The nurse's role in a patient-centered approach for reducing COVID-19 vaccine hesitancy during pregnancy: An American Academy of Nursing consensus paper.

The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy.

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.

Advancing the symptom science model with environmental health.

OBJECTIVE: Globally, indoor and outdoor pollutants are leading risk factors for death and reduced quality of life. Few theories explicitly address environmental health within the nursing discipline with a focus on harmful environmental exposures. The objective here is to expand the National Institutes of Health Symptom Science Model to include the environmental health concepts of environmental endotype (causative pathway) and environmental exposure. DESIGN: Meleis' research to theory strategy for theory refinement was used. Research workshop proceedings, environmental health nursing research expert consensus, panelist research trajectories, and review of the literature were utilized as data sources. RESULTS: Ongoing emphasis on the physical environment as a key determinant of health and theoretical perspectives for including environmental exposures and endotypes in symptom science are presented. Definitions of these concepts, further developed, are provided. Recommendations to strengthen environmental health nursing research and practice through capacity building/infrastructure, methods/outcomes, translational/clinical research, and basic/mechanistic research are included. CONCLUSION: The revised model deepens theoretical support for clinical actions that include environmental modification, environmental health education, and exposure reduction. This modification will enable a middle-range theory and shared mental model to inspire the prioritization of environmental health in nursing leadership, research, practice, and education.

Pediatric Emergency Department Staff Preferences for a Critical Incident Stress Debriefing.

INTRODUCTION: There are significant and negative psychological effects that can occur in nursing staff caring for pediatric patients experiencing critical incidents. Debriefings can provide relief from the stressors caused by critical incidents. Adapting a pre-existing critical incident stress debriefing (CISD) process to ED staff is 1 way to provide staff debriefing. METHODS: This qualitative study used an emerging, descriptive design. Focus groups, (n = 3, total participant n = 19), consisting of pediatric emergency nurses and a nursing assistant, met for a minimum of 63 to a maximum of 83 minutes. Participants provided feedback on current debriefing strategies and suggestions for adapting a currently existing critical incident stress- debriefing process. Focus group questions included "Have you participated in a structured debriefing process? If so, tell us about it" and "What would you like to see in a structured debriefing process?" RESULTS: A theoretical orientation content analysis revealed 1 main theme-Clearing the Air and Finding Answers-and 6 subthemes: Current Debriefing Strategies; Positive Reinforcement; Constructive Critique; Clinical, Not Emotional; I've already moved on; and CISD Structure. DISCUSSION: Pediatric ED staff de-stress in a variety of ways, and a nonmandatory, formalized CISD process-open to staff involved and facilitated by an emergency nurse-could provide additional relief from stress. This debriefing process should include positive feedback and critiques to help improve care processes, information about mechanism of injury, and should occur before the end of shift or within 12 to 24 hours of the incident. Staff may deal with personal feelings outside of debriefing.

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.

Smartphone Use by Nurses in Acute Care Settings.

The use of smartphones in acute care settings remains controversial due to security concerns and personal use. The purposes of this study were to determine (1) the current rates of personal smartphone use by nurses in acute care settings, (2) nurses' preferences regarding the use of smartphone functionality at work, and (3) nurse perceptions of the benefits and drawbacks of smartphone use at work. An online survey of nurses from six acute care facilities within one healthcare system assessed the use of personal smartphones in acute care settings and perceptions of the benefits and drawbacks of smartphone use at work. Participants (N = 735) were primarily point-of-care nurses older than 31 years. Most participants (98%) used a smartphone in the acute care setting. Respondents perceived the most common useful and beneficial smartphone functions in acute care settings as allowing them to access information on medications, procedures, and diseases. Participants older than 50 years were less likely to use a smartphone in acute care settings and to agree with the benefits of smartphones. There is a critical need for recognition that smartphones are used by point-of-care nurses for a variety of functions and that realistic policies for smartphone use are needed to enhance patient care and minimize distractions.

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.

Pathways From Socioeconomic Status to Prenatal Smoking: A Test of the Reserve Capacity Model.

BACKGROUND: Low-income, unemployed women with low levels of education are more likely to smoke during pregnancy compared to their higher-income, employed, and well-educated counterparts. The reserve capacity model (RCM) offers a theoretical framework to explain how psychosocial factors may serve as pathways connecting socioeconomic status (SES) to health behaviors. Research supports the link between prenatal smoking and several psychosocial variables such as chronic stressors, depressive symptoms, and social support. How these variables interrelate to explain the predominance of prenatal smoking in lower socioeconomic groups of pregnant women has not been fully elucidated. OBJECTIVE: The aim of this study was to test the RCM to evaluate the roles of early pregnancy levels of chronic stress, quality of the primary intimate relationship, and depressive symptoms in explaining the relationship between SES and persistent prenatal smoking. METHODS: A secondary analysis of data from 370 pregnant nonsmokers, spontaneous quitters, and persistent prenatal smokers was conducted. On the basis of the RCM, chronic stressors, depressive symptoms, and the quality of the primary intimate relationship were evaluated as potential mediating variables linking SES with persistent prenatal smoking using path analysis. RESULTS: Path analyses indicated that a simple model with all three psychosocial variables as mediators of the relationship between SES and persistent prenatal smoking provided the best fit. DISCUSSION: Findings indicated that chronic stressors, depressive symptoms, and the quality of the primary intimate relationship play important roles in the pathway from SES to prenatal smoking status. This knowledge can assist in the development of prevention and intervention strategies to target these variables and ultimately reduce prenatal smoking.

Advancing Nursing Research in Hospitals Through Collaboration, Empowerment, and Mentoring.

Meeting the Magnet Recognition Program® requirements for integrating research into practice can be daunting, particularly for nonacademic hospitals. The authors describe 1 healthcare system's approach to advancing nursing research in 5 hospitals through collaboration with a local university school of nursing and development of an infrastructure to support, empower, and mentor clinical nurses in the conduct of research. Outcomes include completed research, presentations, publications, practice change, and professional development.

Compassion Fatigue in Pediatric Nurses.

Compassion fatigue in nursing has been shown to impact the quality of patient care and employee satisfaction and engagement. The aims of this study were to determine the prevalence and severity of compassion fatigue among pediatric nurses and variations in prevalence based on respondent demographics using a cross-sectional survey design. Nurses under 40 years of age, with 6-10 years of experience and/or working in a medical-surgical unit had significantly lower compassion satisfaction and higher levels of burnout. Secondary traumatic stress from caring for children with severe illness or injury or end of life was a key contributor to compassion fatigue.

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.