Assessing Interprofessional Collaboration at Clinical Learning Sites: Methodology on Developing the IP-CLEAR Tool.

Interprofessional Clinical Learning Environment Assessment and Reflection (IP-CLEAR) tool was developed by a team of faculty from the schools of nursing, pharmacy, and medicine at University of North Carolina at Chapel Hill (UNC-CH), with the support of the North Carolina Area Health Education Consortium (NC AHEC) and the UNC-CH Office of Interprofessional Education and Practice (IPEP). The IP-CLEAR tool is intended for use by clinical sites that have or want to have clinical learners engaged and integrated into an excellent interprofessional CLE. The development of the IP-CLEAR and projections for future work are described here.

Parental food selection questionnaire - Infant version.

PURPOSE: Complementary feeding practices (CFPs) are associated with health outcomes (e.g., obesity and food allergies). Understanding how parents select foods for their infant is limited. This study's purpose was to develop a psychometrically sound measure of parents' food selection motives for their infant during the complementary feeding period. METHODS: Development and testing of the Parental Food Slection Questionnaire-Infant Version (PFSQ-I) occurred in three phases. English-speaking, U.S. mothers of healthy infants, aged 6-19 months old participated in a semi-structured, face-to-face interview (Phase 1) or a web-based survey (Phases 2 & 3). Phase 1 was a qualitative study of maternal beliefs and motives surrounding complementary feeding. Phase 2 involved adaptation and exploratory factor analysis of the original Food Choice Questionnaire (Steptoe et al., 1995). Phase 3 involved validity testing of the relationships among PFSQ-I factors and CFPs (timing/type of complementary food introduction, frequency of feeding method, usual texture intake, and allergenic food introduction) using bivariate analyses, and multiple linear and logistic regression analyses. RESULTS: Mean maternal age was 30.4 years and infant age was 14.1 months (n = 381). The final structure of the PFSQ-I included 30 items and 7 factors: Behavioral Influence, Health Promotion, Ingredients, Affordability, Sensory Appeal, Convenience, and Perceived Threats (Cronbach's α = 0.68-0.83). Associations of factors with CFPs supported construct validity. DISCUSSION: The PFSQ-I demonstrated strong initial psychometric properties in a sample of mothers from the U.S. Mothers who rated Behavioral Influence as more important were more likely to report suboptimal CFPs (e.g., earlier than recommended complementary food introduction, delayed allergenic food introduction, and prolonged use of spoon-feeding). Additional psychometric testing in a larger, more heterogenous sample is needed, along with examination of relationships between PFSQ-I factors and health outcomes.

How Does Workplace Violence-Reporting Culture Affect Workplace Violence, Nurse Burnout, and Patient Safety?

BACKGROUND: Workplace violence (WPV) against nurses has a negative impact on the nurses and the care they provide. Formal reporting of WPV is necessary to understand the nature of violent incidents, develop proactive coping strategies, and provide support for nurses affected by WPV. PURPOSE: This study explored the relationships among nurses' WPV experiences, burnout, patient safety, and the moderating effect of WPV-reporting culture on these relationships. METHODS: This descriptive cross-sectional study used secondary data collected from 1781 nurses at a large academic medical center. RESULTS: Workplace violence increased nurse burnout, which in turn negatively affected patient safety. A strong WPV-reporting culture increased the negative effect of WPV on burnout but mitigated the negative effect of burnout on patient safety. CONCLUSIONS: The findings indicate that nurses may perceive WPV-reporting behavior as a stressor. Violence-reporting systems and procedures need to be improved to reduce the burden of reporting.

The role of Doctor of Nursing Practice-prepared nurses in practice settings.

BACKGROUND: The role of the Doctor of Nursing Practice-prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely explored, and therefore the value DNP-prepared nurses bring to their practice settings is largely unknown. This study: (1) surveyed existing DNP programs to identify the nonacademic settings in which their DNP graduates were employed and (2) conducted semistructured interviews with employers to identify the role and value of the DNP-prepared nurse in nonacademic settings. METHOD: Data were collected from January 2016 to August 2016 in two parts: (1) an online survey of the DNP programs and (2) qualitative semistructured telephone interviews with employers. First, we conducted an online survey of program directors (or their equivalent) from 288 DNP programs across the United States to capture descriptive information about current DNP programs (e.g., location, modality, profit status), the types of nonacademic institutions that hire their graduates, percentage of graduates employed by each setting, and the contact information for these employers. Employers were identified either by DNP program directors through the online survey or by a convenience sampling method. Using semistructured telephone interviews, we asked questions to employers in different care settings about the role of the DNP in these settings and how the DNP compares to other nurse leaders and advanced practice nurses (APRN). Employers were asked to describe the role of the DNP-prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators, and managers. FINDINGS: Descriptive thematic analyses were derived from the interviews, to identify the roles DNP-prepared nurses filled and how they compared to other nurse leaders and advanced practice nurses in these settings. A total of 130 DNP program directors responded to the online survey. Twenty-three employers participated in semistructured telephone interviews. The thematic analysis resulted in four main themes regarding the role of the DNP-prepared nurse in non-academic settings: "DNP-Prepared Nurse Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees. DISCUSSION: The role of the DNP-prepared nurse in nonacademic settings is unclear. These DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders. While there is a low number of DNPs in clinical practice settings, the number is expected to grow as more graduate and enter practice. Thus, knowledge of the roles, value, and outcomes of the DNP-prepared nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting.

Blogs Written by Families During Their Child's Hospitalization: A Thematic Narrative Analysis.

PURPOSE: To identify stressors experienced by parents whose child is hospitalized in an intensive care unit, and identify coping mechanisms utilized to ameliorate those stressors. DESIGN AND METHODS: Using Lazarus and Folkman's Transactional Model of Stress and Coping as a framework, 20 publicly available blogs written by parents while their child was a patient in intensive care were analyzed using thematic analysis techniques. Stressors and coping techniques were identified, and grouped by theme for further analysis. RESULTS: The most frequently noted types of stressors were related to information; both knowing and not knowing information related to their child's condition was reported as stressful, as well as waiting for information and when the information was not what was expected. Reframing was the emotion-focused technique most often identified by the parents, and seeking support was the most frequently noted problem-focused coping mechanism. CONCLUSIONS: Illness blogs represent a rich source of information regarding the experiences of families with a child in the hospital. Parents transitioned from more emotion-focused coping strategies to problem-focused strategies during their child's hospital stay. PRACTICE IMPLICATIONS: When nurses give information to parents, they should be aware that knowing information can be stressful as well as not knowing, and care should be taken to provide support for parents after information is given. Nurses can also help parents identify sources of support. Writing about their experiences, either online or in a journal, may help parents cope in stressful situations.

Newly Licensed RN Retention: Hospital and Nurse Characteristics.

OBJECTIVES: The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence. METHODS: A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience. RESULTS: The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay. CONCLUSION: Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

Mentoring and Development Resources Available to New Doctorally Prepared Faculty in Nursing.

AIM: This study examined faculty mentoring practices and strategies currently in place in nursing programs. BACKGROUND: Mentoring is a critical component of organizations and can be especially important in times of organizational change. Schools of nursing are experiencing rapid organizational shifts with increases in retirement and the proliferation of Doctor of Nursing Practice-prepared faculty. METHOD: Deans and department chairs of baccalaureate and higher degree programs across the United States participated in a web-based survey. RESULTS: Results from the survey suggested that the vast majority of nursing programs had practices and strategies aimed at mentoring faculty that were based on the traditional mentor-protégé approach. Few programs differentiated their mentoring practices depending on the type of doctoral education or anticipated roles of the faculty member. CONCLUSION: Our research highlights the fact that nursing programs still employ traditional methods of faculty mentoring. Recommendations for nursing programs are discussed.

A Measure of Lean Quality Improvement for Hospital Staff Nurses.

In this study, a measure of Lean management was developed and tested. Items were identified using the Delphi technique with literature review and expert responses. Twenty-five nurses pilot-tested the instrument and then 212 nurses in 5 hospitals completed the instrument, and their responses were subjected to exploratory factor analysis. The 75-item instrument includes 12 factors describing Lean management conceptualization. Reliability and validity are acceptable for a new instrument.

Preceptor Support in Hospital Transition to Practice Programs.

OBJECTIVE: The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention. BACKGROUND: Preceptors are widely used, but little is known about the benefit from the perspective of the NLRN or about the models of the relationships. The National Council of State Boards of Nursing added questions about the preceptor experience in a study of transition-to-practice programs. METHODS: Hospitals were coded as having high or low preceptor support in regard to scheduling NLRN on the same shifts as their preceptors, assignment sharing, and preceptor release time and a low number of preceptors per preceptee. RESULTS: Half of the 82 hospitals were classified as high, and half as low preceptor support. NLRNs and their preceptors in high-support hospitals evaluated the preceptor experience and NLRN competence higher. In addition, NLRN retention was higher in the high-support hospitals. CONCLUSIONS: To improve NLRN competence and retention, preceptors should have adequate time with each NLRN, share shift and patient assignments, and have few preceptees assigned to each preceptor concurrently.

An evaluation of state-based support-for-service programs targeting nurse faculty.

AIM: The aim of the study was to assess how state-based support-for-service (SFS) programs are used by deans and directors of nursing programs and to evaluate their perceived impact. BACKGROUND: Given projected nurse faculty shortages, stakeholders are looking for ways to address the maldistribution and shortage of nurse faculty. One state-level strategy is the implementation of loan repayment and scholarship programs, which incentivize individuals with, or currently pursuing, graduate degrees to become or remain nurse faculty. METHOD: This study used a mixed-method and multilevel approach to assess the impact of SFS programs in seven states. RESULTS: Programs are perceived to affect both recruitment and retention of faculty and play a role in increasing the educational qualifications of current nurse faculty. CONCLUSION: Nurse educators need to be aware of SFS programs and how best to use them to support nurse faculty.

Measuring the meaning of miscarriage: revision of the Impact of Miscarriage Scale.

BACKGROUND AND PURPOSE: The purpose of this study was to determine a factor structure for the Impact of Miscarriage Scale (IMS). The 24 items comprising the IMS were originally derived from a phenomenological study of miscarriage in women. Initial psychometric properties were established based on a sample of 188 women (Swanson, 1999a). METHOD: Data from 341 couples were subjected to confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). RESULTS: CFA did not confirm the original structure. EFA explained 57% of the variance through an 18-item, 4-factor structure: isolation and guilt, loss of baby, devastating event, and adjustment. Except for the Adjustment subscale, Cronbach's alpha coefficients were > or = .78. CONCLUSION: Although a 3-factor solution is most defensible, with further refinement and additional items, the 4th factor (adjustment) may warrant retention.

Lessons learned from 10 years of research on a post-baccalaureate nurse residency program.

OBJECTIVES: The aim of this study was to examine outcomes from 10 years of research on a post-baccalaureate new graduate nurse residency program and to report lessons learned. BACKGROUND: Transition to practice programs are recommended by the Future of Nursing report, the Carnegie Foundation study, the Joint Commission, and the National Council of State Boards of Nursing. METHODS: Data from new graduate residents who participated in the University HealthSystem Consortium/American Association of Colleges of Nursing residency from 2002 through 2012 are presented. Analysis of variance results from the Casey-Fink Graduate Nurse Experience Scale and outcomes from the graduate nurse program evaluation instrument are provided. RESULTS: Retention rates for new graduates in the residency increased considerably in the participating hospitals. Residents' perception of their ability to organize and prioritize their work, communicate, and provide clinical leadership showed statistically significant increases over the 1-year program. CONCLUSION: The recommendations for new graduate nurse residency programs are supported by the findings.

Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout.

BACKGROUND: Patient and health care worker safety is an interconnected phenomenon. To date, few studies have examined the relationship between patient and worker safety, specifically with respect to work safety culture. Therefore, we examined patient safety culture, workplace violence (WPV), and burnout in health care workers to identify whether patient safety culture factors influence worker burnout and WPV. METHODS: This cross-sectional study used secondary survey data sent to approximately 7,100 health care workers at a large academic medical center in the United States. Instruments included the Hospital Survey on Patient Safety Culture, a WPV scale measuring physical and verbal violence perpetrated by patients or visitors, and the Emotional Exhaustion scale from the Maslach Burnout Inventory. FINDINGS: These analyses included 3,312 (47%) hospital staff who directly interacted with patients. Over half of nurse (62%), physician (53%), and allied health professional respondents (52%) reported experiencing verbal violence from a patient, and 39% of nurses and 14% of physicians reported experiencing physical violence from a patient. Burnout levels for nurses (2.67 ± 1.02) and physicians (2.65 ± 0.93) were higher than the overall average for all staff (2.61 ± 1.0). Higher levels of worker-reported patient safety culture were associated with lower odds of WPV (0.47) and lower burnout scores among workers (B = -1.02). Teamwork across units, handoffs, and transitions were dimensions of patient safety culture that also influenced WPV and burnout. CONCLUSIONS/APPLICATION TO PRACTICE: Our findings suggest that improvements in hospital strategies aimed at patient safety culture, including team cohesion with handoffs and transitions, could positively influence a reduction in WPV and burnout among health care workers.

A study of error reporting by nurses: the significant impact of nursing team dynamics.

Background: Error reporting is crucial for organisational learning and improving patient safety in hospitals, yet errors are significantly underreported. Aims: The aim of this study was to understand how the nursing team dynamics of leader inclusiveness, safety climate and psychological safety affected the willingness of hospital nurses to report errors. Methods: The study was a cross-sectional design. Self-administered surveys were used to collect data from nurses and nurse managers. Data were analysed using linear mixed models. Bootstrap confidence intervals with bias correction were used for mediation analysis. Results: Leader inclusiveness, safety climate and psychological safety significantly affected willingness to report errors. Psychological safety mediated the relationship between safety climate and error reporting as well as the relationship between leader inclusiveness and error reporting. Conclusion: The findings of the study emphasise the importance of nursing team dynamics to error reporting and suggest that psychological safety is especially important to error reporting.

Instrument development measuring critical care nurses' attitudes and behaviors with end-of-life care.

BACKGROUND: Although critical care nurses are expected to focus on providing life-sustaining measures, many intensive care patients actually receive end-of-life care. OBJECTIVES: The aim of this study was to develop an instrument to measure nursing attitudes and behaviors regarding end-of-life care. METHOD: Phase 1 was focused on item development from a content analysis of the literature and qualitative interviews of critical care nurses. Phase 2 consisted of content validity assessment and pilot testing. Phase 3 included field testing, factor analysis, and reliability estimation. RESULTS: The Values of Intensive Care Nurses for End-of-Life (n = 695) was found to have four factors: Self-appraisal, Appraisal of Others, Emotional Strain, and Moral Distress. Reliability estimates ([alpha]) were acceptable at .59-.78, but the interitem range (.12-.78) was wider than desirable. Test-retest reliability was deemed adequate based on Pearson's correlations (.68-.81) and intraclass correlation coefficients (.65-.79) but less so when considering [kappa] (.05-.30). The Behaviors of Intensive Care Nurses for End-of-Life (n = 682) was found to have two factors: Communication and Nursing Tasks. Reliability estimates were adequate when considering internal consistency ([alpha] = .67 and .78, respectively), item total correlations (.30-.61), and test-retest as judged by Pearson's and intraclass correlations (.77-.81) but not when [kappa] was considered (.02-.40). The interitem correlations (.20-.35) were also lower than desirable. DISCUSSION: Both the Values of Intensive Care Nurses for End-of-Life and the Behaviors of Intensive Care Nurses for End-of-Life were found to have conceptually linked factors and acceptable internal consistency estimates ([alpha]). However, test-retest estimates were inconsistent, suggesting that further work needs to be done on the stability of these instruments.

Psychometric evaluation of a new instrument to measure uncertainty in children and adolescents with cancer.

BACKGROUND: Although uncertainty has been characterized as a major stressor for children and adolescents with cancer, it has not been studied systematically. OBJECTIVES: The objective of this study was to describe the development and initial psychometric evaluation of a measure of uncertainty in school-aged children and adolescents with cancer. METHODS: Interview data from the first author's qualitative study of uncertainty in children undergoing cancer treatment (Stewart, 2003) were used to generate 22 items for the Uncertainty Scale for Kids (USK), which were evaluated for content validity by expert panels of children with cancer and experienced clinicians (Stewart, Lynn, & Mishel, 2005). Reliability and validity were evaluated in a sample of 72 children aged 8 to 17 years undergoing cancer treatment. RESULTS: The USK items underwent minor revision following input from content validity experts, and all 22 were retained for testing. The USK demonstrated strong reliability (Cronbach's alpha = .94, test-retest r = .64, p = .005), and preliminary evidence for validity was supported by significant associations between USK scores and cancer knowledge, complexity of treatment, and anxiety and depression. Exploratory factor analysis yielded two factors, not knowing how serious the illness is and not knowing what will happen when, which explained 50.4% of the variance. DISCUSSION: The USK, developed from the perspective of children, performed well in the initial application, demonstrating strong reliability and preliminary evidence for construct and discriminant validity. It holds considerable promise for moving the research forward on uncertainty in childhood cancer.

Reliability and validity of the perspectives of Support From God Scale.

BACKGROUND: Existing spiritual support scales for use with cancer survivors focus on the support believed to come from a religious community, clergy, or health care providers. OBJECTIVE: The objective of this study was to evaluate the reliability and validity of a new measure of spiritual support believed to come from God in older Christian African American cancer survivors. METHODS: The Perceived Support From God Scale was administered to 317 African American cancer survivors aged 55-89 years. Psychometric evaluation involved identifying underlying factors, conducting item analysis and estimating reliability, and obtaining evidence on the relationship to other variables or the extent to which the Perceived Support From God Scale correlates with religious involvement and depression. RESULTS: The Perceived Support From God Scale consists of 15 items in two subscales (Support From God and God's Purpose for Me). The two subscales explained 59% of the variance. Cronbach's alpha coefficients were .94 and .86 for the Support From God and God's Purpose for Me subscales, respectively. Test-retest correlations were strong, supporting the temporal stability of the instrument. Pearson's correlations to an existing religious involvement and beliefs scale were moderate to strong. Subscale scores on Support From God were negatively correlated to depression. DISCUSSION: Initial support for reliability and validity was demonstrated for the Perceived Support From God Scale. The scale captures a facet of spirituality not emphasized in other measures. Further research is needed to evaluate the scale with persons of other racial/ethnic groups and to explore the relationship of spirituality to other outcome measures.

Test of a conceptual model of uncertainty in children and adolescents with cancer.

Despite recognition as a significant stressor in childhood cancer, illness-related uncertainty from the perspective of children remains under-studied. We tested a conceptual model of uncertainty, derived from Mishel's uncertainty in illness theory, in 68 school-aged children and adolescents with cancer. As hypothesized, uncertainty was significantly related to psychological distress, but only one hypothesized antecedent (parental uncertainty) significantly predicted children's uncertainty. An alternative model incorporating antecedent developmental factors (age and illness-specific expertise) explained 21% of the variance in child uncertainty; controlling for stage of treatment, uncertainty was higher in children with shorter time since diagnosis, older age, lower cancer knowledge, and higher parental uncertainty. These findings provide the foundation for further studies to understand children's management of uncertainty and its contribution to psychological adjustment to illness.

Lessons learned in instrument pilot testing with Mexican American caregivers of elders.

Given the fast-growing Mexican American (MA) population, it is common for investigators to be pressured into using Spanish translated instruments developed for English-speaking populations. However, these translated instruments may have limited relevance for data collection without adequate assessment and vetting. The purpose of this paper is to present lessons learned from the pilot testing of instruments designed for use with Mexican Americans. Pilot testing of two instruments was conducted with 22 Mexican American family caregivers of older adults. Issues that emerged were classified into three categories-instrumentation, methodology, and demographic data. Within the area of instrumentation, six issues were identified-level of abstraction, concreteness, pronoun use, clarity, exclusiveness, and response format. Methodological concerns were focused on test-retest administration and inclusion criteria. Issues within the demographic data were concerned with marital status, country of birth, household size and income, and validity of self-rated scales. By addressing those concerns, investigators may be more likely to have culturally sensitive measures and greater generalization to relevant MA populations.

Utilizing courageous dialogue to support minority and disadvantaged background nursing students.

BACKGROUND: Nursing students from historically underrepresented ethnic minorities and disadvantaged background (HUREM-DB) groups often face barriers such as a lack of consistent financial resources, fewer professional role models, bias, and micro-inequities. Utilizing a multifaceted approach for support can be crucial to enhancing student success. PURPOSE OF THE PROJECT: MENTORS2 mitigates some of the challenges for HUREM-DB nursing students with educational, cultural, social, and financial resources. Courageous dialogue (CD) was one required activity of MENTORS2 and included topics such as stress management, time management, and honors project preparation. IMPLEMENTATION OF THE PROJECT: Courageous dialogue sessions were conducted with 56 HUREM-DB undergraduate nursing students enrolled in a baccalaureate program. The number of evaluations submitted for a session averaged 17 (range 7-36). Courageous dialogue sessions allowed students to express views in a safe environment with opportunities for peer support, role modeling, open discussion, and problem solving. PROJECT OUTCOMES: Student evaluations reflected an appreciation of the opportunity to share experiences and learn new skills, knowledge, and approaches to aid their success in nursing school and perhaps their entry into the profession of nursing. CONCLUSION: Courageous dialogue can be an important part of a comprehensive strategy to support HUREM-DB nursing students academically, socially, and professionally.