Pilot Study to Determine the Effectiveness of a Home Health Nursing Simulation.

Demand for home care has increased due to the expansion of preventive care, people living longer with chronic conditions, and the need for healthcare services as the baby boom population ages. Nurses must be prepared to meet the needs of patients and families in the home setting. Home care nursing simulations have been utilized as a teaching-learning strategy in baccalaureate nursing education, yet less is known about their use with practicing home care nurses and associate degree nursing students. The purpose of this pilot study using simulation was to prepare practicing nurses and student nurses to respond using nursing skills and clinical judgment. The convenience sample consisted of associate degree nursing students (n = 9), practicing home healthcare nurses (n = 8), and nursing faculty (n = 2). The Simulation Effectiveness Tool - Modified (SET-M) Survey (Leighton et al., 2015) was utilized for data collection. Participants perceived the home healthcare simulation to be an effective practice experience with high overall agreement for Pre-briefing, Scenario-Confidence, Scenario-Learning, and Debriefing. The findings of this study provide data to support partnerships to provide home care simulation experiences for associate degree nursing students and practicing home care nurses.

Exploring Interprofessional Collaboration in Teaching Between Nursing and Physical Therapy.

BACKGROUND: Integrating interprofessional concepts and competencies in the classroom teaches students to perform successfully in complex interprofessional care environments. There is little information regarding the effects of interprofessional collaboration in education utilizing faculty and students from other disciplines. METHOD: Satisfaction and Self-Confidence in Learning Survey (SCLS) scores and written responses were collected from 31 nursing students to explore nursing students' perceptions of an interprofessional collaboration in teaching between nursing and physical therapist (PT) educators. RESULTS: Nursing students' SCLS scores were higher on days where PT educators participated in teaching students. Analysis of written responses revealed five themes: appreciation of an outside expert perspective, enhanced self-efficacy with patient mobility skills, opportunity for interprofessional collaboration, satisfaction with the learning experience, and conflicting information. CONCLUSION: Interprofessional collaboration in teaching resulted in high levels of satisfaction and self-confidence and provided an opportunity to work toward an aspect of core competency for interprofessional collaborative practice. [J Nurs Educ. 2024;63(6):402-404.].

The Development and Feasibility of an Empathy Virtual Reality Scenario in Healthcare Education.

Technology-enhanced simulations such as virtual reality and computer-based experiences allow students to improve their understanding of patient perspectives and increase empathy for patients. These technologies can be daunting to nursing faculty without robust technology and video development resources. The purpose of this project was to share a guide for creating and implementing a patient-centered immersive virtual reality scenario within a nursing program. The research team developed, filmed, and produced a cost-effective virtual reality simulation scenario for use with smartphones and inexpensive virtual reality headsets, which could be widely disseminated for students to watch in class or online. The virtual reality simulation allowed an immersive first-person view and was well received by both faculty and students. The virtual reality scenario was implemented with ease in classroom, virtual, and laboratory settings. These virtual reality simulations work in the live setting or remotely, and synchronously or asynchronously with minimal equipment, which reduces barriers to access.

The Development and Testing of a Perinatal Tobacco Attitudes and Behaviors Survey.

Background and Purpose: Accurate assessment of tobacco use in pregnant smokers is key to effective nursing intervention. There is a lack of valid and reliable tools easily integrated into prenatal care. Therefore, the purpose of this study was to develop and test a perinatal survey, guided by the Health Promotion Model (HPM). Methods: The survey was tested with 107 pregnant women via iPad. Urine cotinine assays and a process evaluation were conducted. Results: Reliability yielded a Cronbach's alpha of .873 for the ever-smoker sample and .835 for the total sample. Factors dovetailed with HPM constructs. Conclusions: Perinatal Tobacco Attitudes and Behaviors Survey (PTABS) exhibits high reliability and validity and is easily utilized. Updates need to include questions on all nicotine products and to be streamlined. With accurate identification of nicotine users nurses can provide targeted interventions early in pregnancy.

Long-Term Mississippi River Trends Expose Shifts in the River Load Response to Watershed Nutrient Balances Between 1975 and 2017.

Excess nutrients transported by the Mississippi River (MR) contribute to hypoxia in the Gulf of Mexico. Nutrient balances are key drivers to river nutrient loads and represent inputs (fertilizer, manure, deposition, wastewater, N-fixation, and weathering) minus outputs (nutrient uptake and removal in harvest, and N emissions). Here, we quantified annual changes in nitrogen (N) and phosphorus (P) river loads and nutrient balances at the MR Outlet and documented that the river load response to watershed nutrient balances shifted between 1975 and 2017. Annual nutrient balances and river loads were positively correlated between 1975 and 1985, but after, a disconnect between both the N and P balances and river loads emerged, and the subsequent river load patterns were different for N versus P. We evaluated the relative impacts of legacy nutrients and other latent factors, for which data were not available, on river nutrient load trends. Our analysis showed that in the case of N, latent factors were potentially just as important in explaining changes in river nutrient loads over time as N balances, and in the case of P, they were even more important. We hypothesized that these factors included implementation of best management practices, changes in watershed buffering capacity, the effects of tile drainage, or increased precipitation. Our analytical approach shows promise for the investigation of drivers of water quality trends that are not well-represented in typical national scale geospatial datasets.

Prioritizing river basins for intensive monitoring and assessment by the US Geological Survey.

The US Geological Survey (USGS) is currently (2020) integrating its water science programs to better address the nation's greatest water resource challenges now and into the future. This integration will rely, in part, on data from 10 or more intensively monitored river basins from across the USA. A team of USGS scientists was convened to develop a systematic, quantitative approach to prioritize candidate basins for this monitoring investment to ensure that, as a group, the 10 basins will support the assessment and forecasting objectives of the major USGS water science programs. Candidate basins were the level-4 hydrologic units (HUC04) with some of the smaller HUC04s being combined; median candidate-basin area is 46,600 km2. Candidate basins for the contiguous United States (CONUS) were grouped into 18 hydrologic regions. Ten geospatial variables representing land use, climate change, water use, water-balance components, streamflow alteration, fire risk, and ecosystem sensitivity were selected to rank candidate basins within each of the 18 hydrologic regions. The two highest ranking candidate basins in each of the 18 regions were identified as finalists for selection as "Integrated Water Science Basins"; final selection will consider input from a variety of stakeholders. The regional framework, with only one basin selected per region, ensures that as a group, the basins represent the range in major drivers of the hydrologic cycle. Ranking within each region, primarily based on anthropogenic stressors of water resources, ensures that settings representing important water-resource challenges for the nation will be studied.

Landscape Drivers of Dynamic Change in Water Quality of U.S. Rivers.

Water security is a top concern for social well-being, and dramatic changes in the availability of freshwater have occurred as a result of human uses and landscape management. Elevated nutrient loading and perturbations to major ion composition have resulted from human activities and have degraded freshwater resources. This study addresses the emerging nature of streamwater quality in the 21st century through analysis of concentrations and trends in a wide variety of constituents in streams and rivers of the U.S. Concentrations of 15 water quality constituents including nutrients, major ions, sediment, and specific conductance were analyzed over the period 1982-2012 and a targeted trend analysis was performed from 1992 to 2012. Although environmental policy is geared toward addressing the long-standing problem of nutrient overenrichment, these efforts have had uneven success, with decreasing nutrient concentrations at urbanized sites and little to no change at agricultural sites. Additionally, freshwaters are being salinized rapidly in all human-dominated land use types. While efforts to control nutrients are ongoing, rapid salinity increases are ushering in a new set of poorly defined issues. Increasing salinity negatively affects biodiversity, mobilizes sediment-bound contaminants, and increases lead contamination of drinking water, but its effects are not well integrated into current paradigms of water management.

Variable impacts of contemporary versus legacy agricultural phosphorus on US river water quality.

Phosphorus (P) fertilizer has contributed to the eutrophication of freshwater ecosystems. Watershed-based conservation programs aiming to reduce external P loading to surface waters have not resulted in significant water-quality improvements. One factor that can help explain the lack of water-quality response is remobilization of accumulated legacy (historical) P within the terrestrial-aquatic continuum, which can obscure the beneficial impacts of current conservation efforts. We examined how contemporary river P trends (between 1992 and 2012) responded to estimated changes in contemporary agricultural P balances [(fertilizer + manure inputs)-crop uptake and harvest removal] for 143 watersheds in the conterminous United States, while also developing a proxy estimate of legacy P contribution, which refers to anthropogenic P inputs before 1992. We concluded that legacy sources contributed to river export in 49 watersheds because mean contemporary river P export exceeded mean contemporary agricultural P balances. For the other 94 watersheds, agricultural P balances exceeded river P export, and our proxy estimate of legacy P was inconclusive. If legacy contributions occurred in these locations, they were likely small and dwarfed by contemporary P sources. Our continental-scale P mass balance results indicated that improved incentives and strategies are needed to promote the adoption of nutrient-conserving practices and reduce widespread contemporary P surpluses. However, a P surplus reduction is only 1 component of an effective nutrient plan as we found agricultural balances decreased in 91 watersheds with no consistent water-quality improvements, and balances increased in 52 watersheds with no consistent water-quality degradation.

Assessing water-quality changes in US rivers at multiple geographic scales using results from probabilistic and targeted monitoring.

Two commonly used approaches for water quality monitoring are probabilistic and targeted. In a probabilistic approach like the US Environmental Protection Agency's National Rivers and Streams Assessment, monitoring sites are selected using a statistically representative approach. In a targeted approach like that used by many monitoring organizations, monitoring sites are chosen individually to answer specific questions. One important goal of both approaches is documenting long-term changes in water quality. Here, we compare chloride change results in US rivers and streams between the early 2000s and early 2010s from both approaches. The probabilistic approach provided an unbiased representation of change in all US rivers and streams, but was designed to measure low-streamflow conditions within a spring/summer index period during periodic survey years. The targeted approach was focused on larger, more developed watersheds but samples were collected frequently throughout the assessment period in different seasons and streamflows. The probabilistic results showed a small decrease in chloride concentrations in rivers and streams with the lowest concentrations, but no consistent increase or decrease in the remainder. The increased granularity of the targeted results showed that there was, in fact, a mix of changes occurring, with increases at 132 sites, decreases at 112 sites, and relatively stable conditions at 55 sites. The combined results suggest that chloride is not responding to a widespread, common driver across the USA and that management of chloride would be most effective when targeted regionally or locally.

Water-quality trends in U.S. rivers, 2002 to 2012: Relations to levels of concern.

Effective management and protection of water resources relies upon understanding how water-quality conditions are changing over time. Water-quality trends for ammonia, chloride, nitrate, sulfate, total dissolved solids (TDS), total nitrogen (TN) and total phosphorus (TP) were assessed at 762 sites located in the conterminous United States between 2002 and 2012. Annual mean concentrations at the start and end of the trend period were compared to an environmentally meaningful level of concern (LOC) to categorize patterns in water-quality changes. Trend direction, magnitude, and the proximity of concentrations to LOCs were investigated. Of the 1956 site-constituent combinations investigated, 30% were above the LOC in 2002, and only six (0.3%) crossed the LOC threshold, either from above or below, indicating that waterquality conditions are not substantially improving, nor are they degrading, in relation to the LOCs. The concentrations of ammonia, nitrate, sulfate, chloride, and TDS tended to be below the LOC, and in cases where the trend was increasing (concentrations approached the LOC from below), the increases were varied and small in magnitude. In contrast, concentrations of TN and TP tended to be above the LOC, and where the trend was decreasing (concentrations approached the LOC from above), the decreases were larger in magnitude and more consistent. These results indicate that if water-quality conditions continue to trend in the same direction, at the same rate, for all sites and constituents studied, elevated concentrations are more likely to drop below an LOC before low concentrations will exceed an LOC.

Water-quality trends in US rivers: Exploring effects from streamflow trends and changes in watershed management.

We present a conceptual model that explores the relationship of streamflow trends to 15 water-quality parameters at 370 sites across the contiguous United States (US). Our analytical framework uses discrete water-quality data, daily streamflow records, and a statistical model to estimate water-quality trends between 1982 and 2012 and parse these trends into the amount of change attributed to trends in streamflow versus changes in watershed management, such as changes in point or non-point sources related to pollution control efforts. We conceptualize a water-quality trend as an additive function of these two trend components. We found that for most of these records the water-quality trends were more strongly affected by changes in watershed management as opposed to trends in streamflow. However, the importance of these trend components on water quality varied by estimate type (i.e. concentration versus load trends), parameter, and site. Trends in load were more influenced by changes in the streamflow regime than trends in concentration. Trends in major ions, salinity, and sediment were more sensitive to changes in streamflow than nutrients. When results were aggregated by site, 25% of the sites had at least 1 parameter where streamflow trends attributed >7.5% to the water-quality trend for concentrations. For loads, this was the case for 66% of the sites. The findings of this work have important implications for the analysis of water-quality trends. Understanding the relative role of streamflow and management changes can help to isolate the effects of pollution control efforts on water quality and provide clearer understanding of progress, or lack thereof, towards water-quality goals.

What Goes Up Must Come Down: Integrating Air and Water Quality Monitoring for Nutrients.

Excess nitrogen and phosphorus ("nutrients") loadings continue to affect ecosystem function and human health across the U.S. Our ability to connect atmospheric inputs of nutrients to aquatic end points remains limited due to uncoupled air and water quality monitoring. Where connections exist, the information provides insights about source apportionment, trends, risk to sensitive ecosystems, and efficacy of pollution reduction efforts. We examine several issues driving the need for better integrated monitoring, including: coastal eutrophication, urban hotspots of deposition, a shift from oxidized to reduced nitrogen deposition, and the disappearance of pristine lakes. Successful coordination requires consistent data reporting; collocating deposition and water quality monitoring; improving phosphorus deposition measurements; and filling coverage gaps in urban corridors, agricultural areas, undeveloped watersheds, and coastal zones.

Modeling drivers of phosphorus loads in Chesapeake Bay tributaries and inferences about long-term change.

Causal attribution of changes in water quality often consists of correlation, qualitative reasoning, listing references to the work of others, or speculation. To better support statements of attribution for water-quality trends, structural equation modeling was used to model the causal factors of total phosphorus loads in the Chesapeake Bay watershed. By transforming, scaling, and standardizing variables, grouping similar sites, grouping some causal factors into latent variable models, and using methods that correct for assumption violations, we developed a structural equation model to show how causal factors interact to produce total phosphorus loads. Climate (in the form of annual total precipitation and the Palmer Hydrologic Drought Index) and anthropogenic inputs are the major drivers of total phosphorus load in the Chesapeake Bay watershed. Increasing runoff due to natural climate variability is offsetting purposeful management actions that are otherwise decreasing phosphorus loading; consequently, management actions may need to be reexamined to achieve target reductions in the face of climate variability.

CE: Original Research: The Experiences of Pregnant Smokers and Their Providers.

: Background: The U.S. Department of Health and Human Services' initiative Healthy People 2020 targets tobacco use, including smoking during pregnancy, as a continuing major health concern in this country. Yet bringing the U.S. Public Health Service's 2008 clinical practice guideline, Treating Tobacco Use and Dependence, into routine prenatal care remains challenging. Our previous nurse-managed intervention study of rural pregnant women found no significant cessation effect and significant discordance between self-reported smoker status and urinary cotinine levels. PURPOSE: The overall purpose of this follow-up study was to increase our understanding of the experiences of pregnant smokers and their providers. No qualitative studies could be found that simultaneously explored the experiences of both groups. DESIGN AND METHODS: This qualitative descriptive study used focus group methodology. Nine focus groups were held in two counties in upper New York State; six groups consisted of providers and three consisted of pregnant women. Four semistructured questions guided the group discussions, which were audiotaped and transcribed verbatim. Transcripts were read and coded independently by six investigators. Themes were identified using constant comparative analysis and were validated using the consensus process. RESULTS: The total sample consisted of 66 participants: 45 providers and 21 pregnant women. Most of the providers were white (93%) and female (93%). A majority worked as RNs (71%); the sample included perinatal and neonatal nursery nurses, midwives, and physicians. The pregnant women were exclusively white (reflecting the rural demographic); the average age was 24 years. All the pregnant women had smoked at the beginning of their pregnancies. Four common themes emerged in both the provider and the pregnant women groups: barriers to quitting, mixed messages, approaches and attitudes, and program modalities. These themes corroborate previous findings that cigarette smoking is used for stress relief, especially when pregnancy itself is a stressor, and that pregnant women may feel guilty but don't want to be nagged or preached to. CONCLUSIONS: These results have implications for how smoking cessation programs for pregnant women should be designed. Health care providers need to be cognizant of their approaches and attitudes when addressing the subject of smoking cessation. Specific educational suggestions include "putting a face" to the issue of tobacco use during pregnancy. More research is needed on how best to implement the 2008 clinical practice guideline in specific populations.

Challenges with secondary use of multi-source water-quality data in the United States.

Combining water-quality data from multiple sources can help counterbalance diminishing resources for stream monitoring in the United States and lead to important regional and national insights that would not otherwise be possible. Individual monitoring organizations understand their own data very well, but issues can arise when their data are combined with data from other organizations that have used different methods for reporting the same common metadata elements. Such use of multi-source data is termed "secondary use"-the use of data beyond the original intent determined by the organization that collected the data. In this study, we surveyed more than 25 million nutrient records collected by 488 organizations in the United States since 1899 to identify major inconsistencies in metadata elements that limit the secondary use of multi-source data. Nearly 14.5 million of these records had missing or ambiguous information for one or more key metadata elements, including (in decreasing order of records affected) sample fraction, chemical form, parameter name, units of measurement, precise numerical value, and remark codes. As a result, metadata harmonization to make secondary use of these multi-source data will be time consuming, expensive, and inexact. Different data users may make different assumptions about the same ambiguous data, potentially resulting in different conclusions about important environmental issues. The value of these ambiguous data is estimated at $US12 billion, a substantial collective investment by water-resource organizations in the United States. By comparison, the value of unambiguous data is estimated at $US8.2 billion. The ambiguous data could be preserved for uses beyond the original intent by developing and implementing standardized metadata practices for future and legacy water-quality data throughout the United States.

The effects of smoking cessation and a programme intervention on birth and other perinatal outcomes among rural pregnant smokers.

OBJECTIVE: The purpose of this study was to evaluate the perinatal outcomes of rural pregnant smokers enrolled in the Smoke Free Baby & Me trial. METHODS: Data on smoking status and other pre-natal variables were collected during pregnancy. Outcomes were retrieved from a review of hospital records of 161 singleton births (79 from the control group, 82 from the intervention group). RESULTS: The results show that, after adjusting for gender and gestational age, the more self-reported cigarettes at the first pre-natal visit, the less the infant birth weight (p = 0.033), the less maternal weight gain (p = 0.042) and the shorter the labour length (p = 0.041). Infants of women with positive urinary cotinine at the first pre-natal visit in the intervention group had higher 1 minute Apgar scores than those with negative cotinine (p = 0.022). Smokers also had a preponderance of male infants (64% vs 36%), while non-smokers had more females (59% vs 41%) (p = 0.006). CONCLUSIONS: Smoking during pregnancy affects perinatal outcomes. Assuming a foetal origin of chronic disease morbidity, implementing smoking cessation during pregnancy would not only improve maternal and foetal health, but also might contribute to an improvement in the incidence of adult chronic disease morbidity.

Relating management practices and nutrient export in agricultural watersheds of the United States.

Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.

A pilot randomized, placebo-controlled, double-blind trial of a multistep herbal program for assisting smokers to quit.

This pilot randomized-controlled trial was designed to evaluate the effectiveness of an over-the-counter multistep herbal smoking cessation regimen, SmokeRx, that employs four different herbal formulations taken at different times during the program. Twenty-two subjects were randomized to a placebo group and 20 to the SmokeRx program. The results show that the odds of reduced or validated cessation of smoking were not significantly different between the groups at any juncture over the 6 months of the trial but that there was a trend for higher odds in the SmokeRx group. Subjects were also more likely to drop out of the placebo group (p = .06), suggesting a possible positive effect of the SmokeRx regimen. Overall, early dropouts (at 2 week follow-up) appeared less motivated to quit smoking, as they were more likely to be younger, had smoked more than 5 years, had greater difficulty refraining from smoking in places where it is forbidden, had fewer previous quit attempts, did not intend to quit smoking in the next month, and exercised fewer hours per week. These results suggest that a larger trial of SmokeRx may be warranted and that more studies that assess the efficacy of herbal formulas are needed to provide valid data for non-nicotine smoking cessation options.