practical nurses (LPNs), nursing assistants, administrators/managers, administrative support, and rehabilitation staff. Secondary data on falls in the five LTCFs from quarters 1 to 3 of 2014 were obtained from the Centers for Medicare and Medicaid Services in February 2015. Spearman's ρ and the Generalized Estimating Equations using a log link (Poisson distribution) were used. RESULTS: Communication and feedback about incidences reported the highest mean scores (M = 4.35, SD =0.71). Higher rate of falls was associated with a lower level of team work, lower degree of handoffs, and lower levels of organizational learning. The risk for falls increased as the number of residents per facility increased (rate ratio [RR] = 1.02; 95% confidence interval [CI] = 1.01-1.02) and as the number of LPN hours per resident increased (RR = 37.7, 95% CI = 18.5-76.50). Risk for long stay urinary tract infections increased as number of residents increased (RR =1.01, 95% CI =1.01-1.01). Increase in culture of safety score was associated with decrease in risk of falls, long stay urinary tract infections, and short stay ulcers. CONCLUSIONS: With the shortage of registered nurses in LTCFs and new reimbursement regulations, many LTCFs are hiring LPNs to have full staffing and save money. Licensed practical nurses may lack essential knowledge to decrease the rate of falls.

Initiating Telephone Follow Up After Hospital Discharge From an Inpatient Psychiatric Setting to Reduce Recidivism.

The purpose of the current evidence-based practice (EBP) project was to reduce recidivism in patients with depression after acute psychiatric hospital discharge through implementation of telephone follow up. Eight patients (intervention group) were called within 72 hours of discharge to reinforce discharge instructions and administer the Patient Health Questionnaire-9 (PHQ-9). The results were compared to 16 patients (control group) who were discharged during the same timeframe 1 year prior. The findings from the control group revealed one (6.25%) patient was readmitted and three (18.75%) patients visited the emergency department (ED) within 30 days of discharge. No one in the intervention group was readmitted or visited the ED within 30 days post discharge. Statistically significant differences were not detected in discharge telephone call status (received or did not receive) and readmissions (p = 1.000) and ED visits (p = 0.526). For six patients in the intervention group, the mean PHQ-9 score was 3.3, which was within a depression severity of none to minimal. This quality improvement project helped address patient lack of knowledge related to discharge instructions after being discharged from the hospital to home. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 25-31.].

Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider.

Health care providers (HCPs) face many obstacles as they undertake efforts to meet the challenges of caring for African American patients with comorbid diabetes and depression. This review article discusses the incidence of comorbid diabetes and depression in African Americans, cultural factors affecting diabetes self-management, and clinical practice implications for the HCP. The role of patient-centered care, engagement, and best-practice strategies are discussed to provide the HCP with guidelines regarding the minimal standards that support improved health care outcomes for African Americans with comorbid diabetes and depression.

Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis.

This article examines role stress, key psychosocial variables, and well-being in adults recently diagnosed with rheumatoid arthritis. Patients recently diagnosed with rheumatoid arthritis must often learn to balance disease and role-related responsibilities. This was cross-sectional, descriptive study ( N = 80). Data were analyzed using correlation coefficients and linear regression models. Participants were predominantly female (78%), married, and employed. Mean age and disease duration were 54.2 years and 24.2 months, respectively. The findings suggest that well-being is influenced by feelings of being self-efficacious and having balance in their roles and less to do with social support received from others.

An organizational process for promoting home fire safety in two community settings.

The purpose of this study was to describe the home fire safety quality improvement model designed to aid organizations in achieving institutional program goals. The home fire safety model was developed from community-based participatory research (CBPR) applying training-the-trainer methods and is illustrated by an institutional case study. The model is applicable to other types of organizations to improve home fire safety in vulnerable populations. Utilizing the education model leaves trained employees with guided experience to build upon, adapt, and modify the home fire safety intervention to more effectively serve their clientele, promote safety, and meet organizational objectives.

Geographic Mapping as a Tool for Identifying Communities at High Risk for Fires.

The purpose of this study was to evaluate whether the sample of older adults in a home fire safety (HFS) study captured participants living in the areas at highest risk for fire occurrence. The secondary aim was to identify high risk areas to focus future HFS interventions. Geographic information systems software was used to identify census tracts where study participants resided. Census data for these tracts were compared with participant data based on seven risk factors (ie, age greater than 65 years, nonwhite race, below high school education, low socioeconomic status, rented housing, year home built, home value) previously identified in a fire risk model. The distribution of participants and census tracts among risk categories determined how well higher risk census tracts were sampled. Of the 46 census tracts where the HFS intervention was implemented, 78% (n = 36) were identified as high or severe risk according to the fire risk model. Study participants' means for median annual family income (P < .0001) and median home value (P < .0001) were significantly lower than the census tract means (n = 46), indicating participants were at higher risk of fire occurrence. Of the 92 census tracts identified as high or severe risk in the entire county, the study intervention was implemented in 39% (n = 36), indicating 56 census tracts as potential areas for future HFS interventions. The Geographic information system-based fire risk model is an underutilized but important tool for practice that allows community agencies to develop, plan, and evaluate their outreach efforts and ensure the most effective use of scarce resources.

Development of a Fire Risk Model to Identify Areas of Increased Potential for Fire Occurrences.

The purposes of this study were to use geographic information systems to create a cartographic risk model predicting areas of increased potential for fire occurrences and to validate the model. Seven literature-identified risk factors associated with burn injury were older than 65 years, non-white race, below high school education, low socioeconomic status, rented housing, year home built, and home value. Geographic information system methods were used in risk factor model development. Model validation occurred using residential county fire dispatch data and statistical analysis. Areas of high and severe risk were primarily located in the northwestern and central county regions. A strong correlation (r = .66) was found between risk model scores and fire incidence rates. Significant differences in mean fire rates by risk category (F (187,3) = 87.58, P < .0001) were found, with the exception of the low and medium risk categories. Fire incidence rates among census tracts showed positive spatial autocorrelation (Moran's I = 0.542, P < .0001) producing a map showing a significant cluster of high fire incidence in the northwestern region. The risk model has potential to lead to more targeted and effective fire prevention education programs. Such models would allow fire departments to focus limited resources in areas of highest fire risk.

Intervention study for changes in home fire safety knowledge in urban older adults.

Older adults are more likely to experience problems that contribute to an increase in burn-related morbidity and mortality. The purpose of the current study was to determine if the educational home fire safety (HFS) intervention was an effective method of improving HFS knowledge over time in two groups of urban older adults, home bound and community-based. HFS knowledge of 110 urban older adults was assessed at baseline, immediately after watching a HFS DVD (recall), and at 2-week follow-up (retention). The United States Fire Administration Home Safety Checklist which examines HFS practices in the home was also administered. HFS knowledge scores significantly increased over time for both groups (p<0.0001), but no significant differences existed between the two groups over time (p=0.183). In addition, HFS knowledge scores were significantly impacted by the number of chronic illnesses, number of independent activities of daily living, and income. The findings from this study suggest the educational HFS intervention was effective in increasing urban older adults' HFS knowledge over time. Lowering the burns morbidity and mortality in the older adult population is an important public health concern that needs to be addressed through tailored prevention and education strategies.

Home fire safety beliefs and practices in homes of urban older adults.

The purpose of this study is to examine factors influencing urban older adults and develop a thematic analysis of how these factors affect seniors' home fire safety (HFS) beliefs and practices. This was a focused ethnography using participant observation and semi-structured interviews. Additionally, public housing records, cognitive functioning, and general health status were assessed. Individual interviews were transcribed verbatim using a constant comparative analysis. Eight seniors participated in the study. Two main themes described older adults' HFS while aging in place: the risk associated with the living environment and the journey associated with maintaining independence. All participants experienced HFS challenges such as limited mobility and financial constraints. Participants' general health and cognitive status additionally influenced their ability to maintain HFS. The findings suggest that urban seniors may have diverse HFS environment risks compared with the general population, highlighting the need for older adult focused HFS interventions.

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

PURPOSE: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. DESIGN AND METHODS: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. FINDINGS: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. CONCLUSIONS: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. CLINICAL RELEVANCE: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.

Patient-centered hand hygiene: the next step in infection prevention.

Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients' flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs.

A review of documented oral care practices in an intensive care unit.

Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31, 2007. Data were analyzed using bivariate and multivariate analyses to determine the variables related to patients receiving oral care. Frequency of oral care documentation was found to be performed, on average, every 3.17 to 3.51 hr with a range of 1 to 8 hr suggesting inconsistencies in nursing practice. This study found that although oral care is a Center for Disease Control and Prevention (CDC) recommendation for the prevention of hospital-associated infections like ventilator-associated pneumonia (VAP), indication of documentation of the specifics are lacking in the patients' medical record.

Problematic social support, family functioning, and subjective well-being in women with rheumatoid arthritis.

The purpose of this study was to examine the relationship of problematic social support and family functioning to measures of subjective well-being in a sample of women with rheumatoid arthritis. Seventy-three women with rheumatoid arthritis completed questionnaires that assessed problematic support (i.e., negative support, unavailability of emotional support), family functioning, and subjective well-being (i.e., life satisfaction and the absence of negative affect or depressive symptoms). Pearson product moment correlation coefficients and hierarchical multivariable regression analyses were conducted. The latter analyses controlled for age, length of time since diagnosis, education, income, pain and fatigue-two prominent symptoms of rheumatoid arthritis. The two measures of problematic support were significantly inversely related to family functioning (p < 0.01 and p < 0.001) and life satisfaction (p = 0.02 and p < 0.001), but were not significantly related to each other. Family functioning was positively related to life satisfaction (p < 0.001) and inversely related to negative affect (p < 0.001) and depressive symptoms (p < 0.001). In multiple regression analyses higher symptom severity, greater problematic support, and lower family functioning were associated with depressive symptoms (p < 0.001) and negative affect (p < 0.001), while higher family functioning and a decrease in symptom severity were associated with life satisfaction (p < 0.001), above and beyond demographic variables and length of time since diagnosis. Subjective well-being in women with rheumatoid arthritis is related to perceptions of family functioning and the amount and type of support received from others, above and beyond the pain and fatigue that characterizes rheumatoid arthritis and is negatively associated with well-being.

Roles and well-being among healthy women and women with rheumatoid arthritis.

AIM: This paper is a report of a study examining the relationships among number of roles, role quality, role stress, role balance, and psychological well-being in women diagnosed with rheumatoid arthritis. BACKGROUND: A substantial literature exists examining multiple roles in healthy women. However, less is known about multiple roles and well-being in women with a chronic illness such as rheumatoid arthritis. METHODS: A questionnaire study was conducted in 2003 examining four role-related constructs (number of roles, quality of roles, role stress, and role balance) and psychological well-being in healthy women (n = 47) and women diagnosed with rheumatoid arthritis (n = 50). Correlation coefficients and multiple regression analyses were calculated to determine the nature of the relationships among the variables. FINDINGS: The two groups were similar in demographics except for employment, with fewer women with rheumatoid arthritis employed. The two groups differed statistically significantly on psychological well-being. Women with rheumatoid arthritis had a lower mean psychological well-being score than healthy women. Regression analyses revealed that role stress was the only unique predictor of psychological well-being in healthy women, while role balance was the sole unique predictor among women with rheumatoid arthritis. CONCLUSION: Women with rheumatoid arthritis experienced lower levels of well-being than their healthy counterparts. Examination of the relationships among the variables can facilitate the development of interventions to improve these women's mental health. Nurses are in a position to assess the psychosocial needs of women with rheumatoid arthritis and assist those experiencing role stress and role imbalance.

Prenatal and postpartum focus groups with primiparas: breastfeeding attitudes, support, barriers, self-efficacy, and intention.

INTRODUCTION: The purpose of this study was to explore women's prenatal attitudes, perception of support, anticipated barriers, facilitators, and breastfeeding self-efficacy beliefs and how their attitudes, beliefs, and perceptions of support changed as a result of their postpartum experiences. METHODS: A prospective, descriptive design with qualitative data collection methods was used for this study. Eight primiparas participated in prenatal and postpartum focus groups held in the conference room of a local school of nursing. One additional mother participated in individual interviews before and after giving birth at her request. RESULTS: In the prenatal groups, the major themes included beliefs that breastfeeding benefits both the mother and baby, availability of support, looking toward the future, and uncertainty about what to expect with breastfeeding. In the postpartum groups, the major themes centered around the realization that breastfeeding was both easy and difficult, the importance and role of supportive others, receiving conflicting advice, having validating experiences, and modifying breastfeeding intention based on postpartum experiences. DISCUSSION: Mothers need to be better educated for breastfeeding prenatally, and the information must be consistent, realistic, and evidence-based.