Foreword to: Indiana University's Response to the Addictions Crisis: A Grand Challenge Initiative.

Use of heroin, prescription painkillers, methamphetamines, and fentanyl led to a national health crisis in 2017, resulting in 1852 overdose deaths in Indiana. Governor Eric J. Holcomb made tackling substance use in the state one of his highest priorities, calling on all Hoosiers to collaborate. In October 2017, Indiana University (IU) President Michael A. McRobbie responded, announcing that the University would be initiating the Responding to the Addictions Crisis Grand Challenge (AGC). Partners included Governor Holcomb, IU Health, and Eskenazi Health. Leveraging the university's research strengths and partnering with more than 160 community organizations across the state, the AGC sought to address substance use facing Indiana and beyond. Fifty interdisciplinary research projects were created through the AGC, focusing on IU's greatest strength in five areas: (1) education, training, and certification; (2) data science and analysis; (3) policy analysis, economics, and law; (4) basic, applied, and translational research; (5) community engagement and workforce development. Diversity, equity, and inclusion implications were often considered. This supplement describes the IU approach to address the health of the people of the State, investigator initiated projects and research conducted to inform practice, strategy and policy.

Exploring the Demographic and Professional Characteristics of Physicians and Nurse Practitioners Associated With Providing Medication-Assisted Treatment: A Retrospective Observational Study.

Integration of medication-assisted treatment (MAT) for opioid use disorder in primary care settings is an emerging health care delivery model that supports increased access to specialized care but requires primary care provider engagement. Examining the characteristics of providers who provide this service is key to informing targeted recruitment. Using administrative and supplemental data collected during license renewal, this study aimed to identify the characteristics of primary care physicians and nurse practitioners (NPs) associated with greater odds of providing MAT in their practice. A retrospective observational study was conducted using a descriptive correlational design. The analysis included 5259 physicians and 3486 NPs who renewed their licenses electronically in 2021 and specialized in primary care or psychiatry. Chi-square and logistic regression analyses were conducted to identify the demographic and clinical characteristics of physicians and NPs associated with MAT participation in their practice. Physicians had a higher odds ratio (OR) of providing MAT if they were younger than 35 years (OR = 1.334; P = .0443), practiced in a federally qualified health center (OR = 3.101, P < .0001), and offered a sliding fee scale in their practice (OR = 2.046; P < .0001). Likewise, NPs had higher odds of providing MAT if they practiced in a public or community health center (OR = 3.866; P < .0001). The results of this study highlight the personal and professional characteristics of physicians and NPs associated with higher odds of providing MAT. These findings may have implications for the recruitment and sustainability of MAT integration in primary care.

Evidence of validity of the Smoking Cessation Counseling scale - Brazilian version.

OBJECTIVE: to evaluate the evidence of validity of the internal structure and reliability of the Brazilian version of the Smoking Cessation Counseling instrument. METHOD: psychometric study of confirmatory factor analysis and reliability carried out on 250 nurses in clinical practice. For the analysis of the convergent validity of the factor model, Average Variance Extracted values were calculated, and discriminant analysis was carried out using the Fornell-Larcker criterion. Reliability was examined using Cronbach's alpha coefficient and composite reliability. RESULTS: it was necessary to exclude seven items from the Advanced Counseling domain and one item from the Basic Counseling domain in order to properly obtain the Average Variance Extracted values and the Fornell-Larcker criterion. The composite reliability ranged from 0.76 to 0.86 and the overall Cronbach`s alpha coefficient was 0.86, ranging from 0.53 to 0.84 depending on the domain assessed. The final version of the instrument was made up of 16 items divided into 4 domains. CONCLUSION: the Brazilian version of Smoking Cessation Counseling obtained adequate psychometric evidence of validity and reliability. Further studies are needed to refine the instrument. BACKGROUND: (1) Instrument shows adequate internal consistency and validity. BACKGROUND: (2) Evaluate counseling practices and their impact on patient care. BACKGROUND: (3) Instrument for evaluating smoking cessation counseling. BACKGROUND: (4) Provides important information for planning nursing care.

Evidence of validity of the Smoking Cessation Counseling scale - Brazilian version / Evidencias de validez de la escala Smoking Cessation Counseling - versión brasileña / Evidências de validade da escala Smoking Cessation Counseling - versão brasileira

Objective: to evaluate the evidence of validity of the internal structure and reliability of the Brazilian version of the Smoking Cessation Counseling instrument Method: psychometric study of confirmatory factor analysis and reliability carried out on 250 nurses in clinical practice. For the analysis of the convergent validity of the factor model, Average Variance Extracted values were calculated, and discriminant analysis was carried out using the Fornell-Larcker criterion. Reliability was examined using Cronbach's alpha coefficient and composite reliability Results: it was necessary to exclude seven items from the Advanced Counseling domain and one item from the Basic Counseling domain in order to properly obtain the Average Variance Extracted values and the Fornell-Larcker criterion. The composite reliability ranged from 0.76 to 0.86 and the overall Cronbach`s alpha coefficient was 0.86, ranging from 0.53 to 0.84 depending on the domain assessed. The final version of the instrument was made up of 16 items divided into 4 domains Conclusion: the Brazilian version of Smoking Cessation Counseling obtained adequate psychometric evidence of validity and reliability. Further studies are needed to refine the instrument.

Objetivo: evaluar las evidencias de validez de la estructura interna y de la confiabilidad de la versión brasileña del instrumento Smoking Cessation Counseling. Método: estudio psicométrico de análisis factorial confirmatorio y de confiabilidad realizado en 250 enfermeras de la práctica clínica. Para el análisis de la validez convergente del modelo factorial se calcularon valores de Average Variance Extracted, el análisis discriminante se realizó mediante el criterio de Fornell-Larcker. La confiabilidad se examinó por el coeficiente de alfa de Cronbach y por la confiabilidad compuesta. Resultados: fue necesaria la exclusión de siete ítems del dominio de Asesoramiento avanzado y un ítem del dominio Asesoramiento básico para obtener adecuadamente los valores de Average Variance Extracted y del criterio de Fornell-Larcker. La confiabilidad compuesta varió de 0,76 a 0,86 y el coeficiente de alfa de Cronbach global alcanzado fue de 0,86, variando de 0,53 a 0,84 dependiendo del dominio evaluado. Se obtuvo la versión final del instrumento compuesto de 16 ítems distribuidos en 4 dominios. Conclusión: la versión brasileña de Smoking Cessation Counseling obtuvo adecuadas evidencias psicométricas de validez y confiabilidad. Estudios posteriores serán necesarios para el refinamiento del instrumento.

Objetivo: avaliar as evidências de validade da estrutura interna e da confibialidade da versão brasileira do instrumento Smoking Cessation Counseling Método: estudo psicométrico de análise fatorial confirmatória e de confiabilidade realizado em 250 enfermeiras da prática clínica. Para a análise da validade convergente do modelo fatorial foram calculados valores de Average Variance Extracted , a análise discriminante foi realizada pelo critério de Fornell-Larcker. A confiabilidade foi examinada pelo coeficiente de alfa de Cronbach e pela confiabilidade composta Resultados: foi necessária a exclusão de sete itens do domínio de Aconselhamento avançado e um item do domínio Aconselhamento básico para obtenção adequada dos valores de Average Variance Extracted e do critério de Fornell-Larcker. A confiabilidade composta variou de 0,76 a 0,86 e o coeficiente de alfa de Cronbach global alcançado foi de 0,86, variando de 0,53 a 0,84 a depender do domínio avaliado. Obteve-se a versão final do instrumento composto de 16 itens distribuídos em quatro domínios Conclusão: a versão brasileira da Smoking Cessation Counseling obteve adequadas evidências psicométricas de validade e de confiabilidade. Estudos posteriores serão necessários para o refinamento do instrumento.

State of Mental Health, Healthy Behaviors, and Wellness Support in Big 10 University Nursing and Health Sciences Faculty, Staff, and Students During COVID-19.

BACKGROUND: Federal and national entities urge organizations to assess healthcare professionals' mental health and well-being as the COVID-19 pandemic has compounded the issue. AIMS: This study aimed to (1) describe rates of mental health issues, healthy lifestyle behaviors, and perceptions of COVID-19's impact among Big 10 University nursing and health sciences faculty, staff, and students; (2) identify predictors of depression, anxiety, stress, and burnout; and (3) assess the relationships among perceived school wellness support, healthy lifestyle behaviors, physical/mental health, and mattering. METHODS: A cross-sectional descriptive correlational design was used. Nursing and health science deans emailed invitations to faculty, staff, and students concerning an anonymous wellness assessment survey. Correlation coefficients tested associations among mental health indicators and wellness cultures. Multiple linear regression examined factors associated with mental health indicators. RESULTS: Faculty, staff, and students responded (N = 1345). Findings indicated that most respondents were not getting adequate sleep, meeting physical activity recommendations, or eating the daily recommended number of fruits/vegetables. Fourteen to 54.9 % of participants reported depression, anxiety, and burnout. Overall, students, faculty and staff at colleges that operated under a strong wellness culture had better outcomes. CONCLUSION: Wellness cultures impact the mental and physical health of faculty, staff, and students.

A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study.

BACKGROUND: Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention. PURPOSE: To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention. METHODS: We conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes. DISCUSSION: The RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay. CONCLUSION: The results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.

RWJF Future of Nursing Scholars experience and recommendations: Focus group results at final convening.

BACKGROUND: The Robert Wood Johnson Foundation launched the Future of Nursing Scholars program to support nurses to complete PhDs in 3 years in schools across the United States. PURPOSE: To explore why scholars participated in the program and to articulate challenges and facilitators to successful completion of their doctoral degrees. METHOD: Thirty-one scholars representing 18 different schools participated in focus groups at a convening in January 2022. FINDINGS: Scholars identified that funding and planned length of degree completion were important factors in their choosing the accelerated program. Mentorship, networking, and support were identified as facilitators to program completion with the tight timeline of three years noted as a challenge. DISCUSSION: Accelerated students require adequate resources including access to data, mentoring, and financing to overcome challenges presented by accelerated PhD training programs. Cohort models provide support and clarity of expectations for both students and mentors is critical.

Seeking to Understand: Qualitative Research on Sustainability of Evidence-Based Practice in Acute Care.

OBJECTIVE: The aim of this study was to describe cultural characteristics, values, and beliefs that influence sustainability of an evidence-based practice (EBP) intervention in the acute care clinical setting. BACKGROUND: There is an urgent need to identify best practices to sustain EBP to gain efficiencies in nursing care delivery and improve patient outcomes. METHODS: A focused ethnographic qualitative study was conducted in a community hospital with nurses that used Screening, Brief Intervention, and Referral to Treatment (SBIRT). RESULTS: Customizing the intervention to the unit culture evolved and was crucial for sustainability. Overlap in responsibilities, time, clinician confidence, and impact to workflow were noted as negative influences. The intervention was primarily viewed as a task to be checked off a list instead of a tool that informs the patient's plan of care. CONCLUSIONS: Assessing clinician experiences, beliefs, and values of an EBP should be incorporated into a strategic sustainability plan. Clinician understanding of how an EBP can advance the patient plan of care could promote ownership of professional practice and sustainment.

A study of Indiana University Health's spirit of inquiry and innovation during COVID.

BACKGROUND: COVID-19 has required nursing innovations to meet patient care needs not previously encountered. PURPOSE: The purpose of this study was to describe nursing innovations conceived, implemented, and desired during the first COVID-19 surge. METHODS: The investigators invited registered nurses employed across 16 Midwest hospitals (6,207) to complete the survey. Respondents provided demographics and written descriptions of innovations they conceived, witnessed, and desired. Investigators analyzed text responses using standard content analytic procedures and summarized quantitative demographics using percentages. FINDINGS: Nurses reported seven types of innovations that would (a) improve personal protective equipment (PPE), (b) limit the need to repeatedly don and doff PPE, (c) ensure safer practice, (d) conserve and access supplies, (e) provide patient and family education and support, (f) make team member communication more efficient, and (g) improve peer support. DISCUSSION: Nurses are in a unique position to generate innovative solutions to meet patient care needs under adverse and rapidly changing situations.

911 Calls for Emergency Medical Services in Heart Failure: A Descriptive Qualitative Study.

BACKGROUND: Heart failure (HF) is a common condition leading to activation of emergency medical services (EMS). OBJECTIVE: The aim of this study was to describe reasons given by persons with HF, family members, or other caregivers for requesting EMS activation during 911 calls. METHODS: In this descriptive qualitative study, a content analysis was performed on transcribed audio files of 383 EMS requests involving 383 persons with HF in the community. RESULTS: One hundred forty-seven calls (38.4%) were placed by the family members, 75 (19.6%) were placed by the patients, 56 (14.6%) were placed by healthcare workers or personnel from living facilities, and the remaining calls (n = 105, 27.4%) were placed by others (eg, friends, neighbors, officers). Three broad categories of symptoms, signs, and events were identified as the reasons for an EMS request. Frequently reported symptoms were breathing problems (55.4%), chest pain (18.3%), and other pain (eg, head, extremities) (16.7%). Signs included decreased consciousness (15.4%), swelling (5.7%), and bleeding (5.0%). The reported events involved falls (8.1%), heart attack (6.3%), hypoxic episodes (6.0%), stroke (5.2%), and post-hospital-discharge complications (4.7%). In most calls (74.9%), multiple reasons were reported and a combination of symptoms, signs, and events were identified. Heart failure diagnosis was mentioned in fewer than 10% of the calls. CONCLUSIONS: Overall, symptoms and signs of HF exacerbation were common reasons to activate 911 calls. Falls were frequently reported. Under the duress of the emergent situations surrounding the 911 call, callers rarely mentioned the existence of HF. Interventions are needed to guide patients with HF and their family members to promote the management of HF to reduce EMS activation as well as to activate EMS quickly for acute changes in HF conditions.

Software Training in HEP.

The long-term sustainability of the high-energy physics (HEP) research software ecosystem is essential to the field. With new facilities and upgrades coming online throughout the 2020s, this will only become increasingly important. Meeting the sustainability challenge requires a workforce with a combination of HEP domain knowledge and advanced software skills. The required software skills fall into three broad groups. The first is fundamental and generic software engineering (e.g., Unix, version control, C++, and continuous integration). The second is knowledge of domain-specific HEP packages and practices (e.g., the ROOT data format and analysis framework). The third is more advanced knowledge involving specialized techniques, including parallel programming, machine learning and data science tools, and techniques to maintain software projects at all scales. This paper discusses the collective software training program in HEP led by the HEP Software Foundation (HSF) and the Institute for Research and Innovation in Software in HEP (IRIS-HEP). The program equips participants with an array of software skills that serve as ingredients for the solution of HEP computing challenges. Beyond serving the community by ensuring that members are able to pursue research goals, the program serves individuals by providing intellectual capital and transferable skills important to careers in the realm of software and computing, inside or outside HEP.

Development and assessment of the usability of a web-based referral to treatment tool for persons with substance use disorders.

BACKGROUND: Hospitalized people with unhealthy substance use should be referred to treatment. Although inpatient referral resources are often available, clinicians report that outpatient referral networks are not well-established. The purpose of this manuscript is to describe the development and usability testing of a web-based Referral to Treatment Tool (RTT © 2020 Trustees of Indiana University, all rights reserved) designed to identify treatment centers for people with unhealthy substance use. RESULTS: The RTT was conceptualized, developed, and then populated with public use and local survey data of treatment centers from 14 market ZIP codes of hospitals participating in an SBIRT implementation study. The tool underwent initial heuristic testing, followed by usability testing at three hospitals within a large healthcare system in the Midwest region of the United States. Administrative (n = 6) and provider (n = 12) users of the RTT completed a list of tasks and provided feedback through Think-Aloud Tests, the System Usability Scale, and in-person interviews. Patients (n = 4) assessed multiple versions of a take-home printout of referral sites that met their specifications and completed in-person interviews to provide feedback. Each administrative task was completed in less than 3 min, and providers took an average of 4 min and 3 s to identify appropriate referral sites for a patient and print a referral list for the patient. The mean System Usability Scale score (M = 77.22, SD = 15.57, p = 0.03) was significantly higher than the passable score of 70, indicating favorable perceptions of the usability of the RTT. Administrative and provider users felt that the RTT was useful and easy to use, but the settings and search features could be refined. Patients indicated that the printouts contained useful information and that it was helpful to include multiple referral sites on the printout. CONCLUSION: The web-based referral tool has the potential to facilitate voluntary outpatient referral to treatment for patients with unhealthy substance use. The RTT can be customized for a variety of health care settings and patient needs. Additional revisions based on usability testing results are needed to prepare for a broader multi-site clinical evaluation. Trial Registration Not applicable.

Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. METHODS: A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. RESULTS: Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. DISCUSSION: In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.

Perceptions of the barriers, facilitators, outcomes, and helpfulness of strategies to implement screening, brief intervention, and referral to treatment in acute care.

BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a clinical intervention used to address alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs' experiences pertaining to SBIRT implementation across a health system. METHODS: Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs' perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. Qualitative data were analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 strategies identified from qualitative data and was administered electronically to determine the SC's perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). RESULTS: All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful implementation strategies were reexamining the implementation (M = 4.38; n = 8), providing ongoing consultation (M = 4.13; n = 8), auditing and providing feedback (M = 4.1; n = 10), developing education materials (M = 4.1; n = 10), identifying and preparing champions (M = 4; n = 7), and tailoring strategies (M = 4; n = 7). CONCLUSION: SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.

Implementation of screening, brief intervention, and referral to treatment (SBIRT) by nurses on acute care units: A qualitative descriptive study.

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention for patients with substance use disorders, but this intervention is under-utilized. Little is known about the implementation of SBIRT in acute care facilities. The purpose of this study is to describe implementation of SBIRT by nurses in acute care hospitals. Methods: A qualitative descriptive design was used for this study. Registered nurses who agreed to participate in the study completed a 1:1 interview using a semi-structured interview guide. Interviews were audio recorded and transcribed and then data were analyzed using qualitative content analysis. Results: When implementing SBIRT in an acute care setting, participants identified several factors that affect implementation. Some nurses felt that it is "one more thing to do" but other nurses feel that it was a "good, simple" screening tool that does not take long to do and can "plant the seeds of change" for patients. Additionally, participants mentioned barriers and facilitators related to the patients' responses to SBIRT and organizational factors. Conclusions: This study identified several barriers and facilitators to SBIRT implementation related to the nurses, patients, and organization. By understanding the factors that influence implementation, healthcare providers can develop strategies to support effective implementation of SBIRT.

Assessing public behavioral health services data: a mixed method analysis.

BACKGROUND: Measuring behavioral health treatment accessibility requires timely, comprehensive and accurate data collection. Existing public sources of data have inconsistent metrics, delayed times to publication and do not measure all factors related to accessibility. This study seeks to capture this additional information and determine its importance for informing accessibility and care coordination. METHODS: The 2018 National Survey for Substance Abuse and Treatment Services (N-SSATS) data were used to identify behavioral health facilities in Indiana and gather baseline information. A telephone survey was administered to facilities with questions parallel to the N-SSATS and additional questions regarding capacity and patient intake. Quantitative analysis includes chi-square tests. A standard qualitative analysis was used for theming answers to open-ended questions. RESULTS: About 20% of behavioral health facilities responded to the study survey, and non-response bias was identified by geographic region. Among respondents, statistically significant differences were found in several questions asked in both the study survey and N-SSATS. Data gathered from the additional questions revealed many facilities to have wait times to intake longer than 2 weeks, inconsistency in intake assessment tools used, limited capacity for walk-ins and numerous requirements for engaging in treatment. CONCLUSION: Despite the low response rate to this study survey, results demonstrate that multiple factors not currently captured in public data sources can influence coordination of care. The questions included in this study survey could serve as a framework for routinely gathering these data and can facilitate efforts for successful coordination of care and clinical decision-making.

Development and use of a toolkit to facilitate implementation of an evidence-based intervention: a descriptive case study.

BACKGROUND: Implementation of evidence-based clinical interventions in real-world settings becomes a futile effort when effective strategies to foster adoption are not used. A toolkit, or a collection of adaptable documents to inform and facilitate implementation, can increase the use of evidence-based interventions. Most available toolkits provide resources about the intervention but lack guidance for adaptation to different contexts or strategies to support implementation. This paper describes the development and use of a toolkit to guide the implementation of an evidence-based intervention to identify and intervene for people with risky substance use. METHODS: A descriptive case study describes the development and use of a toolkit throughout a two-year study. Investigators and site coordinators from 14 acute care hospitals developed tools and engaged external stakeholders as they prepared for implementation, integrated the clinical intervention into practice, and reflected on implementation. RESULTS: The final toolkit included 54 different tools selected or created to define the intervention, engage and communicate with stakeholders, assess for readiness and plan for implementation, train clinical nurses and other stakeholders, evaluate training and implementation effectiveness, create policies and procedures for different contexts, and identify opportunities for reimbursement. Each tool corresponds to one or more implementation strategies. CONCLUSION: The approach used to develop this implementation toolkit may be used to create resources for the implementation of other evidence-based interventions.

Methods of nursing certification in North America-A scoping review.

BACKGROUND: Definitions of nursing certification are lacking in the research literature and research on certification in nursing is remarkably limited. METHODS: A six-stage scoping review framework was used to identify the nature, extent, and range of certification within the nursing literature. FINDINGS: Thirty-six articles were included in this scoping review. Most originated in the United States (89%), were classified as research articles (56%), and used a quantitative approach (90%). The majority focused on initial certification (50%), and written examination was the most prevalent approach to certification (39%). Missing and incomplete data were prevalent. DISCUSSION: The overall lack of nursing certification origin, focus, methodological rigor, and clear certification mastery criteria have hindered meaningful study of the relationship between nursing certification and patient outcomes. Common data elements, reporting standards, and observational studies linking common data elements and patient outcomes could guide future research and improve the transparency of certification processes and reporting.