Nursing the Nuu-chah-nulth Way: Communities Driving Nursing Policy Priorities.

Rural and remote Indigenous communities face unique challenges, and they must drive solutions for sustaining and maintaining distinct nursing practices. Resourcing Indigenous community needs and aspirations for health depends on sustainable funding and an appropriately resourced nursing workforce. An Indigenous community-engaged research team led a program of study exploring Indigenous systems of care with three distinct communities. We used Indigenous research methodologies to identify obstacles to care and ways to advance nursing and healthcare delivery according to unique values and demographical and geographical influences. Using a collaborative analysis approach with communities, we identified themes related to resourcing nursing positions, supporting nursing education and valuing nursing influence in determining program priorities. The voice of the community in research is a powerful force for advocacy, ensuring that nurses are supported in relationships with communities and in designing programs that fit the community's vision for health and wellness. We recognize the essential contributions of nurse leaders to policy processes in formulating and coordinating ideas for program redesign across and within levels of organizations for health and social justice impacts. We conclude our paper by noting implications for nursing leadership in diverse settings with the goal of sustaining a nursing workforce to provide culturally safe, wellness-focused care.

Oncology Training Needs Assessment Among Health Care Professionals in Nigeria.

PURPOSE: This study investigated the status of training and preparedness for oncology practice and research and degree of interprofessional collaboration among health care professionals in the six geopolitical regions of Nigeria. METHODS: A convergent parallel mixed methods design was used. Three hundred seventeen respondents completed a three-part, online questionnaire. Self-rated competencies in oncology research (26 items), oncology practice (16 items), and interprofessional collaboration (nine items) were assessed with a one- to five-point Likert scale. Six key informant and 24 in-depth interviews were conducted. Descriptive statistics, analysis of variance, and pairwise t-test were used to analyze the quantitative data, whereas thematic analysis was used for the qualitative data. RESULTS: Respondents were mostly female (65.6%) with a mean age of 40.5 ± 8.3 years. Respondents include 178 nurses (56.2%), 93 medical doctors (29.3%), and 46 pharmacists (14.5%). Self-assessed competencies in oncology practice differed significantly across the three groups of health care professionals (F = 4.789, P = .009). However, there was no significant difference across professions for competency in oncology research (F = 1.256, P = .286) and interprofessional collaboration (F = 1.120, P = .327). The majority of respondents (267, 82.4%) felt that educational opportunities in oncology-associated research in the country are inadequate and that this has implications for practice. Key training gaps reported include poor preparedness in data analysis and bioinformatics (138, 43.5%), writing clinical trials (119, 37.5%), and writing grant/research proposals (105, 33.1%). Challenges contributing to gaps in cancer research include few trained oncology specialists, low funding for research, and inadequate interprofessional collaboration. CONCLUSION: This study highlights gaps in oncology training and practice and an urgent need for interventions to enhance interprofessional training to improve quality of cancer care in Nigeria. These would accelerate progress toward strengthening the health care system and reducing global disparities in cancer outcomes.

Charting a Research Agenda for the Advancement of Nursing Organizations' Influence on Health Systems and Policy.

Nursing organizations across Canada play a significant role in influencing and shaping public policy. 2020, the Year of the Nurse and the Midwife, is an opportune time not only to support nurses in building policy leadership but also to explore opportunities to better understand and strengthen the policy advocacy work of nursing organizations. Given various social, political, and economic forces, the nature of organized nursing across Canada is changing significantly. We draw on recent key national and global events including our systematic inquiry into Canada's 2019 federal election, the Year of the Nurse and Midwife, and the Coronavirus pandemic to examine how Canadian nursing organizations respond in highly complex and evolving contexts. We use our observations to offer a vision and chart a research agenda for the advancement of nursing organizations' influence on health systems and policy. Specifically, we focus on three key areas including examining nursing organizations' policy agendas and spheres of influence; nursing organizations' decision-making around policy advocacy tactics and engagement approaches; and the impact of policy advocacy coalitions and networks on nursing organizations' influence.

British Columbia's One Nursing Regulator: A Critical Commentary on the Amalgamation Process.

Nursing organizations including regulatory colleges are undergoing transitions that fundamentally alter the face of Canadian nursing. As British Columbia regulatory and professional organizational transitions are held up as a potential model for the rest of Canada, we offer a critical commentary on a most recent transition to the One Nursing Regulator of all nursing role designations in the formation of the British Columbia College of Nursing Professionals in 2018. We draw attention to amalgamation processes - professional regulation and governance, the preservation of nursing history, allocation of nurses' fees and resources and the role distinctions and identities of registrant groups - Registered Nurses, Nurse Practitioners, Licensed Practical Nurses and Registered Psychiatric Nurses. We argue that nursing's collective engagement and nursing leadership in self-regulation and decision making related to professional practice is key to public safety and integral to the identity of Canadian nursing. In our critique we identify issues and raise questions for consideration in the coming years.

Engaging Nursing Voice and Presence During the Federal Election Campaign 2015.

During the Canadian federal election in 2015, we conducted a systematic inquiry into the methods and messages developed by national nursing organizations to communicate their policy platforms and their strategies for member and public engagement. Throughout the campaign and in the post-election period, the nursing organizations presented an outward-looking view to improve health and healthcare for Canadians. We observed ways in which they adopted a nursing lens on the issues by showcasing background research, by drawing on relevant nursing knowledge and by communicating clear policy messages based on nursing expertise. The organizations and their members were effective in using social media as a primary tool for reaching out to the candidates, the public and the opinion leaders. The increasing engagement of nursing students in political action is noted as a promising sign for the future impact of the profession. Although the nursing presence was visible in this election, healthcare did not become a strong issue for the public and the political parties. We include a section on post-election uptake of issues raised during the campaign. We conclude with a call for a policy research agenda that deepens our knowledge of political advocacy with a view to identifying how patterns of engagement are defining nursing's collective influence and contributions to health equity.

Personal, Family, and Peer Correlates of General and Sport Physical Activity among African American, Latino, and White Girls.

This study examined associations between personal, family, and peer variables on objectively measured physical activity (PA), and sports participation, of African American, Latino, and white girls. Specific variables included barriers efficacy, parent PA, parent support of PA, the home exercise environment, friends' PA, and friends' support of PA. The sample comprised 372 girls (mean age = 12.03 years; SD = 1.81; n = 128 African American, n = 120 Latino, and n = 124 white). Data were analyzed using multiple-sample structural equation models (by ethnicity), controlling for age, household income, body mass index, and physical development. Girls' moderate to vigorous PA (MVPA) was positively related to friends' support for all groups, and to parent PA only for African American girls. For sports, greater parental support related to more participation across ethnic/racial groups, whereas friends' support was important only for African American girls. Age and physical development were negatively related to MVPA, and higher income was associated with greater sports participation. Numerous significant correlations emerged between the independent variables, with some differences across racial/ethnic groups. Findings highlight the role of parent and friends' support for both MVPA and sports participation of early adolescent girls, as well as the importance of determining PA correlates among different ethnic/racial subgroups.

Evolving trends in nurse regulation: what are the policy impacts for nursing's social mandate?

We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three 'pillars' - the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally.

Quality of life in a cohort of men with epilepsy compared to a healthy population and those with common chronic diseases in the UK using a generic patient-reported outcome measure.

Patient-reported outcome measures (PROMs) are increasingly used in epilepsy. Epilepsy-specific instruments enable clinicians to gain insight into patients' health-related quality of life (HRQoL) but do not allow comparison between conditions and do not reflect subjective well-being (SWB). Using the World Health Organization Quality-of-Life Questionnaire - Brief (WHOQOL-Bref), a short generic PROM, we compared the HRQoL in a cohort of men with epilepsy (MWE) recruited from the epilepsy clinic and via the website of a large UK epilepsy charity, with seven other groups with chronic diseases. Multiple linear regression showed that mood was the most important independent predictor of the WHOQOL-Bref score. The sample, however, rated their global quality of life as highly as the UK control group, and 38% reported life 'very' or 'extremely' meaningful, and 4% enjoyed life 'very much' or 'extremely'. Because of its structure, the WHOQOL-Bref gives clinicians an indication not only of HRQoL but also of SWB, a broader construct. Our study suggests that the narrow focus of epilepsy-specific HRQoL questionnaires may give only a partial picture of a patient's quality of life. In addition, by concentrating on the negative aspects of life with epilepsy, these instruments may distract both the patient and the clinician from what is good about life, denying the patient the benefits of 'positive psychology' and the clinician the opportunity to build the patient's resilience.

Dairy intake and related self-regulation improved in college students using online nutrition education.

BACKGROUND: Dairy intake by college students is markedly lower than recommendations. Interventions to improve dairy intake based on Social Cognitive Theory (SCT) have potential to successfully change behavior by improving mediators that influence dietary choices. OBJECTIVE: We aimed to use SCT to improve social support, self-efficacy, outcome expectations, self-regulation, and behavior related to dairy intake in college students. DESIGN: We conducted a randomized nutrition education intervention. PARTICIPANTS/SETTING: Participants included 211 college students (mean age 20.2 ± 0.1 years; 63% women and 37% men) recruited from a university campus. Participants in the intervention group (n=107) and comparison group (n=104) received an 8-week dairy intake or stress management intervention, respectively, via electronic mail. Data collection included dairy intake from 7-day food records and SCT variables from questionnaires administered during January 2008 and April 2008. MAIN OUTCOME MEASURES: Changes in dairy intake and SCT variables (ie, social support, self-efficacy, outcome expectations, and self-regulation). STATISTICAL ANALYSES PERFORMED: Multivariate analysis of covariance, with age and sex as covariates (P<0.05). RESULTS: Ninety-one percent of participants (n=97 intervention, n=94 comparison) provided data; complete data were analyzed for 85% of participants (n=90 intervention, n=89 comparison). Participants in the intervention group reported higher intake of total dairy foods (P=0.012) and improved use of self-regulation strategies for consuming three servings per day of total dairy (P=0.000) and low-fat dairy foods (P=0.002) following the intervention. CONCLUSIONS: Nutrition education via electronic mail based on an SCT model improved total dairy intake and self-regulation. Participants reported increased dairy intake and better use of self-regulation strategies. Future interventions should focus on benefits of consuming low-fat vs higher-fat dairy foods.

Changes in local school policies and practices in Washington State after an unfunded physical activity and nutrition mandate.

INTRODUCTION: Policies and practices in schools may create environments that encourage and reinforce healthy behaviors and are thus a means for stemming the rising rates of childhood obesity. We assessed the effect of a 2005 statewide school physical activity and nutrition mandate on policies and practices in middle and high schools in Washington State. METHODS: We used 2002, 2004, and 2006 statewide School Health Profiles survey data from Washington, with Oregon as a comparison group, to create longitudinal linear regression models to describe changes in relevant school policies after the Washington statewide mandate. Policy area composite measures were generated by principal component factor analysis from survey questions about multiple binary measure policy and practice. RESULTS: Relative to expected trends without the mandate, we found significant percentage-point increases in various policies, including restricted access to competitive foods in middle and high schools (increased by 18.8-20.0 percentage points); school food practices (increased by 10.4 percentage points in middle schools); and eliminating exemptions from physical education (PE) for sports (16.6 percentage-point increase for middle schools), exemptions from PE for community activities (12.8 and 14.4 percentage-point increases for middle and high schools, respectively) and exemptions from PE for academics (18.1 percentage-point increase for middle schools). CONCLUSION: Our results suggest that a statewide mandate had a modest effect on increasing physical activity and nutrition policies and practices in schools. Government policy is potentially an effective tool for addressing the childhood obesity epidemic through improvements in school physical activity and nutrition environments.

Get moving: a web site that increases physical activity of sedentary employees.

PURPOSE: Develop and test a Web site to encourage physical activity (PA) by sedentary workers. DESIGN: Randomized control design with 30-day follow-up. SETTING: Large manufacturing plant. SUBJECTS: Included 221 workers; average body mass index was 29.5. INTERVENTION: Get Moving was a repeat-visit Web site providing information and support to develop a personalized PA plan. MEASURES: Self-reported: PA, depression, anxiety, stage of change, attitudes, knowledge, self-efficacy, intention, perceived barriers to PA, and motivation. ANALYSIS: Multivariate analysis of covariance and univariate analysis of covariance models were used to compare the two study conditions on posttest outcomes, controlling for baseline levels. RESULTS: Compared with the control group, the treatment group showed significant improvement. The multivariate test was significant (p < .001), with a large effect size (η(2) =  .42). The treatment group differed significantly from the control participants on 11 outcomes (p < .005), with large effect sizes for PA status, min/d, and knowledge, attitudes, and behavioral intention. Medium effect sizes were measured for perceived barriers, depressive symptoms, motivation, and self-efficacy. Multiple visits resulted in significantly improved PA, motivation, self-efficacy, and intention, compared with one-time visits. CONCLUSIONS: The Get Moving Web site had positive effects and was well received. Interventions Web site have potential to increase the PA of sedentary individuals in worksites and elsewhere, but more research is needed into mediators of Web-based interventions.

Global leadership priorities for Canadian nursing: a perspective on the ICN 24th Quadrennial Congress, Durban, South Africa.

We had the privilege of joining over 5,000 nurses attending the 24th Congress of the International Council of Nurses, held for the first time on the African continent in Durban, South Africa. The Congress inspired us to reflect on how leadership and policy directions in Canadian nursing resonate with global health challenges and opportunities. Dynamic plenary speakers from African countries inspired the conference theme: Leading Change--Building Healthy Nations. Ensuing discussions signalled shifting priorities and urgent implications for nursing leadership and programs of research in Canada and worldwide, in areas of primary healthcare renewal, nursing health human resources sustainability and health interventions for the achievement of the United Nations Millennium Development Goals (MDGs) (United Nations 2009; WHO 2008). Sharing challenges with nurses worldwide, Canadian nurses are privileged with the resources to address these challenges (CNA 2008; WHO 2008). Our experience at the Congress prompted the question: How must Canadian nurses reshape leadership priorities and agendas not only in the Canadian context, but also in the mutual interests of health for all? Reflecting upon the themes of the Congress and the leadership role of Canadian nurses, we identify three interconnected priorities: Invest our hearts, souls and resources in primary healthcare renewal. Grapple with the complexity of an equitable and sustainable global nursing human resources system. Ensure a lens of social justice through leadership, research and education for the achievement of the MDGs.

A critical policy analysis of an emerging agenda for home care in one Canadian province.

Amidst projections of the increased care demands and expectations for home care, policy in this area demands urgent attention. Home care is inherently complex as it challenges us to deliberate fundamental issues of responsibility for care, and the limits of care for people in their most immediate contexts and needs. This research takes the form of a critical policy analysis of the interaction of the context, process and content of policy proposals in home care in a regional health system in one Canadian province. The method of study includes thematic and comparative analyses of perspectives derived from policy documents, and interviews with policy actors (decision-makers, healthcare providers, public advocates) regarding their perspectives of policy problems and processes. The content and process of policy in home care interact in important ways with political, economic, social and historical contexts. This critical analysis revealed that the emerging policy agenda in regional home care is one of medicalisation, which stands in contrast to the principles of primary health care, and potentially leads to further marginalisation of the most vulnerable. This contrast is characterised by tensions between the fundamental values of equity and efficiency, choice and universality, and public vis-à-vis individual responsibility for the provision of care.

Alcohol use from ages 9 to 16: A cohort-sequential latent growth model.

This study examined alcohol use from pre-adolescence to mid-adolescence and determined the influence of hypothesized covariates on changes in alcohol use rates during this developmental period. The sample comprised 405 randomly recruited youth from three age cohorts (9, 11, and 13 years), assessed annually for 4 years. Youth were 48.4% female, 50.4% African-American, and 49.6% White. A cohort-sequential latent growth model was employed which modeled alcohol use (use versus non-use) from ages 9 to 16 years, accounting for demographic variables of gender, race, parent marital status, and family economic status. Covariates of alcohol use included parent alcohol use, family alcohol problems, family cohesion, parent supervision, peer deviance, peer alcohol use, and peer encouragement of alcohol use. Results showed that proportions of alcohol users increased steadily from ages 9 to 16 years. Significant covariates were found on the intercept and slope. Being female and higher levels of parent alcohol use were associated with higher initial rates of alcohol use, whereas greater friends' encouragement of alcohol use was related to lower initial rates of alcohol use (intercept). Alternatively, more peer deviance and friends' encouragement of alcohol use was related to an increase in alcohol use rates from ages 9 to 16 years (slope), as was being White and from a single-parent family.

Relations between youth antisocial and prosocial activities.

This study examines relations among antisocial and prosocial activities for boys and girls aged 10, 12, and 14 years. Antisocial activities included substance use and other deviant behaviors. Prosocial activities included physical activity, organized sports, organized nonsport activities, volunteer and religious activities. Household income and single-parent vs. two-parent family status were included as covariates. The sample comprised 356 youth (mean age = 12.06 years, 50% female, 73% White). A six-group (Age x Gender) multiple-sample structural equation model was employed to determine the existence of latent factors (substance use, deviant behaviors, prosocial activities) and relations among variables. Results showed a positive relationship among prosocial behaviors, and between substance use and other deviant behaviors. Organized sport and days of physical activity were inversely related to substance use. Higher income and living in a two-parent family were associated with less substance use and deviant behavior. There was little variation by gender and age.