Assessing community response to wildfire smoke: A multimethod study using social media.

OBJECTIVE: The purpose of this study was to assess health-related responses to wildfire smoke on social media. We examined whether seasonal wildfire smoke is an active topic on Twitter, the correlation between fine particulate matter (PM2.5 ) and Twitter search terms, and dimensions of community-level expression to wildfire smoke through tweets. DESIGN: Search terms were identified using a conceptual model developed and refined by healthcare providers and public health experts. Wildfire-related tweets were downloaded from Twitter users in Spokane, Washington during the 2017 and 2018 wildfire seasons. PM2.5 data were correlated with the search terms. A subset of tweets was deductively and then inductively coded to identify perceptions and behavioral responses to wildfire smoke. RESULTS: Seasonal wildfire smoke is an active topic on Twitter. The term "smoke" was strongly correlated with poor air quality and "unhealthy" was moderately correlated. Deductive analyses revealed a multidimensional response to wildfire smoke. Inductive analysis identified new areas of concern, such as pet and animal health. CONCLUSIONS: Social media is a lens through which public health professionals can assess and respond to local community needs. Findings will be used to broaden the conceptual model, enhance ongoing surveillance of community-identified health risks, and communicate protective actions.

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.

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.

Psychometric Evaluation of the Creighton Competency Evaluation Instrument in a Population of Working Nurses.

BACKGROUND AND PURPOSE: This study explored the psychometric properties of the Creighton Competency Evaluation Instrument (C-CEI), previously validated for use with nursing students, to assess simulation performance among registered nurses working 12-hour shifts. Valid and reliable measurements are needed to test clinical and simulation competencies and characterize the effects of fatigue on nursing performance. METHODS: Trained raters scored nurses' patient care performance in simulation scenarios using the C-CEI. We analyzed the instrument's principal components, internal reliability, and construct validity. RESULTS: Internal reliability of the C-CEI aggregate score and the Clinical Decision-making component were high (>.70). The latter robustly correlated with predicted cognitive effectiveness, a measure of fatigue. CONCLUSIONS: The C-CEI is a reliable measure for use among registered nurses and its further development will be important for testing performance of working nurses and fatigue-mitigation innovations.

Effectiveness of a household environmental health intervention delivered by rural public health nurses.

OBJECTIVES: Parents need meaningful and actionable information if they are to reduce household environmental health risks to their children. To address this issue, we tested the effectiveness of a multi-risk social/cognitive intervention on rural low-income parents' (1) environmental health self-efficacy and (2) stage of environmental health precautionary adoption. METHODS: Biomarker (lead, cotinine) and household samples (carbon monoxide, radon, mold/mildew, and drinking water contaminants) were collected from 235 families (399 adults, 441 children) in Montana and Washington states. Families were randomly assigned to intervention or control groups; intervention families received 4 visits from public health nurses who provided tailored information and guidance to parents; controls received usual and customary public health services. RESULTS: At 3 months, the intervention group had significantly higher scores on (1) all 6 risk-specific self-efficacy subscales (P < .01), (2) general environmental health self-efficacy (P < .001), (3) 5 of 6 risk-specific precaution adoption subscales (P < .05), and (4) general environmental health precaution adoption (P < .001). CONCLUSIONS: The intervention yielded significant improvements in both outcomes. This evidence supported the need for a policy discussion addressing the added value that broadbased public health nurse interventions might bring to children's environmental health.

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting.

OBJECTIVE: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. DESIGN AND SAMPLE: Structured one-to-one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. RESULTS: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. CONCLUSIONS: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.

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.

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

BACKGROUND: Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied. OBJECTIVE: To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures. DESIGN: A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested). SETTING: Participants were tested in a northwestern US university's nursing simulation laboratory. PARTICIPANTS: A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals. METHODS: Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness. RESULTS: In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors. CONCLUSIONS AND RELEVANCE: Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

Integrating Arts with STEM to Foster Systems Thinking.

Interest is growing among out-of-school time (OST) educators in integrating the arts into STEM (science, technology, engineering, and mathematics) programming (e.g., Kelton & Saraniero, 2018). Arts-integrated STEM-or STEAM-programming now takes place in a wide variety of OST environments, from relatively institutional learning settings, such as a library, to emergent or fluid settings, such as a pop-up program in a housing development community room.

Barriers and facilitators to the incorporation of environmental health into public health nursing practice.

OBJECTIVES: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. DESIGN AND SAMPLE: A cross-sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). MEASURES: A 39-item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. RESULTS: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. CONCLUSION: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.

Incorporating environmental health into nursing practice: a case study on indoor air quality.

More than one-quarter of the global disease burden is attributable to environmental exposures, with children bearing a disproportionate amount of risk. Physiologically and behaviorally, children have unique characteristics that make them vulnerable to environmental contaminants. In particular, indoor environmental exposures, such as carbon monoxide, mold, and radon, have an impact on children's health and well being. A case study based on the experiences of nurses working on the Environmental Risk Reduction through Nursing Intervention and Education study is presented to illustrate multiple exposures children may face in the home environment and the role nurses play in prevention and response. Nurses can improve children's environmental health by providing risk assessments, environmental health education, and referrals to community health nurses and environmental health specialists. Resources on indoor air quality and maintaining a healthy home are provided.

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.

Assessing Science Learning and Systems Thinking Through Arts.

We present two interventions aimed at promoting science learning. We utilize arts-based assessments alongside traditional measures to examine systems thinking. Taking place in rural communities in Washington State and focusing on students in third through fifth grades, our results indicate that arts-based assessment in STEM can support demonstration of systems thinking about socio-scientific issues. We conclude by illustrating the viability of arts-based approaches for assessment and how these methods can complement and extend more traditional measures of learning in and out of the classroom.

Sleep health and predicted cognitive effectiveness of nurses working 12-hour shifts: an observational study.

BACKGROUND: Due to the 24hr nature of society, shift work has become an integral part of many industries. Within the literature there exists an abundance of evidence linking shift work-related sleep restriction and fatigue with errors, accidents, and adverse long-term health outcomes. OBJECTIVE: The study goal was to physiologically measure sleep patterns and predicted cognitive decline of nurses working both 12hr day and night shifts to address the growing concern about sleep restriction among healthcare workers. DESIGN: This study presents the results of a quasi-experimental, mixed between-within design where the sleep of 12hr day and night shift nurses was measured using ReadiBand wrist actigraphs. The between groups component was comprised of day v. night shift nurses. The within groups component was comprised of two separate measurement periods for each nurse-once for three consecutive days while they were working shifts (on duty) and once for three consecutive days off work (off duty). SETTING: Participants wore the wrist actigraph at home and in the hospital, and were instructed to adhere to their regular sleep schedule. PARTICIPANTS: Participants were recruited from two hospitals in Washington State (n=90). Participants were 48 night- and 42 day-shift nurses. All participants worked 12-hour shifts. METHODS: Sleep was measured using ReadiBand wrist actigraphs, which are licensed with the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTEtm) Alertness Score model, a biomathematical model that predicts cognitive effectiveness based on sleep/wake schedule. ReadiBands also calculate sleep quantity, sleep efficiency, and sleep latency. Results were analysed in SPSS (v26) through multilevel modelling. RESULTS: Differences were observed in sleep quantity, efficiency, and latency based on shift type (day vs. night) and shift duty (on vs. off). The most extreme differences, however, were noted in cognitive effectiveness (SAFTEtm), whereby night shift nurses experienced substantial decline-frequently into the "high risk" zone-throughout their shifts compared to day shift nurses. CONCLUSIONS: The present study identifies sleep characteristics that differ between day and night nurses working 12-hour shifts using objective measurements of sleep. Biomathematical modelling can offer a novel method to estimate hours of greatest cognitive decline, and have implications for policy around shift duration, timing, and overtime allocation.

Nursing Students' Sleep Patterns and Perceptions of Safe Practice During Their Entrée to Shift Work.

Background: The transition into shift work represents a critical and challenging time point in a nurse's career. The purpose of this study was to describe nursing students' sleep patterns and perceptions of safe practice during their first semester of clinical rotations. Method: Repeated measures pertaining to the sleep patterns of 19 full-time junior undergraduate nursing students were measured before, during, and after their first clinical rotations. Sleep was measured using wrist activity monitors and sleep diaries for seven consecutive days at each time period. Students' "self-efficacy" or belief in their ability to provide safe practice was measured for (a) patient care (preventing adverse events to patients) and (b) occupational health (preventing occupational injuries to themselves) using Bandura's self-efficacy scales. Associations between students' sleep, sleepiness, and their perceptions of safe practice were explored. Results: Nursing students' self-efficacy scores regarding patient care (preventing adverse events) improved across the three time periods (from 80% before clinical rotation, to 84% during clinical rotation, to 87% after clinical rotation). Although lower overall, students' self-efficacy scores regarding occupational health (preventing occupational injuries to themselves) also improved across the three time periods (from 71% before clinical rotation, to 76% during clinical rotation, to 77% after clinical rotation). Furthermore, increased sleepiness significantly predicted lower self-efficacy scores for both patient care and occupational health. Conclusion/Application to Practice: Sleepiness can impair nursing students' confidence in their ability to practice safely.

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.