Specific Medication Literacy in Older Adults with Asthma.

Purpose: To explore specific medication literacy (SML) of older adults and associations of SML strength. Methods: This was an observational study. Participants were at least 60 years old, with an asthma diagnosis and in good health. Data were collected by a registered nurse researcher. The SML data collection instrument gathered information about each medication a participant used: name, purpose, how taken, special instructions, adverse effects, and drug-drug or drug-disease interactions. An SML scoring rubric was developed. Results: All could provide name, and most provided purpose, how taken. The lowest SML domains were side effects and interactions. Age at time of asthma diagnosis correlated with stronger SML scores and living in a disadvantaged neighborhood correlated with lower SML scores. Discussion: Gaps in medication literacy may create less ability to self-monitor. Patients want medication literacy but struggle with appropriate, individualized, information. Conclusion: The study provides insights on gaps and opportunities for SML.

Resilience, Moral Distress, and Job Satisfaction Driving Engagement in Emergency Department Nurses: A Qualitative Analysis.

AIM: The aim of this study was to explore how resilience, job satisfaction, and moral distress affect emergency department (ED) nurses' workplace engagement. BACKGROUND: Stressful nursing workplace conditions increase moral distress. Lowering moral distress and improving resilience can increase workplace engagement. METHOD: Semistructured qualitative interviews were conducted with 15 ED nurses. RESULTS: Participants indicated that greater nursing experience, increased confidence in skills, ability to overcome emotional stressors, and more satisfaction with patient care all improved resilience and workplace engagement. Morally distressed, disengaged nurses reportedly lacked workplace autonomy and/or ability to make workplace changes or worked in hostile and/or unsafe workplaces. Engaged nurses invested more time in their job and were more willing to remain in their workplace. CONCLUSION: Retaining older, more experienced nurses, valuing staff work, and creating a meaningful workplace foster workplace engagement. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can support nurses' workplace engagement through interventions that build resilience, lower moral distress, and increase job satisfaction.

Pain Management and Education for Ambulatory Surgery: A Qualitative Study of Perioperative Nurses.

BACKGROUND: Ambulatory surgery presents unique challenges regarding adequate pain management and education. Studies have documented issues with transfer of information and patient comfort. Our objective was to explore perioperative nurses' perspectives of current practices and challenges with pain management and education. MATERIALS AND METHODS: We used a qualitative descriptive design and conducted four focus group interviews, with 24 total participants from two perioperative areas of an academic medical center, using a standardized script. Using qualitative analysis software, two investigators reviewed the data and coded major themes and subthemes. The consolidated criteria for reporting qualitative studies guidelines were followed for reporting the data. RESULTS: We identified four major themes impacting current perioperative pain management and education practices: communication among the perioperative care team, sources of nurses' frustrations in the perioperative setting, patient expectations for pain, and nurse-driven pain management and education. Nurses highlighted their work became easier with adequate information transfer and trust from physicians. Frustrations stemmed from surgeon, system, and patient factors. Nurses often use their clinical experience and judgment in managing patients throughout the perioperative period. Furthermore, nurses felt patients have limited pain education and stressed education throughout the surgical care pathway could improve overall care. CONCLUSIONS: Perioperative pain management, assessment, and education practices are inconsistent, incomplete, and sources of frustrations according to participants. Participant experiences highlight the need for improved and standardized models. Patient pain education should use a multidisciplinary approach, beginning at the point of surgery scheduling and continuing through postoperative follow-up.

Recruitment strategies and challenges: Lessons learned from a coal ash and children's health study.

The purpose of this paper is to describe the approaches and recruitment strategies of a study focused on the impact of coal fly ash on neurobehavioral performance among children living in proximity to coal-burning power plants. Challenges encountered with each recruitment approach are highlighted as well as solutions used to overcome those challenges and ultimately enroll children and one of their parents or guardians. To ensure participants were distributed throughout the study area, geographical information systems were used to guide recruitment and achieve the target sample size (N = 300). Several approaches were employed to recruit the number of needed participants, including "shoe leather" or door-to-door recruitment, placement of flyers and brochures in public spaces, mailings to targeted addresses, media announcements, and local government outreach. Since September 2015, 265 participants have been enrolled in the study using a combination of the described recruitment approaches. Even with a well-designed plan, it is important to re-examine strategies at every step to maximize recruitment efforts. Researcher flexibility in adapting to new strategies is vital in facilitating recruitment efforts, and the recruitment of participants in the study remains a dynamic and evolving process.

Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results.

Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are ≥60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.

A scoping review of environmental health nursing research.

OBJECTIVE: The purpose of this scoping review was to determine the extent and focus of published environmental health nursing research. DESIGN AND SAMPLE: The search was limited to peer reviewed, English-language environmental health nursing research with at least one nursing author, published between 1995 and 2015 in a nursing journal, and catalogued in CINAHL. RESULTS: Publication of the 548 identified articles occurred in 118 different nursing journals. Annual number of publications increased from nine articles in 1995 to 50 in 2013 and 2014. Most (63%) of the studies occurred in the Unnited States; the remaining studies took place in 33 other countries. Three primary focus areas were identified: disasters/disaster preparedness, occupational health, and the home environment. Other focus areas included environmental exposures, environmental risk perception, secondhand smoke, and environmental health education. The primary populations studied were nurses/nursing students (40%) and adults (26%). Most common research designs employed were cross-sectional (42%) and qualitative methods (20%). CONCLUSIONS: Findings from this scoping review support a global expansion of published environmental health nursing research addressing a variety of environmental health topics. Additional studies are needed that use more complex research methods and address timely topics such as climate change and sustainability.

Public Health Nursing Position Descriptions Congruence with ANA Standards, Public Health Essential Services, and Quad Council Domains.

OBJECTIVE: To map position descriptions (PDs) for staff public health (PH) nurses to two national frameworks for PH nursing and one framework for PH. DESIGN AND SAMPLE: This descriptive study included PDs (N = 161) from 66 Ohio local health departments. MEASURES: Statements in each PD were analyzed for congruence with the twenty 2007 American Nurses Association Public Health Nursing Standards/Substandards (ANA Standards), the 10 Essential Services of Public Health (ES), and the eight 2003 Quad Council Public Health Nursing Skills Domains (QC domains). Health department and PD characteristics also were obtained. RESULTS: PDs addressed an average of 6.1 of the 20 ANA Standards, 4 of the 10 ES, and 1.9 of the 10 QC domains. The most commonly addressed ANA Standards, ES, and QC domains focused on assessment, linkages, health education, and regulation enforcement. About 78% of the PDs included task statements that did not correspond to any of the professional frameworks. CONCLUSIONS: Findings from this study demonstrate a lack of congruence between the organizational and the disciplinary expectations for PH nurses. Given the increasing focus on PH department accreditation, performance management, and workforce development, PH nursing must address this incongruence to strengthen the profession and the public's health.

Student nurses' risk perceptions of home environmental hazards.

OBJECTIVE: This study described nursing students' perceptions of home health risks. DESIGN AND SAMPLE: Nursing students (N = 254) at two large urban universities completed a cross-sectional survey during the 2011-2013 academic years. MEASURES: From a list of 22 common home health hazards, students identified what they perceived as the three: (a) most dangerous hazards, (b) most common hazards in their state, (c) hazards most likely to be present in their current home, and (d) hazards they would most afraid to find in their home. Students also rated perceived dangerousness of the hazards, how healthy they perceived their home to be, and the perceived effect of their home on their own health. RESULTS: Tobacco smoke, asbestos, and cleaning products were the most commonly identified home hazards. Individual characteristics, hazard experiences in personal homes, and university geographic location (state) were associated with perceptions of home hazards. Students who identified hazards in their own homes were more likely to identify them as hazards in general and for their own state. CONCLUSIONS: These results fill a foundational knowledge gap by describing the risk perceptions of near-future health care providers about home environmental hazards.

The impact of an urban home-based intervention program on asthma outcomes in children.

OBJECTIVES: This program evaluation examines the outcomes of a multicomponent urban home-based asthma program implemented through a city health department in a large Midwestern city. The purpose of the program was to improve asthma outcomes by controlling indoor asthma triggers in the home environment. DESIGN AND SAMPLE: This was a pre-post evaluation study. Participants received home-based education from a public health nurse or a health educator, cleaning and other supplies, and physical home interventions such as mold abatement and pest control. Asthma outcomes, caregiver quality of life, trigger-related activities, and asthma management activities at baseline and 6 months following the intervention were evaluated using survey data. A total of 115 participants for whom baseline and follow-up data were available were included in this analysis. MEASURES: This study used parent self-reported quantitative and qualitative data which were collected through baseline and follow-up surveys administered by program staff. RESULTS: Significant reduction in asthma symptom days, nighttime awakenings, days with activity limitation, and albuterol use were observed. Emergency department visits, missed school days, and caregiver missed work days also were significantly reduced, and caregiver quality of life improved. CONCLUSIONS: This multifaceted home-based intervention decreased asthma triggers and improved asthma outcomes in children, and improved the quality of life of their caregivers.

Congruence between position descriptions for public health nursing directors and supervisors with national professional standards and competencies.

OBJECTIVES: This study described the extent to which position descriptions (PDs) for public health directors of nursing (DONs) and non-DON public health nursing (PHN) supervisors in Ohio local health departments incorporate national standards of PHN practice and competencies for public health managers. DESIGN: Ninety-four PDs were obtained from 66 local health departments. Statements in each PD were analyzed for congruence with the 2007 American Nurses Association Public Health Nursing Scope and Standards of Practice (ANA Standards) and the Council on Linkages Core Competencies for Public Health Professionals (COL Competencies). Health department and PD characteristics were also obtained. COL Competencies within each COL skill domain were pooled for analysis. RESULTS: Position descriptions addressed an average of 7.6 of the 20 ANA Standards/Substandards (range, 1-15). The most commonly addressed ANA Standards were Leadership, Regulatory Activities, Collegiality and Professional Relationships, and Planning; the least often addressed were Population Diagnosis and Priorities, Professional Practice Evaluation, Outcomes Identification, Advocacy, and Evaluation. Position descriptions addressed an average of 3.6 of the 8 COL skill domains (range, 0-6). Financial Planning and Management, Policy Development/Program Planning, Community Dimensions of Practice, and Analytic/Assessment were the most commonly addressed COL skill domains, whereas Cultural Competence and Basic Public Health Sciences were the least commonly addressed. About 75% of the PDs included task statements that did not correspond to any of the ANA Standards or COL Competencies. CONCLUSIONS: Results indicate that PDs do not reflect compliance with professional mandates for the practice of PHN. This lack of fit between PDs and nationally recognized standards of practice and competencies suggest that PHN may be undifferentiated as a public health discipline and as a nursing specialty.

Inpatient pain assessment and decision-making in internal medicine and general surgery residents: A qualitative analysis.

Background: Understanding physician approaches to pain treatment is a critical component of opioid and analgesic stewardship. Practice patterns learned in residency often persist longitudinally into practice. Objective: This study sought to identify salient factors and themes in how resident physicians assess and manage pain. Methods: Video-recorded focus groups of internal medicine and general surgery residents were conducted via videoconferencing software. Data were analyzed using a ground theory approach and constant comparative method to identify themes and subthemes. Focus groups occurred in September and October 2020. Results: 10 focus groups including 35 subjects were conducted. Four general themes emerged: (1) Assessment considerations; (2) Education & Expectations; (3) Systems Factors; and (4) Management considerations. Participants indicated that while it is important to treat pain, its inherently subjective nature makes it difficult to objectively quantify it. The 0-10 numeric rating scale was problematic and infrequently utilized. Patient expectations of no pain following procedures was viewed as particularly challenging. The absence of formal best practices to guide pain assessment and management was noted in every group. Management approaches overall very highly variable, often relying on word-of-mouth relay of the preferences of specific attending physicians. Conclusions: Pain is highly nuanced and resident physicians struggle to balance pain's subjectivity with a desire to quantify and appropriately treat it. The 0-10 numeric rating pain scale, though ubiquitous, is problematic. Priority areas of improvement identified include education for both patients and physicians, functional pain scales, and expansion of existing effective resources like the nursing pain team.

Application and modification of the integrative model for environmental health.

The Integrative Model for Environmental Health (IMEH) has guided research, literature reviews, and practice initiatives since 2002. This article presents the Modified IMEH that was developed based on using the IMEH as a guiding conceptual framework in a community-based participatory research environmental health project. Concepts from the Model of Risk Information Seeking and Processing as well as emergent themes from the data analysis were instrumental in this process. The Modified IMEH alters the structure of the IMEH in that the Vulnerability and Epistemological Domains are more prominent and feedback between domains is included.

Polypharmacy Interactions Impacting Methacholine Challenge Testing for Asthma Assessment in Older People.

Objective To investigate potential reasons for unusually high incidence of negative Methacholine Challenge Tests (MCT), following standardized MCT medication-hold protocol, in older people with physician-diagnosed asthma. Design An analysis of a longitudinal observational parent study of asthma. Setting Community-dwelling participants were evaluated in an outpatient clinic and at home. Participants Screening inclusion criteria for the parent study included 60 years of age or older, physician diagnosis of asthma, and a positive response to at least one of six asthma screening questions. Participants were enrolled in the study if they also demonstrate either: (1) a postbronchodilator administration response showing an increase of at least 12% and 200 mL in forced expiratory volume or an increase of at least 12% and 200 mL in forced vital capacity, or (2) an MCT result of PC20 ≤ 16 mg/mL (indicating bronchial hyper-responsiveness, MCT positive). Exclusion criteria included diagnosis of cognitive impairment or dementia, residing in a long-term care facility, more than 20 pack/ year smoking history or a history of smoking within the previous five years, inability to perform pulmonary function testing maneuvers, and a Prognostic Index score of greater than 10. Interventions Analysis of participant data for non-medication- and medication-exposure factors for association with negative MCT results. Results Anticholinergic burden and statin use were positively associated with negative MCT. Conclusion Medications not accounted for in medication-hold protocols, and concurrently in use, may impact clinical tests and outcomes.

Rationale and design of integrating a parents first obesity intervention with a pediatric weight management intervention for rural families - Evaluating the ripple effect.

Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment tailored for rural participants. Outcomes of this study include participant weight loss from baseline to 9-months, device-measured physical activity, and dietary intake. This project will additionally compare reach between clinic and school settings and evaluate the impact of nurse engagement. This study will include 240 participants from eight rural communities who will be randomized to either a Parent +Family-based group or a Newsletter +Family-based group. Parents in the Parent +Family-based group will receive a 3-month adult obesity treatment designed for adult behavior change as a first step. Then, parents and children together will enter the family-based program (iAmHealthy), allowing for potential enhancement of a theorized ripple effect. Parents in the Newsletter +Family-based group will receive 3 monthly newsletters and then participate in the 6-month family-based intervention designed for child behavior change. This study is the first RCT to examine the effectiveness of an integrated adult- and child-focused obesity treatment program. Registered with ClinicalTrials.gov NCT ID NCT05612971.

Evaluation of a disaster-surge training for public health nurses.

OBJECTIVE: To examine the effect of a blended educational intervention (in-class and independent learning modules) developed to enhance Ohio PHN confidence in 25 disaster surge competencies that address the PHN role and skills in Preparedness, Response, and Recovery. DESIGN AND SAMPLE: This was a quasi-experimental one group pre and post design. Participants (N = 54) completed pre- and postintervention surveys to evaluate intervention impact on self-perceived confidence and need for further training in the 25 competencies. MEASURES: Parallel pre and post surveys assessed participant evaluation of confidence and need for further competency training. Paired t tests and repeated measures ANOVA compared pre- and postsurvey results. RESULTS: Confidence in Preparedness, Response, and Recovery PHN disaster surge competencies significantly increased, whereas self-perceived need for further competency training correspondingly significantly decreased. CONCLUSIONS: A blended learning approach to disaster surge training effectively improved PHNs confidence in competency achievement and reduced perceived need for further training.

Home environmental hazard education for undergraduate and prelicensure nursing students.

This paper presents a Healthy Homes education module for undergraduate and prelicensure nursing students. The education module, which is based on the National Center for Healthy Housing's framework for Healthy Homes, was developed, implemented, and evaluated in three phases. Phase 1 included nine Web-based recorded lectures on the Healthy Homes principles and on home assessment and referral. In the next phase, a Healthy Homes clinical laboratory simulation (home visit scenario and four rooms of an apartment) was created. Phase 3 involved piloting home visits by students who, under the supervision of a clinical instructor, conducted Healthy Homes assessments of clients living in two low-income subsidized housing sites. Using a pretest-posttest format, students' knowledge of Healthy Homes concepts significantly increased after completing the Phase 1 Web-based lectures. Student evaluations, which were collected after each phase, were consistently positive.

CE: Environments & Health: Chemicals in the Home That Can Exacerbate Asthma.

ABSTRACT: Although chemical exposures from cleaning and disinfectant products often go unnoticed or unrecognized, such exposures have been associated with asthma-related symptoms and exacerbations. The Environmental Working Group (EWG) website provides consumer information on a wide range of issues and products related to human health and the environment, including the use of cleaning and disinfectant products, 2,500 of which it has rated in terms of their effects on respiratory function and asthma. In discussing how the use of cleaning and disinfectant products and the frequency of their use may affect asthma control, the authors use the EWG ratings as well as data collected for a study they conducted on older adults with asthma.

Mask Use Experiences, COVID-19, and Adults with Asthma: A Mixed-Methods Approach.

BACKGROUND: Although masks are recommended for those with asthma in the era of COVID-19, there is limited research exploring the extent of and problems related to mask use in adults with asthma. OBJECTIVE: We sought to describe in adults with asthma: (1) the extent masks are worn and attitudes and beliefs about wearing masks; (2) participant characteristics associated with problems experienced while wearing a mask, and (3) participant experiences and recommendations regarding masks. METHODS: The Mask Use in Adults with Asthma online survey was conducted with 501 adults with asthma (96.6%) primarily from the United States. A Mask Effects Scale (MES) was compiled from items addressing problems experienced wearing a mask with higher total scores indicating more problems. Open-ended questions explored factors considered when choosing a mask, problems experienced while wearing a mask, and recommendations to others with asthma. Survey data were analyzed descriptively and via multiple regression. Themes were generated from open-ended items. RESULTS: Almost all participants (98.4%) indicated wearing a mask in public, and most (67.4%) wore a mask ≤3 hours per day. Poorer asthma control and wearing a mask longer were significantly associated with higher MES scores (P ≤ .001 and .005, respectively). Participant recommendations included "Just wear it," use a comfortable, well-fitting mask, take mask breaks, and carry your inhaler. CONCLUSIONS: Wearing a mask in public was almost uniformly adhered to by participants, despite reporting problematic effects. Implementing recommendations, such as planned mask breaks, can support and enhance the experience of wearing a mask for adults with asthma.