Palliative Care Practices and Knowledge of Home Care Nurses in Saudi Arabia: A Cross-Sectional Study.

Palliative Care (PC) is an interdisciplinary specialty focused on relieving symptoms and optimizing quality of life for people living with serious illnesses and their families. A great need for PC exists in Saudi Arabia due to its aging population and prevalence of cancer and other chronic diseases. Home healthcare can make PC more accessible to patients, but clinicians must be equipped with the PC knowledge and skills to perform their roles. This study was a descriptive, correlational examination of PC practices and knowledge of home care nurses recruited from military hospitals in Saudi Arabia. We surveyed participants using the Palliative Care Quiz for Nursing (PCQN) and the Modified Global Home Health Nursing Care Assessment Questionnaire. The mean PCQN score was 8.40, indicating low levels of PC knowledge. A nurses' demographic and physical, spiritual, religious, cultural, linguistic, ethical, and legal aspects of care revealed significant associations. Given the low levels of PC knowledge and skills, we recommend focusing on education, training, and research. Universities should review their curriculum to ensure PC content. Hospitals should provide training programs focused on all aspects of PC, specifically emotional and spiritual, without limiting training to physical aspects of care. Future research is also needed to inform policy in this area.

Centering diversity, equity, and inclusion in a regional professional nursing organization.

BACKGROUND: Professional nursing organizations can respond to threats to social justice by strengthening structures to support diversity, equity, and inclusion (DEI). PURPOSE: Describe implementation strategies and outcomes to advance DEI from the Western Institute of Nursing (WIN). METHODS: In 2019, WIN committed to prioritizing DEI by updating its vision and mission. A taskforce was assembled to conduct member surveys, focus groups, and open forums to generate recommendations on developing and implementing organizational change. DISCUSSION: These initiatives culminated in centralized efforts that include the formation of a standing committee, ongoing member surveys, selection of diverse conference topics and speakers, adoption of inclusive practices, and ongoing assessments to make recommendations to the Board to advance DEI. CONCLUSION: The work of the Committee ensures the organization remains committed to DEI. These strategies inform other nursing organizations as they advance DEI to impact research, education, policy, and practice.

Reflections on the Process of Implementing Trauma-Informed Education Lunch and Learns.

BACKGROUND: The trauma-informed education (TIE) framework can help create an equitable learning environment supportive of all learners. PROBLEM: Stress and trauma can be impediments to academic success for students, particularly from backgrounds historically excluded from nursing. APPROACH: This article shares the initial steps of a training program on implementing a series of Lunch and Learns (LLs) on TIE in a school of nursing to introduce TIE to faculty and staff and obtain their feedback on facilitators and barriers to implementing recommended approaches. OUTCOMES: The series was well attended, averaging 33 participants per session. Using experts in TIE positively impacted the learning but contributed to inconsistencies in presentation style and scaffolding of content across sessions. CONCLUSION: Purposeful recruitment and engagement of faculty during the development of the LLs were effective in increasing attendance. Multiple sessions require early planning and meetings with team and presenters to ensure consistency and better use of resources.

Supporting an Inclusive Environment Through Correct Name Pronunciation.

BACKGROUND: The Future of Nursing 2020-2030 Report recommends eliminating practices within nursing education that contribute to racism and discrimination. PROBLEM: Name mispronunciation has been identified as a microaggression that can interfere with an inclusive learning environment and a sense of belonging. APPROACH: The faculty development approach used a TEDx talk of a story about personal naming, followed by a discussion on appropriate and inappropriate responses to name mispronunciation. Tools and strategies to promote correct name pronunciation were shared. OUTCOMES: Participants reported (1) the training and video were meaningful and impactful; (2) increased understanding that name mispronunciation may be considered a microaggression; and (3) increased awareness of their response to correct name pronunciation. CONCLUSIONS: A just and equitable learning environment free of discrimination is integral to achieving inclusion and belonging in nursing education. Correct name pronunciation tools and techniques can engender a sense of inclusion.

Oregon PRAMS 2012-2018: Revealing racial inequity in postpartum depression.

Researchers have suggested that some women are undiagnosed and untreated for postpartum depression (PPD). However, there are mixed findings of the factors most likely to predict those most at risk. Recognizing historical racial and ethnic disparities existing in health outcomes, we sought to determine the extent of PPD inequity in Oregon. Using data from the Oregon pregnancy risk assessment monitoring system 2012-2018 and univariate weighted logistic regression models, we explored the relationship between PPD, maternal characteristics, and social variables. These variables included race/ethnicity, social support, life stressors, financial security, and perceived healthcare discrimination. A further phased analysis examined whether race/ethnicity remained a predictor of PPD when combined with other significant variables. Over 8000 respondents were included in the full phased analysis. Almost 17% of women reported they did not discuss depression with a provider during pregnancy, including over 12% who reported PPD symptoms. Black, Asian/Pacific Islander (API), American-Indian, and mixed race mothers had increased odds of PPD compared to White women (odds ratio ranged from 1.55 to 1.87). Less than baccalaureate education, lack of social support, and perceived healthcare discrimination also increased the odds of PPD. The phased analysis showed that significant differences in odds of PPD symptoms remained between Black, APIs, and American-Indian mothers compared to White mothers. Our analysis suggests that race is an important predictor of PPD. The knowledge of who is most at risk, and the provision of adequate assessment and screening, is of fundamental importance in today's society.

Minimizing Unconscious Bias in Nursing School Admission.

BACKGROUND: The potential exists for unconscious bias to influence decisions throughout the admission process to nursing school and derail holistic admission review processes. Although little is known about unconscious bias in nursing school admissions, unconscious bias has been demonstrated in nurse educators at levels similar to the general population. METHOD: This article examines concepts of unconscious bias, factors that may interfere with accurate and fair assessment of applicants to nursing school, and ways to mitigate unconscious bias in the application and admission decision processes. RESULTS: Interventions that have shown success in reducing unconscious bias center on increased awareness of the presence of unconscious bias and cognitive strategies that include motivation and effort to counter the unconscious bias. CONCLUSION: Creating structures in the admission process that promote fairness and reduce the risk of relying on automatic judgments can minimize the influence of unconscious bias on admission decisions. [J Nurs Educ. 2021;60(6):317-323.].

Nursing workforce diversity: Promising educational practices.

BACKGROUND: Nursing workforce diversity is a national priority for providing culturally competent care and contributing to improved health equity. While nurses from underrepresented populations are increasing in the nursing workforce, the distribution of nurses in the United States is still not representative of the population. PURPOSE: The purpose of this paper is to describe the current state of workforce diversity in Western states and identify promising practices from programs located in Arizona, California, Colorado, and Oregon that are focused on improving nursing workforce diversity. METHODS: Four innovative programs to address nursing workforce diversity are presented. Each project has unique situations and approaches to improving admission, retention, and graduation of students underrepresented in nursing. Similar approaches each project used include holistic admission review, academic and student support, financial support, and mentoring. CONCLUSIONS: These projects contribute to knowledge development related to improving nursing workforce diversity for other colleges, universities, and states to consider. Improving nursing workforce diversity is a priority issue that could lead, through collective impact, to resolving health inequities nationally.

Postpartum depression screening in the first year: A cross-sectional provider analysis in Oregon.

BACKGROUND AND PURPOSE: Postpartum depression (PPD) has significant sequelae for mother and child. To aid diagnosis, PPD screening should continue throughout the postpartum year. In primary care, there may be a lack of consistency in how screening is applied. In Oregon, with a reported PPD rate of 18.2%, it is important to determine whether screening is reaching all women. The purpose of this study was to explore primary care provider screening practices in the postpartum year and determine if there are barriers to meeting PPD guidelines. METHODS: A descriptive, cross-sectional survey was conducted with primary care providers in Oregon. Data were sought on screening practices and timing, as well as potential barriers. To aid comparison, screening was compared against both the American Academy of Pediatrics (AAP) and National Association of Pediatric Nurse Practitioner (NAPNAP)/US Preventative Services Task Force guidelines. Data were analyzed using R statistical computing and Pearson chi-square tests. RESULTS: Of the 55 respondents, 29% followed the AAP recommendations and screened at well-child visits; 64% followed the NAPNAP recommendations and screened at least once in the postpartum year; and 31% did not meet any screening guidelines. The most common screening barriers were limited knowledge and/or availability of referral services. Physicians were more likely to meet any recommended guidelines than nurse practitioners (NPs) (p = .023). IMPLICATIONS FOR PRACTICE: A notable number of women may not be receiving PPD screening. It is concerning that most of those not screening were NPs, given the focus of their practice on disease prevention and health management. Further research is warranted to confirm whether women are missing opportunities for early intervention and whether strategies can be established to standardize the approach in primary care.

Enhancing Student Engagement: Innovative Strategies for Intentional Learning.

AIM: This paper presents four innovative teaching modalities conceptually designed and adherent to National Survey of Student Engagement (NSSE) indicators. BACKGROUND: Nurse education has received 'calls' for transformation, demanding a pedagogical refocus that better equips the future workforce. A key aspect is the need to actively engage students in learning, an approach shown to improve outcomes. METHOD: Four innovative teaching modalities were incorporated into a baccalaureate curriculum, aligned to the NSSE indicators, and targeted an area of the curriculum where active student participation had the potential to improve the learning experience. RESULTS: The four modalities: Theater of the Oppressed; Simulation as a Clinical Site for Active Engagement; Legal Simulation; and Creating Student Researchers were introduced at key stages in the curriculum and covered sophomore to senior levels. CONCLUSION: NSSE can be utilized to provide a robust framework on which to plan and deliver educational opportunities that support meaningful, student-centered participation.

Pharmacist and student pharmacist perspectives on providing preconception care in the United States.

OBJECTIVES: The primary objective was to assess pharmacist and student pharmacist current involvement and interest in providing preconception care services. Secondary objectives were to assess comfort in providing these services to various subpopulations in addition to training and resource needs. METHODS: A cross-sectional online survey was conducted in the United States and its territories from August 26 to October 14, 2016. Pharmacists and student pharmacists were recruited via a Facebook advertisement to participate in a self-administered survey assessing experiences, interest, and comfort in providing preconception care services in addition to training and resource needs. RESULTS: Three hundred thirty-two responses were included in the final analysis from the United States and its territories. Most respondents were female (72%) and pharmacists (65%). Respondents reported providing preconception care services, from routine immunizations (54%) to sexually transmitted disease (STD) and HIV screening and management (13%). Respondents also expressed strongest interest in providing new services for STD and HIV screening and management (68%) and minimizing risk of medication teratogenicity (62%). Respondents were most comfortable providing services to female adults (88%) and female adolescents (65%) compared with male adults (61%) and male adolescents (32%). Respondents indicated that tools, such as patient medical records (67%), patient educational materials (66%), and clinical guidelines (60%), would facilitate adoption of preconception care services. CONCLUSION: This study provides the first insights on the involvement, interest, and comfort of pharmacists and student pharmacists in the United States and its territories related to preconception care. Most respondents indicated that they are currently providing or are interested in providing preconception care services. Tools and resources should be developed to facilitate pharmacist provision of preconception care services.

Eating Behaviors, Weight Bias, and Psychological Functioning in Multi-ethnic Low-income Adolescents.

PURPOSE: The purposes of this study were to: 1) Describe the incidence of disordered eating, weight bias, body dissatisfaction, and psychological distress, 2) Examine the relationship between sociodemographic variables (gender, ethnicity, and income) and disordered eating, weight bias, body dissatisfaction, and psychological distress in a sample of low-income adolescents. DESIGN AND METHODS: A cross-sectional study was conducted with 105 adolescents from low-income neighborhoods. Participants completed self-report questionnaires to assess eating behaviors, weight bias, body dissatisfaction, and psychological functioning. Height and weight were measured, and information on household income was collected. RESULTS: The participant's mean age was 16.31 (SD=2.8) years, 66% female, 47% Hispanic, and 46% African American. The mean annual income was $17,018 (SD=11,355). Twenty-eight percent self-reported having some form of disordered eating, and 15% reported an eating disorder. The group with eating disorder reported the highest levels of weight bias (M=93.4, SD=109.6), body dissatisfaction (M=94.6, SD=47.6), and psychological distress (M=1.4, SD=0.97). CONCLUSION: This study found a high prevalence of eating disorders with eating disorder participants experiencing the highest levels of weight bias and psychological distress. Future studies are needed to identify and evaluate community and school-based interventions to minimize weight bias and disordered eating. PRACTICE IMPLICATIONS: Nurses are at the forefront of healthcare and should collaborate with educators, school counselors, administrators, coaches, parents, and students, to address weight bias and disordered eating in schools by implementing school-based curriculum and policies.

Advancing Health Equity Through Student Empowerment and Professional Success: A Statewide Approach.

BACKGROUND: A lack of diversity in the nursing workforce nationally has been identified by Oregon state leaders as a factor contributing to health inequity. METHOD: The goal of Advancing Health Equity Through Student Empowerment and Professional Success (HealthE STEPS) is to graduate nursing students from disadvantaged backgrounds to improve health equity within their communities. A comprehensive plan of evidence-based strategies was developed based on social determinants of health and addresses academic socialization, learning support, financial resources, networking, curriculum development, and campus culture. RESULTS: Ninety undergraduate nursing students participated in the program during a 2-year period. Retention of participants was 97% with graduation rates of 94%. First-time licensure pass rates were 82% and 96% of participating graduates employed in a medically underserved community. CONCLUSION: This comprehensive innovative program of evidence-based strategies addresses health equity by developing a diverse nursing workforce to practice in medically underserved communities. [J Nurs Educ. 2016;55(6):316-322.].

Nursing students' experiences with high-fidelity simulation.

Research has revealed the effectiveness of simulation for facilitating student development of self-efficacy, knowledge, clinical judgment, and proficiency in technical skills. This grounded theory study was conducted to describe the experience of nursing students in high-fidelity simulation and develop a model which explicates the experience of nursing students in simulation. Focus group interviews were conducted with three cohorts of students enrolled in a baccalaureate nursing program who experienced simulation four to twelve times per academic year. Five prominent themes emerged during analysis Emotional Processing; Anxiety; Making Connections; Fidelity; and Learning. The Simulation Learning Model - Student Experience (SLM-SE) was developed to illustrate the student's multi-dimensional experience of learning through high-fidelity simulation. Findings from this study suggest that students are better equipped to learn through increasing confidence and experience, continued reflection-on action and enhanced peer-to-peer interaction. Recommendations for future research include developing strategies to optimize students' experiences for learning in simulation.