Sexual health and intimacy after cancer treatment in women of color: A systematic review.

OBJECTIVE: Cancer diagnosis and treatment can significantly affect women's sexual health and intimacy, leading to diminished quality of life in survivorship. The perspectives and experiences of women of color (WOC) with cancer are critical to inform comprehensive, inclusive sexual wellbeing care in survivorship. The purpose of this systematic review is to summarize contemporary literature describing sexual wellbeing experiences of WOC treated for cancer. METHODS: A comprehensive search of CINAHL, PubMed, Embase and PsycInfo and Scopus identified studies that addressed sex and intimacy of U.S. WOC treated for cancer published in the last 15 years. The authors identified emergent themes from the literature through thematic content analysis. RESULTS: Eighteen studies (10 qualitative, 8 quantitative) met the inclusion criteria, all with breast or gynecologic cancer samples. Studies include African American (13), Asian American (3), and Latina (10) women, as well as Non-Hispanic Whites and 'other' race/ethnicity women. Overarching themes identified were: 1) impacts of treatment on sexual health and body image, 2) process of accepting and overcoming, 3) value of an engaged and supportive partner, and 4) current clinical practice and barriers to sexual health care. CONCLUSIONS: WOC experience changes in sex and intimacy after cancer treatment, and experiences of sexual function, sexual communication, and sexual healthcare are often shaped by sociocultural experiences. An understanding of WOC's sexual health and intimacy after cancer treatment can inform inclusive, culturally responsive sexual health interventions.

Communication Among Southeast Asian Mothers and Daughters About Cervical Cancer Prevention.

BACKGROUND: Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other's cervical cancer beliefs and screening behaviors. OBJECTIVES: We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women's health issues, specifically cervical cancer and Pap testing. METHODS: We conducted in-depth interviews with Cambodian and Lao mother-daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis. RESULTS: In-depth interviews were conducted with three Cambodian and eight Lao mother-daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother-daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother-daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women's health issues with their daughters. Although mothers did not influence women's health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers' health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers. DISCUSSION: By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.

Cognitive Behavioral Therapy in Adolescents with Type 1 Diabetes: An Integrative Review.

PROBLEM: Type 1 Diabetes (T1D) is a complex chronic condition that impacts physiologic and psychosocial outcomes in adolescents. Adolescents with T1D experience anxiety and depressive symptoms at 2 to 3 times the rate of the general adolescent population. Anxiety and depressive symptoms negatively impact disease management. Cognitive behavioral therapy (CBT) is considered the gold standard therapeutic technique for treating anxiety and depressive symptoms. The aim of this integrative review was to examine and synthesize the extant literature exploring the effect of CBT on physiologic and psychosocial outcomes in adolescents with T1D. ELIGIBILITY CRITERIA: Electronic databases were searched with the terms "type 1 diabetes" and "cognitive behavioral therapy." Studies were included if they were published between 2000 and 2020, evaluated a pediatric population (≤18 years of age), and included individuals with diagnosed T1D. SAMPLE: 475 articles were identified in our initial search, and after removal of duplicates 353 articles remained. 339 did not meet inclusion criteria. A total of 14 papers met inclusion criteria. RESULTS: All studies included CBT, but differed in delivery methods. Several studies demonstrated evidence of the feasibility and acceptability; however, there were mixed results regarding improvement of physiologic and psychosocial outcomes. CONCLUSIONS: CBT is a feasible and acceptable intervention in adolescents with T1D. It may be a method of improving psychologic and psychosocial outcomes for this high-risk population. IMPLICATIONS: In adolescents with T1D, screening and treatment for psychosocial comorbidities should occur regularly at endocrinology visits. CBT can be operationalized to fill this gap.

Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes.

BACKGROUND: Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care. AIMS: We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient's preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP. METHODS: A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach. RESULTS: The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes. LINKING EVIDENCE TO ACTION: Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.

Mindfulness, Anxiety Symptoms, and Quality of Life in Heart Failure.

BACKGROUND: An estimated 6.5 million American adults live with heart failure (HF). Elevated anxiety symptoms may worsen HF symptoms and contribute to decreases in overall quality of life (QOL). Mindfulness has been associated with better psychological health with lower levels of anxiety symptoms. Mindfulness may be a modifiable target for reducing anxiety symptoms and increasing QOL in patients with HF. OBJECTIVE: The objective of this study is to examine the relationships among anxiety symptoms, dispositional mindfulness, and QOL in patients with symptomatic HF. METHODS: In this cross-sectional study, we conducted a secondary analysis of baseline data from 70 participants. We performed descriptive statistics, bivariate Pearson correlations, and multiple linear regression. RESULTS: The sample included 70 individuals with a mean age of 65 ± 10.5 years, 89% male, mean left ejection fraction of 45.7 ± 13.6, mean total QOL of 36.9 ± 21.7, mean total mindfulness of 82.2 ± 12.8, and mean anxiety of 4.8 ± 2.9. In multiple regression analyses, total mindfulness was significantly associated with lower anxiety (ß = -0.491, P < .01), greater observational mindfulness was significantly associated with lower anxiety (ß = -0.377, P < .01), and greater nonreactivity to inner experience was significantly associated with lower anxiety (ß = -0.320, P < .05). Lower anxiety was associated with greater total QOL (ß = 0.488, P < .01), greater physical QOL (ß = 0.381, P < .01), and greater emotional QOL (ß = 0.639, P < .01). CONCLUSIONS: Mindfulness may be a way of improving both anxiety symptoms and QOL in this population.

School-Based Management of Pediatric Type 1 Diabetes: Recommendations, Advances, and Gaps in Knowledge.

PURPOSE OF REVIEW: Children and adolescents with type 1 diabetes (T1D) spend much of their waking time in the school environment. However, there is limited empirical understanding of the challenges youth face in managing their T1D at school. There is even less literature focused on potential interventions to improve health or psychological outcomes in youth with T1D in this milieu. This review seeks to summarize the recent literature on diabetes T1D management in the school setting, including recommendations for care, barriers, and targets for intervention. RECENT FINDINGS: T1D organizations recommend strong collaboration amongst families, school personnel, and health care providers to enable successful T1D management in schools. While challenges remain according to parent, child, and teacher reports, perceptions of school-based management of T1D show signs of improvement. The few existing school-based intervention studies have generally focused on educational or structural interventions to improve diabetes care. The management of T1D within the school setting is critical for overall diabetes management. While barriers to effective T1D care have been examined, a greater understanding of the impact of new diabetes technologies and well-characterized interventions is lacking in this area.

"Anxiety and Type 1 diabetes are like cousins": The experience of anxiety symptoms in youth with Type 1 diabetes.

Type 1 diabetes (T1D) is one of the most common chronic health conditions in youth in the United States, and its incidence is rising worldwide. Youth with T1D are at a high risk of psychological comorbidity, for example, anxiety, depression, and eating disorders. Psychological comorbidities, especially anxiety symptoms, have been correlated with poorer diabetes outcomes, but anxiety symptoms have not been well studied in these youth. The primary aim of this study was to describe the experience of anxiety symptoms in youth with T1D, especially as those symptoms relate to diabetes self-management tasks. We used a qualitative descriptive approach, consisting of an in-depth, semi-structured interview comprising 10 open-ended questions with follow-up probes. The analysis was guided by the principles of thematic analysis. Demographic data, Hemoglobin A1c levels, and the State-Trait Anxiety Inventory for Children survey data were also collected and analyzed. We identified four themes and seven sub-themes. Participants (n = 29, ages 10-16, 55% female) reported that T1D was an extra layer of responsibility that took time away from their ability to participate fully in other aspects of their lives. Some participants were able to integrate diabetes management into their lives, while others were not. Some participants were dependent on parents and the school nurse for diabetes management. Participants described two types of anxiety symptoms, general and diabetes-specific, and they noted that their experience of anxiety was associated with poor quality sleep, general lifestyle factors, and diabetes.

Anxiety in Youth With Type 1 Diabetes.

PROBLEM: Mental health conditions are prevalent in youth with type 1 diabetes (T1D). Anxiety symptoms and depressive symptoms are highly correlated and are two of the most prevalent mental health conditions in youth in the general population. The detrimental effect of depressive symptoms in youth with T1D has been well documented, but the effects of anxiety symptoms are not well understood. ELIGIBILITY CRITERIA: Studies were included if they were published between 1990 and 2015, and evaluated anxiety symptoms in a population of youth with T1D. SAMPLE: A total of 20 studies were identified from a sample of 338 papers. RESULTS: Anxiety symptoms were prevalent in youth with T1D. Anxiety symptoms were associated with higher glycosylated hemoglobin (HbA1c) levels, poorer self-management and coping behaviors, depressive symptoms, fear of hypoglycemia, and lower blood glucose monitoring frequency. State anxiety and trait anxiety symptoms affected health outcomes differently. Girls were at a higher risk of anxiety symptoms than boys. CONCLUSIONS: Anxiety symptoms in youth with T1D have detrimental effects on health outcomes, including self-management, quality of life, and HbA1c. IMPLICATIONS: Future research should aim to improve our current screening and treatment practices.

Stress and Posttraumatic Stress in Mothers of Children With Type 1 Diabetes.

The onset of acute and chronic illness in children frequently triggers episodes of stress and posttraumatic stress symptoms (PTSS) in mothers. Mothers of children with type 1 diabetes (T1D) consistently report high levels of stress and PTSS. The purpose of this integrative review was to review and synthesize the published empirical research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this integrative literature review. A total of 19 studies were identified from a sample of 128. Stress and PTSS were prevalent in mothers of youth with T1D. While PTSS was most severe at disease onset, symptoms often persisted 1 to 5 years after diagnosis. The diagnosis of T1D in a child was traumatic for mothers. Stress and PTSS in mothers adversely affected children's health. Management of stress symptoms in mothers may lead to improved behavioral and metabolic outcomes in children.

Contribution of income to self-management and health outcomes in pediatric type 1 diabetes.

Low income has been established as a risk factor for poorer outcomes in youth with type 1 diabetes; however, the effect of moderate income has not been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and psychosocial outcomes [depression, stress, and quality of life (QOL)] at different income levels in adolescents with type 1 diabetes. Youth (n = 320, mean age = 12.3 + 1.1, 55% female, 64% white, mean A1C = 8.3 ± 1.4) completed established self-management and psychosocial measures. A1C levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40-80K), or low (<$40K). Youth from high-income families had significantly lower A1C (mean = 7.9 ± 1.2) than those from the moderate-income group (8.6 ± 1.7, p < 0.001) or the low-income group (mean A1C = 8.6 ± 1.5, p = 0.003). Youth from the high-income group reported significantly better diabetes problem solving and more self-management goals than those from the moderate- or low-income groups (both p < 0.01). Youth from the high-income group also reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low-income groups (all p < 0.05). Multivariate linear regression models were used to test psychological and behavioral predictors of A1C and QOL. Parents' education status (p < 0.05) and self-management activities (p < 0.01) were significant predictors of hemoglobin A1c, while income (p < 0.01) and self-management activities (p < 0.05) were significant predictors of QOL.

Are Providers Adequately Screening for Anxiety Symptoms During Pregnancy?

OBJECTIVE: To examine the difference in prevalence of self-reported anxiety symptoms throughout pregnancy compared to clinical diagnosis of an anxiety disorder by a provider. DESIGN: Secondary data analysis of a prospective cohort study of 50 pregnant individuals. SETTING/LOCAL PROBLEM: Pregnant individuals commonly experience heightened anxiety symptoms, which are associated with adverse perinatal outcomes. However, a diagnosis of an anxiety disorder by a health care provider is less common, which may result in insufficient mental health intervention. PARTICIPANTS: Pregnant individuals were recruited at their first prenatal appointment and followed until birth. INTERVENTION/MEASUREMENTS: We examined anxiety symptoms using the Edinburgh Postnatal Depression Scale Anxiety subscale. We conducted a medical record review to examine if pregnant individuals were clinically diagnosed with an anxiety disorder. RESULTS: Based on an Edinburgh Postnatal Depression Scale Anxiety subscale cutoff score of ≥5, 40% (n = 20) of individuals experienced anxiety symptoms during pregnancy. However, only 16% (n = 8) of participants were diagnosed with an anxiety disorder by a health care provider. CONCLUSION: Anxiety symptoms are prevalent throughout pregnancy and may be underdiagnosed by health care providers. An intervention to increase clinical diagnosis of an anxiety disorder and subsequent referral to a mental health specialist may be indicated.

"I'm Staring at the Screen All the Time": Technology Use and Mindfulness in Adolescents with Type 1 Diabetes.

Type 1 diabetes (T1D) is a chronic, complex medical condition associated with higher rates of anxiety in adolescents. Higher rates of anxiety are associated with poorer glycemic control. Although technological advancements have been made to improve self-management of glycemia, few technological interventions aim to mitigate anxiety symptoms. Adolescents frequently use technology every day for school and socialization in addition to management of glycemia. Technology has not yet been leveraged to provide evidence-based interventions, such as mindfulness, for anxiety symptoms and other psychosocial comorbidity in adolescents with T1D. We aimed to examine technology preferences in adolescents with type 1 diabetes, their experiences with mindfulness practices, and their perceived acceptability of a mobile health application delivering mindfulness training. Twenty participants aged 14 to 17 years old with T1D participated in this qualitative descriptive study. Interview transcripts were organized using the ATLAS.ti software version 8 and coded using an in vivo approach and thematic analysis. Descriptive statistics regarding participant demographics and hemoglobin A1c levels were analyzed using SAS statistical software version 9.2. Findings supported heavy technology use, limited experience with mindfulness, and positive receptivity regarding an app that delivered a mindfulness training program specifically for adolescents with T1D. Thus, a mobile health application may be a feasible and acceptable way to deliver an evidence-based psychosocial intervention to this vulnerable population.

The association between depressive symptoms and executive function in type 1 diabetes population: A scoping review.

PURPOSE: The purpose of this study was to explore the existing literature on the relationship between depressive symptoms and executive function in patients with type 1 diabetes (T1DM) across the lifespan. METHODS: The scoping review followed the PRISMA protocol by using three databases: PubMed, CINAHL, and PsycINFO on May 14, 2023. Primary research that included reported executive function and the association with depressive symptoms was included in the review. RESULTS: Of 1470 de-duplicated publications identified, nine articles were included in the review. Five studies evaluated the T1DM population, while four studies evaluated T1DM and type 2 diabetes (T2DM) as an aggregate result. Three studies indicated an association between depressive symptoms and executive function in adults with T1DM, and four studies indicated an association between depressive symptoms and executive function in adults with either T1DM or T2DM. In general, participants who reported depressive symptoms also exhibited poor executive function. However, two studies did not find an association between depressive symptoms and executive function. CONCLUSION: In summary, the seven studies in this review suggest that individuals with T1DM who report depressive symptoms are at a higher risk of poor executive function; a clear association between depressive symptoms and executive function in individuals with T1DM remains inconclusive. There is a need to explore this relationship in the future.

Nutritional interventions in depression and perinatal depression.

Depression is the leading cause of mental disability worldwide. Women who are depressed during pregnancy are at a higher risk for preterm delivery, preeclampsia, birth difficulties, and postpartum depression. The treatment of depression in conventional medicine has focused on physiological factors that lead to impaired neurotransmitter function and treatments to improve neurotransmitter function. Pharmaceutical substances pose risks for pregnant and lactating women, and lower risk options are preferred. Micronutrients, including certain B vitamins, folate, and docosahexaenoic acid (DHA), play a role in the synthesis and absorption of neurotransmitters. Experimental studies suggest that supplementation with specific micronutrients may alleviate depressive symptoms and improve birth outcomes in patients with perinatal depression. Alternative treatments for depression, including nutritional supplements, are an important treatment option for depressive symptoms while limiting potential side effects and treatment costs. This article explores the biological basis of perinatal depression and reviews the potential benefits of non-pharmacological interventions.

Psychosocial Outcomes in Adolescents With Type 1 Diabetes: Associations With Grade Level and Disease Duration.

INTRODUCTION: The purpose of this study was to examine anxiety and depressive symptoms in adolescents with type 1 diabetes (T1D) to determine differences based on grade level and disease duration. METHOD: We conducted a secondary data analysis of adolescents with T1D, which included demographic characteristics, general anxiety symptoms, and depressive symptoms. RESULTS: Of the 147 adolescents included in the analysis, 32% (n=47) were in middle school and 68% (n=100) were in high school. Most had been diagnosed with diabetes for less than 3 years (67.3%, n=99). When controlling for covariates, middle schoolers were more likely to report clinically significant depressive symptoms compared to their high school peers (ß = 0.83, p = 0.008). DISCUSSION: Younger adolescents may be at a higher risk of a clinically significant symptom burden from depression and should be screened regularly. Future research should include tailoring psychosocial interventions specifically to an adolescent's age and disease duration.

Anxiety and Depressive Symptoms in Patients with COPD: Modifiable Explanatory Factors.

Anxiety and depressive symptoms affect up to 80% of people with chronic obstructive pulmonary disease (COPD). To reduce this symptom burden, clinicians should target modifiable explanatory factors while accounting for nonmodifiable explanatory factors of these symptoms. The purpose of this secondary data analysis was to examine which modifiable factors explain anxiety and depressive symptoms in COPD. This secondary data analysis of 1,760 COPD patients used multiple regression to explain anxiety and depressive symptoms from sets of modifiable patient characteristics and demographic controls. Clinically significant symptoms of anxiety or depression presented in 29.6% (n = 526) of participants, and 20.6% (n = 363) had both. Significant modifiable explanatory factors of both disorder symptoms were perceived functional status, functional capacity, psychosocial impact, symptom self-management, and significant symptoms for the other. Somatic symptom burden and dyspnea explained anxiety and depressive symptoms, respectively. Addressing these modifiable factors may reduce anxiety and depressive symptoms in patients with COPD.

Psychological Impact of COVID-19 on Oncology Patients: Perceptions of Oncology Health Care Providers.

The COVID-19 pandemic profoundly impacted psychological well-being worldwide. Oncology health care professionals' (OHCPs') perceptions of psychological effects of COVID-19 among people in active cancer treatment were explored. Semi-structured interviews with a purposive sample of OHCPs actively providing care were conducted. Interviews were audio-recorded, transcribed, and coded using Atlas.ti v8 and thematic analysis. In total, 30 OHCPs participated. Most were registered nurses (70%), worked in outpatient setting (56.7%) and were in their current position 1-5 years (53.3%). Overarching themes are as follows: (a) cancer treatment disrupted due to patients' fear of exposure to COVID-19; (b) social distancing restrictions caused discontinued social support and supportive services that exacerbated psychological distress; (c) pandemic-related stressors led to overwhelmed coping skills; and (d) OHCPs played a vital role in providing emotional support and connecting patients with family/friends through technology. Behavioral health interventions should focus within the "new world of COVID-19" of reduced face-to-face support and increased online support for patients.

Mindfulness in adolescents and young adults with diabetes: An integrative review.

BACKGROUND AND PURPOSE: Type 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes. METHODS: Four databases were searched during May 2021. Included studies were published between 2000 and 2021, evaluated adolescents and young adults, diagnosed with type 1 or type 2 diabetes or prediabetes. Studies were excluded if they were not in English; not original research; evaluated complementary/alternative therapies as a group. To assess for risk of bias, the National Institutes of Health quality assessment tools and the Cochrane Collaboration's tool were utilized. Whittemore and Knafl's (2005) method for conducting an integrative review was utilized to synthesize results. RESULTS: We identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes. CONCLUSION: Mindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.

General Anxiety, Diabetes-Specific Anxiety, and Quality of Life in Adolescents With Type 1 Diabetes.

PURPOSE: The purpose of the study was to identify the differential associations between general anxiety, diabetes-specific anxiety, and diabetes-specific quality of life (QOL). METHODS: A cross-sectional study was conducted of 146 adolescents with type 1 diabetes (T1DM) ages 13 to 17 during the COVID-19 pandemic. Participants completed self-report questionnaires assessing demographic characteristics, general anxiety, diabetes-specific anxiety, depressive symptoms, and diabetes-specific QOL. RESULTS: The final sample of 146 adolescents was mostly male, non-Hispanic White, mean age of 14.5 ± 1.27, having diabetes for more than 1 year, and using insulin pumps. Higher diabetes-specific anxiety was associated with poorer general treatment-related QOL, but general anxiety was not. General anxiety, diabetes-specific anxiety, and depressive symptoms were significantly associated with diabetes-specific treatment-related QOL, worry-specific QOL, and poorer communication-related QOL. CONCLUSIONS: There may be a differential impact of general anxiety and diabetes-specific anxiety in adolescents with T1DM. Diabetes-specific anxiety may be a more important factor in adolescents reporting poorer general treatment-related QOL, worry-related QOL, and communication-related QOL, while general anxiety and diabetes-specific anxiety appear to similarly impact poorer diabetes-specific treatment-related QOL. Diabetes-specific anxiety may be a more important component of QOL in adolescents. Targeted interventions may be required to effectively improve QOL.

Evaluating the Impact of a School of Nursing Civility Team.

BACKGROUND: Promoting civility in nursing education can be accomplished with civility teams, assessing perceptions of civility and developing initiatives to address areas needing improvement. PROBLEM: There is a lack of information about the effectiveness of civility teams in nursing education, leading to uncertainty on how to develop and assess civility teams. APPROACH: This article discusses how 1 school of nursing implemented a civility team and used the Clark Healthy Work Environment Inventory to assess the impact of the team. OUTCOMES: The civility team used the inventory responses from 110 team members to establish civility action items. One year later, the inventory was repeated, and the responses from 122 team members were used to evaluate the impact of the civility action items. CONCLUSION: This program evaluation indicates an effective way for nursing programs to develop civility initiatives using a validated assessment tool to create and evaluate civility action items.