Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future.

OBJECTIVE: The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave. BACKGROUND: Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed. METHODS: This cross-sectional correlational study was conducted in a Magnet® hospital. RESULTS: Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic. CONCLUSIONS: Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.

"Did I do the right thing?" Nurses' experiences of caring for victims of child maltreatment: A qualitative study.

PURPOSE: The purpose of this study is to explore and gain insight into pediatric nurses' lived experiences in caring for children who experienced maltreatment. DESIGN AND METHOD: A qualitative descriptive phenomenological approach using Giorgi's method was used to support the inquiry of this study. Participants were recruited through the Society of Pediatric Nurses (SPN) and the International Association of Forensic Nursing (IAFN). To collect data, the research team conducted semi-structured interviews individually with each participant online via online video conferencing. RESULTS: A total of 21 nurses participated in the study. In the final analysis of data, six meaning units are found: (1) helplessly watching children relive the traumatizing events, (2) lack of knowledge and training on caring for children who experienced maltreatment, (3) adversarial relationship and resentment towards parents, (4) conflicting emotions and feelings, (5) long-lasting effects of trauma, and (6) feelings of isolation and loneliness. CONCLUSIONS: Pediatric and forensic nurses' experiences of caring for children who experienced maltreatment were highlighted by the fact that they lacked the knowledge of caring for these children and felt isolated. PRACTICE IMPLICATIONS: Implementing simulation training on nurses' knowledge and confidence in caring for children who experienced maltreatment is a paramount of importance. This in turn may improve nurses' sense of belonging and enhance the quality of care victims receive.

The relationship between urban greenspace perception and use within the adolescent population: A focused ethnography.

INTRODUCTION: Greenspace is beneficial for improving adolescent mental health, yet healthcare professionals still do not understand the connection between the built environment and subjective mental well-being. We also need to understand how this population uses greenspace and how they feel when in it. AIM: The aim of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace and to explore how they feel when they are in greenspace. DESIGN: Focused ethnography. METHODS: Data were collected between June 2022 and August 2022 using participant observation, photo elicitation and semi-structured interviews. Braun and Clarke's (2006) six phases of thematic analysis were used to guide data collection and analysis. RESULTS: A total of 11 adolescents between ages 12 and 18 who resided in and around Newark, NJ, were recruited. Three themes were identified from the data: (1) A tranquil space in an unsafe place; (2) Park means family connection with burgeoning independence; and (3) My park: Sense of ownership and responsibility. CONCLUSIONS: This study deepens the understanding between subjective mental well-being and urban greenspace exposure. Adolescents accepted responsibility for maintaining "my park", which strengthens community cohesion, detailing the importance of youth input during urban planning. IMPLICATIONS FOR PRACTICE: Implications from this study suggest that environmental interventions may help ameliorate an ongoing mental health care crisis among adolescents. Healthcare providers should consider the built environment as another approach to promoting mental health. PATIENT OR PUBLIC CONTRIBUTION: None other than research participants.

Urban greenspace use among adolescents and young adults: An integrative review.

PURPOSE: The purpose of this integrative review was to explore how adolescents and young adults used the social determinant of the built environment, specifically greenspace, as a potential point of intervention to address overall well-being, specifically mental health symptoms. METHOD: The approach used strategies described by Whittemore and Knafl. Peer-reviewed, published research articles in English were identified using electronic databases CINAHL, PubMed, and EMBASE. Seventeen research reports using qualitative or quantitative methods with adolescents and young adults. Each article was evaluated for quality using a critical appraisal tool by Hawker et al. Data were analyzed and then synthesized using the Matrix Method. FINDINGS: Three themes related to the purpose and aims were extracted: elements of greenspace, activity variation, and amenities. All themes shared a common element of quality, which influenced the perception of safety and greenspace use. DISCUSSION: The science of urban greenspace and adolescent-young adult well-being is still relatively new. Public health nurses can incorporate social determinants of health, such as the built environment in research, to understand how greenspace is to be used as an alternative health strategy to possibly reduce mental health symptoms and improve well-being.

Suicide and altitude: A systematic review of global literature.

OBJECTIVE: The purpose of this systematic review was to synthesize the existing global literature examining the relationship between altitude and suicide. METHOD: Using the electronic databases PubMed, CINAHL, EMBASE, and PsychInfo published articles in English that addressed the relationship between altitude and suicide as a primary or secondary aim, and included human subjects, where identified. Studies were assessed for quality based on methodological approach and data relevance on a three-point scale (strong, moderate, or weak). RESULTS: Of the 19 studies related to the purpose and aims, 17 reported evidence of a positive correlation between altitude and increased suicide. Vast design differences were employed within the literature, individual-level suicide data was identified as the preferred level of analysis. DISCUSSION: The relationship between altitude and suicide is an evolving science with a small but growing body of literature suggesting altitude is associated with an increased risk of suicide. This review identifies the need for additional studies examining both individual-level suicide data and improving geographic precision. Public health nurses have a responsibility to carefully examine the quality of studies and the strength of the evidence when addressing variables associated with suicide.

Nursing's Wicked Problems: Partnering With Academic Leadership to Develop Solutions.

Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results.

Exploring Screening Practices for Child Sexual Abuse in School Settings: An Integrative Review.

Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.

Caring for victims of child maltreatment: Pediatric nurses' moral distress and burnout.

BACKGROUND: Moral distress is a significant concern for nurses as it can lead to burnout and intentions to leave the profession. Pediatric nurses encounter stressful and ethically challenging situations when they care for suspected victims of child maltreatment. Data on pediatric nurses' moral distress are limited, as most research in this field has been done in adult inpatient and intensive care units. AIM: The purpose of this study was to describe pediatric nurses' moral distress and evaluate the impact of caring for suspected victims of child maltreatment on nurses' moral distress, burnout, and intention to leave. Design and method: This descriptive cross-sectional correlational study was conducted in a mid-Atlantic, urban area Magnet pediatric level I trauma center that cares for over 1800 cases of suspected child maltreatment annually. An anonymous electronic survey was sent to all the nurses working at the hospital. ETHICAL CONSIDERATIONS: Institutional Review Board approval was received from the first author's university and the hospital where the study was conducted. FINDINGS: Overall, nurses (N = 146) reported low levels of moral distress with a mean score of 59.54 (SD = 49.22) and a range of 0-300 on the Moral Distress Scale Neonatal-Pediatric version. Although the frequency of caring for suspected child maltreatment victims did not affect nurses' moral distress, caring for victims with fatal maltreatment contributed to nurses' intention to leave, χ2 (1) = 5.35, p = 0.02. CONCLUSION: The results of this study add to the understanding of moral distress in pediatric nursing. Caring for victims with fatal maltreatment impacts pediatric nurses' intention to leave.

Cracking the Code for Quality: The Interrelationships of Culture, Nurse Demographics, Advocacy, and Patient Outcomes.

OBJECTIVE: The aim of this study was to describe the complex relationships among patient safety culture, nurse demographics, advocacy, and patient outcomes. BACKGROUND: Why has healthcare lagged behind other industries in improving quality? Little nursing research exists that explores the multifactorial relationships that impact quality. METHODS: A convenience sample of 1045 nurses from 40 medical/surgical units was analyzed using a correlational cross-sectional design with secondary data analysis. Data sources included survey results for patient safety culture, nurse perceptions of patient advocacy, and patient experience and fall and pressure ulcer rates. RESULTS: Significant findings included a positive correlation between patient safety culture and advocacy and a negative correlation between safety culture, advocacy, and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. CONCLUSIONS: Newer nurses were more positive about safety culture and advocacy, whereas experienced nurses were overall less positive.

Reliability and Validity of an Adapted and Translated Version of the Mullen Scales of Early Learning (AT-MSEL) in Rural Guatemala.

BACKGROUND: A growing literature base supports the use of tests developed in high-income countries to assess children in low resource settings when carefully translated, adapted, and applied. Evaluation of psychometric properties of adapted and translated measures within populations is necessary. The current project sought to evaluate the reliability and validity of an adapted and translated version of the Mullen Scales of Early Learning (AT-MSEL) in rural Guatelama. METHODS: The reliability and validity of the AT-MSEL in rural Guatemala were analyzed for children ages 0-5 years. RESULTS: Interrater reliability coefficients (ICC = 0.99-1.0) and internal consistency (Cronbach's alpha = 0.91-0.93) were excellent for all subscales. General linear models utilizing paired data showed consistency between standard scores (p < 0.0001). Mean raw scores increased with chronological age, as expected. Across age groups, subscales were significantly, positively correlated with one another (p < 0.05 - < 0.001) with one exception, visual reception and expressive language at the 0-10 month age range (p = 0.43). CONCLUSIONS: The AT- MSEL showed strong psychometric properties in a sample of young children in rural Guatemala. Findings demonstrate that the AT-MSEL can be used validly and reliably within this specific population of children. This work supports the concept that tests developed in high-income countries can be used to assess children in low resource settings when carefully translated, adapted and applied.

A need for trauma informed care in sexually transmitted disease clinics.

OBJECTIVE: This review examines trauma from violence as a risk factor for sexually transmitted diseases (STDs) among women attending STD clinics. The review also aims to suggest trauma informed care (TIC) integrated into STD clinics might more effectively address traumatic effects of violence linked to sexual risk behaviors among this population. DESIGN AND SAMPLE: A systematic literature review was conducted to identify empirical studies examining the relationship between multiple forms of violence and sexual risk behaviors among women attending STD clinics. RESULTS: All studies found high rates of violence including childhood sexual abuse, intimate partner violence, and/or community violence associated with high rates of sexual risk behaviors among women attending these settings. Researchers recommend screening for multiple forms of violence, interdisciplinary STD clinic services, and more trauma informed sexual risk reduction interventions to address multiple forms of violence found prevalent among this population. CONCLUSION: Women attending STD clinics very often experience multiple forms of violence during their lifetime. TIC to address traumatic effects of violence might reduce sexual risk behaviors and sexually transmitted disease rates for improved health outcomes among this population.

Evaluating Health-Related Quality of Life and School Attendance in a Multidisciplinary School Program for Youth with Significant Medical Needs.

Many youth with significant medical needs have difficulty attending traditional schools due to academic, physical, and psychosocial challenges. To meet the needs of these youth and prepare them for a successful transition to a traditional school, a multidisciplinary school program (MSP) provides support in these three domains. The aims of this program evaluation are to describe the operation of the novel MSP, characterize participants, and determine the impact of participation as related to school attendance and health-related quality of life (HRQoL). Attendance in the MSP was significantly higher than school attendance estimates provided by caregivers prior to participation in the program. Youth reported significant improvement in physical functioning and total HRQoL. Caregivers reported significant improvement in academic functioning and total HRQoL of youth. The MSP represents a unique educational model for youth with significant medical issues that also provides physical and psychosocial support. Initial findings highlight the potential positive impact of this model for this population of youth.

Normative nursing ethics: A literature review and tentative recommendations.

We describe the results and implications of a literature review that identifies the number of normative and empirical articles, respectively, that have appeared in Nursing Ethics in each year from 1994 to 2017. The results of our analysis suggest a powerful trend away from normative scholarship and toward empirical investigation within the field of nursing ethics, both overall and comparatively. We argue that there are several important negative consequences of this trend, and we propose some potential solutions to address them.

Receptive language skills among young children in rural Guatemala: The relationship between the Test de Vocabulario en Imagenes Peabody and a translated and adapted version of the Mullen Scales of Early Learning.

BACKGROUND: Children in low- and lower middle income countries (LMICs) often have poorer language skills compared with children from high-income countries. Limited availability of culturally and linguistically appropriate assessment measures in LMICs, especially for young children, can hinder early identification and prevention efforts. Here, we describe receptive language (RL) skills among young children in rural Guatemala and report on the validity of a translated and culturally adapted developmental measure of RL. METHODS: Children (n = 157; m = 53.6 months, range = 42-68 months) enrolled in a prospective cohort study of postnatally acquired Zika virus infection were administered the Test de Vocabulario en Imagenes Peabody (TVIP) and the RL scale from a translated and adapted version of the Mullen Scales of Early Learning (MSEL). Performance on the TVIP was compared with the Latin American normative sample. Correlational analysis examined the relationship between performance on the TVIP and the MSEL-RL. RESULTS: Mean scores were significantly below the normative sample mean on the TVIP, t(126) = -11.04, p < .001; d = 1.00. Performance on the TVIP among children who passed the practice items (n = 127) was significantly positively associated with performance on the MSEL-RL (r = .50, p < .001), but not significantly associated with age or gender. Older age (p < .0001) and female gender (p = .018) were associated with passing the TVIP practice items. CONCLUSIONS: Delays in RL vocabulary were identified among young children in rural Guatemala on the TVIP. The association between scores on the TVIP and the RL scale of the MSEL provides preliminary support for the construct validity of this translated and adapted version of the MSEL.

The Nurse-Engineer: A New Role to Improve Nurse Technology Interface and Patient Care Device Innovations.

PURPOSE: The purpose of this article is to describe two innovative biomedical engineering and nursing collaborations designed to educate a new cadre of professionals and develop new knowledge and innovations (robots, patient care devices, and computer simulation). ORGANIZING CONSTRUCT: Complex health problems demand a highly skilled response that uses teams of professionals from various disciplines. When the biomedical engineering lens is expanded to include the practical perspective of nursing, opportunities emerge for greater technology-nurse interface and subsequent innovation. A joint nursing-engineering degree program provides the ideal preparation for a well-informed nurse-engineer who can explore new and innovative solutions that will improve care and patient outcomes. APPROACH: A review of the literature provides the background on innovation and engineering in nursing and a rationale for the development of two innovative joint degrees, as well as a description of those programs. FINDINGS: These innovative programs will advance healthcare-related technology and maximize the potential contribution of the nursing profession in the design and implementation of creative solutions. They also have the potential to increase the skills and knowledge for students enrolled in biomedical engineering or Bachelor of Science in nursing programs individually, providing them with interdisciplinary training and exposure. CLINICAL RELEVANCE: Important patient care improvement opportunities are missed when nurses are not actively engaged in patient care device innovation and creation. Innovative nurse and engineer collaborations are needed in various forms to leverage nurse ingenuity and create patient care innovations.

Rural Postpartum Women With Substance Use Disorders.

The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.

Self-care among Filipinos in the United States who have hypertension.

BACKGROUND: Despite the strong literature on the influence of self-care on hypertension (HTN) diagnosis, there is a notable lack of studies that explore self-care among Filipino immigrants in the United States (US) who have HTN. AIM: To determine the levels of and relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care among first generation Filipino immigrants in the US who have HTN. DESIGN: A cross-sectional correlational design was used to determine the relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care using the Transactional Model of Stress and Coping. One hundred and sixty-three community-dwelling first-generation Filipino immigrants participated in the study. METHODS: Data on HTN self-care, acculturation, acculturative stress, HTN self-efficacy, and patient activation were collected. RESULTS: The study results revealed that HTN self-efficacy and patient activation significantly contributed to the regression model that accounted for 29.5% of the variance in HTN self-care for this sample. Further analysis revealed that patient activation had a mediating role between HTN self-efficacy and HTN self-care. CONCLUSIONS: Findings from this study revealed that HTN self-efficacy and patient activation were associated with self-care behaviors associated with HTN management for this sample. CLINICAL RELEVANCE: Findings from this study highlight the importance of addressing HTN self-efficacy and patient activation in improving HTN self-care for this population.

Patient Safety and Workplace Bullying: An Integrative Review.

Workplace bullying is strongly associated with negative nursing outcomes, such as work dissatisfaction, turnover, and intent to leave; however, results of studies examining associations with specific patient safety outcomes are limited or nonspecific. This integrative review explores and synthesizes the published articles that address the impact of workplace nurse bullying on patient safety.

Women in Transition: Experiences of Health and Health Care for Recently Incarcerated Women Living in Community Corrections Facilities.

Health priorities of women after incarceration remain poorly understood, constraining development of interventions targeted at their health during that time. We explored the experience of health and health care after incarceration in a focused ethnography of 28 women who had been released from prison or jail within the past year and were living in community corrections facilities. The women's outlook on health was rooted in a newfound core optimism, but this was constrained by their pressing health-related issues; stress and uncertainty; and the pressures of the criminal justice system. These external forces threatened to cause collapse of women's core optimism. Findings support interventions that capitalize on women's optimism and address barriers specific to criminal justice contexts. © 2016 Wiley Periodicals, Inc.

Exploring Safe Sleep and SIDS Risk Perception in an African-American Community: Focused Ethnography.

OBJECTIVES: Explore the cultural influences of safe sleep practices by African-American caregivers of children under 2 years old. Explore the role of health care professionals in promoting safe sleep. DESIGN AND SAMPLE: A focused ethnography was used to understand the contextual cultural meaning and experiences of safe sleep practices of African-American caregivers of children under 2 years. Nineteen African-Americans participated in this study. MEASURES: Demographic data were collected and semi-structured interviews were conducted with individuals and small groups. Saturation of the data occurred after 17 interviews. Data were analyzed using Leininger's four Phases of qualitative data analysis. RESULTS: (Themes): (1) The informants expressed both accurate and inaccurate knowledge of Sudden Infant Death Syndrome (SIDS) and safe sleep practices influenced by personal experiences, hospital education, family, extended family and television; (2) Sleeping with infants and children was viewed as a cultural caring behavior promoting comfort, closeness and protection for infants, children, parents and caregivers; (3) The informants want and are seeking collaboration with nurses and health care professionals who are viewed as important in promoting accurate information about SIDS and safe sleep practices. CONCLUSION: The role of the nurse can impact accurate outcomes about SIDS and safe sleep practices.