Nursing leadership in tobacco dependence treatment to advance health equity: An American Academy of Nursing policy manuscript.

BACKGROUND: Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PURPOSE: The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing's Health Behavior Expert Panel Tobacco Control subcommittee. METHODS: Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FINDINGS: The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DISCUSSION: Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.

Pilot Intervention for Mindful Drinking and Eating for Patients on Hemodialysis with Fluid Restrictions: Lessons Learned.

Patients requiring hemodialysis would benefit from evidence-based strategies that improve adherence to fluid restrictions while concurrently improving quality of life (QOL). This pilot study examined the effect of a four-week mindful drinking and eating intervention on interdialytic weight gain and QOL in patients on hemodialysis. Using paired t tests, no significant differences from pre- to post-test were found in interdialytic weight gain, a measure of fluid restriction adherence, or QOL in either the intervention (n = 18) or wait list control (n = 19) group. However, there was positive qualitative feedback from participants in exit interviews, and there were other indications of feasibility (low drop out, engagement in at-home practice according to weekly checklists). Lessons learned from this pilot study about conducting research regarding fluid restrictions for patients on hemodialysis are presented.

Lessons learned from eight teams: The value of pilot and feasibility studies in self-management science.

Designing and conducting effective intervention research is an important domain of nursing science. Nurse scientists have long recognized people with chronic conditions need effective self-management strategies across the lifespan, so they have led the way in establishing theoretical and practical grounds for the science of self-management. Guidance from pilot and feasibility research for self-management interventions is scarce. Documented exemplars of successes and failures in pilot and feasibility study designs are scant in the literature. The purpose of this paper is to illustrate methodological approaches using pilot and feasibility examples. To maximize collective lessons learned in self-management science study design, features of our pilot and feasibility research strategies that yielded both desirable and undesirable outcomes are described, analyzed, and paired with alternative solutions. A National Institute of Nursing Research P30 grant center, awarded grants to 8 pilot investigators to pilot self-management interventions. A wide variety of chronic conditions were addressed, including heart failure, chronic kidney disease, multiple sclerosis, diabetes, and HIV. The investigators provided their experiences of study implementation. Common themes across the studies were identified. There were four lessons learned from these studies: 1) maximize resources and develop enough evidence for subsequent studies; 2) embed patient-centered feasibility within implementation testing with new patient populations; 3) develop a flexible participant recruitment plan to allow for adjustments when unexpected barriers arise; and 4) define study-specific data collection procedures to demonstrate feasibility. Researchers conducting preliminary small-scale self-management intervention research must balance resources to develop and implement interventions to meet pilot and feasibility objectives.

Quality of Life after Dietary Self-Management Intervention for Persons with Early Stage CKD.

Dietary recommendations that potentially delay the progression of chronic kidney disease (CKD) can be perceived as restrictive and unpalatable, negatively impacting quality of life (QOL). This pilot study examined the effect of a six-week small group intervention, "Self-Management of Dietary Intake Using Mindful Eating," on QOL, health literacy, and dietary self-efficacy among persons with CKD Stages 1-3. Improvements (n=19) were found from pre-test to post-test in total scores for Kidney Disease Quality of Life Short Form-36 (p=0.003), health literacy (p=0.001), and self-efficacy (p=0.003). The intervention had promising results for improving both diet management and QOL, which supports further testing in randomized control trials.

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease.

Using mindful eating to improve specific dietary recommendations has not been adequately studied. This feasibility study examined an intervention, self-management of dietary intake using mindful eating, with 19 participants that had mild to moderate chronic kidney disease, using a prospective, single group, pretest-posttest design. The intervention had six weekly classes focused on self-management using mindful eating, goal-setting, problem-solving, and food label reading. Weight, body mass index (BMI), 3-day 24-h dietary recalls and fasting blood samples were measured. Participants improved significantly in mean weight (203.21 ± 42.98 vs 199.91 ± 40.36 lbs; P = 0.03) and BMI (32.02 ± 5.22 vs 31.57 ± 5.27 kg/m2; P = 0.04), but not in dietary intake nor blood measures with the exception of cis-beta-carotene levels (0.020 + 0.012 vs 0.026 + 0.012 mcg/mL; P = 0.008), which correlates to fruit and vegetable servings. These promising results warrant further testing of the intervention in randomized control trials.

Relationships among maternal nutrient intake and placental biomarkers during the 1st trimester in low-income women.

PURPOSE: Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester. METHODS: A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy. RESULTS: The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024]. CONCLUSIONS: Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.

An Interprofessional Approach to Advance Care Planning.

CONTEXT: Advance care planning (ACP) can improve patients' outcomes at end of life, and interprofessional collaboration has been recommended to facilitate ACP. However, role confusion in ACP facilitation among team members from different disciplines exists, and health professional disciplines' expectations for interprofessional collaboration in ACP are unclear. OBJECTIVE: To review expectations of major health professional organizations for ACP competencies, in order to identify gaps and opportunities for promoting interprofessional collaboration in ACP facilitation. METHODS: Guidelines and recommendations for ACP across disciplines including chaplaincy, medicine, nursing, psychology, and social work were identified and analyzed using content analysis. Main themes were then reviewed against national consensus statements on 4 ACP outcomes (process outcomes, action outcomes, quality of care outcomes, and healthcare outcomes) and mapped into existing domains for interprofessional education competency: values/ethics, roles/responsibilities, interprofessional communication, and teams and teamwork. RESULTS: Three major content themes were identified: professional commitment to advocating for patients' values and self-determination, professional responsibility to facilitate ACP, and specific tasks in ACP. These themes addressed mostly process and action outcomes of ACP but not quality of care outcomes or healthcare outcomes. Few disciplines included interprofessional collaboration as part of ACP competency. CONCLUSION: There is a need for standardized competency guidelines for interprofessional collaboration in ACP as an important first step in reducing confusion among roles and other challenges in facilitating ACP. Further efforts in practice, research, and policy are needed to facilitate interprofessional ACP, achieve competencies, and improve patients' outcomes.

Predictors of dietary quality in low-income pregnant women: a path analysis.

BACKGROUND: Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. OBJECTIVE: The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. METHOD: A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. RESULTS: The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (ß = .36) and a direct (ß = -.23) and indirect effect on dietary quality (ß = -.30). Poor eating habits had a direct effect on dietary quality (ß = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (ß = .39) and nutritional knowledge (ß = .18) and an indirect effect on dietary quality (total effect, ß = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. DISCUSSION: Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Strategies for and barriers to managing weight when eating at restaurants.

INTRODUCTION: Eating in restaurants contributes to excess caloric intake, which leads to weight gain, but little is known about strategies used to manage weight or barriers to weight management in restaurant settings. We describe and compare the strategies men and women use and the barriers they encounter when eating at restaurants. METHODS: We recruited a convenience sample of 146 adults at a university open house. Participants completed questionnaires on demographics and eating patterns, strategies used to manage weight in restaurants, and barriers to managing weight in restaurants. RESULTS: The most common strategies used by participants were avoiding sugar-filled drinks, choosing steamed vegetables and whole-grain foods, and stopping eating when full. We found few differences by sex: women were more likely to share appetizers or meals, substitute appetizers for meals, have salads as entrées, order salad dressing on the side, and bring half of the meal home. CONCLUSION: Women and men had more similarities than differences in strategies for and barriers to managing weight in restaurants. We need to understand what influences food choices at restaurants in order to develop comprehensive plans for weight management.

Using Videoconferencing for Verbal Reports to Improve Clinical Nurse Specialist Student Performance.

PURPOSE: Clear, concise verbal reports are essential to clinical nurse specialists' practice, yet current literature addressing the development of this skill is sparse. The purpose of this study is to determine the effectiveness of using videoconferencing for verbal reports as a learning strategy for improving clinical nurse specialist students' communication competencies and advanced practice decision making. DESCRIPTION OF THE PROJECT: Videoconferencing, using iPad minis issued to faculty and students, was used routinely for verbal reports on clinical cases to faculty, which included immediate faculty feedback. A verbal report template of patient chief complaint, applicable history, review of systems, physical examination/labs, differential diagnoses, and management was developed and provided to students. OUTCOME: Initial student verbal reports were disorganized, lengthy, lacking content, or containing extraneous details. After students routinely gave verbal reports via videoconferencing, verbal report time for the class decreased from more than 20 minutes to 3 to 5 minutes and the accuracy of reports also increased. CONCLUSION: A concise, clinically relevant verbal report template, combined with videoconferencing that allowed for frequent and immediate feedback from faculty, improved student communication competencies. Current technology, such as tablets and smart phones, provide videoconferencing opportunities that can be used to enhance learning for students.

Food Sources of Sodium in Korean Americans With Type 2 Diabetes: Implications for Cardiovascular Disease.

INTRODUCTION: Excess sodium intake can increase the risk of high blood pressure and cardiovascular disease, common comorbidities for those with type 2 diabetes mellitus (T2DM). The purpose of this study is to describe sodium intake and high sodium food sources among Korean Americans (KAs) with T2DM. METHOD: This study, a descriptive, secondary analysis of baseline data from a clinical trial for diabetes, recruited KAs with T2DM ( n = 232) from the community. RESULTS: Average dietary sodium intake was 3,433 mg. Major sources of dietary sodium were from bicultural diets: noodles and dumplings, Korean-style soups, kimchi, breads and snacks, and boiled or seasoned vegetables. Participants who consumed excessive sodium were more likely to consume more calories and be male, married, and more recently diagnosed with T2DM. DISCUSSION: High consumption of sodium among KAs with T2DM supports the need to develop effective, tailored interventions addressing dietary sodium that incorporates the individual's culture.

Factors influencing dietary fat intake among black emerging adults.

OBJECTIVE: To determine what factors influenced dietary fat intake (DFI) among black emerging adults. PARTICIPANTS: Sample included 251 black emerging adults, ages 18-25 years, living in the US. METHODS: This was a nonexperimental cross-sectional study based on self-report data. RESULTS: The sample had high DFI. Factors related to DFI were gender (rpb = -.22, p < .001), perceived barriers for healthy eating (r = .32, p < .001), and perceived self-efficacy (r = -.33, p < .001). These variables were also significant predictors for DFI. Gender was significantly related to DFI (b = -5.894, p = .000). Religious commitment moderated the effect of stress on DFI. CONCLUSIONS: Gender, perceived barriers for healthy eating, and perceived self-efficacy were significant predictors for DFI. Religious commitment influenced the relationship of perceived stress and DFI. These findings may lead to interventions designed to reduce DFI and cardiovascular risks among black emerging adults.

Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children.

PURPOSE: The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma. METHODS AND DESIGN: Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management. RESULTS: Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions. PRACTICE IMPLICATIONS: Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.

Factors Predicting Sodium Intake of Korean Americans with Type 2 Diabetes.

The increasing prevalence of type 2 diabetes mellitus (T2DM) and its complications including cardiovascular disease and chronic kidney disease threaten Korean Americans (KAs). High dietary sodium intake contributes to both conditions. The purpose of the study was to assess dietary sodium consumption and to examine the predictors of sodium intake among KA with T2DM. A total 232 KA who had uncontrolled diabetes participated in this study. The majority of the sample (69%) consumed more sodium than current national guidelines. A high level of energy intake was the strongest predictor for sodium intake with gender and marital status also related. Our findings identified predictive factors to excessive sodium intake and these data support the need for culturally-tailored education about appropriate dietary sodium and energy intake are needed for patients about T2DM.

Anatomy of a binge: food environment and characteristics of nonpurge binge episodes.

This secondary analysis prospectively examined nonpurge binge eating patterns in a naturalistic setting in 48 nonpurge binge eating women. Binge eating episodes were analyzed from 14-day food diaries to describe the binge and to determine how types of foods consumed and setting variables affected nonpurge binge eating women. Findings indicated that binge episodes occurred mostly during the lunch (27.1%) and dinner hours (45.8%) and on weekends (62.5%). Half of the binge episodes occurred in restaurants. The most common items consumed during binges were breads/pasta (64.6%), sweets (56.2%), high fat meat items (45.3%), and salty snacks (39.6%) while the predominant foods consumed during these binges were high fat meat items (29.2%), sweets (21.0%), and salty snacks (18.8%). Those who predominantly binged on sweets had significantly more binge days [t(46)=-2.8, p<.01]. Women who predominantly binged on fried meat had significantly higher body mass index (BMI) [t(46)=-2.8, p<.01]. A higher BMI was also associated with binging during meals rather than binging during snacks [t(46)=2.4, p<.05]. The results suggest that nonpurge binge eating patterns are more problematic during meal times.

A Multifaceted Model to Evaluate Interprofessional Education in Clinical Nurse Specialist Programs.

PURPOSE: Preparing students to engage in team-based healthcare is a major focus of clinical nurse specialist (CNS) education programs. A robust evaluation plan is needed to monitor achievement of key outcomes in this complex undertaking. DESCRIPTION: Informed by the work of Kirkpatrick and Stufflebeam, an evaluation model that incorporates multiple information sources about process and outcomes related to interprofessional (IP) education is proposed. OUTCOME: Improvements in scores on attitude and competency measures suggest that the program had the desired effects on students' attitudes and self-efficacy for IP collaboration and was validated by faculty clinical observations of IP communication and teamwork. Moreover, students indicated at both graduation and at 1-year follow-up surveys that they were prepared to function on IP teams, providing further evidence that the clinical nurse specialist (CNS) program prepared them in this key area of nursing practice. CONCLUSION: The evaluation plan guided the collection of quantitative and qualitative information that faculty could use to refine the CNS program. Congruent with the CNS role as change agents, future model refinements should incorporate systems change activities.

Managing Gestational Weight Gain: Obstetricians' Perceived Barriers and Interventions.

To support optimal health outcomes during pregnancy, understanding obstetricians' (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs' practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).

Trajectory of weight changes in the first 6 weeks postpartum.

OBJECTIVE: To determine the trajectory of postpartum weight changes and to examine associations between weight change in the first 6 weeks postpartum and demographic, clinical, psychosocial, and behavioral variables. DESIGN: Prospective, longitudinal design. SETTING: Community hospital and university research setting. PARTICIPANTS: 26 low-income women (9 White, 8 Black, and 9 Hispanic) with uncomplicated term pregnancies. MAIN OUTCOME MEASURE: Body mass index measured weekly. RESULTS: Among White women, body mass index decreased significantly for the first 3 weeks of the postpartum period. Black women experienced a significant reduction in body mass index for only the first 2 postpartum weeks. Similarly, the postpartum body mass index decreased for the first 2 weeks for Hispanic women. Prepregnancy body mass index and gestational weight gain each had a significant positive effect on postpartum body mass index. Perception of social support at 4 weeks had a significant positive effect on postpartum body mass index in Black women. CONCLUSIONS: The trajectory of weight change was nonlinear with large initial weight losses during the first 2 to 3 weeks postpartum followed by weight plateaus for the remainder of the first 6 weeks postpartum.

Restaurant eating in nonpurge binge-eating women.

This study describes restaurant-eating behaviors for nonpurge binge-eating women in comparison to dieters. Restaurant-eating behaviors were determined from a content analysis of 14-day food diaries using a convenience sample of 71 women who reported binging without purging and 46 dieters without a recent binge history. Comparing bingers to dieters, there were no significant differences in frequency of eating out, dessert consumption at restaurants, or fast food eating. Bingers more often perceived restaurant eating to be uncontrolled and excessive. Both bingers and dieters consumed significantly more calories (226-253 kcal) and fat (10.4-16.0 gm) on restaurant days. Extra calories consumed on restaurant-eating days may contribute to weight gain over time, especially with frequent restaurant eating. Restaurants may present a high-risk food environment for bingers and dieters, contributing to loss of control and excess consumption.

Developing a course to teach Spanish for health care professionals.

To make the baccalaureate nursing curriculum more responsive to changing U.S. demographics, the School of Nursing at The University of Texas at Austin instituted a required course, titled Spanish for Health Care Professionals. This course, developed in collaboration with the University's Department of Spanish and Portuguese, focuses on conversational Spanish using the communicative language teaching approach, rather than grammar and medical terminology instruction. Class activities, along with course materials, are linked to nursing practice. Course assignments are designed to develop authentic communication in reading, writing, listening, speaking, and understanding culture, and students demonstrated oral and written linguistic gains in relation to their Spanish fluency and accuracy. Because the Hispanic population is now the largest minority group in the United States, this course will help nurses communicate with Spanish-speaking patients.