American Academy of Nursing consensus recommendations to advance system level change for nurse well-being.

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

Achieving Health Equity Through Eradicating Structural Racism in the United States: A Call to Action for Nursing Leadership.

PURPOSE: To advocate for strategic actions by U.S. nursing leadership that denote the presence, customs, and implications of racism that has been institutionalized within the structures of U.S. nursing leadership and the profession. ORGANIZING CONSTRUCTS: A racial equity framework is used to examine the barriers to quality health care and equitable health outcomes and to present evidence-based actions to dismantle structural inequities embedded in the nursing profession. METHODS: This article was developed through a comprehensive literature review and synthesis of relevant research, data, peer-reviewed literature, government reports, and organizational guidelines. FINDINGS: A commitment by U.S. nursing leadership to eradicate structural racism in nursing must be made in order to effect sustainable transformative change toward more equitable systems of health care. CONCLUSIONS: This article presents recommendations for nursing leadership in the United States to renew its commitment to quality health care through dismantling structural racism at all levels of direct and systems nursing practice and education, at the bedside, and in the boardrooms. CLINICAL RELEVANCE: Structural racism in nursing and health care also persists globally as a key social determinant of health. Its elimination aligns with international health care and nursing's policy priorities, yet change can only occur when senior leaders clearly understand it as a key barrier to health, and commit to transformative change in how their "systems" work. These recommendations can also be culturally adapted by global nursing for use in antiracism work.

Perceived Parental Barriers to and Strategies for Supporting Physical Activity and Healthy Eating among Head Start Children.

Despite the need for parents to support their children's healthy behaviors, knowledge of factors preventing parents from doing so is still rudimentary. This study primarily aimed to explore perceived parental barriers to and strategies for supporting physical activity and healthy eating among Head Start children. A semi-structured interview format was used with four focus groups conducted at two urban Head Start centers in the Midwestern U.S. A qualitative content analysis of audio-recorded sessions was facilitated using ATLAS.ti7. A convenience sample of 32 parents (Mage = 34.97 years) participated. Over half were female (78.1 %), African Americans (65.6 %), and single (65.6 %). About 61.3 % reported an annual family income <$20,000, and 43.8 % were unemployed. Three themes reflected the barriers: (1) intrapersonal (child): short attention span and limited eating preferences; (2) interpersonal (parent): lack of time and cooking skills and a tight family budget; and (3) environmental: inaccessible programs, lack of age-appropriate education, electronic media use, and unsafe environment. Parents across all groups expressed high interest in enrolling in a program with their children. Recommendations included: parents' support team; family outings at parks; taking a walk or enrolling in a class with children; and planting a garden. Many parents showed their preference for face-to-face meetings and a support group, but repulsion of counseling. To promote parental support in future interventions with Head Start children, their perceived intrapersonal, interpersonal, and environmental barriers should be considered as intervention targets. Involving parents through a support group and face-to-face meetings is recommended.

Addressing gaps in mental health needs of diverse, at-risk, underserved, and disenfranchised populations: a call for nursing action.

Psychiatric nurses have an essential role in meeting the mental health needs of diverse, at-risk, underserved, and disenfranchised populations across the lifespan. This paper summarizes the needs of individuals especially at-risk for mental health disorders, acknowledging that such vulnerability is contextual, age-specific, and influenced by biological, behavioral, socio-demographic and cultural factors. With its longstanding commitment to cultural sensitivity and social justice, its pivotal role in healthcare, and its broad educational base, psychiatric nursing is well-positioned for leadership in addressing the gaps in mental health prevention and treatment services for vulnerable and underserved populations. This paper describes these issues, presents psychiatric nursing exemplars that address the problems, and makes strong recommendations to psychiatric nurse leaders, policy makers and mental health advocates to help achieve change.

The State of the Science of Nurses' Implicit Bias: A Call to Go Beyond the Face of the Other and Revisit the Ethics of Belonging and Power.

This article summarizes the current state of nurses' implicit bias and discusses the phenomenon from Levinas' face of the Other and ethics of belonging, Watson's human caring and unitary caring science, and Chinn's peace and power theory. Nurses' implicit bias is a global issue; the primary sources of nurses' implicit bias include race/ethnicity, sexuality, health conditions, age, mental health status, and substance use disorders. The current research stays at the descriptive level and addresses implicit bias at the individual level. This article invites nurses to go beyond "the face of the Other" and revisit the ethics of belonging and power.

Understanding systems and rhythms for minority recruitment in intervention research.

We describe one approach for recruitment and retention of minority individuals in intervention research using a systematic environmental perspective based on Bronfenbrenner's ecological systems (BES) model and the construct of temporality. An exemplar in a physical activity intervention study with low-income and primarily African American women is presented. The exemplar illustrates application of BES and temporality to enhance recruitment and retention in research focused on understanding and accommodating environmental influences. Using this theory based approach resulted in successful recruitment and a high level of participant retention.

Barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States.

This study explored barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States. The authors utilized a phenomenological approach and focus group methodology. Participants (n = 9) were enrolled in a teen parent program, an option of the public school system. The metaphor of a merry-go-round emerged from the data and represented the ups and downs that the adolescent mothers experience as they struggle to adjust to the role of mother. Their knowledge of postpartum depression and depression treatment occurred in the context of their demographics and their desire to create a family for their baby, their fears, and surprise at the reality of mothering. Childbirth education for adolescent mothers should include information on depression and the process of depression treatment.

Understanding Culture in Context: An Important Next Step for Patient Emotional Well-Being and Nursing.

The impact of culture on health has gained considerable importance in care delivery. This review discusses the complex interaction of culture and social determinants, and the combined impact of these on emotional well-being. Examples of this interaction are presented and recommendations for change within nursing to improve care are discussed.

Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider.

Health care providers (HCPs) face many obstacles as they undertake efforts to meet the challenges of caring for African American patients with comorbid diabetes and depression. This review article discusses the incidence of comorbid diabetes and depression in African Americans, cultural factors affecting diabetes self-management, and clinical practice implications for the HCP. The role of patient-centered care, engagement, and best-practice strategies are discussed to provide the HCP with guidelines regarding the minimal standards that support improved health care outcomes for African Americans with comorbid diabetes and depression.

An environmental intervention aimed at increasing physical activity levels in low-income women.

BACKGROUND: Regular physical activity is a health promotion and disease prevention behavior. Of all demographic groups, low-income women report the lowest levels of physical activity. RESEARCH OBJECTIVE: The purpose of this study was to test an intervention aimed at reducing community environmental barriers to physical activity in low-income women. METHODS: The research design was mixed methodology: (1) quantitative (quasi-experimental, pretest-posttest, cohort design in which no treatment partitioning was possible) and (2) qualitative (focus groups). The setting was a church-sponsored community center centrally located in a low-income urban neighborhood. The comparison group was recruited first followed by the intervention group to control for setting. The sample consisted of 104 women (comparison group, n = 53; intervention group, n = 51) between the ages of 18 and 63 years who were residents of neighborhoods served by the community center. RESULTS: No between-group differences were found for physical activity behavior. Significant between-group differences in cholesterol (P = .007) and perception of physical activity (P = .033) were observed. Significant intervention group increases from pretest to posttest were found related to advanced registered nurse practitioner support, friend support, and more positive physical activity environment at the community center. Qualitative data supported and enriched the quantitative data. CONCLUSIONS: Physical activity levels were not significantly different between the groups. In a sample of low-income women who have multiple barriers, improving attitudes, expanding their knowledge of community resources, and providing physical activity opportunities in their neighborhoods are important intermediate steps toward initiation and maintenance of regular physical activity.

Contemporary mothering in a diverse society.

The contextual and environmental factors that may affect mothering and perceptions of the maternal role in today's increasingly diverse society are described. Following a historical overview of the development of maternal role theory within the nursing literature, the influence of images and myths in Western society, race/ethnicity, cultural background, and employment status are discussed. Guidelines for nursing interventions that allow for individual and cultural differences are provided.

Supervision as professional development for psychiatric mental health nurses.

Clinical supervision is an essential element in the professional development of advanced practice psychiatric mental health nurses, and many interpersonal approaches exist to facilitate this process. This article discusses the issues underlying supervision, the key elements of the supervision process, and the current literature focused on the development of best practices in the conduct of clinical supervision. Recommendations for the implementation of supervision are identified.

Exploring the Providers Perspective of Health and Social Service Availability for Immigrants and Refugees in a Southern Urban Community.

As the foreign-born population continues to grow and increasingly expand into inland U.S. cities, they experience insufficient resources and facilities to support their unique health and social needs. The purpose of this study was to describe provider perspectives on health and social services for immigrants and refugees in a southern metropolitan city with a rapidly increasing foreign-born population. Ten health and social service providers participated in an ethnographic study using surveys, in-depth interviews, participant observation, and document review methods. Providers identified the greatest need for immigrants and refugees was access to urgent health services and management of chronic illnesses. Barriers and facilitators to service were related to accessibility, availability, affordability, and acceptability factors. Findings indicate that despite the establishment of population specific service organizations, immigrants and refugees continue to experience unmet health and social needs associated with sociocultural, economic, and political contextual factors.

Authoritarianism and attitudes toward mental health services.

Right-wing authoritarians have been shown to resist change and to demonstrate hostility toward out-groups and social movements that may advocate change from traditional and conventional beliefs. Using data from the Louisville Metropolitan Survey, an omnibus survey of 771 adults interviewed by telephone, the authors investigated the relationship between right-wing authoritarianism (RWA) and attitudes toward mental health services. The findings of the bivariate and regression analyses indicated that high scorers on a version of B. Altemeyer's (1988) RWA index were more likely to hold negative attitudes on mental health services. In particular, the Submissive Authoritarianism scale predicted negative attitudes toward mental health services; however, scores on the Conventionality subscale were not related to attitudes toward mental health services.

A comparison of influences on attitudes towards mental health service use in an African-American and White community.

The purpose of this study was to examine the attitudes toward mental health service (MHS) use within a sample of African-American and White adults (N = 739) and to identify correlates associated with those expressed attitudes. African-Americans (n = 132) and Whites (n = 607) were interviewed using the Louisville Metropolitan Survey that included the Attitudes Toward Seeking Professional Psychological Help Scale. Findings from this study indicated that responses regarding seeking mental health services were positively correlated with educational attainment and gender In addition, further findings also suggested that while race was significantly associated with attitudes toward seeking mental health services, it was also associated with prior familiarity with mental health services African-Americans reported both less willingness to seek mental health services and less familiarity with mental health services. The unexpected finding of the association between familiarity and attitudes toward mental health services use has value in furthering scientific inquiry. Investigation into the role of familiarity with mental health services and the decision-making process leading to mental health services use in diverse populations holds potential.