Climate, Health, and Nursing Tool (CHANT): A confirmatory factor analysis.

OBJECTIVE: To confirm the factor structure of the Climate, Health, and Nursing Tool (CHANT) tool via confirmatory factor analysis. DESIGN AND SAMPLE: This is a cross-sectional analysis of voluntary, anonymous responses collected online in 2019, from a non-representative sample of 489 nurses from 12 nations with 95% of the respondents from the United States. MEASUREMENTS: A confirmatory factor analysis (CFA) was conducted to test a five-factor measurement model of the 22-item CHANT. Reliability was examined via Cronbach's α coefficient. RESULTS: The five CHANT subscales demonstrated acceptable reliability with Cronbach's α ranging from 0.67 to 0.91. The five-factor model of CHANT demonstrated good fit, x2 (199) = 582.747, p < .001, CFI = 0.94, RMSEA = 0.06, and SRMR = 0.04 with statistically significant item-factor loadings. CONCLUSION: CHANT is a reliable and robust instrument to measure nurses' awareness, concern, motivation, and home and work behaviors regarding climate change and health, and is ready to be utilized in research, policy, professional settings, and among educators.

Climate, Health, and Nursing Tool (CHANT): Initial survey results.

OBJECTIVES: This study measured nurses' awareness, motivation, concern, self-reported behaviors at work, and self-reported behaviors at home regarding climate change and health. DESIGN: Descriptive study using an anonymous and voluntary web-based survey. SAMPLE: A nonrepresentative sample recruited from nurses. MEASUREMENTS: The CHANT (Climate, Health and Nursing Tool) with five psychometrically evaluated scales used to measure awareness, motivation, concern, behaviors at work, and behaviors at home. RESULTS: The 489 respondents reported moderate levels of awareness (2.97 mean score of 0-4) and high levels of concern (3.43) about health impacts of climate change. They were motivated to reduce greenhouse gas emissions (3.27), yet few did at home (2.28), and even fewer at work (1.81). They were motivated by clean air and water and concern about the future. Barriers to action included not knowing what to do and feeling overwhelmed. Respondents reported discussing climate and health with friends or family more frequently than they did with their colleagues. A majority (63%) never contacted elected officials. CONCLUSION: The respondents were aware of climate and health impacts and motivated to act. However, they reported lower frequencies of changing behaviors at work, and communicating about climate and health professionally and with elected officials.

CHANT: Climate, Health, and Nursing Tool: Item Development and Exploratory Factor Analysis.

Climate change poses significant health risks. Nurses assess, treat, and educate patients about health risks. However, nurses' level of awareness, motivation, and behaviors related to climate change and health is not known. This study developed and tested a novel tool measuring these elements. Three hundred fifty-seven nurses responded to the overall survey. Exploratory factor analysis (EFA) assessed the factor structure of the 22-item CHANT survey and Cronbach's alpha estimated internal consistency. A five-factor model was retained through the EFA, demonstrating good model fit (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, standardized root mean square residual [SRMR] = .09), and items were internally consistent (Cronbach's alpha for each subscale >.70). CHANT has been developed and psychometrically examined and is ready for further use and study.

Perspectives on Patient and Family Engagement With Reduction in Harm: The Forgotten Voice.

BACKGROUND: Despite continued efforts to improve safety in hospitals, hospital-acquired harm persists. Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient and family engagement to reduction of harm is not well understood, with limited findings available in current literature. PURPOSE: This qualitative study explored the perceptions and attitudes of patients and family members and several clinical disciplines toward patient engagement in reducing preventable harm in hospitalized patients. METHODS: We conducted 8 focus groups at 2 nonprofit hospitals with several constituencies: patients/families, registered nurses, physician hospitalists, and pharmacists/physical therapists. RESULTS: Thematic analysis of transcripts revealed multiple themes from different perspectives, including: family presence increases safety, the hospital environment is intimidating, and communication is essential, but I am not being heard. CONCLUSIONS: The rich data suggest a significant opportunity for reducing risk and harm by more actively engaging patients and families in the effort. Increasing patient acuity and complexity of care furthers the need for partnering with patients and families more intentionally for increased safety.

Developing an Intervention to Reduce Harm in Hospitalized Patients: Patients and Families in Research.

BACKGROUND: Patient safety-focused research may be strengthened by the inclusion of patients and family members in research design; yet, published methodologies for doing so are scarce. PURPOSE: This study engaged patients and families in research design of an intervention to increase patient/family engagement, with reduction of harm in hospitalized patients. METHODS: The study design team convened a Patient Safety Advisory Panel to explore potential testable interventions to increase patient/family engagement with safety. They explored the preferred intervention, Speak Up-My Advocate for Patient Safety (MAPS), through multistakeholder focus groups. RESULTS: Participants emphasized the importance of including patient/family when designing interventions. Regarding the Speak Up-MAPS intervention, perceptions from stakeholders were mixed, including the value and potential complexity, role confusion, and cost of the proposed advocate role. CONCLUSION: Intentional inclusion of the patient/family in research is important and practical. Both strengths and challenges of the proposed intervention were identified, indicating the need for further study.

RN Perceptions of a Newly Adopted Electronic Health Record.

OBJECTIVE: The purpose of this study was to understand nurses' perceptions of a newly adopted electronic health record (EHR). BACKGROUND: As use of EHRs in hospital settings increases, leaders prepare staff members for change. There is limited information about impacts of EHR adoption on RNs using EHRs at the point of care. METHODS: Clinical RNs were surveyed about 3 domains (ease of use, usefulness, and attitude) before and after implementation of an EHR. A small subset of nurses was interviewed for a deeper understanding of perceptions associated with this change. RESULTS: One year after adoption, nurses believed that the EHR did not improve patient care, the learning curve was steep, and they had lower confidence using the EHR than anticipated. Nurses commented on both their frustration and optimism about EHRs. CONCLUSIONS: This study provides insight into RNs' perceptions of an EHR, providing important information for nursing administrators.

Validating the Nurses' Perceptions of Electronic Documentation Scale in a Cross-Sectional Sample of Registered Nurses in Australia: A Confirmatory Factor Analysis.

BACKGROUND AND PURPOSE: The Nurses' Perceptions of Electronic Documentation (NPED) scale assesses nurses' perceptions, attitudes, and use of electronic documentation in acute care settings. However, confirmatory factor analysis of the scale had not been conducted. This article describes a confirmatory factor analysis of the NPED scale. METHODS: An 11-item survey was implemented in a cross-sectional sample of 202 registered nurses in a large tertiary hospital in Australia. Confirmatory factor analysis was used to assess validity and reliability was determined by Cronbach's α coefficients. RESULTS: Confirmatory factor analysis generated an excellent model-data fit for a two-factor model. All item-factor loadings were statistically significant and substantial. CONCLUSIONS: The NPED scale is a robust instrument to measure nurses' perceptions of the utility of and concerns about the electronic medical record in practice.

Nurses Promoting Inclusive, Safe, Resilient, and Sustainable Cities and Communities: Taking Action on COVID-19, Systemic Racism, and Climate Change.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article highlights SDG 11-making "cities and human settlements inclusive, safe, resilient and sustainable."

A Tool to Measure Nurses' Perceptions of Electronic Documentation: Exploratory Factor Analysis.

BACKGROUND AND PURPOSE: Electronic Health Records (EHRs) have been widely adopted in US hospitals. EHRs have changed workflow and time allocation and have broad impacts on staff. We adapted an existing instrument to measure nurses' perceptions of a newly adopted EHR. METHODS: The 11-item survey was administered to approximately 500 registered nurses in a mid-sized regional hospital in western US, with 153 responses received. Exploratory factor analysis (EFA) assessed the factor structure and Cronbach's α estimated internal consistency. RESULTS: A 3-factor model was retained through the EFA, and items were internally consistent (Cronbach's alpha for each subscale > .80). CONCLUSIONS: Survey adaptation was iterative and resulted in a psychometrically sound and thematically relevant measure of nurses' EHR perceptions. Next steps include further psychometric evaluation and testing with additional samples.

Environmental Stewardship in Nursing: Introducing the "WE ACT-PLEASE" Framework.

This article introduces a framework for environmental stewardship in nursing practice, the WE ACT-PLEASE framework. The framework describes five content domains of pollution from health-care sources: Waste, Energy/water, Agriculture/food, Chemicals, and Transportation (WE ACT). It identifies six key professional elements: Professional Obligation, Leadership, Education, Accountability, Science, and Engagement (PLEASE). The framework is positioned within a global context of planetary health and planetary-level environmental harm. The framework image includes directional arrows, pointing nurses toward environmentally safe and healthy practice, decreasing pollution and planetary-level disruptions such as climate change, biodiversity loss, and resource depletion. This framework provides structure and guidance to help nurses decrease harm from practice, meet professional obligations, and create a healthier world.