The four stages of neighborhood trust: Classic grounded theory.

INTRODUCTION: Neighborhoods are often overlooked as a determinant of health. Among recent research, the focus on "place-based effects," due to prolonged residential environmental exposure, has been of particular interest. These studies' purpose is to identify and examine how a healthy neighborhood is intentionally created to describe a transferable process-driven theory. METHOD: A classic grounded theory approach was used in these studies. Data sources include individual in-depth interviews, historical documents, and a member-checking focus group, collected over 3-years. RESULTS: Analysis generated the Four Stages of Neighborhood Trust Model, which is nested within the context of perceived neighborhood safety. The theory outlines a social process of four stages of neighborhood trust: (a) rules-based agreements, (b) shared values, (c) cooperation, and (d) neighborhood belonging. CONCLUSIONS: We present the development of a process-driven theory that may be useful for public health nurses as they engage neighborhoods in health promotion activities. The stage of trust development will aid the nurse in identifying what is needed to move to the next stage in a healthy neighborhood process.

The impact of anencephaly on parents: A mixed-methods study.

This study used a convergent parallel mixed-method design to explore the impact of an anencephalic pregnancy on parents. Twenty women and four men between 18-59 years old participated. Interview transcripts were analyzed using interpretive phenomenology and synthesized with Perinatal Grief Intensity Scale scores using a Pearson's correlation. Overall, 75% of parents scored intense grief. Qualitative patterns included overwhelming trauma, patient-centeredness as critical, stigmatizing perinatal loss, embracing personhood, and reframing reality. Control over care was associated with decreased grief (p =.019). Health care professionals are ideally positioned to reduce the risk of intense grief in parents experiencing an anencephalic pregnancy.

Adapting and Testing the Self-Efficacy in Environmental Risk Reduction Instrument Among Spanish-Speaking Populations.

BACKGROUND AND PURPOSE: The purpose of this study was to adapt and test the Self-Efficacy in Environmental Risk Reduction instrument in a Spanish-speaking population. METHODS: Harkness' model of cross-cultural survey design was used to adapt the instrument. We sampled 95 adult, Spanish speakers from a federally qualified health clinic. Exploratory factor analysis with maximum likelihood estimation was used to analyze the factor structure. RESULTS: A 1-factor model provided the best fit to the data. The latent construct of the instrument is household environmental health self-efficacy. All items loaded higher than 0.610, indicating each item explains at least 36% variance in the latent construct. Cronbach's alpha indicates the scale has high internal consistency (α = .92). CONCLUSIONS: Respondents conceptualize self-efficacy in environmental risk reduction as practical solutions to minimize household risks.

Reducing Surgery Scheduling Errors in Multihospital System.

OBJECTIVE: The purpose of this study was to assess whether bundled team training interventions for surgeons and office staff could effectively improve the accuracy of surgery scheduling, minimizing scheduling factors that may contribute to occurrence of wrong site surgery. METHODS: This quasi-experimental observational study used an interrupted time series design to explore surgery scheduling errors (SSEs) and implemented bundled team training interventions intended to reduce SSEs at a Pacific Northwest Regional Surgery Scheduling Department. Each preintervention and postintervention segment consisted of 16 weekly data points. The bundled team training interventions included disclosure of preintervention scheduling errors, a scheduling verification checklist, an updated surgery scheduling policy and procedure, and toolkit to improve office scheduling of surgeries. RESULTS: Improvements in SSEs were observed preintervention to postintervention, with decreased surgery SSE rate from 0.51% to 0.13% (P < 0.001). Reductions were observed in all SSE types. The segmented linear trend demonstrated an observed reduction of 42.70 SSE (P < 0.001). CONCLUSIONS: This is the first study conducted at a large healthcare system with a regional surgery scheduling department to demonstrate that statistically significant and clinically important reductions in SSEs can be achieved. The findings demonstrate that SSEs can be minimized and confirm that verification processes must begin in the surgeon's office once a decision has been reached to proceed with surgery. The study confirms the need for additional research targeted at understanding why SSEs occur at the time of scheduling.

Qualitative Interpretive Metasynthesis of Parents' Experiences of Perinatal Loss.

OBJECTIVE: To identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss. DATA SOURCES: We searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents' experiences of perinatal loss. STUDY SELECTION: We included research on parents' experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature. DATA EXTRACTION: We used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents' perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis. DATA SYNTHESIS: We used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding-Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere. CONCLUSION: Our findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents' overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.

Integrating population health into nursing education: The process of gaining commitment from Washington's nursing deans and directors.

The achievement of health equity requires the expansion of nursing roles to include assessing burdens of disease, practicing cultural humility, implementing prevention strategies, and developing partnerships. In 2017, deans and directors of schools and programs of nursing in Washington State came together to commit to the integration of population health concepts and social determinants of health into all areas of nursing curricula. Through online communications and in-person meetings, facilitated in part by the authors of this paper, and with subcommittee representation from several baccalaureate nursing programs, Washington State academic nursing leaders identified new strategies to increase faculty awareness of population health and how to inspire related curricular changes to their programs. This Washington-wide initiative resulted in a white paper that was formally endorsed by 38 deans and directors representing all 14 baccalaureate and higher degree nursing programs in the state.

Stigma resulting from head lice infestation: A concept analysis and implications for public health.

AIM: The aim of this concept analysis was to examine stigma in the context of head lice, illuminating its components and providing insights for the development of appropriate nursing interventions. BACKGROUND: Stigma associated with the phenomenon of head lice management is pervasive, promulgating fear and influencing policy and treatment practices. Few studies have examined stigma in this context. METHOD: The method followed was the Rodgers's evolutionary method. DATA SOURCES: Health, education, and social sciences databases were searched and yielded 20 articles spanning 1996-2018 used to create a relevant literature review. RESULTS: Stigma arising from head lice infestation is preceded by an actual or perceived case of head lice, negative perceptions of lice, negative perception of groups or persons with head lice, or being associated with a group or person of lesser status believed to be a carrier of head lice. Defining attributes include marks of infestation, negative and unfair beliefs, and shame. Consequences of stigma are economic costs, social costs, mistreatment, and overtreatment with pediculicides. CONCLUSION: The concept of stigma in the context of head lice management is multifaceted. Further research is required to understand the magnitude of stigma as well as other factors associated with optimal treatment of children with head lice.

Balance, Health, and Workplace Safety: Experiences of New Nurses in the Context of Total Worker Health.

Transitioning into independent professional practice may be a difficult and trying process for newly licensed nurses, who may be at risk for burnout and quitting their jobs. Issues related to new nurses' well-being at work may also impact their personal lives. Using thematic analysis within the framework of Total Worker Health, this study examined factors related to the overall work, safety, and health of newly licensed nurses that should be addressed in work environments to promote well-being and prevent burnout and attrition. The main component of Total Worker Health is to find and understand the relevant issues that lead to safety and health risks in the workplace and affect workers' well-being at work and home. The overarching concept of Balance between Work and Life included three main themes: Health, Work Environment, and Learning to Be (a nurse). These themes with their subthemes described the difficulties participants had in balancing the complex interactions of work conditions and social life changes during the transition from student to professional nurse. Participants identified new physical health problems, mental health challenges, physical violence, lack of support structures at work, and alterations in family and friend relationships. However, they also developed protective factors from new connections with coworkers. These findings showed that new nurses are vulnerable to many factors at home and work that affect well-being and may lead to burnout and attrition. Implications include interventions at work that focus on health promotion, group support, and safety risk prevention through occupational nurse management.

Views on Exercise.

INTRODUCTION: There is a large prevalence of asthma, particularly among Hispanic children. Although physical activity is a good way to manage asthma, more Hispanic children with asthma lack activity than their healthy classmates. Given this, the purpose of this study was to explore the development of exercise perceptions in Hispanic children with asthma and to further develop an existing explanatory theory. METHOD: Grounded theory was the approach for the study. Grounded theory illuminated components of exercise perceptions from participants. Participants included Hispanic children with asthma, their families, and professionals who work with Hispanic children with asthma ( n = 29). RESULTS: Findings from this study supported the previously identified grounded theory called The Process of Creating Perceptions of Exercise. In addition, two new concepts ( cultural and peer influences) were identified that further explain the category of exercise influences. CONCLUSION: The revised theory can be used to assist in developing nursing interventions aimed at increasing exercise participation among Hispanic children with asthma.

Retest of a Principal Components Analysis of Two Household Environmental Risk Instruments.

Household Risk Perception (HRP) and Self-Efficacy in Environmental Risk Reduction (SEERR) instruments were developed for a public health nurse-delivered intervention designed to reduce home-based, environmental health risks among rural, low-income families. The purpose of this study was to test both instruments in a second low-income population that differed geographically and economically from the original sample. Participants (N = 199) were recruited from the Women, Infants, and Children (WIC) program. Paper and pencil surveys were collected at WIC sites by research-trained student nurses. Exploratory principal components analysis (PCA) was conducted, and comparisons were made to the original PCA for the purpose of data reduction. Instruments showed satisfactory Cronbach alpha values for all components. HRP components were reduced from five to four, which explained 70% of variance. The components were labeled sensed risks, unseen risks, severity of risks, and knowledge. In contrast to the original testing, environmental tobacco smoke (ETS) items was not a separate component of the HRP. The SEERR analysis demonstrated four components explaining 71% of variance, with similar patterns of items as in the first study, including a component on ETS, but some differences in item location. Although low-income populations constituted both samples, differences in demographics and risk exposures may have played a role in component and item locations. Findings provided justification for changing or reducing items, and for tailoring the instruments to population-level risks and behaviors. Although analytic refinement will continue, both instruments advance the measurement of environmental health risk perception and self-efficacy. © 2016 Wiley Periodicals, Inc.

Rural Families' Process of Re-Forming Environmental Health Risk Messages.

PURPOSE: This study was undertaken to explore how rural low-income families with children process health information following a nurse-delivered intervention designed to reduce environmental risks in their homes. DESIGN AND METHOD: Grounded theory methodology with a constructivist approach was used to conduct the study. Semistructured interviews of 10 primary child caregivers in rural low-income families who had participated in an environmental risk reduction intervention were completed from 2009 to 2011. Data were categorized using comparative analysis, theoretical sampling, and coding techniques. FINDINGS: The three phases-(a) visiting my perception, (b) weighing the evidence, and (c) making a new meaning-explained the core process of the grounded theory of Re-Forming the Risk Message. CONCLUSIONS: Rural low-income families at risk for environmental hazards in their homes determined what health information and needed subsequent actions regarding their risks were important by changing the meanings of nurse-delivered messages. CLINICAL RELEVANCE: Nursing interventions designed to improve health behaviors and reduce risks are often based on stage theories that explain how change occurs through steps leading to positive actions through delivery of risk messages. However, the risk message delivered in an intervention designed to engage action is not always the risk message people decide to use. To understand whether people are ready to engage in positive behaviors through interventions, or if needed changes to the information must be made, nurses need to discover and explore reasons for the re-formed risk messages.

Suicide Assessment and Nurses: What Does the Evidence Show?

Suicide is at epidemic proportions both in the United States and across the globe. Yet, it is a preventable public health problem. Nurses practice on the front-lines and have the greatest number of opportunities to identify and intervene with suicidal patients. Most registered nurses (RNs) have little or no training in how to assess, evaluate, treat, or refer a suicidal patient. Because of this lack of training, RNs feel ill-prepared and afraid to talk to patients about suicide. The purpose of this article is to review the state of the science of suicide assessment training for nurses. Training RNs in how to assess, evaluate, treat, and refer a suicidal patient is key to suicide prevention. Research suggests that once RNs are trained in suicide assessment, they realize it is no different than assessing for any other type of illness and are then able to help those with suicidal tendencies. The article conclusion offers implications for education, research, and practice.

Implementing AACN's recommendations for environmental sustainability in colleges of nursing: from concept to impact.

In 2011, the American Association of Colleges of Nursing (AACN) released a guidance report titled Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education. The report was developed in response to a vivid slide presentation at an AACN meeting depicting the deleterious public and environmental health effects of global industrialization. Following the presentation, AACN members capitalized on the opportunity to provide national leadership to U.S. colleges of nursing in regard to environmental sustainability and stewardship. This article summarizes key features of the AACN plan and outlines one college's multifaceted implementation plan. The goal of the implementation plan was to translate the AACN recommendations from concept into college-specific actions. Specific steps taken by the college included the following: (a) increasing student and faculty awareness, (b) greening business operations, (c) increased participation in media events, (d) leveraging the impact of national sustainability initiatives, and (e) enhancing curricula at the undergraduate and graduate levels. Through this work, the college achieved not only a higher standard of sustainability within its own walls but also a richer appreciation of the importance of educating nurses as future stewards in an environmentally sustainable health care system.

Living on the edge of asthma: A grounded theory exploration.

PURPOSE: Most asthma-related emergency department (ED) visits and hospitalizations for asthma are preventable. Our purpose was to develop a grounded theory to guide interventions to reduce unnecessary hospitalizations and ED visits. DESIGN AND METHODS: Grounded theory inquiry guided interviews of 20 participants, including 13 parents and 7 children. RESULTS: Living on the edge of asthma was the emergent theory. Categories included: balancing, losing control, seeking control, and transforming. PRACTICE IMPLICATIONS: The theory provides the means for nurses to understand the dynamic process that families undergo in trying to prevent and then deal with and learn from an acute asthma attack requiring hospitalization or an ED visit.

The Household Risk Perception instrument and the Self-Efficacy in Environmental Risk Reduction instrument: psychometric testing using principal component analysis.

AIM: To report the psychometric testing of the Household Risk Perception and Self-Efficacy in Environmental Risk Reduction instruments using principal components analysis. BACKGROUND: There are limited instruments available to test household risk perception and self-efficacy related to environmental health behaviours. The Household Risk Perception instrument was developed to measure personal perceptions of household environmental health risks. The Self-Efficacy in Environmental Risk Reduction instrument was designed to measure caregivers' confidence in taking steps to reduce household risks. DESIGN: An exploratory analysis of previous data was undertaken. METHOD: Baseline data from 235 caregivers enrolled in a randomized clinical trial testing a healthy housing intervention were collected between 2006-2009. Principal components analysis was used to determine principal components from measured responses to each instrument. RESULTS: Components were explored and compared to constructs used to design the original instruments. A five-component structure showed the simplest solution and explained 65% of variance in the Household Risk Perception analysis. Cronbach's alpha values indicated satisfactory internal consistency for four of five identified components. Risk perception varied according to available sensory input of the specific risk. A four-component structure explained 64% of the variance in the Self-Efficacy in Environmental Risk Reduction analysis. Cronbach's alpha values were satisfactory. Items mapped to steps in an action-oriented process vs. agent-specific actions. Results from both analyses suggest that environmental tobacco smoke is perceived differently than other household risks. CONCLUSION: Previously, both instruments relied on item reliability and content validity testing. This study provides a basis for further instrument revision and theoretical testing.