Determinants of exclusive direct breastfeeding using constructs from the breastfeeding relationship scale.

OBJECTIVES: This study examined the relationship among constructs of the Breastfeeding Relationship Scale and exclusive direct breastfeeding (EDBF) while controlling for covariates in US breastfeeding dyads in the first 3 months. BACKGROUND: The Breastfeeding Relationship Scale was developed to measure mother-infant mutual responsiveness during breastfeeding in response to perceived insufficient milk, but there is no clear understanding about the relationships between the Breastfeeding Relationship Scale's constructs and EDBF. METHODS: A cross-sectional design was used. The convenience sample of 589 directly breastfeeding mothers in the US whose infants were between 1 and 12 weeks of age were included for analysis using a structural equation model. Covariates for EDBF included mother's age, education, marital status, parity, prior breastfeeding experience, infant's age, weight, and sex. RESULTS: Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity were related (ß = 0.33, p < .001), as were Breastfeeding Synchronicity and Perceived Adequate Milk Supply (ß = 0.35, p < .001) and Mother-Infant Breastfeeding Interaction and Perceived Adequate Milk Supply (ß = 0.08, p = .05). The relationship between Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity with EDBF was fully mediated by Perceived Adequate Milk Supply, where the odds of EDBF was higher for mothers with higher scores on Perceived Adequate Milk Supply (OR = 1.61, p < .001) and prior breastfeeding experience (OR = 2.31, p = .006). CONCLUSIONS: Perceived Adequate Milk Supply and prior breastfeeding experience are major determinants of EDBF in the first 3 months. Breastfeeding Synchronicity can bolster Mother-Infant Breastfeeding Interaction and promote Perceived Adequate Milk. More attention should be paid to breastfeeding relationship to be the result of EDBF.

Promoting risk reduction among young adults with asthma during wildfire smoke: A feasibility study.

OBJECTIVE(S): This study explored the feasibility, acceptability, preliminary impact, and functionality of two risk reduction mobile application (app) interventions on asthma outcomes as compared to a control arm during wildfire season. DESIGN: Three-arm, 8-week randomized clinical trial. SAMPLE: Sixty-seven young adults with asthma were enrolled. MEASUREMENTS: The Asthma Control Test, forced expiratory volume in one second (FEV1 ) and the System Usability Scale were measured at baseline, 4, and 8 weeks. The Research Attitude Scale was administered at 8 weeks. Twenty participants from the two intervention arms completed an optional survey and six were interviewed after completing the study. INTERVENTION: Both intervention arms could access Smoke Sense Urbanova, an app that supports reducing risks from breathing wildfire smoke. The Smoke Sense Urbanova Plus arm also monitored their daily FEV1 , received air quality notifications, and accessed preventive tips and a message board. RESULTS: Most participants agreed the app and spirometer were usable and their privacy and confidentiality were maintained. No adverse events were reported. CONCLUSIONS: Participant-identified recommendations will support intervention refinement and testing. This research supports asthma self-management tools that public health nurses and community health workers can recommend for at-risk populations.

Hospitalized Adult Patient Characteristics Associated With Participation in a Volunteer-Assisted Mobility Program: A Feasibility Study.

BACKGROUND: Physical inactivity during hospitalization commonly results in functional decline. Structured multidisciplinary programs/approaches may be useful to promote mobility in hospitalized adults. PURPOSE: The purpose was to determine whether a volunteer-assisted mobility program was feasible to improve the ambulation of hospitalized patients, and examine the characteristics of patients associated with willingness to participate in the program. METHODS: A prospective descriptive correlation study was conducted in 2 acute care units. A volunteer-staffed program was implemented with the aim of improving the ambulation of hospitalized patients. RESULTS: Hospitalized patients (N = 490) were approached, with 39.2% (n = 192) agreeing to ambulate an average of 109.7 m (interquartile range = 51.45-172.2 m). Patients with a low clinical frailty score, high body mass index, or physical therapy order were more likely to participate in the volunteer-assisted mobility program. CONCLUSIONS: The findings suggest that a volunteer-assisted interdisciplinary program is a feasible way to promote the ambulation of some patients.

Environmental and Climate Change Initiatives in Nursing Education.

Climate change has been labeled the greatest threat to public health and to global health in the 21st century. Addressing climate change has also been reframed as the greatest opportunity for global health in the 21st century, providing a more proactive lens through which to plan and implement actions. Significant climate change impacts to human health are numerous and mounting, including the direct effects of heatwaves, thermal stress and changed frequency or intensity of other extreme weather events. Climate change has been termed a complex public health issue affecting all areas of nursing practice dealing with individuals, families, communities, and the national health arena, and is therefore deserving of inclusion into nursing curricula throughout the entirety of prelicensure coursework. Nursing education programs that include this content will better prepare future nurses to face projected environmental challenges to human health.

Associations Between Hospital-Level Patient Satisfaction Scores and Hospital-Acquired Pressure Ulcer Occurrences Among Medicare Stroke Patients.

BACKGROUND: Limited research has explored the associations between the US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings data and hospital-acquired pressure ulcer (HAPU) occurrences. PURPOSE: We examined the associations between the hospital-level patient satisfaction HCAHPS scores with hospital care experience reported by Medicare patients 65 years or older and the occurrence of HAPUs among Medicare patients with stroke. METHODS: A matched case-control design was used. Patients with a history of stroke were identified using the 2011 Medicare fee-for-service patient data. Medicare Beneficiary Summary and Medicare Provider Analysis and Review files processed by the Chronic Conditions Data Warehouse were analyzed. Conditional logistic regression was used. RESULTS: HAPUs occur less frequently among Medicare patients with stroke who received inpatient care at hospitals with higher patient satisfaction HCAHPS scores for nurses' communication skills and quietness at night for the areas around patient rooms. CONCLUSIONS: Using hospital-level patient satisfaction HCAHPS scores to monitor and project HAPU occurrences is recommended.

Developing an Intervention to Reduce Harm in Hospitalized Patients: Patients and Families in Research.

BACKGROUND: Patient safety-focused research may be strengthened by the inclusion of patients and family members in research design; yet, published methodologies for doing so are scarce. PURPOSE: This study engaged patients and families in research design of an intervention to increase patient/family engagement, with reduction of harm in hospitalized patients. METHODS: The study design team convened a Patient Safety Advisory Panel to explore potential testable interventions to increase patient/family engagement with safety. They explored the preferred intervention, Speak Up-My Advocate for Patient Safety (MAPS), through multistakeholder focus groups. RESULTS: Participants emphasized the importance of including patient/family when designing interventions. Regarding the Speak Up-MAPS intervention, perceptions from stakeholders were mixed, including the value and potential complexity, role confusion, and cost of the proposed advocate role. CONCLUSION: Intentional inclusion of the patient/family in research is important and practical. Both strengths and challenges of the proposed intervention were identified, indicating the need for further study.

Perspectives on Patient and Family Engagement With Reduction in Harm: The Forgotten Voice.

BACKGROUND: Despite continued efforts to improve safety in hospitals, hospital-acquired harm persists. Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient and family engagement to reduction of harm is not well understood, with limited findings available in current literature. PURPOSE: This qualitative study explored the perceptions and attitudes of patients and family members and several clinical disciplines toward patient engagement in reducing preventable harm in hospitalized patients. METHODS: We conducted 8 focus groups at 2 nonprofit hospitals with several constituencies: patients/families, registered nurses, physician hospitalists, and pharmacists/physical therapists. RESULTS: Thematic analysis of transcripts revealed multiple themes from different perspectives, including: family presence increases safety, the hospital environment is intimidating, and communication is essential, but I am not being heard. CONCLUSIONS: The rich data suggest a significant opportunity for reducing risk and harm by more actively engaging patients and families in the effort. Increasing patient acuity and complexity of care furthers the need for partnering with patients and families more intentionally for increased safety.

Local Anesthetic Systemic Toxicity (LAST): Designing an Educational Effort for Nurses That Will Last.

PURPOSE: To improve knowledge and raise awareness of nurses who assist certified registered nurse anesthetists or anesthesiologists with peripheral nerve block or spinal block procedures about a potential life-threatening local anesthetic systemic toxicity (LAST) event. DESIGN: An evidence-based practice project design. METHODS: Nurses in units where nerve block procedures were performed (ie, postanesthesia care unit, preoperative, operating room, outpatient services, labor and delivery unit) received a pretest about their knowledge of LAST events, participated in a 30-minute educational session, and then completed a post-test. The data were analyzed for differences and statistical significance. Included in the test was a question about the nurse's comfort level with managing a LAST event. FINDINGS: The findings demonstrated a knowledge deficit related to LAST events. The average of all three units combined pretest scores was 60% and post-test scores increased to 95%. The average comfort level of all three units was 3.5/10 (35%) before the educational in-service program and increased to 7.9/10 (79%) after education. CONCLUSIONS: Nurses working in units where nerve blocks are performed are lacking in knowledge of the signs and symptoms and the correct course of treatment for a LAST event. This could lead to poor outcomes of a very high-risk low-volume event.

A randomized clinical trial to evaluate the efficacy of contingency management for treatment of waterpipe tobacco addiction.

BACKGROUND AND OBJECTIVES: Unlike cigarette smoking cessation, waterpipe tobacco smoking cessation is relatively understudied. The objective of this randomized clinical trial was to examine the efficacy of contingency management (CM) for promoting initial waterpipe smoking abstinence. METHODS: The study used a two-group, repeated measures design. Participants attended 10 visits (two visits per week, on Mondays and Thursdays) across 5 weeks. Thirty-nine adult waterpipe tobacco users who did not smoke cigarettes and were not planning on quitting waterpipe tobacco smoking were randomly assigned to either the contingent (n = 19) or non-contingent (n = 20) groups. Contingent group received monetary rewards based on negative salivary cotinine results. Earning rewards started at $14 and increased by $.50 with each subsequent negative sample for a maximum $192.50. Non-contingent group earned rewards independent of salivary cotinine results. Prolonged abstinence was defined as having negative salivary cotinine results for eight or more visits (two lapses were allowed); and 7-day point prevalence was defined as having negative salivary cotinine results at visit 9 and 10 (final week). RESULTS: The prolonged abstinence rate in the contingent and non-contingent groups were 42.1% and 5.0%, respectively, (p = .008). The 7-day point prevalence in the contingent and non-contingent were 47.4% and 5.0%, respectively, (p = .003). DISCUSSION AND CONCLUSIONS: Rewards contingent on biochemically verified abstinence promote initial waterpipe tobacco cessation. This is useful information for consideration in future cessation programs for waterpipe smokers. SCIENTIFIC SIGNIFICANCE: CM strategy may have potential benefit in addressing waterpipe tobacco smoking in non-treatment seeking adults. (Am J Addict 2018;27:202-209).

Relational Health in Transitions: Female Adolescents in Chemical Dependency Treatment.

BACKGROUND: Adolescent substance use (SU) remains a serious problem. Inpatient, primary care, and self-treatment models for chemical dependency (CD) yield varying degrees of success impacting the sequelae of chronic or episodic SU. Relational engagement among adolescent substance users is a long known influential factor in the development, maintenance and transformation of addictive behaviors. OBJECTIVES: Following tenets of Relational-Cultural Theory and using the Relational Health Indices for Youth (RHI-Y), a validated survey tool for adolescents, we sought to measure relational health (RH) during times of transitions during CD treatment. This article addresses use of the tool and its potential for improving addictions research and practice. METHODS: During 2015-2017 we explored differences in RH scores in adolescent girls entering inpatient CD treatment at three points: 51 at admission, 39 at discharge, and 13 at 3 months post-discharge. Data were analyzed using a generalized linear mixed model to compare changes in domain scores of RH. RESULTS: Changes in RH scores were significant in the friend domain, but not the mentor and community domains. The RHI-Y shows promise in discerning RH change during transitions in CD treatment.

Establishing Inter- and Intrarater Reliability for High-Stakes Testing Using Simulation.

AIM: This article reports one method to develop a standardized training method to establish the inter- and intrarater reliability of a group of raters for high-stakes testing. BACKGROUND: Simulation is used increasingly for high-stakes testing, but without research into the development of inter- and intrarater reliability for raters. METHOD: Eleven raters were trained using a standardized methodology. Raters scored 28 student videos over a six-week period. Raters then rescored all videos over a two-day period to establish both intra- and interrater reliability. RESULTS: One rater demonstrated poor intrarater reliability; a second rater failed all students. Kappa statistics improved from the moderate to substantial agreement range with the exclusion of the two outlier raters' scores. CONCLUSION: There may be faculty who, for different reasons, should not be included in high-stakes testing evaluations. All faculty are content experts, but not all are expert evaluators.

Retest of a Principal Components Analysis of Two Household Environmental Risk Instruments.

Household Risk Perception (HRP) and Self-Efficacy in Environmental Risk Reduction (SEERR) instruments were developed for a public health nurse-delivered intervention designed to reduce home-based, environmental health risks among rural, low-income families. The purpose of this study was to test both instruments in a second low-income population that differed geographically and economically from the original sample. Participants (N = 199) were recruited from the Women, Infants, and Children (WIC) program. Paper and pencil surveys were collected at WIC sites by research-trained student nurses. Exploratory principal components analysis (PCA) was conducted, and comparisons were made to the original PCA for the purpose of data reduction. Instruments showed satisfactory Cronbach alpha values for all components. HRP components were reduced from five to four, which explained 70% of variance. The components were labeled sensed risks, unseen risks, severity of risks, and knowledge. In contrast to the original testing, environmental tobacco smoke (ETS) items was not a separate component of the HRP. The SEERR analysis demonstrated four components explaining 71% of variance, with similar patterns of items as in the first study, including a component on ETS, but some differences in item location. Although low-income populations constituted both samples, differences in demographics and risk exposures may have played a role in component and item locations. Findings provided justification for changing or reducing items, and for tailoring the instruments to population-level risks and behaviors. Although analytic refinement will continue, both instruments advance the measurement of environmental health risk perception and self-efficacy. © 2016 Wiley Periodicals, Inc.

Pediatric patients with asthma: a high-risk population for subsequent hospitalization.

OBJECTIVES: Asthma is one of the most common chronic conditions among children and is one of the leading causes for pediatric hospitalizations. More evidence is needed to clarify the risks of repeat hospitalization and the underlying factors contributing to adverse health outcomes among pediatric patients hospitalized with asthma. The purpose of this study was to examine the risk of subsequent hospitalizations among pediatric patients hospitalized with asthma compared to a reference cohort of children hospitalized for all other diagnoses. METHODS: The Washington State (WA) Comprehensive Hospital Abstract Reporting System (CHARS) was used to obtain data for the study. Data describing 81,946 hospitalized pediatric patients admitted from 2004 to 2008 were available. The risk of subsequent hospitalization among children admitted for asthma as compared to a reference cohort was examined. RESULTS: The asthma cohort had a 33% (HR = 1.33 [99% confidence interval (CI) 1.21-1.46]; p < .001) increased risk of subsequent hospitalization from 2004 to 2008. Children in the asthma cohort under the age of 13 years demonstrated a significant increased risk of subsequent hospitalization as compared to the age-matched reference cohort of children without asthma. Those in the asthma cohort who were 3-5 years old demonstrated the highest risk (50%) of subsequent hospitalization (HR = 1.50 [99% CI 1.23-1.83]; p < .001). CONCLUSIONS: Study results can be utilized in the development of appropriate interventions aimed at preventing and reducing hospital admissions, improving patient care, decreasing overall costs, and lessening complications among pediatric patients with asthma.

The Household Risk Perception instrument and the Self-Efficacy in Environmental Risk Reduction instrument: psychometric testing using principal component analysis.

AIM: To report the psychometric testing of the Household Risk Perception and Self-Efficacy in Environmental Risk Reduction instruments using principal components analysis. BACKGROUND: There are limited instruments available to test household risk perception and self-efficacy related to environmental health behaviours. The Household Risk Perception instrument was developed to measure personal perceptions of household environmental health risks. The Self-Efficacy in Environmental Risk Reduction instrument was designed to measure caregivers' confidence in taking steps to reduce household risks. DESIGN: An exploratory analysis of previous data was undertaken. METHOD: Baseline data from 235 caregivers enrolled in a randomized clinical trial testing a healthy housing intervention were collected between 2006-2009. Principal components analysis was used to determine principal components from measured responses to each instrument. RESULTS: Components were explored and compared to constructs used to design the original instruments. A five-component structure showed the simplest solution and explained 65% of variance in the Household Risk Perception analysis. Cronbach's alpha values indicated satisfactory internal consistency for four of five identified components. Risk perception varied according to available sensory input of the specific risk. A four-component structure explained 64% of the variance in the Self-Efficacy in Environmental Risk Reduction analysis. Cronbach's alpha values were satisfactory. Items mapped to steps in an action-oriented process vs. agent-specific actions. Results from both analyses suggest that environmental tobacco smoke is perceived differently than other household risks. CONCLUSION: Previously, both instruments relied on item reliability and content validity testing. This study provides a basis for further instrument revision and theoretical testing.

The value of community-focused interprofessional care in peru for developing cultural competency in health professions students.

International immersion experiences for health-care students have increased over the past 10 years. Students and faculty expect these experiences to increase cultural competency; however, research on outcomes of these programs has lacked rigor. Over a 4-year period, groups of nursing and other health professions students spent 3 weeks in Peru providing primary care and health education. Students attended pre-departure seminars addressing personal travel health and safety, culture and health care in Peru, working with interpreters, and ethics of international health care. Student participants (N=77) completed an instrument assessing self-perceived cultural competency before and after the experience. Results of pre- and post-immersion scores showed significant increases in perceived cultural competency and increased self-efficacy in cultural knowledge, skills, and attitudes for four groups of students. Implications and future directions are discussed and recommended.

Findings from a nursing student CPR study: implications for staff development educators.

This article reports a secondary data analysis of a year-long study with 606 nursing students involving brief monthly CPR practice with voice-activated manikins versus no practice. Findings indicate that even with monthly practice and accurate voice-activated manikin feedback, some students could not perform CPR correctly. Implications of these findings for staff educators are discussed.

Student satisfaction and self report of CPR competency: HeartCode BLS courses, instructor-led CPR courses, and monthly voice advisory manikin practice for CPR skill maintenance.

This study evaluated the effects of brief monthly refresher training on CPR skill retention, confidence, and satisfaction with CPR skill level of 606 nursing students from ten different US schools. Students were randomized to course type, HeartCode™ Basic Life Support (BLS) or an instructor-led (IL) course, and then randomized to a practice group, six minutes of monthly practice or no further practice. End-of-study survey results were compiled and reported as percentages. Short answer data were grouped by category for reporting. Fewer HeartCode™ BLS students were satisfied with their CPR training compared to the IL students. Students who practiced CPR monthly were more confident than students who did not practice. Monthly practice improved CPR confidence, but initial course type did not. Students were most satisfied when they participated in the IL courses and frequent practice of CPR skills.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months.

OBJECTIVE: To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States. DESIGN: A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019. PARTICIPANTS: We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion. MEASUREMENTS: The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences. RESULTS: Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]). CONCLUSION: Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Instrument Development and Psychometric Validation Using Confirmatory Factor Analysis of the Breastfeeding Relationship Scale.

Background and Purpose: The Breastfeeding Relationship Scale (BFRS) was developed to measure mother-infant mutual responsiveness during breastfeeding. The purpose of this study was to develop and test the psychometric properties of the BFRS. Methods: Construct validity of a 16-item three-factor model (Mother-Infant Breastfeeding Interaction, Perceived Adequate Milk Supply, and Breastfeeding Synchronicity) was assessed using confirmatory factor analysis (CFA) and reliability (Cronbach's alpha) across two independent samples. Results: CFA of the hypothesized three-factor model demonstrated good fit in both samples (comparative fit index >.90, root mean square error of approximation <.06, square root mean residual < .061). Cronbach's alpha for the constructs ranged between .73 and .83. Conclusion: The BFRS is a valid measure of breastfeeding relations between mother and infant. Reliability was acceptable for all constructs in both samples.

Hyperbaric Oxygen to Assist Adults With Opioid Use Disorder in Reducing Methadone Dose.

ABSTRACT: Opioid withdrawal symptoms can interfere with substance use disorder treatment goals. This study investigated the acceptability, feasibility, and treatment effects of hyperbaric oxygen therapy (HBOT) as an adjunct to reduce withdrawal symptoms for adults initiating a medically supervised methadone dose reduction. Adults prescribed methadone for opioid use disorder were randomized into either a hyperbaric oxygen group (n = 17) or an attention control group (n = 14). The study site was an outpatient opioid treatment program in the northwestern United States. Participants were asked to attend five consecutive daily 90-minute HBOT sessions offered at 2.0 atmospheres absolute with 100% oxygen in a pressurized chamber. Treatment attendance and reported satisfaction were measures of acceptability and feasibility. Medication doses were tracked posttreatment at 1 week, 1 month, and 3 months. Withdrawal symptoms were assessed at baseline and daily during the 5-day intervention period. After randomization, 13 (76.5%) followed through with medical screening and HBOT sessions, and of those, nine (69.2%) completed all five 90-minute HBOT sessions. At 3 months, the treatment group maintained, on average, a 4.3-mg methadone dose reduction compared with an average reduction of 0.25 mg for control group participants. Opioid withdrawal symptoms were reduced after Day 1 of HBOT by twice as much, on average, compared with the control condition. Satisfaction surveys found participants were generally satisfied with ease and comfort of the treatment. The evidence that HBOT is an acceptable, feasible adjunct warrants future trials to determine more conclusively effects on withdrawal symptoms associated with methadone dose taper.