Empowering nursing council implementation science: An appeal to action.

BACKGROUND: In most hospitals, nursing councils are responsible for EBP implementation and evaluation. To enhance the perceived value of council participation by frontline nurses, administrators must promote the impact of council projects on healthcare outcomes. PURPOSE: The purposes of this appeal to action are to describe the role of nursing councils in promoting IS and EBP, and to provide recommendations that enhance the value of IS and/or EBP councils to frontline nurses, thereby incentivizing participation on these councils. METHODS: Nurse researchers from three metropolitan hospitals partnered with a medical librarian to recommend six strategies aimed at enhancing the perceived value of council participation. An argumentative review was conducted to support these strategies. DISCUSSION: Recommendations are inclusion of methods experts on councils; support from nursing administrators in the development, implementation, and evaluation of projects; formation of partnerships with nursing academic departments; expansion of publication opportunities and availability; and connection of projects to measurable quality indicators. CONCLUSION: Enhancing the perceived value of nursing councils by providing tools that optimize time and resource management can result in greater council participation and broader dissemination of IS evidence.

Poor sleep quality is associated with obesity and depression in farmers.

BACKGROUND: Farmers' work schedules can result in inconsistent sleep patterns which negatively impact health. PURPOSE: To explore the relationships between sleep, obesity, and depression in working, older farmers and their spouses. Covariates included body mass index (BMI), age, and gender. METHODS: Sleep quality, BMI, and depression were assessed in farmers (n = 1,394) 50 years and older. Bivariate associations among all covariates (i.e., age, gender, BMI, sleep) and dependent variable (i.e., depression) were analyzed using Pearson's correlation. Multivariable associations of the Center for Epidemiologic Studies Depression Scale (CESD). BMI with other study variables were assessed using linear regression. RESULTS: BMI was positively associated with sleep apnea symptoms (p ≤ 0.0001) and CESD scores (p = 0.0006). Participants with difficulty falling asleep were more likely to have poor sleep quality (p ≤ 0.0001) and higher CESD scores (p ≤ 0.0001). Poor sleep quality was associated with higher CESD scores (p ≤ 0.0001). Increased age, female gender, higher BMI, sleep apnea symptoms, and poorer sleep quality were all predictive of higher depressive symptoms. DISCUSSION: Farmers have unique lifestyles that increase the risk of poor sleep. Screening for sleep pattern disruption and understanding its impact could result in lower rates of depression and obesity in this group of high-risk individuals.

Food Costs Are Higher in Counties With Poor Health Rankings.

BACKGROUND: Poor dietary habits are associated with higher rates of cardiovascular disease. However, the cost of foods associated with lower risk of cardiovascular disease can be a significant barrier to healthy eating. OBJECTIVE: The aim of this study is to determine whether food prices per serving differed across Kentucky counties based on health ranking and overall nutritional quality. METHODS: Fifteen counties were randomly selected based on County Health Ranking. Overall Nutritional Quality Index and cost of 75 foods were assessed in all 15 counties in the same week. A generalized estimating equations model and post hoc analyses were used to assess differences in food cost by nutritional quality and health ranking. RESULTS: Food prices were significantly less in the most healthy counties compared with the least healthy (Z = 3.8; P < .001; $0.08 per serving). Prices were also significantly higher in least healthy counties (tertile 3) compared with moderately healthy counties (tertile 2) (Z = 2.3; P = .024; $0.05 per serving). CONCLUSIONS: Disproportionately higher food costs are associated with poor health outcomes in Kentucky counties. Community-based interventions can potentially improve access to affordable healthy foods. Current supplemental nutritional policies do not address disparate food costs. Health professionals should advocate for policy changes that are reflective of these food cost disparities.

Food cost disparities in rural communities.

Promotion of healthy eating is an effective public health strategy to prevent chronic disease incidence and progression. However, food prices can impede healthy eating, especially in rural communities. The purpose of this study was to determine whether food costs are associated with nutritional quality, geographic location, and month of year. The Overall Nutritional Quality Index and cost of 92 foods were assessed four times over a 10-month period in the primary grocery stores in four Kentucky counties, two rural and two urban. Repeated measures analysis of variance was used to assess differences in food costs by nutritional quality, county, and month. Among more nutritious food items, costs were lower in urban areas. This was particularly true among foods in the highest quartile of nutritional quality. Across all counties, there was a pattern of highest per-serving costs in the second quartile of nutritional quality, whereas more nutritious foods were less expensive. Strategies that help individuals improve the ability to identify and prepare less costly foods with high nutritional value may be effective in improving dietary habits, particularly in rural, impoverished food deserts.

Gender and age are associated with healthy food purchases via grocery voucher redemption.

INTRODUCTION: Grocery vouchers that specifically target foods associated with reduced cardiovascular disease (CVD) risk result in increased consumption of those foods. In regions with disproportionately high CVD rates, there is little research concerning the impact of vouchers on purchases of risk-reducing foods when there are no restrictions placed on grocery voucher redemption. Since many food assistance programs place few restrictions on type of foods that can be purchased, identifying demographic factors associated with purchasing habits is a prerequisite to promoting healthy eating. The purpose of this study was to determine the associations of age, gender, education and income level with purchasing of healthful foods through the use of a grocery voucher in a rural food desert (poverty rate of ≥20% and ≥33% of residents living >16 km from a large grocery store) with high rates of chronic disease. METHODS: The effectiveness of an intervention that included a media campaign, a $5 grocery voucher, local heart healthy food branding and a grocery store event was tested. Brief nutritional articles were published in both local newspapers during four consecutive weeks. These articles explained the physiological actions of healthy foods and listed a health-promoting recipe. During the fourth week of the media campaign, a voucher for a $5 grocery gift card redeemable at one of either community grocery stores was also printed in both local newspapers. In each store, foods that are known to be associated with a reduced risk of CVD were marked with a blue logo. Participants (N=311) completed a questionnaire that assessed demographics and usual servings of fruits, vegetables and grains. Participants received a $5 grocery card and a list of labelled foods. Returned grocery receipts were stapled to the questionnaires to analyse the relationship between demographics and food choices. RESULTS: Participants who bought at least one labelled food item were older (M=48.5, SD=14.7) than those who did not buy any of these items (M=42.3, SD=16.4; p=0.0008). There was a significant association between labelled food purchases and gender, with 47% of male participants purchasing at least one labelled food item compared with 63% of females in the study (p = 0.008). There were no significant associations between purchase of labelled food items and either education or income. The significant predictors were age (p=0.003) and gender (p=0.01). For every 10 year increase in age, there was a 29% increase in the likelihood that at least one labelled food item would be purchased. Male participants were 48% less likely to purchase at least one designated food item than female participants were. CONCLUSIONS: Younger adults and men may be less responsive to media-based educational strategies, heart-healthy food labelling and grocery vouchers to defray the cost of healthy eating than older adults and women. Previous studies show that concerns about cost and availability of foods are greater factors in the decision to purchase these foods than demographic characteristics. However, age and gender are associated with the likelihood of using grocery vouchers for the purchase of healthful foods. Additional research is needed to determine whether different educational strategies paired with food labelling and grocery vouchers may be successful strategies to promote purchase of healthful foods, particularly for men and younger adults.

Systematic review and analysis of self-efficacy in sun protection measurement instruments.

OBJECTIVE: The objective of this study was toidentify and appraise available sun protection self-efficacy instruments and synthesize information. DATA SOURCE: A systematic search of electronic databases from 2005 to 2023 included PubMed, CINAHL, Embase and PsycINFO . BACKGROUND: While instruments have been developed to evaluate sun-protective behaviors and self-efficacy separately, sun-protection self-efficacy instruments have yet to be widely studied. Self-efficacy is an essential antecedent to performing health-related behaviors or practices that can promote or hinder the health of individuals and groups. STUDY INCLUSION AND EXCLUSION CRITERIA: Studies randomized control trials or descriptive studies that used self-efficacy measurement tools to evaluate behaviors, intentions, and sun protection knowledge were included in this review. Sun protection surveys that targeted providers or parents and non-English articles were excluded. DATA EXTRACTION: Data were extracted by one independent researcher. DATA SYNTHESIS: Fifteen studies met the inclusion criterion and included 10 scales of self-efficacy in sun protection. Study design and purpose, and the instrument's validity and reliability statistics, including Cronbach's alphas, were extracted. RESULTS: The two-factor self-efficacy in sun protection scale was the most common measure for primary prevention, with acceptable reliability and validity. However, other instruments also showed reliable psychometric properties, especially measures of sunscreen self-efficacy. CONCLUSION: More research in self-efficacy measurement is warranted to examine specific populations and determine the appropriate constructs of self-efficacy. It is crucial to design evidence-based interventions that affect self-efficacy, are measured by a reliable, valid instrument, and have the potential to increase sun-protective and screening behaviors.

Outdoor workers' perceptions of skin cancer prevention: a qualitative study.

OBJECTIVES: Outdoor workers are at increased risk for skin cancer and melanoma. This qualitative study aimed to explore outdoor workers' perspectives and experiences of primary (i.e. sun protection) and secondary prevention, i.e. skin self-examination (SSE) of skin cancer. METHODS: Purposive, snowball, and theoretical sampling was used to recruit outdoor workers in Kentucky and Indiana. Semi-structured interviews via telephone or videoconference of approximately 45 min were conducted with interviewer probes and questions about perceptions of cancer risk, prevention, and screening techniques conducted, perceived barriers and facilitators, and preferences for health dissemination venues. The recordings were transcribed verbatim and de-identified. Analysis involved constructivist grounded theory coding strategies. Using peer debriefing and consensus building around themes, the researcher established a codebook for all interviews to utilize within Dedoose software for systematizing and organizing data. RESULTS: Eighteen interviews were conducted. Interviewees (N = 18) ranged in age from 35 to 78 yr, with 3 females. Outdoor industries included agriculture, maintenance, and grounds maintenance. Themes derived from the data showed the underlying factors and perceptions that influence outdoor workers to conduct primary and secondary cancer prevention activities. The level of alarm attributed to disease and the level of trust in information contribute to intentions to conduct activities. The intentions and trust toward healthcare institutions and providers drive the primary or secondary prevention behaviors. Cultural and contextual factors included masculinity and self-sufficiency, familial and occupational priorities, and community ties. CONCLUSIONS: These data provide a basis for developing future communications and interventions to decrease skin cancer incidence in outdoor workers. They indicate that secondary prevention and building self-efficacy in conducting SSE should be emphasized in tandem or over primary skin cancer prevention methods in this population. Trusted local healthcare providers should primarily provide prevention information, and materials should utilize testimonials from the local community to best influence this population. Communications and training interventions are needed in this population to induce a proactive level of alarm about cancer and result in the performance of SSE.

Development and Psychometric Evaluation of a Food Resource Acceptability Questionnaire.

The stigma associated with food assistance is a significant barrier to resolution of food insecurity. Interventions and policies aimed at reducing food insecurity would benefit from the inclusion of strategies aimed at minimizing food assistance stigma. We developed the Food Resource Acceptability Questionnaire (FRAQ), a scale that measures the perceptions of stigma associated with food assistance. Qualitative interviews, modified Delphi technique, and exploratory factor analysis were used to develop and evaluate the 17-item scale. The FRAQ consists of two subscales (stigma and the belief that food is a basic right) to measure the likelihood of individuals perceiving food assistance as socially and culturally acceptable. Cronbach's alphas were 0.85, 0.80, and 0.89 for the Stigma subscale, Food as a Basic Right subscale, and the overall FRAQ, respectively. Additional research is needed to determine the applicability of the FRAQ in diverse populations.

Students' perceptions of a community health advocacy skills building activity: A descriptive analysis.

BACKGROUND: Skills to promote advocacy, a nursing competency, are vital to today's cohorts of nursing students, who often struggle with discourse. Opportunities to develop, defend, and rebut science-based arguments enhance resilience and self-efficacy when advocating for health policy. A community health discussion activity was developed to enhance advocacy skills in undergraduate and graduate nursing students at a midwestern university. OBJECTIVES: The purposes of this study were to explore students' perceptions of the benefits of a discussion activity about a controversial health issue, and to describe the impact of the opportunities to form valid arguments using empirical evidence on students' perceptions of their ability to be advocates. DESIGN: Cross-sectional post-activity survey evaluation. SETTINGS: Enrollment in a community health nursing course. PARTICIPANTS: Students from two undergraduate (n = 110) and one graduate (n = 20) nursing cohorts. METHODS: Following completion of the online discussion activity, students were invited to provide feedback on their perceptions of activity benefits. Descriptive analyses were conducted. RESULTS: Undergraduate and graduate nursing students reported the activity helped them learn to form a valid argument using scientific evidence (88.6 %), use credible sources when forming their own opinions (91.7 %), and begin to see themselves as advocates for improving the health of individuals and communities (87.1 %). CONCLUSIONS: Online discussion boards are potential venues for development of advocacy skills.

Socioecological Analysis of a Nursing Advocacy Skills-Building Activity.

BACKGROUND: Advocacy is an expectation of the nursing profession. Nursing curricula should include opportunities for advocacy skills building at multiple levels of potential effect. Analyses of student performances during these advocacy exercises provide insight into how well students understand the multifactorial nature of most public health issues. METHOD: A socioecological model was used to evaluate nursing students' advocacy responses to food-insecurity scenarios during a guided online discussion activity aimed at advocacy skills building. RESULTS: Student recommendations were categorized as individual, interpersonal, organizational, community, and policy interventions, with subcategories at each socioecological level. CONCLUSION: Recommendations are given for future educational research specific to advocacy skills building. Implications for nursing education at each socioecological level also are discussed. [J Nurs Educ. 2023;62(9):509-515.].

Establishing a Permanent Food Pantry in a Pediatric Emergency Department.

Childhood food insecurity is associated with adverse health outcomes. Food pantries housed within healthcare facilities have the potential to reduce childhood food insecurity. An interdisciplinary team established a permanent food pantry in the pediatric emergency department of a metropolitan children's hospital. Members of the team included attending and resident physicians, nurse practitioners, nurses, patient care technicians, a volunteer coordinator, Prevention and Wellness staff, and environmental services staff. The development process, formative evaluation, and impact of the pantry during the first 15 months of use is described. Families presenting to the emergency department were notified of the food pantry and offered a bag of groceries. Data collected included number of adult and children in the household, age ranges of family members, and whether food was accepted. The food pantry provided aid to 2199 households from January 2021 to April 2022. Recipients of food assistance included 4698 children, 3565 adults, and 140 seniors. In addition, the interdisciplinary approach to the development process elucidated barriers to and facilitators of the project's success, thereby maximizing the food assistance outcome.

Expediting dental treatment for patients with diabetes mellitus in a university-based dental clinic.

PURPOSE: This pilot project was implemented to minimize barriers in access to care, reduce the risk for oral health and systemic diabetes complications, and optimize the health outcomes for patients with diabetes seeking comprehensive dental treatment. METHODS: The intervention group included patients with diabetes who participated in hemoglobin A1c (HbA1c) testing during their initial dental screening appointment. The participants whose HbA1c value was ≤ 9.0% were expedited into the scheduling queue for the next comprehensive examination appointment. Health literacy was assessed regarding patients' understanding of the connection between oral health and diabetes. RESULTS: The mean number of days between screening and treatment plan development was decreased by 38.4%. Of the participants in the intervention group with an HbA1c value ≤ 9.0%, 44% rated their understanding of the connection between diabetes and gum disease as "poor", whereas 86% of the patients who were ineligible due to an HbA1c value ≥ 9.1% rated their understanding as "very good" or "excellent". CONCLUSIONS: Patients with diabetes will continue to benefit from this quality improvement project to minimize barriers to dental care and improve overall health outcomes as this intervention is adopted as a permanent practice change. The need has been highlighted for comprehensive education in practice settings concerning medical and dental collaboration, and patient awareness of the interrelationship between diabetes mellitus and oral disease. An increase in oral examinations, assessment of routine oral health behaviors, and referral to dental providers from the primary care setting is warranted.

Polyunsaturated fatty acids. Immunomodulators in older adults.

The immune system tends to become less efficient as people age, and nutrition plays a significant role in older adults' immune responses. In particular, dietary fatty acids are precursors to important immune system components. Certain fatty acids, predominantly those that are polyunsaturated, also tend to decrease the risk of certain neurological diseases in older adults. This article describes the impact of dietary polyunsaturated fatty acids (PUFA) on older adults' immune system and discusses the roles of age and immune status with regard to PUFA supplements.

Characteristics of RN to BSN students in online programs.

BACKGROUND: Registered nurse to baccalaureate in nursing (RN-BSN) programs has rapidly moved to online formats to increase the ability of working nurses to earn their BSN degree. Nursing faculty are tasked with designing programs to meet the needs of the nursing workforce using best practices for online learning. OBJECTIVES: Describe RN-BSN student perceptions of their online programs, including clinical experiences. Specific aims were: 1) evaluate student satisfaction in online courses, 2) describe experiences students were required to have to meet clinical objectives, 3) determine generational differences in satisfaction with online learning 4) determine the students' perception of the value of course content in online program 5) examine life responsibilities impacting student program participation. DESIGN: A descriptive cross-sectional design with convenience sampling was used. SETTING: Participants included 43 RN-BSN students currently enrolled in at least one online course at one of six accredited nursing programs across the United States. METHODS: Survey data were collected over 4 months in the summer of 2019. The research team created a 9-item online survey, including investigator-initiated questions and demographic information. RESULTS: Overall satisfaction in online programs was high. Technology, nursing informatics, computer classes, research and evidence-based practice, public health, pathophysiology, pharmacology, leadership, reading text books, assessment, brushing up on skills, and emotional intelligence were most valued content. Least valued content included discussion boards and group projects. Clinical requirements and setting varied across programs. Life responsibilities impacted students' participation in online programs. CONCLUSIONS: Overall, students were satisfied and found value in their online RN-BSN coursework. Clinical experiences varied between RN-BSN programs and participation in online courses was impacted by extracurricular obligations. Based on this study, more data regarding what could be counted as clinical hours is needed. Faculty need to consider alternative ways to achieve learning outcomes. This study's outcomes may help guide faculty in developing RN-BSN programs and student-centered courses.

Neonatal postgraduate training program for physician assistants: meeting a need in neonatal care.

There is a growing need for advanced practice providers in the NICU. Physician assistants (PAs) with postgraduate training in neonatology can help meet these demands. The premise of training PAs to work in the NICU is being adopted by multiple centers nationwide. Unfortunately, there are no standardized curricula for neonatal PA training that can be utilized to initiate residencies. Since our program is the longest running neonatal PA residency in the nation, we are in a unique position to share the accumulated experiences of our curriculum development. In this article, we describe our neonatal PA residency as it exists today with selected lessons learned. In addition, we present mixed qualitative and quantitative assessments of graduates. We believe that neonatal PA residency graduates become ideal candidates to fill the growing national need. We propose that our model program can be a stepping stone to enhance the role of PAs in neonatal care.

The effects of a Mediterranean-style dietary pattern on cardiovascular disease risk.

Dietary patterns influence cardiovascular disease by inhibiting or promoting atherogenesis. Certain nutrients play key roles at different stages of this process, and the combined nutrients of a Mediterranean-style diet offer a significant source of primary and secondary disease prevention. Although current evidence does not support recommendations for or against single-nutrient supplementation, a Mediterranean-style diet should be recommended to reduce the risk of cardiovascular disease. Current nutrition recommendations and mechanisms by which a Mediterranean-style diet impacts cardiovascular risk are described in this article.

Adolescents' Perceptions of a Gardening Activity at a Juvenile Justice Center.

PURPOSE: The purpose of this study was to elicit participants' ( N = 16) perceptions of a gardening activity at a juvenile justice center and to determine whether past exposure to gardening and farmers markets was associated with their perceptions of the gardening experience. DESIGN: This cross-sectional, exploratory program evaluation was conducted in partnership with the Kentucky Department of Juvenile Justice. Adolescents completing the Cadet Leadership and Education Program participated in gardening in order to provide produce to a local farmers' market. METHOD: After the growing season, participants were asked to complete a nine-item questionnaire about the gardening activity during one of their usual classes at the facility. The questionnaire assessed perception of the experience and past exposure to gardening and farmers' markets. FINDINGS: Participants reported favorably about their participation in the activity, knowledge gained from the activity, and their intent to garden in the future. Those who had previously gardened had more favorable perception of gardening than those who had never gardened. Gardening is an inexpensive means of teaching teamwork and delayed gratification and providing a sense of empowerment and may benefit at-risk adolescents during incarceration.

The effects of sleep-disordered breathing symptoms on voiding patterns in stroke patients.

PURPOSE: The purpose of this study was to compare voiding patterns after catheter removal between post-stroke individuals with symptoms of sleep-disordered breathing (SDB) and those without symptoms of SDB. METHOD: Medical records were reviewed for documentation of SDB symptoms of obstructive sleep apnea (OSA) and voiding patterns before and after catheter removal. SDB was based on established criteria for excessive sleepiness used in the Epworth Sleepiness Scale (Chervin, Aldrich, Pickett, & Guilleminault, 1997). Data on voiding patterns and nocturia were collected for 4 nights after catheter removal. Demographic data, co-morbid conditions, usual hours of sleep, and use of a benzodiazepine medication as a nightly sleep aid were also reviewed. Descriptive statistics and Chi-square analysis were performed to describe the sample, use of nightly sedation, and to compare the incidence of nocturia for 4 consecutive nights after catheter removal in subjects who had SDB symptoms of OSA with those who did not have SDB symptoms of OSA. FINDINGS: Study findings suggest that in post-stroke subjects (a) SDB symptoms of OSA are associated with more episodes of nocturia after evening catheter removal, and (b) use of sedatives for sleep is associated with an increased incidence of nocturia.

Effect of time of day for urinary catheter removal on voiding behaviors in stroke patients.

PURPOSE: The purpose of this study was to compare the effect of urinary catheter removal at 7:00 a.m. with removal at 10:00 p.m. on (a) the length of time to first void after catheter removal, (b) the amount of the first void, (c) post-void-residual urine, and (d) the number of subjects requiring re-catheterization. METHODS: A randomized, comparative design was used. Stroke patients, over the age of 18 years, admitted to a stroke unit, were approached about study participation. Forty-five subjects were enrolled: 26 in Group A (10:00 p.m. removal) and 19 in Group B (7:00 a.m. removal). Groups were compared using t-tests and Chi-square. FINDINGS: No significant differences were identified between the two groups with regard to time to void, volume of first void, post-void residual urine, or the number of subjects requiring recatheterization.

Attitudes, social norms and perceived behavioral control factors influencing participation in a cooking skills program in rural Central Appalachia.

A focus group session, using the Theory of Planned Behavior to guide questions and discussion, was conducted at midpoint of a 12-month cooking skills program in a rural Appalachian food desert. The purpose of this qualitative study was to determine the attitudes, subjective norms and perceived behavioral control beliefs that influenced participation in these classes. Participants viewed the classes as opportunities for social interaction and to have new experiences. Subjective norms were influenced by family members and traditional cooking. Perceived behavioral control was influenced by the opportunity to try new foods without concern of food waste, acquisition of the knowledge to introduce healthy foods into family meals and enhanced food preparation skills. During the evaluation, a strong sense of participant appreciation of researcher presence was discovered. This unexpected positive component of the program will be promoted using motivational interviewing techniques to enhance adherence to healthy eating behaviors during and after cooking skills programs.