Climate, Health, and Nursing Tool (CHANT): A confirmatory factor analysis.

OBJECTIVE: To confirm the factor structure of the Climate, Health, and Nursing Tool (CHANT) tool via confirmatory factor analysis. DESIGN AND SAMPLE: This is a cross-sectional analysis of voluntary, anonymous responses collected online in 2019, from a non-representative sample of 489 nurses from 12 nations with 95% of the respondents from the United States. MEASUREMENTS: A confirmatory factor analysis (CFA) was conducted to test a five-factor measurement model of the 22-item CHANT. Reliability was examined via Cronbach's α coefficient. RESULTS: The five CHANT subscales demonstrated acceptable reliability with Cronbach's α ranging from 0.67 to 0.91. The five-factor model of CHANT demonstrated good fit, x2 (199) = 582.747, p < .001, CFI = 0.94, RMSEA = 0.06, and SRMR = 0.04 with statistically significant item-factor loadings. CONCLUSION: CHANT is a reliable and robust instrument to measure nurses' awareness, concern, motivation, and home and work behaviors regarding climate change and health, and is ready to be utilized in research, policy, professional settings, and among educators.

Nurse-sensitive environmental indicators: A qualitative study.

AIM: This study aims to explore the proposed concept of "nurse-sensitive environmental indicators" among nursing and non-nursing leaders of environmental stewardship who work with nurses. BACKGROUND: Aligned with the Sustainable Development Goals, nurses are obligated to "practice in a manner that advances environmental safety and health." Little is known about environmental impacts in acute-care nursing. METHODS: Nursing and non-nursing leaders of environmental stewardship across the United States (N = 9) were interviewed to explore the concept of acute-care nurse-sensitive environmental indicators. Transcripts were examined using qualitative descriptive analysis. RESULTS: Thematic analysis revealed that nurses are in key positions to influence environmental change, need more education and awareness to be effective, and need leadership support and role-modelling. Issues related to waste were highly nurse sensitive; issues related to food, chemicals, and transportation were moderately nurse sensitive; issues related to energy and water were minimally nurse sensitive. CONCLUSION: Preliminary consensus on nurse-sensitive environmental indicators was confirmed by leader participants in this study. IMPLICATIONS FOR NURSING MANAGEMENT: To help meet environmentally focused Sustainable Development Goals, nursing leaders can use the concept of nurse-sensitive environmental indicators in planning, education, resource allocation, and leadership to improve environmental stewardship in acute care nursing.

Four Years Later: Examining Nurse Perceptions of Electronic Documentation Over Time.

OBJECTIVE: To examine changes in registered nurse (RN) perceptions of electronic documentation over a 4-year period. BACKGROUND: The investigators previously reported differences in RN perceptions prior to and 1 year after adoption of a comprehensive electronic health record (EHR). METHODS: Investigators repeated the study 4 years after adoption, using the Nurses' Perceptions of Electronic Documentation tool and interviews with a subset of RNs. RESULTS: Nurses scored higher on ease of use domain and lower on concern about the EHR domain and showed no difference on the impacts of the EHR domain. Interviews revealed that 4 years later, some aspects of documentation were easier; the tool was comprehensive, but not without risk, and nurses remained ambivalent about the EHR. CONCLUSIONS: Use of EHR technology impacts nursing work. It is important to understand how nurses' perceptions change over time. This study gives nursing leaders insight into adoption and acceptance of an EHR.

Climate, Health, and Nursing Tool (CHANT): Initial survey results.

OBJECTIVES: This study measured nurses' awareness, motivation, concern, self-reported behaviors at work, and self-reported behaviors at home regarding climate change and health. DESIGN: Descriptive study using an anonymous and voluntary web-based survey. SAMPLE: A nonrepresentative sample recruited from nurses. MEASUREMENTS: The CHANT (Climate, Health and Nursing Tool) with five psychometrically evaluated scales used to measure awareness, motivation, concern, behaviors at work, and behaviors at home. RESULTS: The 489 respondents reported moderate levels of awareness (2.97 mean score of 0-4) and high levels of concern (3.43) about health impacts of climate change. They were motivated to reduce greenhouse gas emissions (3.27), yet few did at home (2.28), and even fewer at work (1.81). They were motivated by clean air and water and concern about the future. Barriers to action included not knowing what to do and feeling overwhelmed. Respondents reported discussing climate and health with friends or family more frequently than they did with their colleagues. A majority (63%) never contacted elected officials. CONCLUSION: The respondents were aware of climate and health impacts and motivated to act. However, they reported lower frequencies of changing behaviors at work, and communicating about climate and health professionally and with elected officials.

A Proposal: Nurse-Sensitive Environmental Indicators.

Healthcare contributes significant pollution to the natural environment. Nurses are obligated by professional commitment, to avoid causing harm in their care processes and decisions, including environmental harm. Nurse awareness of healthcare-generated pollution is growing but nurses may lack an understanding of how nursing contributes specifically to this pollution and what nurses can do within their scope and span to address it. This chapter introduces the concept "Nurse-Sensitive Environmental Indicators" as a proposal to identify, measure, and reduce the unintended harm of nursing practice that contributes to healthcare-generated pollution. It discusses the environmental problem, environmental health, and healthcare. The chapter explains what environmental stewardship has to do with nursing and describes nurse sensitive indicators. As has been the case with other quality outcomes measures, identifying agreed-upon environmental outcomes measures may give the nursing profession tools to measure and then address environmental impacts arising from nursing practice.

CHANT: Climate, Health, and Nursing Tool: Item Development and Exploratory Factor Analysis.

Climate change poses significant health risks. Nurses assess, treat, and educate patients about health risks. However, nurses' level of awareness, motivation, and behaviors related to climate change and health is not known. This study developed and tested a novel tool measuring these elements. Three hundred fifty-seven nurses responded to the overall survey. Exploratory factor analysis (EFA) assessed the factor structure of the 22-item CHANT survey and Cronbach's alpha estimated internal consistency. A five-factor model was retained through the EFA, demonstrating good model fit (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, standardized root mean square residual [SRMR] = .09), and items were internally consistent (Cronbach's alpha for each subscale >.70). CHANT has been developed and psychometrically examined and is ready for further use and study.

Perspectives on Patient and Family Engagement With Reduction in Harm: The Forgotten Voice.

BACKGROUND: Despite continued efforts to improve safety in hospitals, hospital-acquired harm persists. Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient and family engagement to reduction of harm is not well understood, with limited findings available in current literature. PURPOSE: This qualitative study explored the perceptions and attitudes of patients and family members and several clinical disciplines toward patient engagement in reducing preventable harm in hospitalized patients. METHODS: We conducted 8 focus groups at 2 nonprofit hospitals with several constituencies: patients/families, registered nurses, physician hospitalists, and pharmacists/physical therapists. RESULTS: Thematic analysis of transcripts revealed multiple themes from different perspectives, including: family presence increases safety, the hospital environment is intimidating, and communication is essential, but I am not being heard. CONCLUSIONS: The rich data suggest a significant opportunity for reducing risk and harm by more actively engaging patients and families in the effort. Increasing patient acuity and complexity of care furthers the need for partnering with patients and families more intentionally for increased safety.

Developing an Intervention to Reduce Harm in Hospitalized Patients: Patients and Families in Research.

BACKGROUND: Patient safety-focused research may be strengthened by the inclusion of patients and family members in research design; yet, published methodologies for doing so are scarce. PURPOSE: This study engaged patients and families in research design of an intervention to increase patient/family engagement, with reduction of harm in hospitalized patients. METHODS: The study design team convened a Patient Safety Advisory Panel to explore potential testable interventions to increase patient/family engagement with safety. They explored the preferred intervention, Speak Up-My Advocate for Patient Safety (MAPS), through multistakeholder focus groups. RESULTS: Participants emphasized the importance of including patient/family when designing interventions. Regarding the Speak Up-MAPS intervention, perceptions from stakeholders were mixed, including the value and potential complexity, role confusion, and cost of the proposed advocate role. CONCLUSION: Intentional inclusion of the patient/family in research is important and practical. Both strengths and challenges of the proposed intervention were identified, indicating the need for further study.

Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy.

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.

Time motion analysis of nursing work in ICU, telemetry and medical-surgical units.

AIM: This study examined nurses' work, comparing nursing interventions and locations across three units in a United States hospital using Omaha System standardized terminology as the organizing framework. BACKGROUND: The differences in nurses' acute-care work across unit types are not well understood. Prior investigators have used time-motion methodologies; few have compared differences across units, nor used standardized terminology. METHODS: Nurse-observers recorded locations and interventions of nurses on three acute-care units using hand-held devices and web-based TimeCaT™ software. Nursing interventions were mapped to Omaha System terms. Unit-differences were analysed. RESULTS: Nurses changed locations approximately every 2 min, and averaged approximately one intervention/minute. Unit differences were found in both the interventions performed and the locations. Most interventions were case-management related, demonstrating the nurses' patient management/coordination role. CONCLUSIONS: Unit differences in nursing interventions and location were found among three unit types. Omaha System terminology, as well as the observational method used, were found to be feasible and practical. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing work varies by unit, yet managers have not been armed with empirical data with which to make more informed decisions about nurses' work priorities, clinical outcomes, patient satisfaction, staff satisfaction and cost. The results from this study will help them to do so.

RN Perceptions of a Newly Adopted Electronic Health Record.

OBJECTIVE: The purpose of this study was to understand nurses' perceptions of a newly adopted electronic health record (EHR). BACKGROUND: As use of EHRs in hospital settings increases, leaders prepare staff members for change. There is limited information about impacts of EHR adoption on RNs using EHRs at the point of care. METHODS: Clinical RNs were surveyed about 3 domains (ease of use, usefulness, and attitude) before and after implementation of an EHR. A small subset of nurses was interviewed for a deeper understanding of perceptions associated with this change. RESULTS: One year after adoption, nurses believed that the EHR did not improve patient care, the learning curve was steep, and they had lower confidence using the EHR than anticipated. Nurses commented on both their frustration and optimism about EHRs. CONCLUSIONS: This study provides insight into RNs' perceptions of an EHR, providing important information for nursing administrators.

Environmental sustainability in the intensive care unit: challenges and solutions.

In acute care practice sites, the intensive care unit (ICU) is one of the most resource-intense environments. Replete with energy-intensive equipment, significant waste production, and multiple toxic chemicals, ICUs contribute to environmental harm and may inadvertently have a negative impact on the health of patients, staff, and visitors. This article evaluates the ICU on four areas of environmental sustainability: energy, waste, toxic chemicals, and healing environment and provides concrete actions ICU nurses can take to decrease environmental health risks in the ICU. Case studies of nurses making changes within their hospital practice are also highlighted, as well as resources for nurses starting to make changes at their health care institutions.

School of Nursing Climate Commitment: Nursing Faculty Bring Climate to the Classroom.

In 2021, the American Association of Colleges of Nursing (AACN) added "the impact of climate change on environmental and population health" into The Essentials: Core Competencies for Professional Nursing Education. Presently, little guidance exists for nursing faculty new to climate education. The year prior, the Nurses Climate Challenge (NCC)-a campaign to educate 50,000 health professionals about health impacts of climate change-launched the School of Nursing Commitment through a series of focus groups and collaborative content development. With an aim of increasing access to knowledge and tools to support education about the health impacts of climate change, the NCC Commitment partners with nursing schools and provides a community of practice. Partner schools use NCC resources in courses and report the number of students educated. Within three years, 61 nursing schools in 30 states joined the Commitment. Participants included academic health centers, research institutions, multi-state schools, and small private colleges, and programs ranged from AD to PhD. Faculty (1) integrated resources into didactic and clinical settings, such as population or organ-system content, leadership, and policy; and (2) used resources to support assignments. In four years, faculty reported educating over 37,700 students, using NCC resources in 439 educational sessions. The Commitment may be valuable for faculty fulfilling AACN Essentials by bringing climate change to the classroom, community, and bedside. Furthermore, the Commitment may be a replicable model for health professional education and inspiring action on climate change.

Nurses at the United Nations.

There is an urgent call to redesign health care to be more equitable, to address the climate change crisis, and to implement the United Nations' Sustainable Development Goals (SDGs) for the health of the global community. Now is the time for nurses to get involved in leading these necessary changes. In 2019, the authors were chosen to present a concurrent session at the 68th United Nations Civil Society Conference. The conference focused on SDG 11, Building Inclusive and Sustainable Cities and Communities. The experience convinced the authors that nurses have unique knowledge and skills to contribute to the mission of the United Nations.

Validating the Nurses' Perceptions of Electronic Documentation Scale in a Cross-Sectional Sample of Registered Nurses in Australia: A Confirmatory Factor Analysis.

BACKGROUND AND PURPOSE: The Nurses' Perceptions of Electronic Documentation (NPED) scale assesses nurses' perceptions, attitudes, and use of electronic documentation in acute care settings. However, confirmatory factor analysis of the scale had not been conducted. This article describes a confirmatory factor analysis of the NPED scale. METHODS: An 11-item survey was implemented in a cross-sectional sample of 202 registered nurses in a large tertiary hospital in Australia. Confirmatory factor analysis was used to assess validity and reliability was determined by Cronbach's α coefficients. RESULTS: Confirmatory factor analysis generated an excellent model-data fit for a two-factor model. All item-factor loadings were statistically significant and substantial. CONCLUSIONS: The NPED scale is a robust instrument to measure nurses' perceptions of the utility of and concerns about the electronic medical record in practice.

Nurses Promoting Inclusive, Safe, Resilient, and Sustainable Cities and Communities: Taking Action on COVID-19, Systemic Racism, and Climate Change.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article highlights SDG 11-making "cities and human settlements inclusive, safe, resilient and sustainable."

A Tool to Measure Nurses' Perceptions of Electronic Documentation: Exploratory Factor Analysis.

BACKGROUND AND PURPOSE: Electronic Health Records (EHRs) have been widely adopted in US hospitals. EHRs have changed workflow and time allocation and have broad impacts on staff. We adapted an existing instrument to measure nurses' perceptions of a newly adopted EHR. METHODS: The 11-item survey was administered to approximately 500 registered nurses in a mid-sized regional hospital in western US, with 153 responses received. Exploratory factor analysis (EFA) assessed the factor structure and Cronbach's α estimated internal consistency. RESULTS: A 3-factor model was retained through the EFA, and items were internally consistent (Cronbach's alpha for each subscale > .80). CONCLUSIONS: Survey adaptation was iterative and resulted in a psychometrically sound and thematically relevant measure of nurses' EHR perceptions. Next steps include further psychometric evaluation and testing with additional samples.

Climate Change Should Be on Every Nursing Research Agenda.

Human-caused climate change is a global emergency, and its harms are predicted to increase exponentially in the coming years, particularly if unsustainable practices continue unmitigated. Adverse effects of climate change on communities affected by or at risk for cancer, such as frail older adults, are already measurable and deadly. If nurse scientists continue to ignore these realities, more people are likely to suffer and die as a result. The purpose of this critical reflection is to discuss the vital necessity of including climate change in the research agenda of the Oncology Nursing Society and all nursing science. Using an approach grounded in critical theory and design justice, the authors provide specific suggestions for the incorporation of scientific considerations and nursing measures related to climate change into oncology nursing science.