Development and Validation of an Instrument to Measure Barriers to Surgical Conscience Action in Perioperative Nurses.

Background: Surgical conscience is a concept well known to perioperative nurses, yet it is rarely studied. The purpose of this study was to develop and psychometrically validate an original instrument called the Surgical Conscience Scale with perioperative nurses. Methods: The Surgical Conscience Scale was designed after a review of the literature, the creation of a concept analysis, content validity, and pilot testing. Validity was explored by an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) with separate groups of participants. Results: EFA results explained 55% of the variance with three factors: Foundational Components, Barriers to Surgical Conscience Action, and Required Attributes. The CFA findings did not support goodness-of-fit indices in total; however, a valid and reliable subscale was discovered that measures barriers to using one's surgical conscience. This six-item scale, now referred to as the Barriers to Surgical Conscience Action Scale, had all six items of this factor (.734, .754, .806, .689, and .573) with strong loadings (>.5). Additionally, a good reliability coefficient of the subscale (α = .874) supports the recommendation to use this subscale on its own to measure barriers of surgical conscience. Conclusion: The use of the Barriers to Surgical Conscience Action Scale can promote awareness about the harmful consequences of failed action on behalf of perioperative nurses and help promote proficient surgical conscience usage.

An Integrative Review of the Perinatal Experiences of Black Women.

OBJECTIVE: To synthesize the current body of evidence regarding the perinatal experiences of Black women. DATA SOURCES: The databases PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus were searched with the search terms "African American" (in PubMed), "Black" (in Scopus), or "Black" OR "African American" (in CINAHL) AND "pregnancy" AND "experiences." STUDY SELECTION: Searches yielded 266 articles published between January 2015 and May 2021. After initial screening, 68 articles were assessed for eligibility, yielding 23 studies that met the inclusion criteria of this review. DATA EXTRACTION: Studies were reviewed for the perinatal experiences of Black women. Nonresearch articles, systematic reviews, and instrument development articles were removed. Also excluded were articles with a focus on adolescent pregnancy, breastfeeding experiences, and those outside of the perinatal time frame. DATA SYNTHESIS: Analysis showed that Black women continue to report negative experiences in perinatal care and that these negative experiences spanned various sociodemographic characteristics. Although some Black women described positive interactions, many more expressed dissatisfaction with the lack of education, resources, and continuity in care, as well as poor communication. Additionally, experiences of racism and biases in care, mistrust in the health care system, and doubts of the efficacy or necessity of medical treatments exist. CONCLUSION: Negative perinatal care experiences and dissatisfaction among Black women remain common. Although Black women desire more holistic, naturalistic, and empowering care, Black women first want safe, respectful care and a health care team that removes biases and racism from its system. More research is needed that includes the voices of Black women to understand these experiences and to develop interventions to improve the perinatal care experience. Nurses and other health care providers providing care in the perinatal period must also listen to, trust, and respect Black women.

Development and validation of the mirror image comfort and avoidance scale (MICAS).

PURPOSE: The purpose of this study was to develop an instrument to measure the experience of viewing one's reflection in the mirror for use in rehabilitation, nursing, psychology, and in research studies designed to improve the mirror-viewing experience for those who have suffered psychological or bodily trauma. A secondary purpose was to explore demographic differences in each subscale of the instrument. METHODS: The developed items went through content expert validation, exploratory and confirmatory factor analyses, and internal consistency reliability testing. RESULTS: Using an exploratory factor analysis (n = 137) and a confirmatory factor analysis (n = 142), we validated a 17-item instrument for two distinct populations: veterans (n = 108) and individuals with upper and lower limb loss (n = 210). The mirror viewing comfort subscale (9 items; α = 0.90) and the mirror avoidance subscale (8 items, α = 0.94) were deemed reliable. Strong, significant correlations between pre-and post-comfort scores (r = 0.81, p < 0.001), as well as pre-and post-avoidance scores (r = 0.94, p < 0.001) provide evidence of test-retest reliability. Demographic differences were noted in the subscales. CONCLUSIONS: This instrument contributes to a greater understanding of the experience of mirror-viewing in clinical practice. In interventional research studies to improve the mirror-viewing experience, this instrument can act as a manipulation check or outcome measure.Implications for rehabilitationIndividuals who suffer actual or perceived body disfigurement due to surgery or trauma may suffer mirror discomfort or mirror trauma when viewing their bodies in a mirror. This reaction is due to a pre-frontal cortex neurological disruption and autonomic nervous system fright/flight or faint. Psychological disorders (e.g., devastation, shame, self-revulsion, decreased body image) may ensue.Falls have occurred due to mirror trauma due to an autonomic nervous system disturbance (faint) and may result in ongoing mirror avoidance. When mirrors are needed for incision visualization, mirror avoidance has led to severe surgical site infections.Although there were many scales available in the literature to measure several aspects of the effects of actual or perceived body disfigurement, there were no scales that measured the mirror-viewing experience.Clinicians and researchers can use the Mirror Comfort and Avoidance Scale (MICAS) to assess mirror comfort and avoidance.

Contraception among women on probation and parole on the United States-Mexico border.

OBJECTIVE: Effective contraception prevents unintended pregnancy which disproportionately affects women in the criminal justice system. This study examined selected variables associated with contraceptive use by women on probation and parole living on the United States-Mexico border. DESIGN: This quantitative correlational study examined individual and interpersonal variables-age, parity, ethnicity, prior contraception, self-efficacy, pregnancy attitudes, and reproductive autonomy-that may influence contraception among 52 women under community supervision. MEASURES: Variable were examined with bivariate, multivariate analyses, and hierarchical logistic regression. Data were collected from a demographic and contraceptive use survey, and validated scales measuring reproductive autonomy and pregnancy attitudes. RESULTS: Contraceptive methods were used by 89% of the women; 65% used effective methods, but this decreased to 35% among those released within the past year. Reproductive autonomy was associated with effective contraceptive use. Prior contraception and contraceptive self-efficacy were significant, but wide confidence intervals suggested instability. The remaining variables were insignificant. CONCLUSION: No known studies have examined contraception use among women on probation and parole on the border. More women used some form of contraception than might be predicted. Collaborative efforts between correctional facilities and the community are needed to expand access to contraception.

To Role Model or Not? Nurses' Challenges in Promoting a Healthy Lifestyle.

Nurses often struggle with maintaining a healthy lifestyle. While nurses are often assumed to have the knowledge to participate in health-promoting behaviors, this knowledge may not translate into sustainable change in behavior. The purpose of this descriptive study was to compare nurses' health behaviors with residents in the community where the nurses were employed. Participants (N = 166) completed the Health Promoting Lifestyle Profile-II survey (HPLP-II) along with a demographic survey. The HPLP-II consists of six dimensions of a health-promoting lifestyle: (a) spiritual growth, (b) health responsibility, (c) physical activity, (d) nutrition, (e) interpersonal relations, and (f) stress management. Both groups scored the highest in spirituality followed by interpersonal relations. However, scores for the other HPLP-II dimensions ranked differently between the two groups. Nurses scored higher in health responsibility while the community participants scored higher on nutrition. Both groups scored the lowest on stress management and physical activity. Significant differences between groups were found only on the health responsibility dimension of the HPLP-II survey with nurses scoring higher. While nurses overall did not do any better than the general population in participating in a healthy lifestyle, patient stakeholders feel strongly that nurses should role model healthy behaviors. Employers need to be better prepared to support nurses to participate in a healthy lifestyle. Success can come from even small incremental changes (e.g., walking groups, team challenges, taking stairs) within the work environment. Furthermore, evidence-based practice teams that include administration, management, and staff are positioned to contribute through education and development of innovative workplace wellness programs.

Relationship of Tympanic and Temporal Temperature Modalities to Core Temperature in Pediatric Surgical Patients.

Temperature monitoring is a standard of anesthesia care as listed in Standard V of the American Association of Nurse Anesthetists Standards of Nurse Anesthesia Practice. The purpose of this quantitative correlational study was to examine which temperature modality (tympanic vs temporal) best correlates with pediatric surgical patients' core rectal temperature. Data were from a sample of 106 intraoperative pediatric surgical patients with ASA physical classification 1 or 2 who were scheduled for elective surgical procedures. Findings from this study support that tympanic temperature correlates more to core rectal temperature both before (Pearson r = 0.36 vs 0.16) and after surgery (Pearson r = 0.57 vs 0.33) and had less bias with core rectal temperature (r = -0.37 vs -0.55) than temporal temperature. Multiple regression analyses further supported tympanic temperature as the best predictor of core rectal temperature both before surgery (R² = 0.17, R²adj = 0.13, F(5, 100) = 4.18, P = .0007) and after surgery (R² = 0.34, R²adj = 0 .30, F(7, 99) = 7.47, P = .001). Although generalizations are limited beyond this study population, the findings add support to recommend tympanic temperature as the temperature modality of choice in the pediatric surgical population.

Development of the exercise motivation questionnaire with Mexican American adults.

Prevalence of physical inactivity is the highest among Mexican Americans (40%) as compared to only 18% among Whites. The purpose of this study was to test a culturally relevant exercise motivation instrument with 269 Mexican Americans living along the southern New Mexico border area. Construct validation was supportive with items clustering into five factors consistent with reversal theory constructs explaining 54% of the variance. Further support was achieved with a positive correlation between the Exercise Motivation Questionnaire--Mexican American (EMQ-MA) and the Motives for Activity Participation Questionnaire (r = .10-.77) and with regular exercisers scoring higher on all subscales. Internal consistency values for the subscales ranged from .80 to .90. There is potential for developing individualized exercise interventions based on exercise motivation as measured by the EMQ-MA.

Implementing an over-the-counter medication administration policy in an elementary school.

A major focus of school nursing interventions is to improve school attendance. In many schools, parents are required to leave work and/or to arrange transportation to bring their children over-the-counter medicines. Many times these children went home, missing class and making it difficult to keep up with class work. The purpose of this study was to examine the impact of a new policy and procedure allowing school nurses to administer certain over-the-counter medications in elementary schools in a southern New Mexico public school district. "Sent home" rates before implementation of the new policy were compared with sent home rates for 2 years following implementation. Although not statistically significant, findings indicated that over-the-counter medication administration by school nurses does show a trend toward sending fewer students home and, therefore, keeping them in the learning environment.