The impact of the Nurse Faculty Scholars program on schools of nursing.

BACKGROUND: The Robert Wood Johnson Foundation Nurse Faculty Scholars program was conceptualized as not only promoting the growth and development of early-career faculty but as enhancing the research infrastructure of scholars' schools of nursing. PURPOSE: At the completion of the scholars' three years of support, deans/directors were asked to provide feedback regarding the institutional impact of the scholars' participation in the program. METHODS: Phone interviews were conducted on the first five completed cohorts and a six-item questionnaire was developed to obtain some quantitative data. DISCUSSION: The program was viewed as having accelerated the scholars' leadership and scholarship, and their influence within the school/university and regionally/nationally. Deans/directors generally agreed that the scholars' experience helped build the school's research portfolio. CONCLUSION: Looking back on how the participating schools of nursing fared, one can say that the program's institutional expectations were achieved most of the time. The program helped scholars build their own reputations and that in turn had consequences for the school's standing as a whole. A number of components are described that can be replicated singly or in various combinations by schools/universities interested in adopting aspects of this program.

The West Virginia WISEWOMAN Program.

This article describes moving The Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) Program from research to practice in a population of low-income, uninsured, or underinsured women in West Virginia (WV) between the ages of 40 and 64 years. Cardiovascular disease risk factors were evident using screening and health history data from women in all stages of change as well as in different phases of the program. An indicator of program success was women's increased activities to improve their cardiovascular health. Women using an interactive Web program, coupled with appropriately delivered health information, can and do make behavior changes. As the WV WISEWOMAN Program moved from research to practice, clinician training and changes to policies and procedures were needed. Clinicians became skilled at motivational interviewing and targeting information to connect women to community resources for ongoing support. The program continues to help clinicians alert women to cardiovascular risks and guide them to take responsibility for their health. Partnerships between women and their providers are the key to successful implementation of healthier lifestyles.

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey.

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum. Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries. Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content. Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice.

The development and psychometric analysis of the short-form Pulmonary Functional Status Scale (PFSS-11).

This article describes the development and psychometric evaluation of the short-form Pulmonary Functional Status Scale (PFSS-11©) derived from the previously validated 35-item PFSS, using data from 179 subjects (120 Chronic Obstructive Pulmonary Disease [COPD]/59 normative, non-COPD). Items were extracted based on item-response distribution and commonality >.60. Factor analysis yielded a three-factor solution, accounting for 65.6% of total variance. Construct validity was supported by PFSS-11© scores for COPD versus norms (p < .001). The PFSS-11© was robustly associated with the PFSS-35 (r = .93), accounting for 88% of variance in the longer version. Internal consistency was satisfactory and significant response to treatment was shown by score changes pre/post-rehabilitation. The PFSS-11© has solid psychometric properties useful in research and clinical practice, similar to the PFSS-35.

Do we need tailored training and development plans for European Union respiratory nurses?

Nurses are critical players in healthcare and should be the next profession to standardise levels of education, preparing them for an active partnership with other healthcare professionals prepared to tackle the chronic disease problem in Europe https://bit.ly/3bMR76b.

Nursing Research Priorities in Critical Care, Pulmonary, and Sleep: International Delphi Survey of Nurses, Patients, and Caregivers.

The objective of this workshop was to determine current nursing research priorities in critical care, adult pulmonary, and sleep conditions through input from consumer (patient, family, and formal and informal caregivers) and nursing experts around the world. Working groups composed of nurses and patients selected potential research priorities based on patient insight and a literature review of patient-reported outcomes, patient-reported experiences, and processes and clinical outcomes in the focal areas. A Delphi consensus approach, using a qualitative survey method to elicit expert opinion from nurses and consumers was conducted. Two rounds of online surveys available in English, Spanish, and Chinese were completed. A 75% or greater threshold for endorsement (combined responses from nursing and consumer participants) was determined a priori to retain survey items. A total of 837 participants (649 nurses and 188 patients, family, and/or caregivers) from 45 countries responded. Survey data were analyzed and nursing research priorities that comprise 23 critical care, 45 adult pulmonary, and 16 sleep items were identified. This project was successful in engaging a wide variety of nursing and consumer experts, applying a patient-reported outcome/patient-reported experience framework for organizing and understanding research priorities. The project outcome was a research agenda to inform, guide, and aid nurse scientists, educators, and providers, and to advise agencies that provide research and program funding in these fields.

From high tech to high touch: integrating community voices in mobile mammography outreach.

Providing mobile screening mammography services across the state of West Virginia (WV) presents unique challenges. The ability of new machines to screen for breast cancer is modern medicine at its best. The use of the mobile unit, "Bonnie's Bus", holds promise for getting this high tech equipment to women in rural areas of West Virginia where it is most needed. Cancer detected in early stages is more treatable and women have a better chance of becoming survivors. The key to the program's success resides with the women who come for the screening, the extension network of community members who help set up and assist women to access the screening system, and community health care providers who care for the women if cancer is found. Linking "community voices" with the programs funded under the WV Komen grant screening programs provides a winning solution for West Virginia and the women served by Bonnie's Bus. Information obtained from five focus groups of 58 community leaders and women residing in rural WV was used to develop the mobile program. Building upon established relationships with the West Virginia Breast and Cervical Cancer Screening Program (WV BCCSP) coordinators and providers, outreach and information gleaned from WV communities, is being used to develop community partnerships based on mutual trust and respect to advance the common goal of decreasing breast cancer related illness and death in West Virginia women.

Cultural and Environmental Enablers and Barriers to Participation and Retention in Clinical Trials for Cancer Research.

BACKGROUND: West Virginia (WV) residents have often rejected participation in community-based cancer research studies. Nationally, 49% of eligible patients participate in clinical trials but less than 10% of patients in WV participate. OBJECTIVE: To understand issues related to recruitment and retention of patients for cancer research in Appalachian WV. METHODS: Data were obtained from 3 focus groups including: (1) 9 patients who participated in clinical cancer trials, (2) 8 cancer research nurse coordinators, and (3) 10 physicians involved in cancer research. Groups were audio-taped and transcriptions were analyzed using MAXQDA and results were verified by two co-investigators. RESULTS: Most enablers and barriers identified were cultural as indicated by 72% of patients; 68% nurse coordinators; and 55% physicians. Patients identified personal emotional strength as an enabler, and negative health behaviors and fears as barriers. Enablers that nurses identified were positive patient characteristics and barriers included fear of trials, randomization, and death. Physicians identified enablers as a patient's understanding of the clinical trial and motivation to help others and the inverse of these two enablers as barriers. CONCLUSION: A foundation for improving recruitment and retention of participants in cancer research in Appalachia was identified. The next step will involve cancer community organizations and patients in developing a plan to enhance enablers and overcome barriers to patient recruitment in cancer studies. IMPLICATIONS FOR PRACTICE: Cultural influences must be considered when recruiting for clinical trials. Community organizations educating the public about cancer research may be the key to enhancing patient enrollment.

The potential of palliative care for patients with respiratory diseases.

Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians. EDUCATIONAL AIMS: To explain the basic domains of palliative care applicable to chronic respiratory diseases.To review palliative care interventions for patients with chronic respiratory diseases.To outline a checklist for clinicians to use in practice, based on the domains of palliative care.To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases.

Factors related to chronic obstructive pulmonary disease readmission in Taiwan.

This study examines the relationships among physiological, psychological, and social factors and hospital readmission to develop a model predicting chronic obstructive pulmonary disease (COPD) readmission for 145 patients with COPD following hospital discharge at 14 days and 90 days in Taiwan. Daily functioning, comorbidity, severity of illness, self-efficacy, depressive symptoms, and perceived informal support were regressed on hospital readmission. Daily functioning was the only significant variable to predict COPD readmission at 90 days in the Taiwan population living in a rural area. Age was significantly correlated with 14 days readmission. Post hoc analyses examined differences in three ethnic groups. Mainlanders perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens and Hakkas, or the Aborigines. The study reinforced the need for identification of cultural differences and low functioning as risk factors for early readmission so they can be addressed in discharge planning.

Predictors of poor coronary heart disease knowledge level in women without prior coronary heart disease.

PURPOSE: The purpose of this study was to measure coronary heart disease (CHD) knowledge levels in women without a history of CHD and to determine predictors of poor CHD knowledge in these women. DATA SOURCES: The sample included 120 women between the ages of 35 and 60, who had no CHD history. Women were asked to complete self-administered surveys including demographic data, personal CHD risk factors, and a CHD Knowledge Test. CONCLUSIONS: Women lack CHD knowledge. Low educational level, normal serum lipids, high body mass index (BMI), and lack of access to a nurse practitioner (NP) were predictors of poor CHD knowledge levels in women without CHD history. IMPLICATIONS FOR PRACTICE: Women who had access to an NP were more likely to have higher CHD knowledge. In an attempt to decrease the morbidity and mortality associated with CHD, NPs may be able to improve CHD knowledge in women, particularly in those with lower educational level, normal serum lipids and higher BMI.

Coping with stigma: the experiences of Chinese patients living with lung cancer.

PURPOSE/OBJECTIVES: To describe the experiences of stigma and coping strategies among patients with lung cancer in China. RESEARCH APPROACH: Qualitative. SETTING: The oncology department at Liaocheng Peoples Hospital. PARTICIPANTS: A purposive sample of 17 patients experiencing stigma related to lung cancer voluntarily participated in data collection. METHODOLOGIC APPROACH: Individual, semistructured qualitative interviews were chosen. Participants completed about a 30-min focused interview. Exploratory qualitative approach guided data analysis. FINDINGS: Three main thematic elements emerged from the interview data:(1) sources of stigma, such as smoking, decreased ability to work, difficulties caring for self and family, damage to self-image, and cough and expectoration; (2) experiences of stigma, including feelings of stigma, remorse, loss of dignity, uselessness, social isolation, perceived exclusion, rejection, and discrimination; and (3) coping strategies, such as concealing the fact of sickness, reducing social activities, seeking medical assistance, adhering to treatment, and disclosing dissatisfaction. CONCLUSIONS: Our results indicate the presence of perceived stigma among patients with lung cancer. Future work should address the stigma associated with lung cancer and its related factors. INTERPRETATION: As point-of-care providers, staff nurses are well positioned to develop effective interventions to help patients deal with stigma and to accomplish the goal of providing holistic nursing care.

The Use of Video Conferencing for Persons with Chronic Conditions: A Systematic Review.

The purpose of this paper is to present a systematic review of studies that used Video Conferencing (VC) intervention for common chronic conditions. Chronic conditions account for the majority of poor health, disability, and death, and for a major portion of health-care expenditures in the United States. Innovative methods and interventions are needed to enhance care and management, improve access to care, improve patient outcomes, narrow health disparities and reduce health-care costs. Video Conferencing could be particularly relevant in improving health, care management, access and cost in the care of chronic illnesses. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 27 articles measuring video conferencing, at least one chronic illness, and patient outcomes for adults living in a community setting. While VC has been found to be feasible and effective, a low number of randomized controlled trials limit evidence. In addition, studies in this review were not designed to address the question of whether access to care in rural areas is improved through VC. Hence, more research is needed.

Management of community-acquired pneumonia in the home: an American College of Chest Physicians clinical position statement.

The number of patients with community-acquired pneumonia (CAP) who are being treated at home is increasing for a variety of reasons. These reasons include the increased availability and cost considerations of oral antibiotics that have been shown to be effective, as well as the consideration of patient and family preferences. However, there is still considerable variability in strategies for the management of patients with CAP. This American College of Chest Physicians position statement, which was cosponsored by the American Academy of Home Care Physicians, provides recommendations on the various aspects of home care for patients with this condition. Included are recommendations for evaluation and diagnosis in the home environment and the determination of the site of care, and an outline of an in-home management plan. The position statement also provides recommendations for issues related to patient and caregiver commitment to the plan, and for monitoring and follow-up. Recommendations are directed toward immunocompetent adult patients with CAP who are at home or in other unskilled residential facilities. These patients can include previously healthy individuals or chronically ill individuals who choose not to go to the hospital, or hospitalized patients who are completing a hospital discharge plan. The recommendations in this statement take into consideration the best course of action for the patient, as determined by incorporating the most recent evidence with clinician judgment and patient preferences. These recommendations also consider the available resources. Therefore, these recommendations may not apply to every patient, and interventions may need to be structured based on the individual. In addition to providing recommendations for the home care management of patients with CAP, we hope that this clinical policy statement will alert readers to the need for more scientific evidence related to the clinical and psychosocial issues associated with managing this condition.

Characteristics influencing weight reduction among veterans in the MOVE!® Program.

Obesity is a common health problem for veterans. This study explored background and program characteristics associated with a 5% weight reduction for veterans enrolled in MOVE!(®), a weight management program. For data analysis, 404 veteran records were examined using logistic regression. Background characteristics included socio-demographic variables, comorbidity, body mass index, rurality, and Veterans Administration (VA) priority group. Program characteristics included the program type (group attendee or self-managed) as well as the number and type of provider contacts. Thirteen percent of participants achieved a 5% weight reduction. Age in years (odds ratio [OR] = 1.04) and the number of group visits (OR = 1.05) were significant predictors for achieving a 5% weight reduction. Given the importance of weight reduction, health professionals should consider these significant predictors when planning weight-reduction programs for veterans.

Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level. AIMS: The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients. METHODS: From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n=76, age 73 (8) years, forced expiratory volume during the first second, FEV1 41(19) % predicted) or usual care (n=84, age 75(9) years, FEV1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient's empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years. RESULTS: IC enhanced self-management (P=0.02), reduced anxiety-depression (P=0.001) and improved health-related quality of life (P=0.02). IC reduced both ED visits (P=0.02) and mortality (P=0.03) but not hospital admission. No differences between the two groups were seen after 6 years. CONCLUSION: The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force.

Developing personal and community learning in graduate nursing education through community engagement.

Community engagement through service-learning was introduced into a graduate program in nursing education to develop student leadership skills, interest in learning, and social responsibility. With faculty expertise and guidance, students worked in partnership with underserved community agencies. The goal of sustainability was accomplished by developing faculty expertise in service-learning as a method of instruction and integrating community engagement into academic assignments within existing courses. Opportunities to reflect on the benefits of the experiences were considered crucial to bridging service to learning in the community. Evaluation findings indicate that students gained insight into community needs and resources as they moved outside traditional health care settings. Graduates increased their understanding of their role as a resource to the community, and community agencies saw the value of a nurse educated at an advanced practice level.

Smoking cessation interventions for hospitalized patients with cardio-pulmonary disorders.

This article reviews the evidence for effective smoking cessation interventions in hospitalized cardiac and pulmonary patients. Research evidence from 1992 through June 2002 was located through searches of CINAHL (169 manuscripts), Medline (227 manuscripts), PsycINFO (123 manuscripts), the Cochrane Library, and AHCPR Clinical Practice Guidelines. Seventy-one studies were critiqued for this review. The results of the searches indicated that cigarette smoking and nicotine dependence exponentially increase risk factors for cardiac and pulmonary diseases. Stages of smoking behavior change and readiness to quit were identified as major components in the process of smoking cessation. Factors predicting success and change activities include: higher education, level of craving or nicotine dependence, and social support by work or family/friends. Risk factors for relapse include: work environment/stress and other smokers in the home or workplace. Hospitalized patients were shown to be in a "window of opportunity" for assisting the behavior change process of smoking cessation due to increased health motivation.

APN-directed transitional home care model: achieving positive outcomes for patients with COPD.

Advanced practice nurses (APNs) have not been widely used in home care, despite evidence of their effectiveness with a variety of patient groups. This study examined the use of the transitional model for home care patients with chronic obstructive pulmonary disease. The study found patients cared for by an APN-directed visit team had fewer nursing visits, rehospitalizations, and acute care visits. Depressive symptoms were also less, and functional abilities increased compared with patients cared for by a usual care model.

Feasibility study: home telemonitoring for patients with lung cancer in a mountainous rural area.

PURPOSE/OBJECTIVES: To explore the feasibility of rural home telemonitoring for patients with lung cancer. DESIGN: Exploratory, descriptive, observational. SETTING: Patient homes within a 75-mile radius of the study hospital in West Virginia. SAMPLE: 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis. METHODS: Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months. MAIN RESEARCH VARIABLES: Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction. FINDINGS: Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer. CONCLUSIONS: Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact. IMPLICATIONS FOR NURSING: Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.