NYS Nonprofit Hospital Assessment and Response to Environmental Pollution as Community Health Need: Prevalence in Community Benefit Practices.

CONTEXT: Given the impact of environmental pollution on health and health inequity, there may be substantial value in integrating assessment and response to pollution into nonprofit hospital community benefit processes. Such hospital engagement has not yet been studied. OBJECTIVES: We take a preliminary step of inquiry in investigating if nonprofit hospitals in New York State (NYS) assess, identify, or respond to environmental pollution as part of community benefit processes. DESIGN: This study is of retrospective, observational design. Data were abstracted from community health needs reports (2015-2017), associated implementation plans, and related IRS (Internal Revenue Service) filings from a randomly geographically stratified selection of NYS nonprofit hospitals. PARTICIPANTS: The sample includes 53 hospitals from 23 counties. The sampling frame consists of NYS nonspecialty private nonprofit hospitals. MAIN OUTCOME MEASURES: Dichotomous findings for the following: (1) engagement of environmental pollution in the process of assessment of community health needs; (2) environmental pollution concern identified as a priority community health need; (3) strategic planning present to address pollution identified as community health need; and (4) action taken on same. RESULTS: We found that 60.5% (95% confidence interval [CI], 0.46-0.74) of hospitals evidenced some form of assessment of environmental pollution and 18.9% (95% CI, 0.09-0.32) identified pollution as a priority community health need. However, no hospital went on to take independent or collaborative planning or action to address pollution. In additional analysis, we found that social justice in hospital mission was a positive predictor of assessment of environmental pollution. CONCLUSIONS: For NYS hospitals, we found a substantial presence of assessment and identification of pollution as a community health concern. Our finding of the absence of response to environmental pollution represents a gap in community benefit implementation. This indicates a yet untaken opportunity to address racial and economic environmental health injustices and to improve population health.

Usability Experience of a Personal Sleep Monitoring Device to Self-manage Sleep Among Persons 65 Years or Older With Self-reported Sleep Disturbances.

Increasingly, persons with self-reported health symptoms are using mobile health technologies to better understand, validate, and manage their symptoms. These off-the-shelf devices primarily utilize actigraphy to estimate sleep and activity. The purpose of this study was to describe qualitatively the experience of using a personal sleep monitoring device for sleep self-management in adults 65 years or older with self-reported sleep disturbances. This study followed a hybrid qualitative design using deductive and emergent coding derived from open-ended interviews (n = 25) after a period of 4 weeks using a wearable personal sleep monitoring device. Results expanded existing theoretical models on usability with the theme of personal meaning in the interaction between health and self-monitoring technology that were associated with age and technology use, privacy, and capability. Future studies for sleep health self-management and personally tailored interventions using personal sleep monitoring devices should continue to collect qualitative information in extending the understanding of user experience across different symptom clusters, such as sleep disturbances, that manifest more commonly in older age populations. This research is important for application in the use of mobile health technologies for nursing led health self-management interventions.

Social and Emotional Wellbeing (SEW) Intervention for Mental Health Promotion Among Resettled Bhutanese Adults in Massachusetts.

Preventative behavioral interventions aimed at reducing mental problems among refugees are limited. We assessed the effect of a Social and Emotional Wellbeing (SEW) intervention on health-promoting behaviors (coping, social-networking, and conflict-resolution) and health-outcomes (stress, anxiety, and depression) among resettled Bhutanese adults in Western Massachusetts. The study was a community-based SEW intervention with pre-posttest evaluation among 44 Bhutanese adults in Western Massachusetts. The SEW is a culturally tailored 5-week, once-weekly health-education, problem solving, and mind-body exercise program to promote stress management skills. We used validated scales to measure outcomes. Mean scores of mental problems decreased by 5.9 for depression, 9.0 for anxiety, and 5.0 for stress post-intervention (p < 0.01). Mean scores increased by 27.3 for coping, 10.6 for social support, and 20.4 for conflict-resolution. Mean social-network scores increased by 4.6 for family, 4.7 for friends, and 1.8 for community networks (p < 0.01). Our Bhutanese participants reported improvement in their mental health after attending SEW intervention.

Use of a Personal Sleep Self-Monitoring Device for Sleep Self-Management: A Feasibility Study.

The purpose of the current study was to establish feasibility of personal sleep monitoring devices (PSMDs) as an intervention for sleep self-management in older adults. This study followed a mixed-methods experimental design based on the World Health Organization's International Classification of Functioning, Disability, and Health, and the proposed conceptual model of symptom management in a social context. Results showed an acceptable recruitment and retention rate of participants, and acceptability of PSMDs by users. Participants were able to meaningfully interpret PSMD data as evidenced by the numeracy evaluation scores, initiate sleep goals, and share their sleep data and goals with friends or relatives. Findings support extending this research protocol to a larger sample. Future studies for sleep health self-management and personally tailored interventions using personal sleep monitoring are recommended. [Journal of Gerontological Nursing, 47(1), 28-34.].

Older adults' experiences with a tablet-based self-management intervention for diabetes mellitus type II: A qualitative study.

Technological interventions to support self-management can potentially help older adults manage their health, live active lives, and maintain their independence. The objective of this study was to assess individuals' experiences and perceptions of using a tablet-based application for 30 days as a component of routine diabetes self-management care in older adults with type 2 diabetes mellitus (T2DM) in the context of daily living. A qualitative research design using semi-structured interviews was used. The participants found the tablet-based application to be a beneficial and valuable component of their routine self-management activities. Five themes emerged from the interviews, namely self-dependence, awareness, positive impact on attitude and behavior, support, and balance. Findings from the individual interviews indicate that technological applications have a unique potential to support the foundations for attitude and behavioral changes toward self-management behaviors and activities, thus improving clinical outcomes.

Improving Mental Health in Refugee Populations: A Review of Intervention Studies Conducted in the United States.

Mental health is one of the most pervasive health concerns in the refugee population due to the combined effects of traumatic experiences prior to migration and post-migration stressors related to resettlement. The objectives of this systematic search were to synthesize evidence on the effectiveness and identify gaps of mental health interventions on mental health outcomes for refugees resettled in the United States. This review search identified a combination of quasi-experimental (7 studies) and qualitative research studies (5 studies). Twelve papers, published between 2003-2017, evaluating twelve different interventions, were selected for review. Studies were conducted in a variety of refugee populations: Africans (8), Southeast Asians (2), Bhutanese (1), and multicultural (1). Interventions included groups/workshops (10) and individual counseling (2). The results from the mental health interventions showed increases in health confidence, health seeking behaviors, consistency with treatment course, English proficiency, quality of life, and level of enculturation. Results also showed decreases in depression and psychological distress. Also identified from this review were different methods for interventions including linguistic and ethnically-matched facilitators versus non-matched facilitators, as well as group interventions versus non-group interventions. These differences were identified in the review and discovered to be areas for further research as these items were not often addressed in the literature.

The Use of Technology to Support Precision Health in Nursing Science.

PURPOSE: This article outlines how current nursing research can utilize technology to advance symptom and self-management science for precision health and provides a roadmap for the development and use of technologies designed for this purpose. APPROACH: At the 2018 annual conference of the National Institute of Nursing Research (NINR) Research Centers, nursing and interdisciplinary scientists discussed the use of technology to support precision health in nursing research projects and programs of study. Key themes derived from the presentations and discussion were summarized to create a proposed roadmap for advancement of technologies to support health and well-being. CONCLUSIONS: Technology to support precision health must be centered on the user and designed to be desirable, feasible, and viable. The proposed roadmap is composed of five iterative steps for the development, testing, and implementation of technology-based/enhanced self-management interventions. These steps are (a) contextual inquiry, focused on the relationships among humans, and the tools and equipment used in day-to-day life; (b) value specification, translating end-user values into end-user requirements; (c) design, verifying that the technology/device can be created and developing the prototype(s); (d) operationalization, testing the intervention in a real-world setting; and (e) summative evaluation, collecting and analyzing viability metrics, including process data, to evaluate whether the technology and the intervention have the desired effect. CLINICAL RELEVANCE: Interventions using technology are increasingly popular in precision health. Use of a standard multistep process for the development and testing of technology is essential.

Cancer Pain Social Processes and Pain Management in Home Hospice Care.

BACKGROUND: The high incidence of pain associated with end-stage cancers indicates the need for a new approach to understanding how and why patients, caregivers, and clinicians make pain management choices. AIMS: To provide pilot data and preliminary categories for developing a middle-range nursing theory and framework through which to scrutinize and identify problematic processes involved in management of poorly controlled pain for home hospice patients, caregivers, and nurses, the "caring triad." DESIGN: A qualitative pilot study using constructivist grounded theory methodology to answer the question, "In the context of hospice, what are the social processes occurring for and between each member of the hospice caring triad and how can these processes be categorized?" SETTINGS: Home hospice care. PARTICIPANTS/SUBJECTS: Hospice patients experiencing cancer pain, family caregivers, hospice nurses. METHODS: From a sample of triads including hospice patients, caregivers and nurses, data were collected at observational visits, individual interviews, and a focus group over the course of each triad's study involvement. We used recursive coding processes to interpret data. RESULTS: Three preliminary categories of social processes were identified: Pain Meaning, Working Toward Comfort, and Bridging Pain; and six subcategories: perceiving pain and discomfort, knowing what to do, planning activities, negotiating a pain plan, talking about pain, and being together in pain. CONCLUSIONS: As illustrated in the caring triad cases presented, this study moved the management approach of pain from a dichotomous realm of nurse-patient, to the more naturalistic realm for home hospice of nurse-patient-caregiver. In analyzing social processes within and across triad members, we identified categories of impact to target assessment, intervention, and education to improve pain outcomes.

Precision health: Advancing symptom and self-management science.

BACKGROUND: Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. PURPOSE: To present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. METHODS: Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. DISCUSSION: The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. CONCLUSION: Nurse scientist leadership is necessary to realize the vision of precision health as reflected in the NSPH Model.

Sociocultural Perceptions and Enablers to Seeking Mental Health Support Among Bhutanese Refugees in Western Massachusetts.

This qualitative study aimed to identify cultural influences on seeking mental health support among Bhutanese refugees resettled in Western Massachusetts. Bhutanese refugees aged 18 years or older were recruited for eight focus group discussions, organized by age and gender ( N = 67, 49.3% female, mean age = 38, SD = 15.9). The PEN-3 cultural model was used as the theoretical framework to examine the roles of cultural perceptions that influence mental health-seeking behaviors. Focus group discussions were audio taped to facilitate the thematic-analysis. Younger participants (<35 years) reported experiencing stressors relating to economic hardships and difficulties in developing academic and social skills as they juggle breadwinner and care-giving responsibilities for their families. Older participants reported frustration with the difficulties in learning English and increased dependence on their children. Family members provided the initial frontline support to persons with mental health problems. If family support did not work, they consulted with their relatives and trustworthy community members for further assistance. Psychological factors such as fears of emotions, social norms, beliefs, and self-esteem associated with cultural norms and values influenced seeking mental health support. All participants expressed the need to have a culturally tailored intervention to develop acquired skills to improve their self-esteem and self-efficacy in order to integrate into their new social and cultural environment. Because family members make important decisions about seeking mental health support, involving family members in developing and delivering culturally appropriate skill development interventions could be a potential strategy to reduce their stress and increase resilience in this refugee community.

Concept Analysis and the Advance of Nursing Knowledge: State of the Science.

PURPOSE: Despite an overwhelming increase in the number of concept analyses published since the early 1970s, there are significant limitations to the impact of this work in promoting progress in nursing science. DESIGN: We conducted an extensive review of concept analyses published between 1972 and 2017 to identify patterns in analysis and followed this with exploration of an exemplar related to the concept of normalization to demonstrate the capabilities of analysis for promoting concept development and progress. METHODS: Scoping review of peer-reviewed literature published in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) in which the terms "concept analysis," "concept clarification," and "concept derivation" appeared in any part of the reference. The original search returned 3,489 articles. This initial pool was refined to a final sample of 958 articles published in 223 journals and addressing 604 concepts. A review of citations of the original analysis of the concept of normalization resulted in 75 articles selected for closer examination of the process of concept development. FINDINGS: Review showed a clear pattern of repetition of analysis of the same concept, growth in number of published analyses, preponderance of first authors with master's degrees, and 43 distinct descriptions of methods. Review of the 75 citations to the normalization analysis identified multiple ways concept analysis can inform subsequent research and theory development. CONCLUSIONS: Conceptual work needs to move beyond the level of "concept analysis" involving clear linkage to the resolution of problems in the discipline. Conceptual work is an important component of progress in the knowledge base of a discipline, and more effective use of concept development activities are needed to maximize the potential of this important work. It is important to the discipline that we facilitate progress in nursing science on a theoretical and conceptual level as a part of cohesive and systematic development of the discipline. CLINICAL RELEVANCE: The absence of effective concepts impedes the ability to recognize, discuss, define, and conduct studies important to clinical practice and research. This article reflects the pressing need as well as the potential for concept analysis work to be approached in a way that promotes nursing science and enables conceptually sound research to improve clinical care.

Computer technology for self-management: a scoping review.

AIMS AND OBJECTIVES: The purpose of this scoping review of literature is to explore the types of computer-based systems used for self-management of chronic disease, the goals and success of these systems, the value added by technology integration and the target audience for these systems. BACKGROUND: Technology is changing the way health care is provided and the way that individuals manage their health. Individuals with chronic diseases are now able to use computer-based systems to self-manage their health. These systems have the ability to remind users of daily activities, and to help them recognise when symptoms are worsening and intervention is indicated. However, there are many questions about the types of systems available, the goals of these systems and the success with which individuals with chronic illness are using them. DESIGN: This is a scoping review in which the Cumulative Index of Nursing and Allied Health Literature, PubMed and IEEE Xplore databases were searched. A total of 303 articles were reviewed, 89 articles were read in-depth and 30 were included in the scoping review. The Substitution, Augmentation, Modification, Redefinition model was used to evaluate the value added by the technology integration. FINDINGS: Research on technology for self-management was conducted in 13 countries. Data analysis identified five kinds of platforms on which the systems were based, some systems were focused on a specific disease management processes, others were not. CONCLUSIONS: For individuals to effectively use systems to maintain maximum wellness, the systems must have a strong component of self-management and provide the user with meaningful information regarding their health states. RELEVANCE TO CLINICAL PRACTICE: Clinicians should choose systems for their clients based on the design, components and goals of the systems.

The Competency Model for Professional Rehabilitation Nursing.

BACKGROUND: Rehabilitation nursing is practiced in various settings along the healthcare continuum. No framework is noted in the literature that defines the necessary competencies of the rehabilitation nurse. PURPOSE: To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical and educational practice. METHOD/DESIGN: A seven-member Association of Rehabilitation Nurses (ARN) task force was convened; conducted a literature review, reviewed current and historical ARN documents, including the Strategic Plan, and developed a Competency Model for Professional Rehabilitation Nursing practice. FINDINGS: The Competency Model for Professional Rehabilitation Nursing delineates four domains of rehabilitation nursing practice and essential role competencies. CONCLUSION: The Competency Model for Professional Rehabilitation Nursing addresses this diverse specialty practice in the current healthcare arena. This framework can be used to guide nurses practicing at different levels of proficiency in various settings. CLINICAL RELEVANCE: The Competency Model can be used as a structure for staff orientation, evaluation tools, clinical ladder components, role descriptions and rehabilitation nursing courses.

An integrative review of dignity in end-of-life care.

BACKGROUND: Dying with dignity is regarded as a goal of quality end-of-life care. However, the meaning of dying with dignity is ambiguous, and no comprehensive synthesis of the existing literature has been published. AIM: To synthesize the meaning of dying with dignity and to identify common aspects of dignity in end-of-life care. DESIGN: This is an integrative review article. Methodological strategies specific to the integrative review method proposed by Whittemore and Knafl were followed to conduct data analysis. The matrix method was used to summarize characteristics of included articles. DATA SOURCES: Five electronic databases were searched in October 2012, with no date restriction: PubMed, CINAHL, PsycINFO, Academic Search Premier, and Social Sciences Abstracts. Theoretical reports, and both qualitative and quantitative empirical reports, focused on dignity in end-of-life care were included. RESULTS: Themes of dying with dignity are as follows: a human right, autonomy and independence, relieved symptom distress, respect, being human and being self, meaningful relationships, dignified treatment and care, existential satisfaction, privacy, and calm environment. Factors influencing dignity include demographic, illness-related, and treatment-/care-related factors, as well as communication. Models of dignity in end-of-life care and instruments to measure dignity were reported. Interventions to support dignity stressed physical, psychological, and spiritual supports not only to dying patients but also to family members. CONCLUSION: This review clarified the meaning of dying with dignity and synthesized common aspects of dignity in end-of-life care. Further research is needed to evaluate the meaning of dying with dignity across cultures and to explore individualized dignity-based care.

Evaluating the psychometric properties of the Jacelon Attributed Dignity Scale.

AIM: To develop and psychometrically test the Jacelon Attributed Dignity Scale (JADS). BACKGROUND: The JADS was designed to measure self-perceived attributed dignity in community-dwelling older adults. Attributed dignity was conceived of as a state characteristic of the self. The JADS is a short, positively scored, norm-referenced, evaluation index designed to measure self-perceived attributed dignity during the last week. DESIGN: Instrument development and testing including psychometric properties, internal consistency, factor structure, temporal stability and construct validity. METHOD: Using a quota sample, 289 older adults (65-99 years old) were recruited from senior centres in western New England to complete the JADS, demographic information, the Self-Esteem Scale and the Social Desirability Scale during 2010-2011. Descriptive statistics, exploratory factor analysis, construct validity and temporal stability were evaluated. RESULTS: The resulting positively scored 18-item scale has four factors with high internal consistency for each factor and the entire scale. Construct validity was established by examining correlations with instruments that measured self-esteem and social desirability. Attributed dignity is a unique concept that is stable over time. CONCLUSION: The JADS is an 18-item Likert-scaled instrument designed to measure attributed dignity. Attributed dignity is a concept with four factors and is defined as a cognitive component of the self-connoting self-value, perceived value from others, self in relation to others and behaving with respect. The importance of attributed dignity for older adults in relation to health, function, independence, quality of life and successful ageing can now be evaluated.

Thai novice nurses' lived experiences and perspectives of breastfeeding and human milk in the Neonatal Intensive Care Unit (NICU).

BACKGROUND: Breastfeeding and human milk have well-documented health benefits for newborn infants, particularly those who are sick. However, breastfeeding rates and human milk feeding among infants in neonatal intensive units (NICU) in Thailand are still low; thus, breastfeeding promotion and support are required for Thai mothers of premature infants. Newly graduated nurses can play a critical role within the healthcare support system and can have a significant impact on improving breastfeeding practices in the NICU. The objective of this study was to investigate the lived experiences and perspectives of Thai novice nurses on supporting breastfeeding and human milk feeding in the NICU. METHODS: The study was conducted between March 2021 and May 2022 at three medical centers in the central region of Thailand. This study employed a descriptive phenomenological approach to explore Thai novice nurses' experiences and perspectives on breastfeeding. Purposive sampling was used to invite Thai novice nurses who have work experience in providing breastfeeding support to NICU mothers and their infants to participate in online interviews using a video conference platform (Zoom). Semi-structured questions were used to interview study participants in their native language. Data were analyzed using Colaizzi's method of data analysis to identify emergent themes. Member checks, peer debriefing, and self-reflection were applied to ensure the validity and trustworthiness of the study results. Back-translation was also used as a quality and accuracy assurance. RESULTS: A total of thirteen novice nurses agreed to participate in the study. All were female, and their ages ranged from 21 to 24 years old at the time of the interview. The researchers identified five major themes related to the overall study objectives and research questions. They are: positive attitude toward breastfeeding and human milk, facing breastfeeding challenges at work, self-confidence rooted in experience, professional skill needs, and requiring further support. CONCLUSIONS: Our results suggest that breastfeeding education plays a vital role in encouraging new nurses to provide breastfeeding support to mothers of preterm infants. Establishing breastfeeding support training and innovative learning strategies can be crucial in developing appropriate breastfeeding practice guidelines and policies to support Thai breastfeeding mothers in the NICU.

Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

BACKGROUND: Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. PURPOSE: The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. METHODOLOGY: A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. RESULTS: The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. CLINICAL IMPLICATIONS: Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Older adults' participation in the development of smart environments: an integrated review of the literature.

Smart environments are being developed to support older adults aging in place. However, the design contributions of the older users have not been explicated. The purpose of this review of literature was to determine how older adults' ideas are being incorporated into the design of smart environments. Twenty-one research articles, incorporating older adults' preferences into the design and evaluation of smart environments are presented. Although only one study was found that used findings from older adult focus groups in the design and development of their system, the findings indicate that older adults are open to living in technically advanced environments if doing so would improve their quality of life and help them stay in their own homes, and that incorporating older adults ideas about smart environments improve the desirability of smart homes.

Social Influences on Perceptions of Sense of Control and Attributed Dignity Among Older People Managing Multiple Chronic Conditions.

PURPOSE: The aim of this study was to explore associations between social support, sense of control, and attributed dignity in persons aged 65 years and older who self-manage multiple chronic conditions while living in the community. DESIGN: A descriptive, nonexperimental, correlational design was used in this study. METHODS: Eighty-nine participants completed telephone surveys that measured social support, sense of control and attributed dignity. Regression analysis was used to identify associations. RESULTS: Participants were independent in seven of the eight instrumental activities of daily living, with participants having an average of 11 (±4) chronic conditions. Significant positive relationships between social support, perceived sense of control, and attributed dignity were identified. CONCLUSIONS: Positive social support is strongly associated with perceived sense of control and attributed dignity. CLINICAL RELEVANCE: Healthcare professionals, especially rehabilitation nurses, can assess social support and offer ways to improve social support, thus enhancing sense of control and attributed dignity. These concepts enhance older individuals' ability to manage multiple chronic conditions.