Valuing Joyful Teaching Moments: Nursing Faculty Experiences in Texas.

Purpose: Studies of joyful experiences in teaching nursing and related implications are lacking in the literature. The concept of joy seems undervalued yet critical to the theoretical basis for improving holistic faculty experiences and potentially affecting students and patients. The purpose of this study is to give voice to instances of joyful teaching identified by nursing faculty and to consider related implications, including advancing holistic nursing education. Design: In this sequential exploratory multimethod study, faculty discussed joyful teaching, responded to survey questions, and completed a Likert-type measure of outcomes. Eleven faculty were interviewed; interviews were digitally recorded and professionally transcribed. Interviews were coded using qualitative content analysis; quantitative data provided frequency counts. Findings: Four main themes emerged: "aha" moments, faculty validation, witnessing transformation, and planting seeds. Faculty shared experiences with peers, students, or both, and occasionally with others. Three outcome themes of joy were identified: transcendence, meaning, and activity. The most frequently reported significance of joy was hope and resilience. Conclusions: Joyful experiences belong in the literature and can inform holistic practice. Our results suggest that joyful moments support faculty and that students and patients may also benefit from this emotion, even though it has been undervalued in nursing research.

Resiliency and Self-Care Behaviors in Health Professional Schools.

Background: Resilience is crucial for students in health schools as care becomes more complex and as the adjustment to meet patient, environmental, and professional demands with success can seem a daunting challenge. Self-care activities can support the development of resilience in the student population. The purpose of this study is to explore and describe self-care practices, health-promoting behaviors, and resilience among students, faculty, and staff of the health professional schools at a large metropolitan university. Method: This was a cross-sectional study of data from 148 participants. Analysis included descriptive statistics, t tests, analysis of variance, crosstabs, and Pearson correlations. Results: Resilience was lower among students than among faculty and staff. The most frequent self-care activities were humor and music. Resilience was significantly correlated with the self-care behaviors of praying (p = .006), healthy sleeping habits (p = .024), reading (p = .007), and mindful acceptance (p = .025); yoga and meditation were not significantly correlated with resilience.

Exploring health care experiences of transgender people living in Texas.

BACKGROUND: Although the transgender population in the United States is greater than 1.4 million, health care experiences in this group are underaddressed. PURPOSE: To explore the health care experiences of transgender people in Texas. METHODS: This was an exploratory, sequential multimethod study. In Phase 1, to identify key health-related topics, a self-selected sample of 14 participants completed an online survey. In Phase 2, the focus was understanding care experiences for 12 participants using audio-recorded interviews and theme identification. NVivo software was used for data management. FINDINGS: In Phase 1, findings included needing to: educate providers (89%), correct care staff on pronoun use (75%), tolerate staff's refusal to use one's preferred pronoun (50%). In Phase 2, four themes emerged: discrimination, provider practices, challenges to navigating the health care system, and gender identity. DISCUSSION: Valuing transgender experiences is a first step in addressing care gaps. Change will require provider introspection and application of care guidelines.

Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health.

The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit's acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.

e-Health and new moms: Contextual factors associated with sources of health information.

OBJECTIVE: Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors. DESIGN AND SAMPLE: Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample. MEASURES: Use of online media about mother-baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education. RESULTS: Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother-baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messaging (χ2 statistics, p < .001). Stress and race/ethnicity were among factors associated with preferences. CONCLUSIONS: Mothers widely used e-Health related media, but use was associated with contextual factors. In public health efforts to reach new mothers, partnering with mother-favored Web sites, focusing on audience-relevant media, and adopting attributes of successful sites are recommended strategies.

Behavioral and Psychosocial Health of New Mothers and Associations With Contextual Factors and Perceived Health.

OBJECTIVE: To test the association of behavioral and psychosocial health domains with contextual variables and perceived health in ethnically and economically diverse postpartum women. DESIGN: Mail survey of a stratified random sample. SETTING: Southwestern community in Texas. PARTICIPANTS: Non-Hispanic White, African American, and Hispanic women (N = 168). METHODS: A questionnaire was sent to a sample of 600 women. The adjusted response rate was 32.8%. The questionnaire covered behavioral (diet, physical activity, smoking, and alcohol use) and psychosocial (depression symptoms and body image) health, contextual variables (race/ethnicity, income, perceived stress, and social support), and perceived health. Hypotheses were tested using linear and logistic regression. RESULTS: Body image, dietary behaviors, physical activity behaviors, and depression symptoms were all significantly correlated (Spearman ρ = -.15 to .47). Higher income was associated with increased odds of higher alcohol use (more than 1 drink on 1 to 4 days in a 14-day period). African American ethnicity was correlated with less healthy dietary behaviors and Hispanic ethnicity with less physical activity. In multivariable regressions, perceived stress was associated with less healthy dietary behaviors, increased odds of depression, and decreased odds of higher alcohol use, whereas social support was associated with less body image dissatisfaction, more physical activity, and decreased odds of depression. All behavioral and psychosocial domains were significantly correlated with perceived health, with higher alcohol use related to more favorable perceived health. In regressions analyses, perceived stress was a significant contextual predictor of perceived health. CONCLUSION: Stress and social support had more consistent relationships to behavioral and psychosocial variables than race/ethnicity and income level.

Focusing on the "T" in LGBT: an online survey of related content in texas nursing programs.

BACKGROUND: As nurses, we advocate for the most vulnerable and underserved, who, within the lesbian, gay, bisexual, and transgender (LGBT) community, are transgender individuals. Yet, the existence of LGBT education in nursing schools has not been examined. METHOD: After approval by the university institutional review board, 113 nursing programs in Texas were surveyed between November 2013 and January 2014, with a 12-question, Web-based questionnaire. A Verisign certificate and 128-bit encryption program supported compliance with the Health Insurance Portability and Accountability Act of 1996. RESULTS: Nineteen percent of the surveys were returned. Ten (47.62%) of 21 respondents addressed transgender or transsexual individuals. Fifteen (71.43%) of 21 answered a free-text question to estimate the number of hours spent addressing LGBT content, reporting an average of 1.6 hours. CONCLUSION: Our study suggests that, in Texas, nursing students may not be receiving sufficient content, nor do they understand transgender health needs or how to best deliver competent, compassionate care to this population.

Translation cost, quality, and adequacy.

PURPOSE: Although the inclusion of non-native-speaking participants in nursing research is important in every country where nursing research takes place, the literature contains little on the method of achieving quality translation while simultaneously addressing cost containment. We describe a process for evaluating translation adequacy and demonstrate its use in comparing procedures for translating data from non-native-speaking interviews. ORGANIZING CONSTRUCT: This work demonstrates a process for establishing, evaluating, and achieving translation adequacy when conducting qualitative research for cross-cultural comparisons. METHODS: In an ethnographic investigation of disability in Mexican American women, we describe a process for obtaining translation adequacy, defined here as the methodological goal whereby the quality of the translated text meets the needs of the specified study. Using a subset of responses transcribed from Spanish audiotapes into Spanish text, the text was subjected to two separate translation processes, which were compared for adequacy based on error rates and accuracy of meaning, as well as for cost. FINDINGS: The process for discriminating translation adequacy was sensitive to differences in certified versus noncertified translators. While the noncertified translation initially appeared to be seven times less expensive than the certified process, auditing and correcting errors in noncertified translations substantially increased cost. No errors were found with the certified translations. CONCLUSIONS: The level of translation adequacy needed for any qualitative study should be considered before beginning the study itself. Based on a predetermined level, translation choices can be assessed using specified methods, which can also lead to greater transparency in the research process. CLINICAL RELEVANCE: An ongoing process to verify translation outcomes including cost, a component minimally discussed in the current literature, is relevant to nurses worldwide. Awareness of expense and quality issues makes greater methodological transparency possible in the design of translation projects and research studies.

The pain and suffering of a Mexican American woman with mobility impairment.

There is a dearth of literature examining how adversity shapes the experiences of pain and/or suffering in middle-aged Mexican American women. The purpose of this qualitative descriptive study was to understand pain and suffering from a life course perspective as described by a Mexican American woman aging with early-onset mobility impairment. This Hispanic woman experienced episodes of abuse and rejection over the life course, which may have significantly influenced her pain and suffering experience in adulthood. This adds to the literature on how adversity influences later life pain experience and provides insight on why pharmacological treatment alone may not be as successful as a holistic intervention.

Maternal worries, home safety behaviors, and perceived difficulties.

PURPOSE: The aim of the study was to explore the worries, safety behaviors, and perceived difficulties in keeping children safe at home in a purposive sample of low-income, predominantly non-English speaking mothers as a foundation for later nursing interventions. DESIGN: This study was a qualitative, descriptive design with content analysis to identify maternal concerns, behaviors, and perceptions of home safety as part of a larger study. METHODS: Eighty-two mothers, 64% of whom were monolingual Spanish-speakers, responded in writing to three semistructured interview questions. When mothers were unable to read and write the researcher wrote the responses, then read the content aloud for verification. A standardized probe for each question was posed to obtain richer responses. Data management included use of the software program NUD*IST and coding analyses following the Miles and Huberman guidelines (1994). Interpretations were translated into English for this report. FINDINGS: The major worries were falling, health, kidnapping, and being hit by a car. The leading maternal behaviors were coded as being physically, verbally, and environmentally preventive. Mothers said that it was their role to provide safety, and that this role could be wearisome, such that constant supervision was difficult. CONCLUSIONS: Low-income mothers described their worries for their 1 to 4 year-old children, explored their behaviors for preventing injury, and discussed what made keeping children from harm difficult. Understanding how mothers keep children safe, the barriers to home safety, and effective safety behaviors are important to the health of children. CLINICAL RELEVANCE: The clinical relevance of this study includes building trust as clinicians plan assessment, intervention and evaluation of home safety to encourage dialog about concerns, safety behaviors, and barriers to keeping children from injury.

Video recruitment of non-English-speaking participants.

Recruitment of underserved participants begins to close the disparity gap evident within disadvantaged communities, and innovative approaches to recruitment support this effort. Literacy, communication, and credibility barriers distance potential research participants. The literature search from 1975 to 2005 included the Cochrane Review, MEDLINE, EBSCO, PsycINFO, Google Scholar, and CINAHL for the terms video recruitment, videotaped, minority recruitment, and research subject recruitment with no documented use of videotape recruitment of non-English-speaking (NES) participants. Based on this review, an innovative recruitment video was developed and targeted to monolingual Hispanic mothers to explain a study using home safety visits. Community assistants collaborated on the script. In 4 minutes, potential participants, some illiterate, saw what they could not read, and also whom they should expect at their door if they decided to participate. A total of 82 women were recruited, and with a retention rate of 95%. Classic minority recruitment barriers are reducible with this approach.

Beyond translation ... cultural fit.

Reaching non-English-speaking families, the economically disadvantaged, and those who are disproportionately represented in disease and injury statistics is challenging. This article describes the process of making a questionnaire developed in English, culturally appropriate for low-income, monolingual, Mexican and Mexican American mothers. The questionnaire, guided by the Health Belief Model, assesses maternal childhood injury health beliefs and was originally used with a 96% African American, English-speaking sample in the Eastern United States. Two research assistants from the target population worked with the non-Hispanic, bilingual investigator to redesign the questionnaire's language and presentation and to collect data. Sixty monolingual Latina mothers participated in the study to determine the internal consistency of the 42-item Spanish language Maternal Childhood Injury Health Belief Questionnaire (MCIHB). Cronbach's alpha coefficients ranged from .76 (Benefits subscale) to .90 (Consequences subscale).

Broadening the understanding of injury prevention: a case study.

The death or injury of a loved one is tragic, especially if that injury could have been prevented. Programs to reduce the incidence and severity of neurological trauma are traditionally driven by injury statistics, and the literature on neurological injury prevention often fails to capture individual experiences. Understanding community members' concerns about injury and safety efforts can move injury-prevention programs to a new level by assessing injury-related beliefs and refining interventions suited to the community. Pediatric injury is an especially complex problem that is influenced by developmental, environmental, sociopolitical, economic, geographic, parental, and child-related factors. Recognition of injury as a public health concern supports updating program development. The following case study, based on an in-depth parent interview, offers a unique perspective on pediatric injury. The audiotaped interview was transcribed verbatim following qualitative guidelines. Three main themes emerged from the analysis: (a) sources of parental concern for children's safety, (b) private versus public safety influences, and (c) behaviors making children vulnerable to injury. As this case study illustrates, parents may consider children susceptible to injury as a result of factors often not considered by injury prevention programs, for example, being "injury prone." Parents also have access to resources, grandparents, for example, not typically considered when programs are marketed. The challenge is to identify how programs become an accepted public safety influence and to address real-life parental concerns.