ADAPTATION AND TESTING OF THE DEVELOPMENTAL DISABILITY ATTITUDES IN NURSING CARE INSTRUMENT.

Background and Purpose: Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD. Methods: The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument. Results: Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach's alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD. Conclusions: The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.

Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology.

BACKGROUND: People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care. PURPOSE: The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs. METHODS: A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data. RESULTS: Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral. CONCLUSIONS: The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.

Innovative Approach to Address Disability Concepts and Standardized Patients With Disability in an Undergraduate Curriculum.

BACKGROUND: Despite a growing population of people with disabilities (PWD), health care professionals, including nurses, receive little educational preparation to provide health care to them. To address this issue in nursing education, the faculty of a school of nursing designed and implemented an innovative teaching strategy that can be adopted by other nursing programs and faculty. METHOD: A systematic plan was developed and implemented to integrate standardized patients with disabilities (SPWD) into an existing undergraduate nursing program. Steps included careful planning, review, and modification of existing simulation-based scenarios, obtaining buy-in of faculty across the curriculum, recruitment and training of PWD to be SPWD, and implementation of the project. RESULTS: The program in which all undergraduate nursing students have repeated contact with SPWD has been successfully implemented throughout the curriculum. CONCLUSION: The project addressed the multiple calls to improve the preparation of health care professionals to provide quality care to PWD. [J Nurs Educ. 2018;57(12):760-764.].

Access to and Satisfaction with Prenatal Care Among Pregnant Women with Physical Disabilities: Findings from a National Survey.

BACKGROUND: Previous qualitative studies suggest that women with physical disabilities face disability-specific barriers and challenges related to prenatal care accessibility and quality. This study aims to examine the pregnancy and prenatal care experiences and needs of U.S. mothers with physical disabilities and their perceptions of their interactions with their maternity care clinicians. MATERIALS AND METHODS: We conducted the first survey of maternity care access and experiences of women with physical disabilities from 37 states. The survey was disseminated in partnership with disability community agencies and via social media and targeted U.S. women with a range of physical disabilities who had given birth in the past 10 years. The survey included questions regarding prenatal care quality and childbirth and labor experiences. RESULTS: A total of 126 women with various physical disability types from 37 states completed the survey. Almost half of the respondents (53.2%) reported that their physical disability was a big factor in their selection of a maternity care provider and 40.3% of women reported that their prenatal care provider knew little or nothing about the impact of their physical disability on their pregnancy. Controlling for maternal demographic characteristics and use of mobility equipment, women who reported that their prenatal care provider lacked knowledge of disability and those who felt they were not given adequate information were more likely to report unmet needs for prenatal care. CONCLUSIONS: The findings from this study suggest the need for training and education for clinicians regarding the prenatal care needs of women with physical disabilities.

The Impact of Physical Disability on Pregnancy and Childbirth.

BACKGROUND: Women with physical disabilities increasingly aspire to become pregnant and bear children. Limited information about the potential interaction of their disabling conditions with pregnancy and childbirth exists to guide these women and their clinicians. MATERIALS AND METHODS: The interview guide was created with questions on topics such as pregnancy complications and secondary conditions, the impact of prior surgeries, experiences with pain relief during labor, and the impact on women's independence and participation in life activities. Interviews were conducted by telephone with 25 women with physical disabilities. They were subsequently transcribed verbatim and analyzed by using Atlas TI. RESULTS: Women generally reported a relatively modest impact of disabling conditions on their pregnancies. Most women were satisfied with the mode of delivery, but they experienced challenges during the labor and delivery process. The women found that careful advanced planning was helpful in managing the impact of their disabling conditions. The involvement of clinicians with disability-related expertise was, in some cases, another factor that contributed to a positive outcome. CONCLUSIONS: The importance of advanced planning and the utility of involving clinicians with disability-related expertise suggest that the use of integrated, interdisciplinary team approaches could promote quality care by facilitating improved planning and management. Additional clinical research is needed to provide women and their clinicians with more information on potential complications and options for labor and delivery.

Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

BACKGROUND: Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. OBJECTIVE: This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. METHODS: We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. RESULTS: Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). CONCLUSION: Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population.

Assessment of the Impact of Teaching Demands on Research Productivity Among Doctoral Nursing Program Faculty.

This article reports the findings of a study that examined the research and scholarship productivity of doctorally prepared nursing faculty teaching and mentoring doctoral students and the conflicting demands on them to maintain programs of research and scholarship. The specific aims were to (a) examine the research productivity and scholarship of faculty members teaching in doctoral programs and mentoring doctoral students to examine the perceived effectiveness of existing institutional mechanisms to support scholarship, (b) explore institutional features and personal practices used by doctoral program faculty to develop and maintain research and scholarship productivity, and (c) analyze predictors of scholarship productivity. Data were collected via an on-line researcher-developed survey that examined doctoral faculty roles/responsibilities and their relationship to their scholarly productivity, overall research productivity, and institutional features and personal practices to support research/scholarship activities. Survey respondents reported spending a large amount of time engaged in research-related activities with 58.9% (n = 326) spending anywhere from 6 to 20 hours per week conducting research, writing research-based papers, giving presentations, grant writing, or conducting evidence-based improvement projects. Scholar productivity among the respondents was robust. Personal practices that most strongly supported faculty members' scholarship productivity were the belief that engaging in scholarship made them better teachers and the personal gratification in experiencing doctoral students' successes. A multiple regression analysis conducted to determine predictors of productivity indicated that the strongest predictor was the average number of hours spent on research/scholarship-related activities, followed by time bought out from teaching and other responsibilities of the faculty role for research.

Psychometric Analysis of the Work/Life Balance Self-Assessment Scale.

BACKGROUND AND PURPOSE: This study investigated the psychometric properties of the Work/Life Balance Self-Assessment scale among nurse faculty involved in doctoral education. METHODS: A national random sample of 554 respondents completed the Work/Life Balance Self-Assessment scale, which addresses 3 factors: work interference with personal life (WIPL), personal life interference with work (PLIW), and work/personal life enhancement (WPLE). RESULTS: A principal components analysis with varimax rotation revealed 3 internally consistent aspects of work-life balance, explaining 40.5% of the variance. The Cronbach's alpha coefficients for reliability of the scale were .88 for the total scale and for the subscales, .93 (WIPL), .85 (PLIW), and .69 (WPLE). CONCLUSION: The Work/Life Balance Self-Assessment scale appears to be a reliable and valid instrument to examine work-life balance among nurse faculty.

Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy.

BACKGROUND: Despite concerns raised in the literature on the adverse pregnancy outcomes of women with physical disabilities, there is little information about unmet needs of women with physical disabilities during pregnancy and childbirth. OBJECTIVE: This article provides an in-depth examination of unmet health care needs during and around the time of pregnancy among a sample of women with physical disabilities. It also offers recommendations to other women with physical disabilities who are considering pregnancy. METHODS: Twenty-five phone interviews were conducted with women with physical disabilities from across the United States who had a baby in the past ten years. Individual semi-structured qualitative interviews lasting about 2 h were conducted. Interviews were audio-recorded, transcribed, and analyzed using an iterative, interpretive process. RESULTS: Women reported a wide range of disabling conditions. Analysis revealed three broad themes related to unmet needs during pregnancy among women with physical disabilities. They included (1) clinician knowledge and attitudes, (2) physical accessibility of health care facilities and equipment, (3) need for information related to pregnancy and postpartum supports. The women also provided recommendations to other women with disabilities who are currently pregnant or thinking of becoming pregnant. Recommendations related to finding a clinician one trusts, seeking peer support, self-advocating, and preparing oneself for the baby. CONCLUSIONS: This study sheds light on the unmet needs and barriers to care of women with mobility disabilities during pregnancy and childbirth. The study findings highlight the need for policy and practice recommendations for perinatal care of women with mobility disabilities.

A perinatal health framework for women with physical disabilities.

BACKGROUND: Studies suggest that women with disabilities experience health and health care disparities before, during, and after pregnancy. However, existing perinatal health and health care frameworks do not address the needs and barriers faced by women with physical disabilities around the time of pregnancy. A new framework that addresses perinatal disparities among women with physical disabilities is needed. OBJECTIVE: To propose a framework for examining perinatal health and health care disparities among women with physical disabilities. METHODS: We developed a perinatal health framework guided by the International Classification of Functioning, Disability and Health (ICF) and the integrated perinatal health framework by Misra et al. RESULTS: The proposed framework uses a life span perspective in a manner that directly addresses the multiple determinants specific to women with physical disabilities around the time of pregnancy. The framework is based on longitudinal and integrated perspectives that take into account women's functional status and environment over their life course. CONCLUSION: The perinatal health framework for women with physical disabilities was developed to inform the way researchers and health care professionals address disparities in perinatal health and health care among women with physical disabilities.

"How did that happen?" Public responses to women with mobility disability during pregnancy.

BACKGROUND: Little is known about current societal attitudes toward women with significant mobility disability who are visibly pregnant. OBJECTIVE: To use qualitative descriptive analysis methods to examine perceptions of women with significant mobility disability about how strangers reacted to their visible pregnancies. METHODS: In late 2013, we conducted 2-h telephone interviews with 22 women with significant mobility difficulties who had delivered babies within the prior 10 years. The semi-structured, open-ended interview protocol addressed wide-ranging pregnancy-related topics, including statements from strangers. Most participants were recruited through social networks, coming from 17 states nationwide. We used NVivo to sort the texts for content analysis. RESULTS: The women's mean (standard deviation) age was 34.8 (5.3) years; most were white, well-educated, and higher income, although half had Medicaid during their pregnancies; and 18 used wheeled mobility aids. Eighteen women described memorable interactions with strangers relating to their pregnancies or newborn babies. Strangers' statements fell into six categories: (1) curious; (2) intrusively and persistently curious; (3) hostile, including concerns that taxpayers would end up supporting the mother and child; (4) questioning woman's competence as a potential parent; (5) oblivious, not recognizing visible pregnancy or motherhood; and (6) positive. Many women reported strangers asking how their pregnancy had happened. The women doubted that visibly pregnant women without disabilities evoke the same reactions from strangers. CONCLUSIONS: Women with mobility disability who are visibly pregnant may perceive reactions from strangers that appear intrusive. Planning ahead for handling such encounters could reduce the stresses of these interactions.

A profile of U.S. nursing faculty in research- and practice-focused doctoral education.

PURPOSE: This study, which is part of a larger project, was conducted to profile the nursing faculty in the United States teaching in PhD and DNP programs. DESIGN: This is a descriptive study. A sample of 554 nursing faculty who teach in PhD and DNP programs was recruited by email solicitation to represent all geographic regions of the United States. Data were collected from November 2013 through January 2014 using an online survey instrument. METHODS: The instrument was developed based on results of review of the literature and of focus groups of doctoral faculty (faculty teaching in doctoral programs) to ascertain characteristics of faculty teaching in doctoral programs and of the schools in which they teach. Frequencies and descriptive statistics are reported. FINDINGS: Growth in DNP programs has outpaced growth in PhD programs, and DNP graduates have moved into doctoral education in greater numbers than PhD graduates. DNP faculty report less prior experience and current productivity scholarship than faculty in PhD programs only or both types of programs. CONCLUSIONS: Strategies are needed to ensure that doctoral programs are staffed by faculty who are prepared for doctoral education and the development of nursing science. CLINICAL RELEVANCE: The Institute of Medicine has recommended doubling the number of doctorally prepared nurses in the United States by 2020 to ensure that sufficient numbers of faculty are available to prepare the nursing labor force that is needed for delivery of healthcare services. Nurse scientists are needed to contribute to improvement in patient care quality and safety, and practice leaders are needed to facilitate the translation of research into safe, high-quality, and cost-effective care. The landscape of doctoral education in nursing is rapidly changing.

Prevalence and risk factors for postpartum depression symptoms among women with disabilities.

The adverse consequences of postpartum depression on the health of the mother and her child are well documented. However, there is little information on postpartum depression among mothers with disabilities. This study examines the patterns of depression and depressive symptoms before, during and after pregnancy and the association between depression before and during pregnancy and postpartum depression symptomatology (PPD) among women with and without disabilities. Data from the 2009-2011 Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2013. Almost 30% (28.9%; 95% CI 22.8-35.8) of mothers with disabilities reported often or always feeling down, depressed or sad after childbirth compared to 10% of those without disabilities (95% CI 8.9-11.3). Compared to other women in the study, women with disabilities had a greater likelihood for PPD symptoms (RR 1.6, 95% CI 1.1-2.2) after accounting for sociodemographics, maternal characteristics related to PPD, and depression before and during pregnancy. Adjusting for other covariates, self-reported prenatal diagnosis of depression was not associated with symptoms of PPD and depression during pregnancy was marginally associated with PPD symptomatology for women with disabilities. Women with disabilities are at a greater risk of experiencing symptoms of postpartum depression than other women. Screening for PPD among new mothers with disabilities and timely referral of those with PPD diagnosis are vital to the health of mothers with disabilities and their children.

Nursing doctoral faculty perceptions of factors that affect their continued scholarship.

This focus group study was undertaken as part of a larger investigation of how the demand for increased production of nurses with doctorates affects doctoral faculty's scholarly productivity. This study provided a basis for development of the national survey questionnaire. Two focus groups that included 29 faculty teaching in doctor of philosophy and/or doctor of nursing practice programs took place at one of two national conferences. The focus group interviews were transcribed and content analyzed for the identification of themes; all members of the research team reached consensus. The three major themes were the demands of teaching, the importance of institutional structure and climate, and the sustainability of one's self, the institution, and the discipline. Participants identified strategies for enhancing scholarly productivity. Findings are limited by the small sample size and the voluntary participation of conference attendees. The strength of emotion that participants revealed underscores the need for nursing leaders to address the increasing academic expectations for faculty. If the profession does not address the needs of its current and future faculty, goals explicated by the Institute of Medicine in The Future of Nursing cannot be achieved, and the health of the nation will suffer.

Commentary: defining disability in health care education.

According to the 2008 American Community Survey, about 12% of the population of the United States is living with one or more disabling conditions. These conditions impact lives in a variety of ways, some with more or less direct impact on an individual's health and access to health care services. Although it has been 20 years since the passage of the Americans with Disabilities Act, people with disabilities still experience health disparities and a lack of access to the appropriate care. This commentary is part of a collection of articles that describe various aspects of incorporating content into the medical school curriculum to enhance the preparation of today's medical students to meet the needs of people with disabilities. The authors briefly describe the scope of the problem and define the population of people with disabilities that constitutes the focus of the work described in the other articles in this collection.

Updated research priorities for neuroscience nursing.

In 2007, the Neuroscience Nursing Foundation (NNF) convened a research panel to update NNF's research priorities used to guide funding. The research panel identified leaders in neuroscience nursing and conducted a review of neuroscience nursing research literature and an American Association of Neuroscience Nurses membership survey on research priorities. A workgroup of leaders in neuroscience nursing was then convened to draft and set priorities on the basis of the review of the literature and the membership survey. The updated priorities were submitted to the NNF Board of Trustees for approval. The revised document reviews the mission of NNF and outlines six strategies and five program areas (including specific subareas) that represent priorities for NNF research funding. The purpose of the updated priority document is to provide guidelines for the systematic development of knowledge in neuroscience nursing through the encouragement of selected neuroscience nursing research activities.

Improving the health and wellness of persons with disabilities: a call to action too important for nursing to ignore.

In 2005, the US Surgeon General issued a Call to Action to Improve the Health and Wellness of Persons with Disabilities, with the goal being the improvement of the health status of men, women, and children with disabilities. Despite federal legislation to address inequities in health care for the 54-60 million people in the US with disabilities, many have reported negative experiences in their interactions with health care providers from all health professions. Collectively, the nursing profession has been silent in its response to this call. This article describes the current status of health care of individuals with disabilities in the US, and suggests appropriate responses by the nursing profession to the Surgeon General's Call to Action. Specific suggestions are identified for nursing practice, education, research, nursing leaderships, and the profession of nursing as a whole.

Perspectives of women with disabilities on reaching those who are hard to reach.

Healthcare needs of women with disabilities are often neglected, even for women who are well connected to the community and to the healthcare system. So-called "hard-to-reach" women, whose degree of disability impedes use of community resources, have even greater difficulty obtaining health care. The purpose of this study was to gain insight into the perceptions of women with mobility and sensory limitations about several healthcare issues that may affect them: barriers to obtaining care, sources of information about health issues, ways to improve access to care, and ways to help hard-to-reach women overcome barriers to health care and health information. Researchers conducted six focus groups, comprising 43 women with limitations of mobility, hearing, or vision. To validate the women's input, researchers conducted two additional focus groups: the first comprised female physicians with special interest in the health care of women with disabilities, and the second included professional administrative staff of agencies that provide services for people with disabilities. In several cases, members of the physician and agency focus groups were themselves women with disabilities. In addition, 16 women with disabilities participated in an online survey; their responses were used to validate the findings of the face-to-face focus groups. Transcribed data were content analyzed and 10 themes identified. Seven of those themes are discussed in this article: communication barriers; lack of knowledge and awareness among healthcare providers; access issues; working the system; system issues; outreach to healthcare providers; and reaching hard-to-reach women. The findings of this study can provide direction to development of more effective outreach to hard-to-reach women with disabilities, resulting in better integration of healthcare services for this population.

Pregnancy in women with physical disabilities.

Women with disabilities are growing in number and increasingly interested in becoming mothers and raising children. However, health care providers are often unfamiliar with the health care needs of this group of women and overlook the important issues that make the difference between positive and negative experiences of these women. This article describes the preconception, antenatal, pregnancy, and postpartum issues of women with disabilities and suggests approaches to ensuring that women with disabilities have successful reproductive experiences.

Integration of disability-related content in nursing curricula.

Despite evidence that health care professionals, including nurses, do not perceive persons with disabilities in a positive light and fail to attend to their health care needs, it is not known how nursing programs address the topic of disability. This descriptive study was conducted to examine the extent to which schools of nursing in the United States address disability-related issues and the strategies used to integrate disability-related content in their curricula. A 27-item investigator-developed survey was sent to a national stratified random sample of 1,000 schools of nursing. Questions pertained to curricular content, specific groups of persons with disabilities, and teaching methods and resources used to teach nursing students about disability. Respondents indicated that they included some content related to disability in their curricula. Nursing textbooks were the most common source of information used. Barriers to including disability-related content were lack of time and lack of faculty interest or expertise. These findings can serve as a stimulus to increase the extent and breadth of disability-related issues in nursing curricula.