Validation and Revision of the Household Emergency Preparedness Instrument (HEPI) by a Pilot Study in the City University of New York.

OBJECTIVE: The aim of this study was to pilot test the Household Emergency Preparedness Instrument (HEPI) with a diverse sample, allowing for assessment of reliability and validity of the instrument. The HEPI is an international, all-hazards questionnaire created to measure disaster preparedness of households, which results in data that can be used to enhance health promotion/disease prevention for individuals and promote resilience for communities. METHODS: A cross-sectional study of faculty, staff, and students (N = 284) was completed to perform factor analysis to establish the HEPI's construct validity and compare preparedness across groups. RESULTS: The factor analysis revealed 2 dimensions of general preparedness, explaining 35% of the sample variance (Cronbach's α = 0.89): preparedness actions and planning (α = 0.86) and disaster supplies and resources (α = 0.80). This factor analysis resulted in the revision of the subscaling of HEPI questions. Consistent with previous studies, faculty/staff, older age, higher income, and those with previous disaster experience were more prepared. The mean score was 15.28 out of 40 points. CONCLUSIONS: The HEPI is easy to administer and explains an acceptable amount of variance. The reliability was strong in this assessment, particularly for a pilot test. Construct, criterion, face, and content validity support the adequacy of the HEPI to capture essentials of household emergency preparedness.

Household Emergency Preparedness Instrument Development: A Delphi Study.

OBJECTIVE: The main objective of this research was to generate a consensus on the conceptual definition of household emergency preparedness from experts representing multiple disciplines and countries, in order to facilitate the development of an all-hazards, comprehensive, valid, and reliable instrument. METHODS: Questions were generated via 3 methods: literature search, using existing instruments, and expert panels using the Delphi technique. RESULTS: Panelists (n = 154) representing 36 countries came to a consensus that household emergency preparedness is defined as the completion of several preparedness actions and assembling a kit that can be transported in an evacuation. The new 51-question instrument demonstrates face, content, and criterion validity and internal consistency reliability (α = 0.96). The instrument assesses whether specific preparedness actions have been taken, and the presence or absence of essential supplies that could enable households to safely endure conditions that disasters would likely present (loss of power, water limitations, and/or lack of access to additional supplies for a few days). CONCLUSION: A valid and reliable instrument provides researchers with a replicable approach to assessment of preparedness levels, which is necessary to plan mitigation strategies, enhance health promotion, prevent injuries, and increase resilience for individuals and communities. The instrument can provide evidence to support interventions addressing health needs of community members following a disaster.

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability.

The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

Emergency Preparedness Competencies Among Nurses: Implications for Nurse Administrators.

OBJECTIVE: The aim of this study was to examine current levels of self-reported professional emergency preparedness competence among nurses. In addition, relationships between nurse professional emergency preparedness competence, personal preparation for a disaster, and perceived likelihood of reporting to work after a disaster are examined. BACKGROUND: Evidence suggests wide gaps in nurses' familiarity with the dimensions of professional emergency preparedness competence and their likelihood to report, potentially impacting human life after a disaster. METHODS: An exploratory, cross-sectional survey design was used with a sample of 186 RNs and licensed practical nurses. RESULTS: Results indicate significant weaknesses in nurses' professional emergency preparedness competence. There are positive correlations between likelihood to report, personal preparedness, and professional emergency preparedness competence. CONCLUSIONS: Nurses across the United States lack sufficient competence in professional emergency preparedness. Results demonstrate the need to improve the education of nurses to meet the demands of populations in urgent situations. Action items nurse administrators can take are provided.

Exploring the Relationships Among Moral Distress, Moral Courage, and Moral Resilience in Undergraduate Nursing Students.

BACKGROUND: Nurses and students face a demanding and fluid health care system that can present overwhelming challenges. Moral distress is a challenge encountered by students who experience complex situations. Certain virtues such as moral courage and moral resilience are necessary to navigate around this phenomenon. METHOD: Using a descriptive correlational study design, a convenience sample of nursing students distributed among three sites were surveyed using three tools: The Moral Distress Thermometer (MDT), the Connor-Davidson Moral Resilience Scale (CD-RISC), and the Moral Courage Scale for Physicians (MCSP). RESULTS: Students reported mild levels of moral distress (M = 2.73, SD = 1.9). Moral resilience was significantly correlated with moral courage, age, and students having a previous degree. CONCLUSION: Interventions to cultivate moral resilience in nursing curricula are necessary. Valid instruments to measure moral resilience and moral distress in nursing students should be investigated further. [J Nurs Educ. 2020;59(7):392-395.].

Characterization of nurses' duty to care and willingness to report.

BACKGROUND: Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care. RESEARCH AIM: The purpose of this study was to investigate nurses' perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care. RESEARCH DESIGN: A cross-sectional survey research design was used in this study. PARTICIPANTS AND RESEARCH CONTEXT: Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board. ETHICAL CONSIDERATIONS: Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas. FINDINGS: Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: "lower level of perceived duty to care group" and "higher level of perceived duty to care group." The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics. DISCUSSION: The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses' safety, minimize nurses' risk, and promote nurses' knowledge to confidently work during disaster situations. CONCLUSION: Level of perceived duty to care affects nurses' willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses' perceived duty to provide care and willingness to report to work during disasters.

Individual emergency-preparedness efforts: A social justice perspective.

BACKGROUND: Since 2010, the United States has experienced 228 disasters, affecting over 86 million people. Because of population shifts, the growing number of people living with chronic conditions or disabilities, and the growing number of older citizens living independently, access and service gaps often exist for those without money or other transferable resources. There is a lack of evidence regarding individual community members' capacity to prepare for emergencies. RESEARCH OBJECTIVE: The purpose of this study is to highlight participant experiences in becoming better prepared for emergencies and provide insight from a social justice perspective. RESEARCH DESIGN: This is a descriptive qualitative study, staying very close to the data as an end product rather than a beginning for interpretation. PARTICIPANTS AND RESEARCH CONTEXT: A total of 13 low-income, uninsured, or under-insured attendees at a medical outreach clinic were interviewed. ETHICAL CONSIDERATIONS: Institutional Review Board approval was obtained from the University of Texas at Tyler. FINDINGS: Four themes emerged from the interview data: (a) evaluation of the emergency-preparedness education, (b) making emergency plans, (c) challenges in preparing for emergencies, and (d) facilitators of emergency preparedness. DISCUSSION: Identifying the potential challenges to individual emergency preparedness among vulnerable populations is the first step in overcoming them. The capacity to comply with such measures, especially the ability of those with limited incomes and other vulnerable populations, must be considered. CONCLUSION: Synchronized, well-ordered assistance will close gaps in recovery and enhance efficiency in pre- and post-event aid. Theoretically, doing so will promote engaged and resilient members of society who are better able to withstand adverse events. The importance of the relationship between individual preparedness levels and the resiliency of nations supports the social justice imperative to address the needs of vulnerable populations in the mitigation and planning phase of the emergency management cycle.

Nursing impact on chronic disease Medicaid health home patients: A qualitative study.

BACKGROUND: Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the US health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. The Affordable Care Act provides opportunities to launch chronic disease Medicaid health homes (MHH) to address the existing health care gaps. Within a multidisciplinary team, the nurse serves an integral role as the main care manager and coordinator aimed to improve patient experiences, health outcomes, and lowering health care costs. AIMS: The aim of this qualitative study is to assess the nurse's perception of their MHH role and how they may impact patient health care utilization patterns. MATERIALS & METHODS: The qualitative study included a focus group of eleven nurses and individual interviews with seven nurses. RESULTS: Six themes were identified that focus on how nurses can use a wide range of effective communication strategies and interpersonal skills to establish and maintain a nurse-patient relationship. DISCUSSION: The six themes provided insight as to nurses' perceived role in an MHH and how they impact patient health outcomes. The overarching message addressed connecting with the patient and taking the time to find out what was important to them. CONCLUSION: Nurses were able to impact patient health care utilization patterns.

Development of the Self-Efficacy for Sleep Hygiene Inventory.

BACKGROUND AND PURPOSE: Few studies have examined how self-efficacy is related to sleep behaviors in young adults. The purpose of this study was to develop and test an instrument specifically designed to measure self-efficacy for sleep hygiene in young adults. METHODS: The Self-Efficacy for Sleep Hygiene Inventory (SESHI) was developed in three phases using principal components analysis. The 30-item scale was pilot tested with a sample of 305 young adults. A second study with a sample of 96 young adults confirmed reliability. RESULTS: A 24-item three-factor solution: time management, disruptive influences, and sleep influences. Cronbach's alphas were 0.83 (total SESHI), 0.87 (time management), 0.69 (disruptive influences), and 0.73 (sleep influences). CONCLUSIONS: Initial psychometric testing indicated the SESHI may be a reliable measure of self-efficacy for sleep hygiene in this population.

A Process for Teaching Research Methods in a Virtual Environment.

Translating and integrating scholarship into practice is a difficult concept for students to embrace through a passive education model. Therefore, innovative teaching strategies were integrated into a translational science course for online graduate nursing students. The purpose of this project was to increase understanding of the research process and stimulate interest in translating nursing evidence into practice. The result was an effective educational strategy for teaching and learning about the research process in a virtual environment.

Effects of a sleep hygiene text message intervention on sleep in college students.

OBJECTIVE: To test the effectiveness of a text-message intervention to promote sleep hygiene to improve sleep in young adult college students. PARTICIPANTS: A convenience sample of undergraduate students from one Southwestern university (n = 96), 18-26 years old, recruited in August 2015. METHODS: A 2-group pretest-posttest experimental design assigned participants to receive biweekly text messages about sleep hygiene or healthy behaviors for 6 weeks. Survey questions addressed sleep knowledge, sleep hygiene, self-efficacy for sleep hygiene, and sleep quality at baseline and posttest. RESULTS: Though not significant, sleep quality, sleep hygiene, and sleep knowledge improved in both groups. CONCLUSIONS: Self-efficacy for sleep hygiene is a modifiable factor that may serve to improve sleep quality. Sleep quality improved in both groups. Text messaging is a feasible approach to delivering an intervention to promote healthy behaviors among young adults.

Professional values, job satisfaction, career development, and intent to stay.

BACKGROUND: Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse-an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future. RESEARCH OBJECTIVE: The purpose of the study was to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system. RESEARCH DESIGN: A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted. Participants and research context: A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents. Ethical considerations: Institutional Review Board approval was obtained from both the university and hospital system. FINDINGS: Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention. DISCUSSION: Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future. CONCLUSION: Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities.

An Evidence-Based Educational Intervention to Improve Personal Emergency Preparedness of Nursing Students.

The purpose of this study was to compare the effectiveness of 2 educational intervention modalities (face-to-face or online) aimed at improving nursing students' personal emergency preparedness. Personal emergency preparedness means an individual has a Grab-and-Go kit, has developed a plan for self and family, and remains informed about potential disasters. Outcomes indicated that face-to-face instruction for BSN nursing students and online instruction for RNs were effective at increasing knowledge and increasing personal emergency preparedness.

Survey of Nursing Students' Self-Reported Knowledge of Ebola Virus Disease, Willingness to Treat, and Perceptions of their Duty to Treat.

The purpose of this study was to explore nursing students' self-reported knowledge of Ebola Virus Disease (EVD), willingness to treat patients with EVD, and student perceptions of duty to treat patients with EVD. The researchers developed the Survey of Nursing Student Self-Reported Knowledge of EVD, Willingness to Treat, and Perceptions of Duty to Treat, a quantitative tool with open-ended questions to inform the responses. On-line survey software was used for gathering anonymous data. A mixture of descriptive, nonparametric, and parametric statistics were used to describe, compare, and examine relationships between variables. Results demonstrated that licensed students scored significantly higher on self-reported knowledge of EVD than their prelicensure student counterparts (P=.039). Licensed students and prelicensure students did not differ on self-assessed willingness to treat (P>.05). The students had significantly higher willingness-to-treat scores when self-reported knowledge scores were higher (P=.007) and when they were older (P=.004). Willingness to treat was not influenced by whether one was partnered or single (P>.05) or had children or did not have children (P>.05). In conclusion, basic EVD knowledge and training appears to be critical to ensure willingness to treat. However, it is imperative that students have an indepth understanding of the principles of infectious diseases in general.

The impact of educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease: A mixed method study.

BACKGROUND: As the population ages, the effects of Alzheimer's disease will be felt by all nurses. Providing proper care for people with Alzheimer's disease is difficult and requires specific skills, attitudes, and knowledge. Limited data exists regarding nursing students' attitudes and knowledge toward people with Alzheimer's disease, whether undergraduate education prepares students to care for this population, or the best methods to support students in learning in an innovative and interactive environment. OBJECTIVES: The aim of this study was to determine the effect of different educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease and to explore nursing students' knowledge and attitudes surrounding the care of people with Alzheimer's disease. DESIGN: A convergent mixed method design. A three group (Alzheimer's disease clinical experience, online learning module, and no dementia-specific intervention), pretest and posttest design served as the quantitative arm of the study. A focus group discussion with themes extracted served as the qualitative piece of the study. SETTING: College of Nursing in North Texas. PARTICIPANTS: Convenience sample of 94 senior level nursing students enrolled in the undergraduate nursing program's Community Health course. METHOD: Students completed pre and posttest surveys which included Alzheimer's Disease Knowledge Scale, Dementia Attitudes Scale, and demographic questionnaire. Content analysis was conducted on focus group responses to qualitative interview questions. RESULTS: The Alzheimer's disease clinical group experienced increased knowledge and improved attitudes toward people with Alzheimer's disease compared with students who completed the online module or had no dementia-specific intervention. Four themes emerged from focus group data: Basic Alzheimer's disease knowledge, need for Alzheimer's disease experiential learning, negative feelings related to behaviors, and appropriate responses to behavioral and psychological symptoms of dementia. CONCLUSION: Experiential learning in the form of clinical placements increased knowledge and improved attitudes about Alzheimer's disease compared with an online module and no dementia-specific intervention.

Cultural Competence and Related Factors Among Taiwanese Nurses.

BACKGROUND: Taiwan is a multicultural and multiethnic society with a growing number of immigrants who have diverse ethnic, racial, and cultural needs. Although this diversity highlights the pressing need for culturally competent healthcare providers, cultural competence is a concept that is little understood and implemented only sporadically in Taiwan. PURPOSE: This study investigates the cultural competence of Taiwanese nurses and the related factors of influence. METHODS: An online self-report survey was used to collect data from 221 Taiwanese nurses from December 2012 through January 2013. Data from the demographic questionnaire, the Nurses' Cultural Competence Scale, and the Perceived Nurses' Cultural Competence Rating were analyzed using descriptive statistics, Pearson correlation, independent sample t tests, and multiple regressions. RESULTS: The cultural competence of the participants was in the "low to moderate" range, with relatively higher mean scores for the subscales of cultural awareness and cultural sensitivity and relatively lower scores for the subscales of cultural knowledge and cultural skills. Participants generally perceived themselves as being "not culturally competent." Variables found to predict cultural competence included years of work experience, hours of continuing education related to cultural nursing care, and frequency of caring for clients from culturally and ethnically diverse backgrounds. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Participating Taiwanese nurses rated their level of cultural competence as in the low-to-moderate range and self-perceived as being not culturally competent. These findings support the need to further expand and enhance cultural-competence-related continuing education and to address the topic of cultural care in the nursing curricula.

Preparing for disasters: education and management strategies explored.

During the last half of the 20th century, the focus of nursing changed from home and field to high-tech clinics and hospitals. Nursing in the absence of technology due to man-made or natural disasters almost disappeared from the curriculum of many nursing schools. Numerous disaster events and threats in the early 21st century caused educators and practitioners to increase the emphasis on disaster nursing and those principles that guide the nurse's practice in response to disasters. This article chronicles tools used by nurse educators to integrate disaster nursing into the didactic and clinical experiences of baccalaureate nursing students. We represent two nursing schools about 90 miles apart that collaborated to provide students with practical application of disaster nursing concepts. Part 1: An educational journey toward disaster nursing competencies: A curriculum in action provides an overview of the curricular tools used to insure adequate coverage of disaster nursing concepts across the curriculum. Part 2: Collaborative learning in Community Health Nursing for emergency preparedness relates the steps taken to plan, implement, and evaluate two different collaborative disaster simulation events. In this manuscript we have attempted transparency so that others can learn from our successes and our failures.

Using a strengths model to build an on-line nursing education program.

The on-line environment is the new frontier for academia struggling to define its place in the evolving economy. A concern is how to engage students who maximize their on-line experience and graduate in a timely manner. A strengths model was used as the basis for development of an on-line doctoral nursing program. Upon entering the program, students were given a strengths assessment that focused both students and faculty on the positive attributes students were bringing to their doctoral studies. A positive feedback methodology using on-line discussions in each course was used to support the identified strengths. The optimal picture of a successful entering doctoral student appears to be a person whose top five strengths are learner, achiever, input, connectedness and responsibility. A strengths model promotes a positive learning environment and supports a teacher-learner dynamic where faculty members are encouraged to focus on the students' strengths rather than their challenges.

Comparison of professional values of Taiwanese and United States nursing students.

Globalization is a part of modern life. Sharing a common set of professional nursing values is critical in this global environment. The purpose of this research was to examine the professional values of nursing students from two distinct cultural perspectives. Nurse educators in Taiwan partnered with nurse educators in the United States to compare professional values of their respective graduating nursing students. The American Nurses Association Code of Ethics served as the philosophical framework for this examination. The convenience sample comprised 94 Taiwanese students and 168 US students. Both groups reported high scores on an overall measure of values. They did differ substantially on the relative importance of individual items related to advocacy, competence, education, self-evaluation, professional advancement, and professional associations. Global implications for the collaborative practice of nurses from different cultures working together can be improved by first recognizing and then attending to these differences in value priorities.

Nurses' preparedness and perceived competence in managing disasters.

PURPOSE: This article is a descriptive analysis of rural nurses' perceived readiness to manage disaster situations. DESIGN AND METHODS: The 58-item Disaster Readiness Questionnaire was used to survey hospital-based nurses from rural communities in Texas during the summer of 2011. The data were collected by emailing a link through the various hospital intranet sites, resulting in a sample size of 620 nurses. RESULTS: Findings revealed that most nurses are not confident in their abilities to respond to major disaster events. The nurses who were confident were more likely to have had actual prior experience in disasters or shelters. Self-regulation of behavior (motivation) was a significant predictor of perceived nurse competence to manage disasters only in regard to the nurse's willingness to assume the risk of involvement in a disaster situation. Healthcare climate (job satisfaction) was not a determinant of disaster preparedness. CONCLUSIONS: Global increases in natural and human-induced disasters have called attention to the part that health providers play in mitigation and recovery. Since nurses are involved in planning, mitigation, response, and recovery aspects of disasters, they should actively seek opportunities to participate in actual disaster events, mock drills, and further educational opportunities specific to disaster preparedness. Administrators must support and encourage disaster preparedness education of nurses to promote hospital readiness to provide community care delivery in the event of a disaster situation. CLINICAL RELEVANCE: Nursing comprises the largest healthcare workforce, and yet there is very little research examining nurses' readiness for disaster.