An exploration of language: How nurses describe social factors that contribute to health.

BACKGROUND: Over the last two centuries nurses have been practicing, teaching, and conducting research on social factors that contribute to health and the language has evolved over this time. PURPOSE: To explore how social factors that contribute to health are described by nurse authors and how that use has changed over time. METHODS: A scoping review using the JBI Manual for Evidence Synthesis, Cochrane Handbook, and PRISMA guidelines was completed. FINDINGS: From 1967 to 2021, nurses used the term "social factors" most commonly and there was a shift from demographic to social factors. DISCUSSION: As the language that nurses use has shifted from demographic descriptions to the social factors that may be associated with those descriptions, nurses have an opportunity to promote the use of non-deterministic language for health promotion and research.

Staff Duress Alarms for Workplace Violence in the Emergency Department: A Mixed-Methods Evaluation.

INTRODUCTION: Complex personal duress alarms may be implemented as part of a multicomponent approach to preventing and mitigating workplace violence in emergency departments. Evaluation of duress alarms after implementation has been identified as a gap in the literature. The purpose of this quality improvement project was to examine the impact of a duress alarm system on workplace violence and user experience in an urban emergency department. METHODS: A comprehensive system evaluation was performed using a mixed-methods approach, which included retrospective data review, key informant interviews, observations, and a survey. Forty clinical staff at an emergency department in North Carolina were interviewed and provided feedback on the duress system. RESULTS: Findings indicated that the duress system was not associated with a decrease in workplace violence, and that the majority of clinical staff did not even wear the duress alarm. Staff indicated that the primary barriers to use of the alarm were the bulky design of the alarm badge, inadequate education about the alarm device and process, and the lack of a reliable and timely response from security. DISCUSSION: Ongoing engagement of clinical staff is critical to the success of health care technology implementations. Staff feedback, periodic re-education, and recurring process evaluations are vital to ensuring the continued relevance of systems, especially when staff safety is the intended purpose.

Problematic internet use in adolescents and implementation of a social media hygiene protocol.

PURPOSE: This quality improvement project aimed to evaluate whether a social media hygiene education intervention designed for adolescents with problematic internet use (PIU) receiving treatment at a pediatric outpatient mental health clinic reduced PIU and/or improved mental health outcomes in adolescents. METHODS: Participants were 28 adolescents (71.4% females, mean age = 14.2 years) with PIU seeking outpatient mental health treatment. The most common associated diagnoses were anxiety (42.9%) and attention-deficit activity disorder (28.6%). A within-adolescent pre-post design was used to evaluate changes in PIU severity measured by the Generalized Problematic Internet Use Scale-2 (GPIUS-2), depression and anxiety severity was assessed by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS), and screen time defined as the average hours/day during past 7-days recorded of the adolescent's smartphone. The practice change was an ad hoc social media hygiene education intervention conducted by their provider over five, once-a-week, one-hour telehealth sessions. RESULTS: A significant reduction in screen time (paired t = 10.14, df = 27, p < 0.001), severity of PIU (paired t = 12.07, df = 27, p < 0.001), and severity of depression and/or anxiety symptoms (paired t = 8.3, df = 27, p < 0.001) was demonstrated. Large effect sizes were observed (Cohen d = 1.6 to 2.3). Attendance for each session was 100% for Weeks 1, 2 and 5, 93% for Week 3 and 89% for Week 4. CONCLUSION: The findings suggest administration of a social-media hygiene protocol conducted via telehealth may reduce the severity of PIU and improve mental health outcomes in adolescents seeking outpatient mental health treatment.

Improving Youth Sports Safety: Implementing an Emergency Action Plan for Sudden Cardiac Arrest.

BACKGROUND: Children who participate in youth sports are at risk for sudden cardiac arrest (SCA) related to undetected cardiac anomalies or abrupt impact to the chest. Nurse-led interventions may prevent sudden cardiac death by helping leagues implement an emergency action plan to respond to SCA and improve safety. A youth soccer league in the Southeast with participants between the ages of 5-19 years, led by volunteer board members and coaches, did not have reliable access to automated external defibrillators or receive standardized education on SCA and cardiopulmonary resuscitation with a site-specific action plan. METHODS: A nurse-led quality improvement pilot project used partnerships to provide league access to automated external defibrillators, institute preseason SCA and cardiopulmonary resuscitation training, and establish an emergency action plan for the league's volunteers. Anonymous pre- and post-training testing was conducted to measure participant knowledge, confidence, and willingness to respond to SCA. A cross-sectional survey, using a convenience sample of board members and coaches, evaluated sustainability of the intervention at midseason. INTERVENTION: Training targeted board members (Blue Shirts) to serve as leaders on the field during an SCA event and educated coaches on activating the emergency action plan. RESULTS: Blue Shirts and coaches showed significant (p < .05) improvement of knowledge, confidence, and willingness to respond to SCA after receiving the standardized preseason intervention; Blue Shirts' changes were sustained at midseason. CONCLUSION: Nurses are ideal for helping youth sports leagues implement a sustainable SCA action plan based on best-practice recommendations for emergency health and safety.

Behavior Change Counseling of Patients with Substance Use Disorders by Health Professions Students.

OBJECTIVE: The purpose of this project was to create an interprofessional substance use disorders (SUDs) course that provided health professions students an opportunity to acquire and apply behavior change counseling skills for patients with SUDs with direct observation, assessment, and feedback. METHODS: The interprofessional SUDs course was offered five times within one academic year as part of a one-month psychiatry clerkship. The course focused on developing empathy and examining personal bias, behavioral change counseling, and recognition, screening, and treatment of SUDs. Students practiced behavior change counseling during the course and with a SUD patient. A faculty member experienced in behavior change counseling assessed students' patient counseling using the validated Behavior Change Counseling Index (BECCI). RESULTS: Seventy-eight students from medicine, nursing, pharmacy, social work, and physician assistant programs completed the one-month course. Fifty-three students counseled a SUD patient. Students' BECCI-rated counseling skills indicated they performed recommended counseling practices and spoke "less than half the time" or "about half the time" when counseling. Ninety-three percent of SUD patients reported a willingness for follow-up care about their substance use after the student-led session with a student. CONCLUSION: Following participation in an innovative interprofessional SUD course that included behavior change counseling, students demonstrated their ability to apply their skills during training and with a SUD patient. The study demonstrated promising patient outcomes following student counseling.

At the Front Lines: Effectively Training Community Stakeholders to Recognize and Report Child Abuse and Neglect.

In states with universal mandatory reporting of child abuse and neglect (CAN), it is essential that people who work with children and youth in a community be appropriately trained to recognize and report CAN. The primary goal of CAN training is early detection and intervention with a secondary purpose of impacting rates of violence, disease, drug use, and teen pregnancies in the community. The purpose of this project was to implement a standardized, community-tailored CAN training for laypersons and a train-the-trainer program in a rural Oklahoma community. The CAN training was evaluated on knowledge, confidence, training satisfaction, and willingness to participate in the train-the-trainer session. The train-the-trainer session was evaluated on confidence and training satisfaction. Participant knowledge and confidence was measured by comparing pretest scores to immediate and 4 months after the training posttest scores. Posttest scores indicated increase in knowledge at the posttest (p < .001) and posttest 2 (p < .001). There was a significant increase in confidence at the posttest (p < .001) and posttest 2 (p = .009).

Let's Work Together: Interprofessional Training of Health Professionals in North Carolina.

Implementation of interprofessional education efforts at Duke University Health System and the University of North Carolina have enhanced teamwork, education, and mentoring for health professional learners and faculty. The IPE initiatives address the critical need for enhanced collaboration among all team members in the evolving health care arena.

Strategies to Address Individual Level Social Determinants of Health Designed to Cultivate the Next Generation of Minority Nurse Leaders Committed to Health Equity.

In response to the need for increased racial and ethnic diversity in the nursing profession, the Duke University School of Nursing (DUSON) established the Academy for Academic and Social Enrichment for Leadership Development in Health Equity (Health Equity Academy). The aim of the Health Equity Academy is to improve the diversity of the nursing workforce by expanding nursing education opportunities for underrepresented minority (URM) students who are economically disadvantaged to prepare for, enroll in, and graduate from the DUSON's Accelerated Bachelors of Science in Nursing program. The goal of this program is to cultivate URM nursing graduates with advanced knowledge and leadership skills who can address health disparities and positively influence health care issues currently plaguing underrepresented populations. The article discusses the Health Equity Academy framework, which consists of two unique components: the Pre-entry Immersion in Nursing and the Pathway to Success in Nursing (PSN). These two components are designed to address the nursing student individual level social determinants which could be potential barriers to success as well as provide support in their academic and professional development goals.

Use of Workshops to Develop Nurses' and Nursing Students' Writing Skills.

Workshops have been described in the literature as a strategy for preparing nurses to publish their work and develop their writing skills. Articles about the use of workshops for these purposes have not been integrated systematically. Seventeen articles were included in the current review. The workshop method has been found to be effective for preparing nurses to write for publication and for improving nurses' and nursing students' writing skills. However, workshops must be combined with one-to-one mentoring and feedback on writing to be successful.

Screening for critical congenital heart disease in newborns using pulse oximetry: evaluation of nurses' knowledge and adherence.

PURPOSE: The purpose of this project was to evaluate the benefits of an online nursing education program addressing the significance and rationale of an evidence-based critical congenital heart disease (CCHD) screening protocol using pulse oximetry implemented on full-term newborns delivered at an academic obstetric referral center. The aim was to assess nurses' knowledge of the protocol and nurses' adherence to the protocol documentation before and after the education module was implemented. SUBJECTS: Registered nurses working in the birthing center who completed the online knowledge tests and an education module. DESIGN: A repeated-measures quality improvement study was conducted to assess nurses' knowledge of the evidence supporting CCHD screening by pulse oximetry and adherence to the correct documentation of the screening protocol before, immediately after, and 3 months following participation in an online education module. METHODS: Nurses' knowledge of the CCHD screening protocol was determined by the number of correct answers on a 10-item online test administered before and after the education module. Adherence to correct documentation of the protocol before and after the education intervention was evaluated. The medical charts of 300 newborns delivered at the center with pulse oximetry readings performed after 24 hours of age and before discharge were randomly selected and reviewed. RESULTS: A significant improvement in knowledge test scores was observed immediately after the education module (9.1 ± 1.0), relative to baseline (8.4 ± 1.2; paired t = 3.02, P = .0046). A significant increase in knowledge test scores measured at baseline, immediately after, and 3 months postintervention was also indicated (F = 3.25; df = 2, 24; P = .0564). Documentation of the protocol in the medical charts for the location of the readings significantly improved after the educational intervention (right hand: 28%, 83%, and 90%; right foot: 27%, 82%, and 89%; both P < .0001). CONCLUSIONS: Providing education to staff before implementing new practice changes enhances their knowledge. Quality improvement monitoring is recommended to ensure nursing adherence to any practice change.

Increasing Diversity in the Advanced Practice Nursing Workforce Through Partnerships With Historically Black Colleges.

BACKGROUND: Health inequities have enhanced efforts to diversify the nursing workforce. Despite recruitment strategies, the percentage of Black nurse practitioners (NPs) lags in comparison with the populous. PROBLEM: Barriers to improving workforce diversity can be traced to academic nursing's lack of diversity in faculty, under-resourced education opportunities for students from underrepresented backgrounds, and historical hurdles. APPROACH: One systems-level approach to increasing NP workforce diversity is developing pathway programs aimed at preparing, recruiting, and supporting Black students into advanced practice nursing education. Current undergraduate RN students from 2 historically Black colleges and universities (HBCUs) attended a 1-week summer immersion program at a graduate school of nursing at a predominately White institution. CONCLUSION: Pathway programs for Black undergraduate RN students show promise for increasing awareness of graduate nursing, offering race and ethnicity concordant mentorship, and cultivating deep awareness for health equity.

Culturally Aligned Health Care: Implications for Patient Care and the Nursing Profession.

Professional nurses utilize person-centered/patient-centered models of care to provide meaningful and effective healing or promotion of wellness. Using their skills, knowledge, and expertise, nurses are poised to lead quality improvement efforts that enhance patient outcomes, reduce inequities among populations, and contain costs. Culturally aligned organizational models are built on key concepts of cultural competency, patient- and family-centered care, and diversity, equity, inclusion, and belonging concepts. Nurses are poised to lead cultural alignment innovations across health-care professional teams, using their foundational skills to enhance quality and safety across the health-care spectrum.

Improving Interprofessional Collaboration Between Behavioral Mental Health and Pediatric Primary Care Providers Through Standardized Communication.

INTRODUCTION: Pediatric mental health crisis increases demand for integrated behavioral health and pediatric primary care providers (PPCP). Communication is key to successful integrated pediatric behavioral-mental health, but studies demonstrate gaps between existing and desired communication practices. Project aims to improve PPCP factors and patient outcomes by implementing standardized communication tool in the Electronic Health Record (EHR). METHOD: Pre-post 20-week intervention. SETTING AND SAMPLE: Pediatric primary care and affiliated pediatric behavioral-mental health clinic of academic health system. PBMH patients and referring PPCPs. MEASURES: PPCP satisfaction with communication, comfort and confidence continuing mental health care pre-post PBMH consult, and patient appointment attendance. RESULTS: PPCP confidence and comfort treating mental health in primary care increased. No significant change in PPCP satisfaction after implementing standardized communication.  Identified factors associated with patient appointment continuity. DISCUSSION: Standardized EHR communication tools and enhancing PPCP confidence in managing common pediatric mental health conditions are effective collaboration strategies.

Evaluating the Implementation of the Online HUG Your Baby Course "Roadmap to Breastfeeding Success" for Nevada WIC Professionals.

Lack of knowledge on the impact of infant development and behavior on breastfeeding affects both professionals and the clients they serve. Continuing education for Nevada WIC professionals with the online HUG Your Baby course Roadmap to Breastfeeding Success was implemented. This two-hour online course teaches about baby's development from birth to one year in relation to the breastfeeding journey. Tests and self-report surveys were used to evaluate these objectives pre- and post-intervention. Results showed significant improvement in knowledge about infant behavior and development, confidence in identifying and responding to infant behavior, and the positive integration of HUG resources into the professionals' work.

Promoting an Emergency Action Plan for Sudden Cardiac Arrest in Youth Sports During a Pandemic.

INTRODUCTION: Pandemic-related restrictions increased the risk of delayed emergency response of bystanders to sudden cardiac arrest among youth athletes. Education and SCA emergency preparedness, implemented by nurse leaders and adapted to environmental changes, can greatly reduce the risks associated with an SCA episode. METHOD: A nurse-led, quality improvement pilot project was implemented in a recreational youth soccer league. The project included the implementation of an emergency action plan (EAP; with or without the pandemic and social-distancing restrictions) for bystanders responding to SCA. RESULTS: Participants showed significant improvement in knowledge and perceptions of SCA and emergency response (p < .001). Willingness to initiate cardiopulmonary resuscitation (CPR) improved (p = .127), and fear to engage in EAP decreased (p = .119) following an educational intervention on SCA. DISCUSSION: Nurse-led SCA education and implementation of youth league EAP successfully demonstrated safety in SCA preparedness and best practice recommendations for youth sports from the Interassociation Task Force.

Bridging The Gap in Adolescent Depression: An Action Plan Intervention.

INTRODUCTION: Depression is a common diagnosis among adolescents. Routine screening for depression is recommended, yet standardization in screening and management is lacking. A care gap exists due to long wait times for referrals to counseling and other specialized care. Use of a written action plan demonstrated positive effects as an initial management tactic of elevated screening scores. METHOD: A take-home action plan was provided to adolescents with elevated Patient Health Questionnaire-9 (PHQ-9) scores. Approximately 30 days after initiation, participants completed a post-intervention survey and a re-administration of the PHQ-9. RESULTS: Pre-intervention and post-intervention PHQ-9 scores were compared, showing a statistically significant decrease in PHQ-9 score (p = .008), with a median decrease of 4.5 points. Additionally, 92% of participants were somewhat likely or very likely to endorse the use of the action plan to a peer or friend. DISCUSSION: Using a written action plan is an effective strategy to bridge gaps in the care of adolescents with elevated depression screening scores.

Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting.

INTRODUCTION: Evaluation of a quality improvement project designed to improve HPV vaccine uptake in a pediatric primary care setting for young adolescents. METHOD: Three strategies were implemented in one private pediatric practice to promote HPV vaccine uptake for 11- and 12-year-old adolescents. 1) a standardized vaccine policy change was made to include HPV vaccine with other adolescent vaccines, 2) a pre-visit email was sent to parents of teens to provide factual vaccine information in preparation for the visit, and 3) a provider communication initiative was implemented to ensure all providers communicated consistent messages and delivered an effective cancer prevention recommendation for HPV vaccination. A pre/post design was used to compare vaccine rates. Data was obtained via the electronic health records. RESULTS: The post-intervention group demonstrated HPV vaccine rates increased substantially from 17.8% to 63.6%. DISCUSSION: Strategically implementing standardized clinical vaccine policies and presumprive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations.

Vaping Prevention in a Middle School Population Using CATCH My Breath.

INTRODUCTION: The number of teens using electronic cigarettes in the United States has reached epidemic proportions. One in 20 middle school youth currently vapes regularly (Wang et al., 2020), supporting the need for e-cigarette education and prevention programs in this vulnerable population. METHOD: The evidence-based youth vaping prevention program, CATCH My Breath, was implemented and evaluated in a small, private, parochial middle school using a quasi-experimental, within-subjects, longitudinal design. RESULTS: Students' e-cigarette knowledge significantly improved postintervention (p < .001) and was sustained at 3 months follow-up. Attitudes about vaping remained stable after postintervention and at 3 months follow-up (p > .05). Susceptibility toward vaping increased or remained consistent despite increased knowledge (p = .096). DISCUSSION: CATCH My Breath is an effective school-based resource to educate middle school youth about the dangers of vaping. Additional research is needed to evaluate the intervention's impact on e-cigarette attitudes and the measurement of susceptibility in teens.

Telehealth Educational Resources for Graduate Nurse Faculty.

BACKGROUND: The rapid acceleration of virtual health care delivery, telehealth, has underlined the pressing need for graduate nursing students to gain skills and competencies that will ensure effective and efficient delivery of telehealth care in future generations. PROBLEM: There is a need for graduate nursing students to be prepared to use telehealth, but few nursing programs offer this training. Barriers to this implementation may be due to lack of faculty knowledge, telehealth resources, or telehealth opportunities. SOLUTION: Graduate nursing faculty should use resources and the wisdom of early adopters of telehealth to ensure adequate telehealth preparation is integrated into all graduate nursing programs. CONCLUSION: This article describes emerging core competencies for telehealth education and offers guidance, resources, and activities for nurse educators who seek to prepare emerging advanced practice RNs to plan, deliver, and implement effective telehealth practices.