Nursing workforce diversity: Promising educational practices.

BACKGROUND: Nursing workforce diversity is a national priority for providing culturally competent care and contributing to improved health equity. While nurses from underrepresented populations are increasing in the nursing workforce, the distribution of nurses in the United States is still not representative of the population. PURPOSE: The purpose of this paper is to describe the current state of workforce diversity in Western states and identify promising practices from programs located in Arizona, California, Colorado, and Oregon that are focused on improving nursing workforce diversity. METHODS: Four innovative programs to address nursing workforce diversity are presented. Each project has unique situations and approaches to improving admission, retention, and graduation of students underrepresented in nursing. Similar approaches each project used include holistic admission review, academic and student support, financial support, and mentoring. CONCLUSIONS: These projects contribute to knowledge development related to improving nursing workforce diversity for other colleges, universities, and states to consider. Improving nursing workforce diversity is a priority issue that could lead, through collective impact, to resolving health inequities nationally.

Nursing Theory in the Quest for the Sustainable Development Goals.

The 17 United Nations Sustainable Development Goals (SDG) are intended to promote a safe, healthy, and equitable world by the year 2030. Nurses are at the forefront of realizing the 2030 agenda through concerned citizenship and professional leadership. Nursing theory informs knowledge development and theory-guided practice essential for nurses working in all domains and in all nations. Although all extant nursing theories are relevant, a select few are discussed in detail to make explicit the links between theory and SDG realization. Middle-range theories are also valuable in helping to contextualize nursing practice through the lens of the SDGs. The SDGs address five themes - People, Planet, Peace, Prosperity, and Partnership - and theory remains vital to ensure nurses working in all settings are equipped to meet the needs of humanity and the world, now and in the future.

Funding big research with small money.

This department highlights change management strategies that maybe successful in strategically planning and executing organizational change initiatives.With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools,and resources that mobilize and sustain organizational change initiatives.In this article, the guest authors introduce crowd sourcing asa strategy for funding big research with small money.

Credentialing: the need for a national research agenda.

A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.

Surgical treatment differences among Latina and African American breast cancer survivors.

PURPOSE/OBJECTIVES: To describe breast cancer treatment choices from the perspectives of Latina and African American breast cancer survivors. DESIGN: An interdisciplinary team conducted a mixed-methods study of women treated for stages I-IV breast cancer. SETTING: Participants' homes in metropolitan areas. SAMPLE: 39 participants in three groups: monolingual Spanish-speaking Latinas (n = 15), English-speaking Latinas (n = 15), and African American women (n = 9). METHODS: Individual participant interviews were conducted by racially and linguistically matched nurse researchers, and sociodemographic data were collected. Content and matrix analysis methods were used. MAIN RESEARCH VARIABLES: Perceptions of breast cancer care. FINDINGS: High rates of mastectomy were noted for early-stage treatment (stage I or II). Among the participants diagnosed with early-stage breast cancer, the majority of English-speaking Latinas (n = 9) and African American women (n = 4) received a mastectomy. However, the majority of the Spanish-speaking Latina group (n = 5) received breast-conserving surgery. Four factors influenced the choice of mastectomy over lumpectomy across the three groups: clinical indicators, fear of recurrence, avoidance of adjuvant side effects, and perceived favorable survival outcomes. Spanish-speaking Latinas were more likely to rely on physician treatment recommendations, and the other two groups used a shared decision-making style. CONCLUSIONS: Additional study is needed to understand how women select and integrate treatment information with the recommendations they receive from healthcare providers. Among the Spanish-speaking Latina group, limited English proficiency, the use of translators in explaining treatment options, and a lack of available educational materials in Spanish are factors that influenced reliance on physician recommendations. IMPLICATIONS FOR NURSING: Oncology nurses were notably absent in supporting the women's treatment decision making. Advanced practice oncology nurses, coupled with language-appropriate educational resources, may provide essential guidance in clarifying surgical treatment choices for breast cancer among culturally and linguistically diverse populations.

Measuring the "whole system" outcomes of an educational innovation: experience from the integrative family medicine program.

BACKGROUND AND OBJECTIVES: Six family medicine residency programs in the United States collaborated on the development and implementation of an integrative family medicine (IFM) program, which is a postgraduate training model that combines family medicine residency training with an integrative medicine fellowship. This paper reports on effects of IFM on residency programs and clinical systems in which it was implemented. METHODS: We used the Integrative Medicine Attitudes Questionnaire (IMAQ) to assess participants' attitudes toward integrative medicine before and after the program was implemented. We assessed residency program recruitment success before and after the program was implemented. We conducted interviews with key informants at each program to evaluate the effects of the IFM on the six participating residency programs. RESULTS: IMAQ scores demonstrated a significant increase in the acceptance of integrative medicine after implementation of IFM. Recruiting data showed that participating programs filled at a rate consistently above the national average both before and after implementation. Analysis of interview data showed that programs became more open to an integrative medicine (IM) approach and offered a wider range of clinical services to patients. CONCLUSIONS: Our mixed-methods strategy for evaluation of IFM showed that implementing the program increased acceptance of IM, did not affect residency fill rates, and increased use of IM in clinical practice. The combination of quantitative and qualitative methods was an effective strategy for documenting the "systems level" effects of a new educational program.

Counternarratives of Mexican-origin women with breast cancer.

Little is known about cancer health disparities among undocumented Latino immigrant populations, who represent a rapidly growing sector in the United States. Federal and state legislative reforms to control immigration have increased significantly over the past year. Although the effects of immigration reforms are being documented in housing, education, and public service industries, no data have been found examining the impact on the health of immigrant communities. In this article, we identify the consequences of recent immigration legislation enacted in Arizona, which has created barriers to accessing cancer treatment and continued follow-up care among a sample of Latina breast cancer survivors.