Undergraduate Nursing Student Reflections on Academic Service Learning Experiences - A Qualitative Study.

The provision of nursing care has shifted toward integrated primary care (provision of community health services by an interprofessional team), requiring that nurse educators take steps to ensure students have opportunities to learn and practice the leadership and professional skills required to function as members and leaders of interdisciplinary teams. We developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for undergraduate nursing students to facilitate this learning. During clinical immersion, students participated in academic service learning (ASL) activities consisting of a minimum of 25 h of clinical agency service each semester. This descriptive qualitative design captures recurring themes in the ASL reflections of eight nursing students participating in the inaugural TRIP cohort. Three themes were identified (1) "Embracing the Nursing Profession" (2) "Utilizing the Professional Skills of Nursing" and (3) "I Am A Nurse". We urge our faculty colleagues to consider incorporating ASL experiences into their undergraduate activities. We believe the effort to initiate, develop and sustain these partnerships will pay handsome dividends in terms skill and confidence enhancements for our undergraduate nursing students.

"Turn It over to God": Faith Enhances Mental Health of Rural Appalachian Older Adults.

In Appalachia, rates of depression and suicidality are higher than national averages. Additional disparities of age, geographic isolation, economic distress, and mental healthcare provider shortages contribute to mental health challenges among rural Appalachian older adults (RAOAs). Based on ethnonursing research in East Tennessee, this article expands on findings about how RAOA faith beliefs and practices enhance mental health. Faith was found to decrease worry, improve coping, facilitate a sense of peace, and deepen thankfulness and joy. Implications for nursing practice and education indicate the importance of providing spiritual care to promote mental health and well-being for this vulnerable population.

Influence of Spiritual Engagement on Appalachian Older Adults' Health: A Systematic Review.

Appalachia leads the country in mortality related to chronic comorbidities, such as heart disease, cancer, depression, and suicide. Appalachian older adults experience disproportionate risks for poor health outcomes. Spirituality is integral to Appalachian culture, and many older adults use spiritual engagement (SE) to cope with health challenges. Despite these connections, there is limited evidence about SE and well-being in this population. Therefore, the current systematic review addresses the literature gap of how SE influences health of Appalachian older adults. Using thematic synthesis, we analyzed 11 qualitative and three mixed methods studies. Major findings indicate that SE positively impacts holistic health through adaptive coping, guided partnerships with God, decreased loneliness, and enhanced sense of purpose. Future studies could examine SE practices among diverse populations, SE virtual experiences, and SE nursing assessments. Understanding how SE influences health of Appalachian older adults could prepare nurses to reduce disparities and improve health outcomes for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 45-52.].

Methods, Ethics, and Cross-Language Considerations in Research With Ethnic Minority Children.

BACKGROUND: Qualitative research seeking the perspectives of minority children on child health issues such as childhood obesity and healthy weight care is limited, especially in nursing research. OBJECTIVE: Our objective is to share methodological, ethical, and cross-language knowledge gained from conducting an ethnonursing research study. This study focused on providing a voice for ethnic minority children in childhood obesity literature. METHODS: The purpose of the study was to discover cultural influences on healthy weight care in children of Burmese refugees of Karen ethnicity. Researchers may exclude children of ethnic minorities from studies because of the distinct challenges in conducting cross-language research and research with children. We critically examine these challenges. The challenge of being a stranger was addressed by a period of immersion in the children's activities prior to data collection, in addition to volunteering as an English teacher with Karen adults. The immersion period was crucial for developing the trust needed in child-inclusive research and research in ethnic minority communities. The challenge of designing an inclusive study with families who experience language barriers was addressed with an interpreter who not only spoke Karen but was also a part of the Karen community. The interpreter provided the authentic sociocultural language equivalence needed for the study's rigor. Ensuring the child's voice was clearly heard was addressed with member checking. Methodological changes necessitated by a pandemic were a distinct challenge discussed in detail. RESULTS: We described methods useful for nurse researchers seeking transformative knowledge to reduce health disparities in childhood obesity. Nurse researchers may use these methods related to cross-language research and child research for designing research inclusive of minorities with language barriers. DISCUSSION: The perspectives of children from ethnic minorities are needed to inform culturally congruent healthy weight care for their communities. The goal in providing transparency of the difficulties, successes, and recommendations for methods in research with children of Burmese refugees is to encourage more nurse researchers to work with marginalized groups. Nurse researchers can inform evidence-based, culturally appropriate interventions to address health inequities of minority communities by including the voice of children from these communities.

Cultural Influences on Healthy Weight Care in Karen Children.

PURPOSE: Although the rates of childhood obesity are disproportionately higher in children of racial and ethnic minorities, research rarely addresses possible cultural factors. The purpose of this study was to discover cultural influences that contribute to or prevent childhood obesity from the perspectives of Burmese-American children and adolescents of Karen ethnicity in the southeast U.S. DESIGN AND METHODS: The ethnonursing research method was used to seek perspectives of healthy weight care from Karen children between 8 and 15 years-of-age (n = 10). Karen parents (n = 5) and non-Karen community members (n = 13) were also interviewed. Data sources - interviews, fieldnotes, and observation notes - were analyzed using the four phases of the ethnonursing method. RESULTS: Four themes important to healthy weight care in Karen children were discovered: views of a healthy child, food and food preparation, physical activity, and mutual support among family and community. These themes revealed both Karen and non-Karen influences. CONCLUSIONS: Most Karen cultural influences promote healthy weight care in Karen children and adolescents which may protect them from childhood obesity. Lack of after-school transportation, limited space to play/exercise, and the sedentary tendencies of girls could limit healthy weight care. PRACTICE IMPLICATIONS: Pediatric nurses may use knowledge gained from this study for promotion of healthy weight care in Karen families and to advocate for community changes which could benefit all children.

Piloting the Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Student Responses.

In this manuscript, we report the pilot results of the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) undergraduate nursing curriculum. Junior nursing students participated in TRIP didactic, simulation and clinical activities and completed a focus group at the midpoint and conclusion of year one. Focus group themes addressed recruitment, understanding or primary care, connections between clinical and didactic, and team based care. TRIP offers the first comprehensive community based integrated primary care training for students in our region. Overall, the TRIP curriculum enhanced student learning and promoted leadership.

Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Background and Content.

Given the large body of evidence linking physical and mental health and the impetus provided by health care reform and the Affordable Care Act, the time is ripe to engage nurses in community based, integrated primary care teams to holistically address psychiatric, mental health and substance abuse needs. There is a compelling need for curricular redesign and clinical innovation to prepare an RN workforce for practice in community based integrated primary care teams. To that end, a faculty team of primary care, interprofessional education and content experts developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for BSN students in a large university in the southeastern United States. The primary goals of the TRIP program are to build/implement an innovative BSN curriculum and expand our academic practice partnership by enhancing student clinical experiences with the goal of preparing an RN workforce for practice in community based integrated care teams. The TRIP program incorporates didactic, simulation and clinical components. Our first student cohort began the TRIP program in the fall of 2018 and will complete the program in spring 2020. In this paper, we provide details about the background, content and activities of this 4-semester (2 year) program.

Using an iPad for Basic Communication Between Spanish-Speaking Families and Nurses in Pediatric Acute Care: A Feasibility Pilot Study.

The growing number of Spanish speakers in the United States poses communication challenges for healthcare providers. Language barriers in pediatric acute care have been associated with an increased risk for adverse events, longer hospital stays, and decreased quality of care. In addition, clinicians' usage of interpreter services is inconsistent. In fact, nurses often lack interpreter support during daily bedside care. Nursing staff at a pediatric children's hospital in the southeastern United States identified bedside communication with Spanish-speaking patients and families as a clinical challenge. To address this challenge, a basic communication interface, UTalk version 1.0 (the author is the owner and proprietor), supported by an Apple iPad, was developed by the researcher with input from nursing staff, a certified medical interpreter, and Spanish-speaking community members. A feasibility pilot study of the interface's usability and engagement was conducted on the hospital's pediatric medical-surgical unit through qualitative interviews with nurse-family dyads. Three themes emerged from the data: UTalk-facilitated communication, UTalk needs improvement, and interpreter miscommunication. These findings indicate that a mobile digital device interface is a feasible method for augmenting bedside communication with Spanish-speaking patients and families. These results also may serve as a reference for the development of similar mobile device interfaces. Further research with a larger sample size is needed.

Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.

The moral courage of nursing students who complete advance directives with homeless persons.

BACKGROUND: Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives. RESEARCH HYPOTHESIS: We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth. RESEARCH DESIGN: The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable. PARTICIPANTS AND RESEARCH CONTEXT: A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency. ETHICAL CONSIDERATIONS: The study was approved by the Internal Review Board of the authors' university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary. FINDINGS: Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person's dying and death, and the challenge of adequately conveying the advance directive's meaning and accurately recording a homeless person's end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings. DISCUSSION: Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service. CONCLUSION: Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants' fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes.

Staff Efficiency Trends Among Pediatric Hospices, 2002-2011.

This study provided the first examination of staff efficiency trends among pediatric hospices. Although pediatric staff efficiency demonstrated large variability from 2002 to 2011, the general trend in efficiency from 2003 to 2010. The decline in efficiency means, on average, pediatric hospices had higher operating expenses and used more capacity, but greater amounts of these greater outputs as measured by visits per patient. The study also highlights the crucial role pediatric hospice nurse managers play in developing effective workforce strategies that allow for responsive changes to workload fluctuations. Due to the associations between efficiency, regulation, and growth, nurse leaders' abilities to develop effective strategies are more imperative than ever to ensure quality end-of-life care for children and their families.

Better Together: A Win-Win Pediatric Academic Partnership.

As healthcare facilities and academic nursing programs are challenged to be efficient and effective in light of an ever-changing healthcare system, recent literature has focused on the value of creating academic practice partnerships. Using the American Association of Colleges of Nursing (AACN) and American Organization of Nurse Executives (AONE) Academic Practice Partnership Guiding Principles, a children's hospital and state university are working collaboratively to improve evidence-based practice and research, create innovative educational opportunities for undergraduate and advanced practice students, promote academic progression that enables nurses to advance their education, improve access to health care services for underserved families, and implement initiatives that improve patient- and family-centered care. This article will describe the initiatives, processes, and outcomes of this fruitful partnership. The examples we provide using the Academic Practice Partnership Guiding Principles can be adapted in other healthcare facilities and nursing programs.

Nurses in Action: A Response to Cultural Care Challenges in a Pediatric Acute Care Setting.

Culturally congruent care is satisfying, meaningful, fits with people's daily lives, and promotes their health and wellbeing. A group of staff nurses identified specific clinical challenges they faced in providing such care for Hispanic and underserved Caucasian children and families in the pediatric medical-surgical unit of an urban regional children's hospital in the southeastern U.S. To address these challenges, an academic-practice partnership was formed between a group of nurse managers and staff nurses at the children's hospital and nursing faculty and graduate students at a local, research-intensive public university. Using the culture care theory, the partners collaborated on a research study to discover knowledge that would help the nursing staff resolve the identified clinical challenges. Twelve families and 12 healthcare providers participated. Data analysis revealed five care factors that participants identified as most valuable: family, faith, communication, care integration, and meeting basic needs. These themes were used to formulate nursing actions that, when applied in daily practice, could facilitate the provision of culturally congruent care for these children and their families. The knowledge generated by this study also has implications for healthcare organizations, nursing educators, and academic-practice partnerships that seek to ensure the delivery of equitable care for all patients.

The relationship between the nursing environment and delivering culturally sensitive perinatal hospice care.

BACKGROUND: Wide variations exist among perinatal hospices, and barriers to perinatal palliative care exist at the healthcare level. Research in the area of culturally sensitive perinatal palliative care has been scarce, a gap which this study addresses. OBJECTIVE: To evaluate the relationship between the nurse work environment and the delivery of culturally sensitive perinatal hospice care. METHOD: This retrospective, correlational study used data from the National Home and Hospice Care Survey, which includes a nationally representative sample of hospice care providers. A multivariate logistic regression model was used to estimate the relationship between the delivery of culturally sensitive care and the nurse work environment. RESULTS: Accreditation, teaching status, and baccalaureate-prepared registered nurse staff had an impact on the provision of culturally sensitive perinatal care Conclusions: The hospice and nursing unit environments, specifically in regards to education and technology, may be important contributors to the delivery of culturally sensitive care.

Emotional Intelligence: A Critical Evaluation of the Literature with Implications for Mental Health Nursing Leadership.

Emotional intelligence (EI) is necessary for the development of interpersonal and professional competence in nurses. We argue that the concept of emotional intelligence has particular relevance for mental health nursing leadership. In this critique, we examine the recent empirical evidence (2010-2014) related to emotional intelligence, in general, and nursing, specifically. Correlations between emotional intelligence and better overall health, increased work satisfaction, higher spiritual well-being, and decreased risk of job burnout are noted. We offer suggestions for mental health nurse leaders in developing successful project management teams and improving retention of current leaders. We also provide suggestions for future research.

Community-Academic Partnership: Intervention to Prepare Community Members for the End-of-Life Journey.

Despite research findings that rural Appalachians prefer to die at home, few people access palliative and hospice care services, and many report limited knowledge about palliative/end-of-life care resources. A community-academic partnership was formed to address this need. Train-the-trainer workshop and materials were co-developed. This study tested the feasibility and cultural acceptability of the training intervention to increase community members' knowledge about palliative/end-of-life care resources for East Tennessee Appalachian people. Community-based participatory research design and culture care theory guided the project, intervention, and research. After engaging in end-of-life training, participants completed a retrospective pretest-posttest survey. Paired samples t tests were used to compare knowledge before and after training. Means and standard deviations were used to report training material usefulness and cultural acceptability. Short-answer qualitative data were analyzed using content analysis. Sixty-six adults completed the survey. Ratings for training materials and cultural/theological acceptability were high. Participant knowledge rankings showed significant improvement after training at the P <.001 level. Qualitative feedback was positive. The training intervention was feasible, culturally acceptable, and effective for increasing East Tennessee Appalachian persons' palliative/end-of-life care knowledge. Community member expertise/collaboration integrated into every stage of the project is the bedrock of cultural acceptability and feasibility.

Influences of Faith on Rural Appalachian Older Adult Health: An Ethnonursing Study.

INTRODUCTION: Rural Appalachian older adults (RAOAs) constitute a vulnerable population and experience significant health disparities. The combination of age, poverty, rural residence, health care provider shortages, and limited transportation increases risks for poor health outcomes. Spirituality enhances older adult health; however, little is known about spirituality-health linkages of RAOAs. Therefore, the purpose of this study was to discover the influences of spirituality on RAOA health. METHODOLOGY: Culture Care Theory and ethnonursing method guided analysis of 32 RAOA interviews in community settings in East Tennessee. RESULTS: "Faith" is an integral component of RAOA culture and health. Three themes were extrapolated: (a) Relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and [the need to] (c) "Open the door" for spiritual care. DISCUSSION: Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.

A comparison of the nurse work environment between perinatal and non-perinatal hospice providers.

BACKGROUND: Hospice nurses have a unique role in providing perinatal care, yet little is known about the work environment in which nurses provide care for families and infants at the end of life. OBJECTIVE: To compare the nurse work environment between perinatal and non-perinatal hospices. METHODS: Data from the 2007 US National Home and Hospice Care Survey was used. The sample included 526 US hospice agencies. Comparisons were calculated using the Pearson chi-square and Wald tests. RESULTS: A majority of hospices provided perinatal care (60%). Compared with non-perinatal hospices, the perinatal nurse work environment had a significantly higher proportion of registered nurses (mean 0.87 vs mean 0.79), along with clinical nurse specialists and nurse practitioners to support them (95.6% vs 84.9%). Nurses within perinatal care providers worked in a climate of significantly greater safety (95.6% vs 84.9%) and technology (63.7% vs 47.1%). CONCLUSIONS: Understanding the unique perinatal hospice nurse work environment may be essential for advancing knowledge and compassion for mothers and babies at the end of life.

Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study.

INTRODUCTION: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study's purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. METHODOLOGY: Leininger's Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger's phases of ethnonursing data analysis for qualitative data. RESULTS: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. DISCUSSION: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.

Transforming RN roles using an academic-practice partnership to improve healthcare access for underserved populations.

There is a national call to improve healthcare access for underserved populations by preparing BSN students to practice at the full scope of their license in community-based, integrated primary care settings upon graduation. In response to this call, a robust academic-practice partnership-using interprofessional education and practice and primary care and leadership development- is preparing BSN students to practice in community-based integrated primary care settings where culturally diverse rural and urban underserved populations receive care. In this article, academic-practice partners describe the implementation, lessons learned, and initial outcomes of a grant-funded program that is transforming nursing education and practice. All partners viewed communication, collaboration, and flexibility as key to a successful partnership. Our work serves as a template to help others shift nursing culture to create a sustainable RN workforce prepared to improve the health and wellbeing of underserved populations.