The role of nurses in surveillance to enhance global health security: A delphi study.

BACKGROUND: Internationally, nurses are gaining recognition for their contributions to public health and global health initiatives, however, their contributions to surveillance and the detection of new and emerging infectious disease, which is an important element of global health security, remain largely unknown. PURPOSE: The purpose of this study was to investigate the perceptions of nurse experts related to the current and optimal roles of nurses in surveillance of new and emerging infectious diseases. Additionally, this study aimed to identify the skills needed by nurses in all practice settings for optimal performance of surveillance and to identify barriers to achieving optimal performance of surveillance. METHODS: A three-round Delphi study was conducted. Nurse experts participated in Round 1 interviews followed by ranking current and optimal role, skill, and barrier statements in Rounds 2 and 3. FINDINGS: Findings revealed four current roles and 13 optimal roles for nurses in surveillance, 13 skills needed to perform surveillance activities, and seven barriers to optimal performance of surveillance activities by nurses. DISUCSSION: Results of this study are intended to inform nursing practice and education in the U.S., and to provide guidance on the role of nurses in surveillance of new and emerging infectious disease as part of the Global Health Security Agenda.

Nurse practitioners' experiences of polypharmacy in community-dwelling older adults.

BACKGROUND: Numerous studies have defined polypharmacy and its impact on health. The literature is also rich in studies documenting the benefits of care provided by nurse practitioners (NPs). A gap in research exists at the intersection of the value of NPs in caring for older adults and their management of polypharmacy. PURPOSE: Coinciding with growth in America's older adult population and the need for adequate care, the purpose of this study was to explore the experiences of NPs caring for community-dwelling older adults experiencing polypharmacy. METHODOLOGICAL ORIENTATION: A qualitative descriptive study was conducted. Interviews were conducted, and data were analyzed for themes. SAMPLE: This study was conducted using a purposive sampling of NPs who care for older adults (n = 15). CONCLUSIONS: Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of NPs in relation to polypharmacy, and medication issues of older adults. The themes depict the complexity of medication management in older adults and the important role of NPs in providing care to older adults. IMPLICATIONS FOR PRACTICE: The significance of the study findings to future practice includes improving communication and collaboration between prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires that NPs consider the unique needs of each older adult while using technology to support collaboration and decision making.

Nurse Graduates' Perceived Educational Needs After the Death of a Patient: A Descriptive Qualitative Research Study.

BACKGROUND: Nurse graduates (NGs) are ill prepared when faced with patient death and dying, despite receiving educational preparation on end-of-life (EOL) care in their prelicensure nursing programs. METHOD: This qualitative descriptive study included a convenience sample of NGs (n = 20) who experienced a first adult patient death during their first 18 months of practice at a large teaching hospital with an extensive NG transition program, including preceptor-guided orientations, nurse internship programs, and nurse residency programs. RESULTS: Six major themes described the NG experience: Navigating the Process, Not Prepared, Support, Missed Opportunities, Preparing NGs for Death and Dying, and Guiding NGs Through Practice. Critical gaps in preparation were evident across all themes. CONCLUSION: Results of this study suggest specific opportunities for improvement of NGs' readiness to effectively care for patients and families in EOL situations by increasing their exposure to death and dying experiences before graduation and during their first year of practice. [J Contin Educ Nurs. 2020;50(6):267-273.].

Parents' experiences using medical cannabis for their child.

BACKGROUND: Parents across the United States use medical cannabis for their children, often without professional guidance. These parents have become more expert on medical cannabis than most health professionals. PURPOSE: Using a case-study design, this study was conducted to describe the experience of parents using medical cannabis for relief of seizures in their child or dependent. METHODS: Data were subjected to qualitative content analysis for the identification of patterns and themes. FINDINGS: Analysis of all data revealed seven themes including "Discovery of Cannabis as a Medication," "Guidance on Dosing," "Costs and Benefits of Cannabis," "Distrust of the Pharmaceutical Industry," "Federal Interference," "God and Cannabis," and "Changing Societal Perceptions about Medical Cannabis." DISCUSSION: Themes revealed a complex, multifaceted experience. Many parents report benefit from medical cannabis, and are not hindered by the financial costs or uncertainties. Political and social influences have significant impact on the stigmatization and normalization of cannabis.

Leisure-time Physical Activity and Fruit and Vegetable Intake of Young Adult Millennials.

This study aimed to identify the prevalence of leisure-time physical activity (LTPA) and fruit and vegetable intake (FVI) behaviors and to examine relationships between biological, sociocultural, and psychological personal factors and these behaviors among young adult Millennials aged 20 years to 32 years. Descriptive and inferential statistics were performed on data from the 2013-2014 National Health and Nutrition Examination Survey. Of the 1,137 respondents, 47% met the recommendations for LTPA, and only 13% and 17% met the recommendations for intake of fruits and vegetables, respectively. Engagement in LTPA was associated with being male, race/ethnicity, and increased education and income. Obesity, measured by body mass index, and poor perceived health status were associated with not meeting the recommendations for LTPA. Increased education was associated with meeting the recommendations for vegetable intake. No other regression models were significant. These findings suggest contemporary young adults would benefit from health promotion efforts.

Challenges to Studying Illicit Drug Users.

PURPOSE: Throughout the world, illicit drug use continues to pose a significant risk to public health. The opioid crisis in North America, the diversion of the prescription drug tramadol throughout Africa, and the increasing supply of methamphetamines in East and South Asia all contribute to increasing risks to individual and societal health. Furthermore, the violation of human rights in efforts to enforce prohibitionist values poses significant threats to many individuals worldwide. With these evolving situations, it is imperative that researchers direct their attention to the various populations of illicit drug users. However, the inclusion of illicit drug users, often considered a vulnerable population, as participants in research studies presents several increased risks that must be addressed in study protocols. Researchers are required to provide "additional safeguards" to all study protocols involving illicit drug users, but there is often substantial variability and inconsistency in how these safeguards are applied. Additional safeguards can be timely, costly, and unduly burdensome for researchers, ethical review boards, and research participants. APPROACH: Through synthesis of the current literature, this article addresses the barriers to studying illicit drug users and the methods researchers can utilize to minimize risk. A case study is provided to illustrate the high level of scrutiny of study protocols involving the participation of illicit drug users and the effect of such scrutiny on recruitment of participants. The article concludes with a discussion of the effects of the current political climate on the recruitment of illicit drug users in research. CONCLUSIONS: Individuals who participate in criminal or illegal behaviors such as illicit drug use, prostitution, illegal entry into a country, and human trafficking are susceptible to multiple physical, mental, and social health risks, as well as criminal prosecution. The importance of research on the health of marginalized populations cannot be overstated. This work must continue, and at the same time, we must continue to protect these individuals to the best of our ability through diligent attention to sound research methods. CLINICAL RELEVANCE: The use of illicit drugs continues to pose a substantial threat to global health. Individuals who use illicit drugs are susceptible to multiple physical, mental, and social health risks, as well as criminal prosecution. It is imperative that researchers study these vulnerable populations in order to develop interventions to minimize individual and societal harm. There are several barriers to the study of illicit drug users that must be addressed through rigorous methodology and the addition of safeguards.

Supporting Transitions in Care for Older Adults With Type 2 Diabetes Mellitus and Obesity.

The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group (n = 35); an inpatient DSME only group (n = 100); and a group who received usual care (n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge. Rates of rehospitalization and A1C improved for older adults who received nurse-led inpatient DSME and homecare during transitions of care from hospital to home. Rehospitalization rates up to 90 days were decreased for the DSME plus homecare group (10%) compared to DSME only (20%) and usual care groups (26.7%) (p < 0.05). A decrease of -0.4 and -2.3 A1C units was observed for the DSME group and DSME plus homecare group, respectively, at 90 days. These results support a transitional care educational intervention for older adults with type 2 diabetes mellitus and obesity. TARGETS: Older adults with type 2 diabetes mellitus and obesity. INTERVENTION DESCRIPTION: Transitional care intervention including diabetes self-management education and homecare. MECHANISMS OF ACTION: Inpatient diabetes education and homecare helps improve rates of rehospitalization and hemoglobin A1C during care transitions from hospital to home. OUTCOMES: Rehospitalization rates, glycemic control (i.e., A1C level). [Res Gerontol Nurs. 2018; 11(2):71-81.].

Perceptions of academic administrators of the effect of involvement in doctoral programs on faculty members' research and work-life balance.

BACKGROUND: Support for research strongly predicts doctoral program faculty members' research productivity. Although academic administrators affect such support, their views of faculty members' use of support are unknown. PURPOSE: We examined academic administrators' perceptions of institutional support and their perceptions of the effects of teaching doctoral students on faculty members' scholarship productivity and work-life balance. METHODS: An online survey was completed by a random sample of 180 deans/directors of schools of nursing and doctoral programs directors. Data were analyzed with descriptive statistics, chi-square analysis, and analysis of variance. DISCUSSION: Deans and doctoral program directors viewed the level of productivity of program faculty as high to moderately high and unchanged since faculty started teaching doctoral students. Deans perceived better administrative research supports, productivity, and work-life balance of doctoral program faculty than did program directors. CONCLUSION: Findings indicate the need for greater administrative support for scholarship and mentoring given the changes in the composition of doctoral program faculty.

Nursing Doctoral Faculty Perceptions Related to the Effect of Increasing Enrollments on Productivity.

Nursing faculty teaching in research and clinical doctoral programs participated in a national survey study to examine the impact of expanded doctoral enrollments on the doctoral faculty's scholarly productivity. They were invited to respond to an open-ended question soliciting information not already addressed in the survey. Results of the analysis are reported here. Findings corroborated the review of literature and results of the survey and focus groups that provided the basis for the survey's development. Current workloads may be unsustainable, jeopardizing the profession's response to Institute of Medicine recommendations.

Growing Clinical and Academic Nursing Leaders: Building the Pipeline.

Nursing faces a crisis because there exists a dearth of qualified nurse academicians and administrators willing to step up to high-level leadership positions such as deanships and chief nursing operators. This article critically appraises the available literature regarding succession planning in the nursing profession and offers pragmatic suggestions to the profession to engage in succession planning in a deliberate and thoughtful manner.

The Experiences of Medical Marijuana Patients: A Scoping Review of the Qualitative Literature.

Medical marijuana is now legal in more than half of the United States but remains federally prohibited and classified as a schedule 1 drug. The chemical compounds in marijuana are known neuroprotectants; however, their clinical efficacy and safety have not been proven. Many healthcare providers remain unaware of the therapeutic potential of marijuana and its adverse effects. The conflicting laws and lack of guidance from healthcare professionals can lead to confusion and frustration for patients seeking this medication. Multiple factors contribute to the unique and varied experiences of medical marijuana patients. Because more individuals with neurological disorders seek therapeutic marijuana, it is important for healthcare professionals to understand their distinctive experiences. Qualitative research methodology is ideal to capture the thick descriptions of these experiences. This review examines the qualitative research exploring the experiences of medical marijuana patients and discusses common themes across all studies.

Assessment of the Impact of Teaching Demands on Research Productivity Among Doctoral Nursing Program Faculty.

This article reports the findings of a study that examined the research and scholarship productivity of doctorally prepared nursing faculty teaching and mentoring doctoral students and the conflicting demands on them to maintain programs of research and scholarship. The specific aims were to (a) examine the research productivity and scholarship of faculty members teaching in doctoral programs and mentoring doctoral students to examine the perceived effectiveness of existing institutional mechanisms to support scholarship, (b) explore institutional features and personal practices used by doctoral program faculty to develop and maintain research and scholarship productivity, and (c) analyze predictors of scholarship productivity. Data were collected via an on-line researcher-developed survey that examined doctoral faculty roles/responsibilities and their relationship to their scholarly productivity, overall research productivity, and institutional features and personal practices to support research/scholarship activities. Survey respondents reported spending a large amount of time engaged in research-related activities with 58.9% (n = 326) spending anywhere from 6 to 20 hours per week conducting research, writing research-based papers, giving presentations, grant writing, or conducting evidence-based improvement projects. Scholar productivity among the respondents was robust. Personal practices that most strongly supported faculty members' scholarship productivity were the belief that engaging in scholarship made them better teachers and the personal gratification in experiencing doctoral students' successes. A multiple regression analysis conducted to determine predictors of productivity indicated that the strongest predictor was the average number of hours spent on research/scholarship-related activities, followed by time bought out from teaching and other responsibilities of the faculty role for research.

Psychometric Analysis of the Work/Life Balance Self-Assessment Scale.

BACKGROUND AND PURPOSE: This study investigated the psychometric properties of the Work/Life Balance Self-Assessment scale among nurse faculty involved in doctoral education. METHODS: A national random sample of 554 respondents completed the Work/Life Balance Self-Assessment scale, which addresses 3 factors: work interference with personal life (WIPL), personal life interference with work (PLIW), and work/personal life enhancement (WPLE). RESULTS: A principal components analysis with varimax rotation revealed 3 internally consistent aspects of work-life balance, explaining 40.5% of the variance. The Cronbach's alpha coefficients for reliability of the scale were .88 for the total scale and for the subscales, .93 (WIPL), .85 (PLIW), and .69 (WPLE). CONCLUSION: The Work/Life Balance Self-Assessment scale appears to be a reliable and valid instrument to examine work-life balance among nurse faculty.

Work-life balance of nursing faculty in research- and practice-focused doctoral programs.

OBJECTIVES: The growing shortage of nursing faculty and the need for faculty to teach doctoral students to address the shortage call for examination of factors that may contribute to the shortage, including those that are potentially modifiable, including work-life balance.This descriptive study examined work-life balance of a national sample of nursing faculty teaching in research-focused and practice-focused doctoral programs. METHODS: Data were collected through an online survey of 554 doctoral program faculty members to identify their perceptions of work-life balance and predictors of work-life balance. RESULTS: Work-life balance scores indicated better work-life balance than expected. Factors associated with good work-life balance included higher academic rank, having tenure, older age, years in education, current faculty position, and no involvement in clinical practice. Current faculty position was the best predictor of work-life balance. CONCLUSIONS: Although work-life balance was viewed positively by study participants, efforts are needed to strengthen factors related to positive work/life in view of the increasing workload of doctoral faculty as the numbers of doctoral students increase and the number of seasoned faculty decrease with anticipated waves of retirements.

Nursing Educational Motivation and Barriers Inventory.

BACKGROUND AND PURPOSE: The major purposes of the study are revision of the Nursing Educational Motivation and Barriers Inventory (NEMBI) and translation of it into Arabic. METHODS: NEMBI was translated into Arabic, then back-translated to ensure the accuracy of the translation. The translation and back-translation of NEMBI were accurate and identical. A panel of experts provided content validation. Reliability was evaluated in a pilot test. For the larger study, 158 Saudi nurses completed the NEMBI. RESULTS: Exploratory factor analysis yielded 8 factors. NEMBI is a valid and reliable tool for use in Arabic-speaking populations. CONCLUSION: As nursing education is transformed in Arabic-speaking norms, this tool provides a valid and reliable means for examining motivational factors that influence nurses' decision to return to school to advance their education.

A profile of U.S. nursing faculty in research- and practice-focused doctoral education.

PURPOSE: This study, which is part of a larger project, was conducted to profile the nursing faculty in the United States teaching in PhD and DNP programs. DESIGN: This is a descriptive study. A sample of 554 nursing faculty who teach in PhD and DNP programs was recruited by email solicitation to represent all geographic regions of the United States. Data were collected from November 2013 through January 2014 using an online survey instrument. METHODS: The instrument was developed based on results of review of the literature and of focus groups of doctoral faculty (faculty teaching in doctoral programs) to ascertain characteristics of faculty teaching in doctoral programs and of the schools in which they teach. Frequencies and descriptive statistics are reported. FINDINGS: Growth in DNP programs has outpaced growth in PhD programs, and DNP graduates have moved into doctoral education in greater numbers than PhD graduates. DNP faculty report less prior experience and current productivity scholarship than faculty in PhD programs only or both types of programs. CONCLUSIONS: Strategies are needed to ensure that doctoral programs are staffed by faculty who are prepared for doctoral education and the development of nursing science. CLINICAL RELEVANCE: The Institute of Medicine has recommended doubling the number of doctorally prepared nurses in the United States by 2020 to ensure that sufficient numbers of faculty are available to prepare the nursing labor force that is needed for delivery of healthcare services. Nurse scientists are needed to contribute to improvement in patient care quality and safety, and practice leaders are needed to facilitate the translation of research into safe, high-quality, and cost-effective care. The landscape of doctoral education in nursing is rapidly changing.