The State of Health and Intentions for Action to Advance Mental Health and Well-being for the Nursing Workforce.

OBJECTIVE: The aims of this study were to explore the health of nurse leaders and assess intentions to integrate workplace mental health/wellness practices. BACKGROUND: National efforts address high rates of poor mental health and lifestyle behaviors among nurses. Few studies describe the extent to which nurse leaders in academic and clinical environments can influence a strategic mission for health/well-being among the nursing workforce. METHODS: Two hundred seventeen email invitations were distributed to nurse leaders from 5 Kentucky nursing organizations to complete a 1-time 46-item online survey assessing individual health behaviors and intentions to build a culture of workplace health/well-being. RESULTS: Most respondents reported positive physical health (86%), positive mental health/intentions for action to change behaviors (80%), improved self-care practices (86%), integration of self-care practices in the workplace (79%), and commitment to integrate suicide prevention training (55%). CONCLUSIONS: Overall, nurse leaders reported positive healthy behaviors. The finding that the highest intentions were reported to integrate, sustain, and/or advance lifestyle behaviors for self-care practices as well as to integrate practices for mental health and well-being in the work environment is encouraging. Enhanced strategies and efforts are needed to prioritize workplace cultures of wellness to benefit nurses and further promote well-being among nurse leaders.

Transformative Learning in an International Immersion Experience for Nursing and Other Undergraduates.

ABSTRACT: This qualitative study described the experience of undergraduates in an international immersion experience designed to foster health promotion among rural Ghanaians. Data in the form of students' reflective writings were analyzed in a rigorous process of literal, interpretive, and reflective readings. Two themes (character building and feeling inspired by others) emerged from the data. The findings suggest that this immersion trip facilitated the transformation of the participants and the development of their cultural competence.

The Long Journey of Alzheimer's Disease.

The growing elderly population is creating record numbers of individuals with Alzheimer's disease (AD) and other dementias. Nursing has an unprecedented opportunity to rethink how we care for adults with dementia, reduce the burden of caregivers, and preserve the personhood of patients. This article reviews AD and dementia pathophysiology, history, screening, stigma, treatments and interventions, and caregiver support. A nurse's journey with her mother with AD imparts the meaning of patient dignity.

The incongruity of workplace bullying victimization and inclusive excellence.

PURPOSE: Bullying occurs frequently-and with significant negative outcomes-in workplace settings. Once established, bullying endures in the workplace, requiring the interaction of a bully perpetrator and an intended target who takes on the role of victim. Not every target becomes a victim, however. The purpose of this study is to investigate the processes by which targets, intended objects of bullies' affronts, become victims, those individuals who experience ongoing emotional injury in response to bullies' affronts, and to clarify how bullying victimization impedes inclusive excellence in the workplace. DESIGN: The design for this study was pragmatic utility, an inductive research approach grounded in assumptions of hermeneutics. METHODS: The pragmatic utility process involved the investigators' synthesis of descriptions from a broad, interdisciplinary published literature. Integrating knowledge from their previous research and practice experiences with the pragmatic utility process, they derived qualitative features of victims' experiences, differentiating target from victim in bullying encounters. FINDINGS: For those targets who ultimately are victimized, response to bullies' affronts extends far beyond the immediate present. Redolence of personal, lived experience revives bygone vulnerabilities, and naïve communication and relationship expectations reinforce a long-standing, impoverished sense. That sense couples with workplace dynamics to augment a context of exclusion. CONCLUSION: Findings suggest that, as Heidegger contended, we are our histories. Personal history demonstrates a significance influence on the manifestation of bullying victimization, acting to distance them from their workplace peers and to impede inclusive excellence.

Unacknowledged threats proffered "in a manner of speaking": recognizing workplace bullying as shaming.

PURPOSE: The purpose of this study was to examine workplace bullying victims' perceptions of what they heard their bully counterparts say through their use of prosody. DESIGN: From a sampling frame of 89 manuscripts referenced in the authors' previous studies, we identified a subset (n = 10) that included quotes regarding bullying victims' perceptions of communication experiences with their bully perpetrators. METHODS: We used hermeneutics and a recursive metasynthesis to interpret quotes embedded in the manuscripts chosen for this study. FINDINGS: Two-thirds of language is expressed nonverbally through prosody or "manner of speaking"-rhythm, stress, intonation, and vocabulary choice. We found that as bullies communicated with their intended victims over time, they used prosody across subtle, linked communications, or boldly and openly in public venues, to establish a context-embedded, one-way communication process of "doublespeak." CONCLUSIONS: Bullies' confusing prosodic communication processes served to recontexualize victims' situations and, through mechanisms largely unacknowledged by the victims, to subtly demean their personhood, and to shame them and render them voiceless. CLINICAL RELEVANCE: This study directs formal attention to the language of workplace bullying. Further study might strengthen opportunities to effectively address and curtail the long-term personal, professional, and organizational injuries deriving from workplace bullying.

Developing reflective writing as effective pedagogy.

While reflective writing about practice experiences is frequently used in nursing curricula to foster critical thinking, faculty members may be unaware of how to help students reflect, what kinds of feedback are helpful, and how to deal with students' concerns. This article describes faculty best practices in mentoring the student to effectively think critically through structured reflective writing. Models of structured reflection, Baker's four-step model and John's revision of Carper's patterns of knowing, are discussed as effective guides at graduate and undergraduate levels. The article addresses potentially problematic issues with the implementation and evaluation of reflective writing assignments in clinical courses. With foresight and planning, reflective writing may be an empowering strategy for facilitating students' thinking skills.

Assessing Family-Like Dynamics in the Workplace as Possible Precursors of Workplace Bullying: Psychometric Analysis of a Modified Instrument.

BACKGROUND AND PURPOSE: Family-like dynamics in workplaces may serve as antecedents to workplace bullying. This study addressed the psychometric properties of an instrument modified to assess family-like dynamics in the workplace. DESIGN: The investigators used categorical principal components analysis (CATPCA) to investigate the psychometric properties of an instrument modified to measure coworker perceptions of family-like dynamics in the workplace. METHODS: Primarily White (95%) study participants (N = 273) completed a brief, demographic form and the modified Family Relationships Index (FRI) of the Family Assessment Scale (FES) (Moos & Moos, 1981, 1986). Demographic data were analyzed using descriptive statistics and perceptions of family-like dynamics in the workplace were analyzed using CATPCA. RESULTS: The modified FRI served as a reasonable model for capturing coworker perceptions of family-like dynamics in the workplace. CONCLUSIONS: Further research is indicated to determine the overall utility of the modified FRI and to ascertain whether family-like dynamics actually are precursors to workplace bullying victimization.

The evaluation of students' reflective writing for evidence of critical thinking.

The purpose of this study was to establish interrater reliability of the Critical Thinking Scale (CTS), a teacher-accessible tool designed to measure the critical thinking of baccalaureate nursing students as evidenced in their reflective writing about their practice experiences.The study is an extension of an earlier pilot test of the CTS. Graduating students from a nursing program at a small liberal arts college were asked to write about a significant practice experience encountered during their last clinical course. Three teachers used the CTS to independently evaluate the students' writing. California Critical Thinking Skills Test (CCTST) scores provided a standard measure of critical thinking. Results indicated statistically significant positive relationships between the CCTST total critical thinking score and mean teacher ratings using the CTS. Meaningfully significant interrater reliability ratings for the CTS were also found. With further development, the CTS has promise as an appropriate tool to evaluate students' reflective writing for evidence of critical thinking.

Evaluating reflective writing for appropriateness, fairness, and consistency.

Nurse educators are divided about how to best evaluate nursing students' reflective writings for evidence of critical thinking. This article reports on a study of consistency among faculty in grading writing in reflective journals. The results indicate a lack of consensus with regard to evaluation and differences among faculty with regard to how they view the purpose of such exercises.

Intervening as a passenger in drinking/driving situations.

This study sought to query adolescents about drinking/driving situations and interventions used in these circumstances. A human science qualitative method was used to analyze descriptions of situations and interventions to gain the perspective of the life world of the young person. Findings include the drinking/driving situations of entangled, endangered, and stranded. Passenger interventions included persuading, interfering, planning ahead, and threatening. Practice, education, and research implications for those who work with adolescents are offered.