Nature-based therapeutics: A collaborative research agenda promoting equitable access and environmental stewardship.

BACKGROUND: Given the duration and intensity of the COVID-19 pandemic, with strict emphasis on social distancing, many individuals and families are experiencing social isolation. The need to explore effective strategies for health promotion and wellness is clear. AIM: The purpose of this report is to highlight evidence supporting the health benefits of nature-based therapeutics and to describe the exploratory and translational research agenda for a nurse-led program entitled RxPLORETM: Prescribing Life Outdoors and Real Exploration. METHODS: Integrative review of the current state of evidence for nature-based therapeutics and operationalisation of a nature-based health promotion framework as the foundation of a PhD-DNP collaborative program of research. DISCUSSION: Amidst the unfolding crisis of the COVID-19 pandemic, the value of nature-based therapeutics is becoming more widely recognised, as are layers of disparities in access to nature. A nurse-led team proposes a program of research outlining priorities for the translation of current evidence into practice and for the investigation of gaps in the evidence base that will inform future recommendations for nature-based health promotion. The initial population of focus is children and families. CONCLUSION: Prescribing nature is a strategy to promote health and wellness throughout the lifespan. For all populations to experience the health-promoting benefits of nature, nurses engage community members and collaborate across sectors to advocate for equitable access to nature and environmental stewardship through conservation practices.

Parents' Underestimations of Child Weight: Implications for Obesity Prevention.

PURPOSE: Obesity prevention efforts may be ineffective if parents lack awareness of their children's overweight status. This study examined the factors that predicted parents' underestimation of child weight status. DESIGN AND METHODS: Using a cross sectional design, researchers recruited children and parents in a local children's museum. Parents completed a demographic questionnaire, the Newest Vital Sign, and the Child Body Image Scale. Children's height and weight were measured to calculate child BMI. Random effects modeling examined the association between predictor variables (parent race/ethnicity, income, education, and health literacy, and child BMI percentile, gender, and age) and the dependent variable, parent underestimation of child weight status. RESULTS: Participants included 160 parents (213 children aged 7-12years) representing a racially and ethnically diverse sample who were affluent, educated, and with 36.6% of parents assessed with limited health literacy. Although 45.1% of children were overweight/obese, only 7.5% of parents chose this weight status; 80% of parents underestimated the weight of their normal weight children, 96% underestimated their overweight children, and 72% underestimated their obese children. Parents were more likely to underestimate weight of older children and those under 81st percentile of BMI. No other predictors were significant. CONCLUSIONS: Parent underestimation of child weight status appears to be a widespread phenomenon in this sample, regardless of race, ethnicity, income, education, and health literacy. PRACTICE IMPLICATIONS: The consistent underestimation of child weight suggests that parents' misperception of weight status represents a critical pathway for intervention. Methods to improve parents' perception of child weight need be developed and tested.

Improving Food Literacy and Access Among Young Adult Cancer Survivors: A Cross-Sectional Descriptive Study.

BACKGROUND: The links between nutrition and chronic disease are well established, but consumption of fruits and vegetables is low among young adult childhood cancer survivors (YACS) worldwide. Ensuring equitable access to fresh produce is a significant, persistent public health challenge. OBJECTIVE: The purposes of this report are to describe patterns of access to fresh produce, daily intake of fruits/vegetables, and nutrition education preferences among a sample of YACS and to highlight early development of a mentored gardening intervention. METHODS: A cross-sectional descriptive study design was used to assess dietary intake, access to fruits/vegetables, and preferences for nutrition education among 124 YACS through a comprehensive cancer survivorship program in a large pediatric cancer center. RESULTS: Most participants (71.8%) live more than 10 minutes' walking distance from a supermarket, and 88.7% do not meet the recommended daily intake of 5 or more servings of fruit and vegetables. A total of 91% of participants express that nutrition is important, and 81.5% desire dietary improvement. Most (78.2%) are likely to use either their computer or cell phone for nutrition content. To establish healthy nutrition habits, many seek the support of a nutritionist (63.7%) or another survivor (41.9%). CONCLUSIONS: Study findings underscore the need for advocacy to support equitable access to fresh produce and technology-enhanced nutrition education among YACS. IMPLICATIONS FOR PRACTICE: To improve access to fresh produce and food literacy among YACS, providers can collaborate with community stakeholders to build capacity for sustainable, technology-enhanced, and mentored gardening interventions at the individual, family, and community level.

School Garden Benefits: Health Promotion and Environmental Conservation.

Garden-based learning promotes environmental awareness, health, and wellness across the school community and beyond. In this article, we review the literature on the benefits of school gardening and describe firsthand experiences for garden success. By sharing lessons learned, our aim is to inspire school nurses to join forces with like-minded teachers and staff or take the lead to build capacity in their school for gardening and a green culture dedicated to the conservation of natural resources.

Engagement in Physical Activity Among Young Adult Childhood and Adolescent Cancer Survivors: Integration of Nature Technology.

This report addresses physical activity (PA) levels and education preferences in young adult cancer survivors (YACS) and outlines strategies for the design of successful interventions. A cross-sectional design was used to assess PA in 124 YACS, using the International Physical Activity Questionnaire-Short Form. Recommended levels were reported by 20.2% and 42.5% for high and moderate PA in metabolic equivalent of task (MET) minutes/week, respectively, while 37.3% reported low level PA in MET-minutes/week. Eighty percent reported likely to use technology for education about PA. Prior research supports using technology to administer tailored interventions to promote consistent PA among YACS, ideally in nature-based activities.

Evaluation of Mental Health Effects of a Mindfulness Workshop with Health Professions Students.

Our interprofessional team examined the mental health effects of a pilot mindfulness meditation workshop for college students (n = 39) from 4 health professions. A mixed-methods survey examined students' self-compassion (short form; SCS-sf), perceived stress (PSS-10), and self-reported mindfulness behaviors pre-workshop and at 2 months. The survey captured attitudes, beliefs, and intentions to continue mindfulness practices over time and perceived barriers to mindfulness practice. Participants (69%; 27/39) indicated significantly improved SCS-sf (p=0.016) and significantly reduced PSS (p=0.009) at 2 months post-workshop. Students reported improved mental health after 2 months, but the small sample size limits generalizability of findings. Interprofessional education promoting mindfulness skills may help prevent burnout and empathy fatigue for health professionals entering the workplace.

Supporting food literacy among children and adolescents: Undergraduate students apply public health nursing principles in clinical practice.

Effective public health nurses excel in partnership building and program planning to address priority health concerns, such as childhood obesity and disordered eating. Worldwide, children are at risk for low food and nutrition literacy with associated patterns of low fruit and vegetable consumption. This report focuses on the application of public health nursing principles by undergraduate nursing student teams in the design and delivery of food literacy interventions among a population of children and adolescents. Over a four-year time period, the cumulative intervention reach was 640 children/adolescents. Over 75 nursing students implemented the public health nursing process in support of food literacy, gaining skills across multiple practice domains. Lessons learned from academic-community partnerships to promote food literacy among children and adolescents have direct implications for undergraduate nursing education. Chief among these implications include the growing significance of integrating nutrition in the nursing curriculum and the need for scaffolding to support clinical application of interventions beyond health teaching to address broad determinants of health.

Anonymity, veracity and power in online patient feedback: A quantitative and qualitative analysis of staff responses to patient comments on the 'Care Opinion' platform in Scotland.

OBJECTIVE: To analyse how staff in one Scottish hospital respond to anonymised patient feedback posted on the nationally endorsed feedback platform Care Opinion; and to understand staff experiences of, and attitudes towards, engaging with Care Opinion data. METHODS: This was a multi-method study comprising: (a) numerical and thematic analysis of stories posted during a six-month period, using a published framework; (b) thematic analysis of interviews with a range of 10 hospital staff responsible for organisational responses to feedback. RESULTS: Seventy-seven stories were published during the six-month period. All received a response, with a mean response time of 3.9 days. Ninety-six responses were made in total, from 20 staff members. Personalisation and tailoring was mostly assessed as performing well against the published framework. Only two 'changes made' were reported. While staff interviewed were mostly understanding of why patients might prefer giving anonymised feedback, some found it uncomfortable and challenging. Participants described instances where they might seek to de-anonymise the individual, in order to pass on personal thanks to the relevant staff member, or to investigate the issue raised and seek resolution offline. Patients did not always want to identify themselves; this could sometimes lead staff to query the veracity or importance of issues raised. Sometimes staff could identify individuals anyway, including one described as 'our regular person'. CONCLUSIONS: Staff used to engaging directly with patients and families, both clinically and in dealing with feedback, need support in dealing with anonymous feedback, and the uncomfortable situation of unequal power it may create.

Family interactions among African Americans diagnosed with type 2 diabetes.

PURPOSE: The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes and their willingness to be involved in a culturally tailored program. METHODS: This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual standard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes. Twenty-one participants were randomly assigned to an individual education group or a culturally tailored intervention group. Family members/peers (n = 6) attended invited group sessions to obtain information about diabetes and family/peer support. The facilitator of the invited group sessions used a guide to help with group discussions. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide, thus identifying recurring themes within the participants' responses. RESULTS: The data revealed that family and friends made a difference in the diabetes management of individuals with diabetes. Although family and friends may have been helpful at times, they also created moments of problems and an environment that made it more difficult to care for diabetes. The data also revealed that diabetes is hard to manage and control. Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging. CONCLUSIONS: These findings confirm that family and peers greatly influence diabetes management among rural African Americans. The study's results will help health care providers understand the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes, particularly within rural African American communities where resources are limited.

Culturally tailored intervention for rural African Americans with type 2 diabetes.

PURPOSE: The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. METHODS: Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. RESULTS: Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. CONCLUSIONS: The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Contextualizing the effects of yoga therapy on diabetes management: a review of the social determinants of physical activity.

This article provides a review of literature both to identify the effects of yoga-based therapy on the management of type 2 diabetes mellitus and to examine the social context of physical activity. Findings from the review indicate that yoga has a positive short-term effect on multiple diabetes-related outcomes; however, long-term effects of yoga therapy on diabetes management remain unclear. The context of the social environment, including interpersonal relationships, community characteristics, and discrimination, influences the adoption and maintenance of health behaviors such as physical activity, including yoga practice. Further research is necessary to determine the extent of this influence.

Culture brokerage strategies in diabetes education.

The purpose of this article is to describe the elements of culture brokerage as applied in a recent educational pilot study among rural African Americans with type 2 diabetes mellitus. Culture Brokerage is a nursing intervention consisting of mediation between the traditional health beliefs and practices of a patient's culture and the health care system. The intervention of Culture Brokerage holds particular relevance for clinicians who work with chronically ill patients, including those with diabetes. Diabetes prevalence rates continue to rise with alarming swiftness, affecting people of all age groups and ethnicities. The burden of disease, however, disproportionately falls on ethnic minority groups, including African Americans. Notable health disparities in the prevalence and long-term complications of diabetes warrant the attention of health care professionals. One way in which public health nurses can address these disparities is to apply strategies of culture brokerage.

Poor Performance of Children Age 7 to 13 Years on the Newest Vital Sign.

Valid and reliable instruments are needed to assess health literacy in children. Although the Newest Vital Sign (NVS) has been well established for use in adults, reports of its use in children have only recently received attention in the literature. Whereas some researchers have reported successful use of the NVS in children as young as age 7 years, others have suggested it is best used in children age 10 years and older. This analysis reports on the performance of the NVS in children age 7 to 13 years, adding to the growing evidence related to the use of the NVS in pediatric populations. Overall, children in this sample performed poorly on the NVS, which refutes previous reports. Differences in child samples and NVS administration procedures may provide some explanation for the lower-than-anticipated NVS performance in this sample. Interpreting the NVS based on educational standards and expectations may provide additional information to determine age-appropriate recommendations for NVS use in children. [HLRP: Health Literacy Research and Practice. 2018;2(4):e175-e179.].

Mental health and behavioral problems of youth in the child welfare system: residential treatment centers compared to therapeutic foster care in the Odyssey Project population.

This is the first multisite, prospective study of behavioral and mental health disorders of youth in residential treatment centers (RTC) and therapeutic foster care (TFC), and the first study to compare the two. This study addressed two questions in a sample of 22 agencies in 13 states: (1) how prevalent were emotional and behavioral disorders in the youth admitted to RTCs and TFC?, and (2) were the youth in RTCs significantly more likely to be disturbed than youth served in TFCs? Data were drawn from the Time 1 phase of the longitudinal national "Odyssey Project" developed by the Child Welfare League of America (1995). Measures included an extensive child and family characteristics form (CFC) and the Child Behavior Checklist (CBCL). The results revealed extremely high levels of behavioral and mental health disorders in the sample as a whole, well above the norms for a non-child welfare population. The prevalence of disorder in the RTC population was substantially greater than in the TFC population.

Improving health in at-risk youth through Photovoice.

Photovoice is a practical method to allow at-risk youth to express the environmental influences in their lives at school, at home, and in their community. This project emerged from an interprofessional collaboration between social work and nursing that focused on school health. The purpose was to explore the factors influencing the mental and emotional health using photographs by students in a largely Hispanic middle school. Ten students were recruited and consented but only eight completed the project. The SHOWeD method was used to assist the students to formally reflect upon their photographs. Data analysis was conducted using content analysis to identify themes presented the students' reflections. The themes were staying healthy, stress dealing with anger/frustration, maintaining friendships and communication, recognizing bullying, and planning for the future. Reflections aided students to provide rich details about how the school environment influences their mental and emotional health. The use of Photovoice is a reasonable method for at-risk youth to explore and describe their environment. Nurses, social workers, parents, and school leaders can use the new knowledge about how the school environment influences the health of students to develop tools to support a healthy school and community environment.

Waterborne Disease Case Investigation: Public Health Nursing Simulation.

BACKGROUND: The lack of safe drinking water is a significant public health threat worldwide. Registered nurses assess the physical environment, including the quality of the water supply, and apply environmental health knowledge to reduce environmental exposures. The purpose of this research brief is to describe a waterborne disease simulation for students enrolled in a public health nursing (PHN) course. METHOD: A total of 157 undergraduate students completed the simulation in teams, using the SBAR (Situation-Background-Assessment-Recommendation) reporting tool. Simulation evaluation consisted of content analysis of the SBAR tools and debriefing notes. RESULTS: Student teams completed the simulation and articulated the implications for PHN practice. Student teams discussed assessment findings and primarily recommended four nursing interventions: health teaching focused on water, sanitation, and hygiene; community organizing; collaboration; and advocacy to ensure a safe water supply. CONCLUSION: With advanced planning and collaboration with partners, waterborne disease simulation may enhance PHN education. [J Nurs Educ. 2017;56(1):39-42.].

Yoga for Self-Care and Burnout Prevention Among Nurses.

The promotion of self-care and the prevention of burnout among nurses is a public health priority. Evidence supports the efficacy of yoga to improve physical and mental health outcomes, but few studies have examined the influence of yoga on nurse-specific outcomes. The purpose of this pilot-level randomized controlled trial was to examine the efficacy of yoga to improve self-care and reduce burnout among nurses. Compared with controls (n = 20), yoga participants (n = 20) reported significantly higher self-care as well as less emotional exhaustion and depersonalization upon completion of an 8-week yoga intervention. Although the control group demonstrated no change throughout the course of the study, the yoga group showed a significant improvement in scores from pre- to post-intervention for self-care (p < .001), mindfulness (p = .028), emotional exhaustion (p = .008), and depersonalization (p = .007) outcomes. Implications for practice are discussed.

Academic-practice collaboration in nursing education: service-learning for injury prevention.

Teams of senior-level baccalaureate nursing students at a private, urban university complete a population-focused public health nursing practicum through service-learning partnerships. Recently, students collaborated with local service agencies for Safe Communities America, a program of the National Safety Council in affiliation with the World Health Organization. This article describes the student-led process of community assessment, followed by systematic planning, implementation, and evaluation of evidence-based interventions to advance prescription drug overdose/poisoning prevention efforts in the community.