Replication and Extension of the Weight Loss For Life Community-Based Treatment Protocol.

Maintaining weight-loss beyond 6-9 months within behavioral treatments has been problematic. However, a social cognitive theory-driven, community-based curriculum emphasizing the generalization of physical activity-related self-regulation, to eating-related self-regulation (phase 1 treatment; n = 55), demonstrated success at both inducing lost weight over its initial 6 months, and maintaining that loss through month 24. The present replication study contrasted those outcomes with a phase 2 version of the year-long treatment (n = 74) that added a follow-up component during year 2 consisting of 5 brief phone interactions to reinforce self-regulatory skills. Participants were all women with obesity (body mass index 30-40 kg/m2; mean age = 48 years). In phase 2, the mean weight loss of 6.3% during baseline-month 6, and regain of 0.7% through month 24, did not significantly differ from phase 1. However, phase 2 methods were associated with significantly better retention of improvements in self-regulation, fruit/vegetable intake, and physical activity. For phase 2 results, second-year change in fruit/vegetable consumption completely mediated the significant relationship between self-regulation and weight change, and change in physical activity completely mediated the significant relationship between self-regulation and weight change, over the 2-year study. Findings suggest the importance of moderate physical activity and more intensive follow-up focused on self-regulation processes.

Effects of the Youth Fit 4 Life physical activity/nutrition protocol on body mass index, fitness and targeted social cognitive theory variables in 9- to 12-year-olds during after-school care.

AIM: Childhood overweight and obesity is unacceptably high in industrialised nations. School-based interventions have largely been atheoretical and ineffective. This study aimed to test a new theory-based protocol for its effects on measures of fitness and body mass index (BMI), and its proposed psychosocial mediators, during elementary after-school (out-of-school hours) care. METHODS: Nine- to 12-year-old participants of YMCA-based after-school care in the southeastern Unites States were randomised into either the experimental Youth Fit 4 Life (YF4L) treatment group (n = 86) or a typical care group (n = 55) for 45 min/day. YF4L is based on social cognitive theory, emphasising mastery over physical activities and the development of self-management/self-regulatory skills to support healthy behaviours. Physiological and psychosocial variables were assessed over a 9-month elementary school year. RESULTS: Of the overall sample, 28% were overweight or obese at baseline. YF4L was associated with significantly greater improvements in BMI, and measures of self-regulation, mood, self-efficacy, cardiovascular endurance and strength over both 3 and 9 months. Changes in self-regulation, mood and self-efficacy significantly mediated the treatment type-BMI relationship over both 3 months (R 2 = 0.12, P = 0.002) and 9 months (R 2 = 0.13, P = 0.001), with change in self-regulation being a significant independent mediator. Changes in BMI and self-regulation reciprocally reinforced one another. Gender was not a significant moderator of those relationships. CONCLUSIONS: The YF4L treatment mitigated rise in BMI in 9- to 12-year-old enrollees of after-school care. The treatment's basis in social cognitive theory was supported. Because of its positive effects and ability to utilise existing staff, large-scale application is warranted after sufficient replication.

Mediation of self-regulation and mood in the relationship of changes in high emotional eating and nutritional behaviors: Moderating effects of physical activity.

High emotional eating (EE) is prevalent in women with obesity. A previous study's subsample of obese women classified as high emotional eaters participated in either a physical activity-focused experimental (n = 29) or an educationally focused comparison (n = 22) behavioral treatment and was assessed over phases of expected weight loss (baseline-month 6) and short- and long-term regain (months 6-12 and 6-24, respectively). The study's aim was to assess theory-based psychological and behavioral mediation and moderation of changes in nutritional behaviors via emotional eating change in order to inform behavioral weight-loss treatments. During the weight-loss phase, significant improvements in eating self-regulation and mood significantly mediated the relationship of reduced EE and intake of both fruits and vegetables (FV) and sweets. Self-regulation was a significant independent mediator. Physical activity significantly moderated the relationship between EE and self-regulation changes. All variables demonstrated large positive effects and significant time × group interactions favoring the experimental group. During the short and long-term phases of expected weight regain, there were no significant changes in FV intake, although consumption of sweets significantly increased during months 6-24. Change in FV and sweets significantly predicted weight change, which was significantly greater in the experimental vs. comparison group over both the initial 6 months (-6.1% vs. -2.6%) and full 24 months of the study (-7.6% vs. -1.3%). Findings suggest that behavioral treatments should address EE through improvements in self-regulation and mood, and supported physical activity will aid in that process. The need for an improved understanding of weight-loss maintenance remains.

Clinical Deterioration Leadership Ability Scale: A Psychometric Study.

BACKGROUND AND PURPOSE: Assessing nurses' perceived leadership abilities during clinical deterioration provides a starting point for designing educational interventions to support leadership improvement. The study purpose was to provide psychometric testing of the Clinical Deterioration Leadership Ability Scale (CDLAS). METHODS: The psychometric properties and factor structure of the CDLAS was examined. RESULTS: Factor analysis determined a 1-factor structure (eigenvalues 5.783). Construct validity was supported by a significant difference between experienced (M = 3.48, SD = .57) and less experienced nurses (M = 3.27, SD = .68; t(146) = -2.00, p = .047). Acceptable levels of internal consistency reliability were found (.93, .95, and .94). CONCLUSION: The CDLAS has demonstrated acceptable validity and reliability. Further testing is needed in diverse populations and establishment of test-retest reliability.

Effects of an after-school care-administered physical activity and nutrition protocol on body mass index, fitness levels, and targeted psychological factors in 5- to 8-year-olds.

Over one third of U.S. youth are overweight or obese. Treatments typically have had unreliable effects, inconsistently incorporating behavior-change theory. After-school care might be a viable setting for health behavior-change programs. We evaluated effects of two consecutive 12-week segments of a revised self-efficacy/social cognitive theory-based physical activity and nutrition treatment on fitness levels, body mass index (BMI), and targeted psychosocial factors in after-school care participants, ages 5-8 years. Changes in physiological measures, exercise self-efficacy (ESE), and physical self-concept over 9 months were contrasted in experimental (n = 72) vs. typical-care (n = 42) groups. Mediation of the group-BMI change relationship by the psychosocial factors was also assessed. Improvements in physiological measures and ESE were significantly greater in the experimental group. ESE change completely mediated the association of treatment type with BMI change. The experimental group demonstrated significantly greater improvements in the physiological measures, with its treatment's theoretical basis and application within after-school care supported.

The effect of preceptor role effectiveness on newly licensed registered nurses' perceived psychological empowerment and professional autonomy.

The first year turnover rate for newly licensed registered nurses is roughly 30% and increases to about 57% in the second year (Twibell et al., 2012). An effective preceptorship has been shown to better facilitate the first year transition (Hodges et al., 2008) and increase retention rates (Pine and Tart, 2007). The purpose of this study was to examine the relationships between newly licensed registered nurses' perceived preceptor role effectiveness, psychological empowerment and professional autonomy. A prospective, cross-sectional, descriptive research design was used. Sixty-nine newly licensed registered nurses were recruited and surveyed. Newly licensed registered nurses were found to have moderately high levels of perceived preceptor role effectiveness, psychological empowerment, and professional autonomy. Preceptor role effectiveness had significant, moderately, positive relationships with professional autonomy and psychological empowerment. There was also a significant relationship found between professional autonomy and psychological empowerment. Results show that preceptor role effectiveness is linked to increased professional autonomy and psychological empowerment. Therefore, effective preceptorships are necessary in easing the newly licensed registered nurse's transition to practice. Strategies to ensure effective preceptorships and enhance the NRLN's transition to practice are proposed.

The Role of Preceptorship and Group Cohesion on Newly Licensed Registered Nurses' Satisfaction and Intent to Stay.

BACKGROUND: Thirteen percent of newly licensed registered nurses (NLRNs) vacate their first job after 1 year, and 37% report that they feel ready to change jobs. Turnover can lead to consistent and detrimental nursing shortages in nursing units, as well as increased costs for health care systems. METHOD: A descriptive, prospective, cross-sectional design was used to understand how preceptor role effectiveness and group cohesion affect NLRNs' satisfaction and intent to stay. RESULTS: NLRNs reported high levels of perceived preceptor role effectiveness, group cohesion, and job satisfaction, with only moderate levels of intent to stay. Statistically significant relationships were found among preceptor role effectiveness, job satisfaction, and intent to stay, as well as among group cohesion, job satisfaction, and intent to stay. Preceptor role effectiveness and group cohesion are predictors of NLRNs' level of job satisfaction. Job satisfaction is a predictor of NLRNs' intent to stay. CONCLUSION: Effective preceptors and positive group cohesion are factors that are important to NLRNs' job satisfaction and intent to stay.

A statement synthesis of emotional eating and body size recognition: advancing nursing science related to obesity research.

AIM: A discussion of a statement synthesis of the relationship between the concepts of emotional eating and body size recognition. BACKGROUND: The interrelatedness of the concepts of emotional eating and body size recognition is poorly understood; however, both factors significantly impact weight management. Nurses can be instrumental in developing more effective weight management interventions as a critical step in helping to ameliorate the public health burden of obesity. DESIGN: This discussion article reports a literary statement synthesis. DATA SOURCES: Five quantitative research studies from 1996 - 2014 were identified, which examined the relationship between the concepts. IMPLICATIONS FOR NURSING: A relational statement delineating the direct association between the amount of self-reported emotional eating and an adult individual's recognition of their body size was constructed. Construction of a relational statement about emotional eating and recognition of body size is a step in the nursing theory-building process. CONCLUSION: The constructed relational statement will guide future research and nursing theory development and may ultimately help to construct more effective weight management interventions.

Psychosocial predictors of emotional eating and their weight-loss treatment-induced changes in women with obesity.

PURPOSE: This study aimed at assessing whether psychosocial predictors of controlled eating and weight loss also predict emotional eating, and how differing weight-loss treatment methods affect those variables. METHODS: Women with obesity (M = 47.8 ± 7.9 years; BMI = 35.4 ± 3.3 kg/m(2)) were randomized into groups of either phone-supported self-help (Self-Help; n = 50) or in-person contact (Personal Contact; n = 53) intended to increase exercise, improve eating behaviors, and reduce weight over 6 months. RESULTS: A multiple regression analysis indicated that at baseline mood, self-regulating eating, body satisfaction, and eating-related self-efficacy significantly predicted emotional eating (R (2) = 0.35), with mood and self-efficacy as independent predictors. Improvements over 6 months on each psychosocial measure were significantly greater in the Personal Contact group. Changes in mood, self-regulation, body satisfaction, and self-efficacy significantly predicted emotional eating change (R (2) = 0.38), with all variables except self-regulation change being an independent predictor. Decreased emotional eating was significantly associated with weight loss. CONCLUSION: Findings suggest that weight-loss interventions should target specific psychosocial factors to improve emotional eating. The administration of cognitive-behavioral methods through personal contact might be more beneficial for those improvements than self-help formats.

Improvement in emotional eating associated with an enhanced body image in obese women: mediation by weight-management treatments' effects on self-efficacy to resist emotional cues to eating.

AIMS: To assess effects of cognitive-behavioural weight-loss treatments on self-efficacy to control emotionally cued eating and whether those changes mediate relationships between body satisfaction and emotional eating. BACKGROUND: Emotional eating is common, especially in women with obesity. A better understanding of relationships of its psychosocial correlates might benefit behavioural weight-loss treatments. DESIGN: A field-based, quantitative study incorporated two theoretically derived weight-loss treatments using repeated measures analyses that employed validated surveys. METHODS: Women with obesity volunteered for a community-based weight-loss study and were assigned to either a treatment of a manual plus phone support (n = 47), or in-person contacts emphasizing self-regulation (n = 48), over 6 months. Both emphasized physical activity, healthy eating and building self-efficacy for enabling the health-behaviour changes. Data were collected between 2013-2014. Multiple regression analyses assessed predictors of self-efficacy change. Mixed-model analysis of variances assessed treatment differences in psychosocial changes. Mediation analyses assessed mediation of the relationships between body satisfaction and emotional eating changes. RESULTS: Changes in Overall mood and Self-regulation significantly predicted change in Self-efficacy to control emotionally cued eating. Changes in Body satisfaction, Emotional eating, Mood, Self-regulating eating and Self-efficacy were significant overall, and each significantly greater in the in-person treatment. Self-efficacy significantly mediated the relationship between changes in Body satisfaction and Emotional eating total (and Emotional eating when depressed or anxious, but not when frustrated/angry). CONCLUSION: Results clarified mediation of the dynamic relationship between body satisfaction and emotional eating, which might enable behavioural weight-loss treatments to better-address emotional eating.

Indirect effects of exercise on emotional eating through psychological predictors of weight loss in women.

An improved understanding of how weight-loss interventions might be tailored to improve emotional eating is required. This study aimed to assess mediation of the relationship between increased exercise and decreased emotional eating so that behavioral treatments might be optimized. After randomization, women with obesity (N = 108; mean age = 48 years) were assigned to either a previously tested treatment of manual-based self-help for nutrition and exercise plus brief phone follow-ups, or a new protocol of cognitive-behavioral methods of exercise support intended to carry-over psychological improvements to better controlled eating and weight loss. A community-based field setting was incorporated. Validated self-report measures were administered over 6 months. Significant overall improvements in exercise outputs, emotional eating, mood, and self-regulation and self-efficacy for controlled eating were found. The newly developed treatment protocol demonstrated significantly greater improvements in exercise outputs and self-regulation. In a multiple mediation analysis, changes in self-regulation, self-efficacy, and mood significantly mediated the relationship between changes in exercise and emotional eating. Changes in self-efficacy and mood were significant independent mediators. Within follow-up analyses, the substitution of emotional eating subscales that addressed specific moods, and a subscale of self-efficacy for controlled eating that addressed that factor specifically in the presence of negative emotions, yielded results generally consistent with those of the multiple mediation analysis. Results suggested a psychological pathway of exercise's association with emotional eating changes in women with obesity. Guided by the present findings, tailoring exercise support and leveraging it to induce specific psychological improvements might reduce emotional eating and improve weight-management outcomes.

Association of a behaviorally based high school health education curriculum with increased exercise.

Increasing exercise in children and adolescents through academic classes is an understudied area. Potential benefits include associated improvements in health, psychosocial, and quality-of-life factors. A sample of 98 students (M(age) = 14.3) from high school health education classes received six, 40-min lessons incorporating cognitive-behavioral methods to increase exercise over 6 weeks. Significant within-group improvements in exercise, mood, and body satisfaction were found, with slightly larger effect sizes identified for the boys. Increase in exercise was significantly associated with reduced mood distress (ß = -.17, p < .001). For the girls only, change in body satisfaction significantly mediated that relationship, and a reciprocal relationship between changes in mood and body satisfaction was also identified. Incorporation of lessons emphasizing goal setting and self-regulation within high school health education classes may foster increased exercise and associated improvements in mood and body satisfaction. For girls, the positive effects may reinforce one another.

Psychometric properties of the Clinical Decision-Making Self-Confidence Scale.

BACKGROUND AND PURPOSE: Nurses' self-confidence in handling acute patient deterioration events may influence decision-making capabilities and implementation of lifesaving interventions during such events. The study purpose is to provide further psychometric testing of the Clinical Decision-Making Self-Confidence Scale (CDMSCS). METHODS: The psychometric properties and factor structure of the CDMSCS was examined. RESULTS: A two-factor solution was discovered for the CDMSCS. Construct validity was further supported by statistically significant differences between registered nurses and nursing students' self-confidence level in handling deterioration events. Cronbach's alpha coefficients were acceptable for the subscales and instrument. CONCLUSION: The CDMSCS is a valid and reliable instrument. Future studies should focus on establishing test-retest reliability and to determine factor loadings of subscale items to retain or delete cross-loading items.

Cultural competency among nurses with undergraduate and graduate degrees: implications for nursing education.

AIM: To compare the level of cultural awareness, knowledge, skills, and comfort of nurses with undergraduate and graduate degrees when encountering patients from diverse populations. BACKGROUND: Cultural competency is a core curriculum standard in undergraduate and graduate nursing programs. Assessing cultural awareness, knowledge, skills, and comfort among nurses can help identify areas to strengthen in nursing curricula. METHOD: A prospective, cross-sectional, descriptive study design was used. Two thousand surveys were sent to nurses in a southeastern state; 365 nurses participated. RESULTS: Undergraduate-degree nurses scored lower than graduate-degree nurses on cultural knowledge. Scores on cultural awareness, skills, and comfort with patient encounters did not vary between groups. Both groups of nurses reported little cultural diversity training in the workplace or in professional continuing education. CONCLUSION: The findings of this study indicate areas of need for undergraduate and graduate nursing education.

Treatment-associated changes in body composition, health behaviors, and mood as predictors of change in body satisfaction in obese women: effects of age and race/ethnicity.

A lack of satisfaction with one's body is common among women with obesity, often prompting unhealthy "dieting." Beyond typically slow improvements in weight and body composition, behavioral factors might also affect change in body satisfaction. Age and race/ethnicity (African American vs. White) might moderate such change. Obese women (N = 246; M(age) = 43 years; M BMI = 39 kg/m(2)) initiating a 6-month cognitive-behaviorally based physical activity and nutrition treatment were assessed on possible predictors of body satisfaction change. At baseline, African American and younger women had significantly higher body satisfaction. The treatment was associated with significant within-group improvements in mood, health behaviors (physical activity and fruit/vegetable intake), and body composition (waist circumference). A multiple regression analysis indicated that mood, health behavior, and body composition changes explained a significant 27% of the variance in body satisfaction change. Of these predictors, changes in mood (ß = -.36, p < .001) and health behaviors (ß = .18, p = .01) made significant, unique contributions to the variance in change in body satisfaction that was accounted for, while only the measure of actual physiological change (body composition) did not. Neither age nor race/ethnicity was a significant moderator when each was entered separately into the multiple regression equation. Practical implications for leveraging manageable changes in behavioral factors for improving body satisfaction were discussed.

Temporal aspects of psychosocial predictors of increased fruit and vegetable intake in adults with severe obesity: mediation by physical activity.

Effective and reliable obesity treatments are lacking because of a poor understanding of the health behavior change process. Community-based organizations with the capacity to train existing staff members are particularly well-positioned to implement evidence-based treatment protocols to impact obesity-related behaviors such as unhealthy eating and lack of physical activity. The aim of this study was to assess temporal aspects of psychosocial predictors (self-regulation, mood, and self-efficacy) on increased fruit and vegetable intake in adults with severe obesity, while also accounting for mediation by physical activity volume. A 6-month, randomized field investigation was conducted. Severely obese adults volunteered for behavioral support of physical activity coupled with nutrition education (n = 73) or cognitive-behavioral methods for nutrition change (n = 71). Improvements in self-regulation, mood, self-efficacy, fruit and vegetable intake (FV), and physical activity (PA) were significant, with significantly greater self-regulation at month 6 for the cognitive-behavioral group. Increase in FV was predicted by changes in the above psychosocial variables over 6 months, with mood change over 3 months also a significant predictor. Change in PA mediated the above relationships, with a reciprocal effect between changes in PA and FV. Findings have implications for the large-scale behavioral treatment of obesity.

Parental perception of child weight: a concept analysis.

AIM: This article is a report of an analysis of the concept of parental perception of child weight. BACKGROUND: Perception is commonly studied, but lacks a strong conceptual definition. Concept analysis is important in providing a conceptual definition of parental perception of child weight. DESIGN: Rodgers's evolutionary view of concept analysis guided this enquiry. DATA SOURCES: A search of multiple nursing and social sciences databases was undertaken, including CINAHL, Academic Search Complete, Science Direct, ProQuest, PsychINFO, Medline and SocINDEX. REVIEW METHODS: Data from 2000-2012 related to the concept of interest were reviewed. Fifty-eight articles meeting the inclusion criteria were included. Key attributes, antecedent occurrences and consequences of the concept's use were identified. Thematic analysis revealed common themes related to the concept attributes, antecedents and consequences. RESULTS: Five attributes were identified including: parental recognition of body size, physical appearance, functional abilities, psychosocial effects and health effects related to body weight. Antecedents of this concept are parental beliefs and values about body weight, fatalism, societal normalization of overweight, parental weight status and parental mental health status. The consequences of this concept are parental concern, increased knowledge about obesity-related health risks, motivation to make changes and family lifestyle changes. The ultimate goal is a healthy weight for the child. CONCLUSIONS: A middle-range explanatory theory of parental perception of child weight was proposed. Parents who recognize child weight issues may be motivated to initiate lifestyle changes, resulting in a healthy weight for the child.

Cultural challenges and barriers through the voices of nurses.

AIMS AND OBJECTIVES: To discover and describe challenges and barriers perceived by nurses in providing culturally competent care in their day-to-day encounters with diverse patient populations. BACKGROUND: Nurses are challenged in today's healthcare environment to provide culturally competent care to a diverse patient population. To provide patient- and family-centred care, nurses must first acknowledge patient's and family's cultural differences, be willing to incorporate patient's and family's beliefs within the healthcare treatment plan, and respect the values and lifeways of differing cultures. DESIGN: Qualitative description with thematic analysis was used to describe nurses' perceptions of barriers and challenges in providing culturally competent care. The qualitative component of the study was part of a larger research study that used a prospective, cross-sectional, descriptive survey. Participants responded to two open-ended questions about potential challenges and barriers to providing culturally competent health care. METHODS: Nurses were recruited in a south-eastern state in the USA. Research surveys were mailed to 2000 nurses throughout the state using a stratified sampling method. RESULTS: Three hundred and seventy-four nurses participated in the study. Three themes emerged from the qualitative description: great diversity, lack of resources, and prejudices and biases. CONCLUSIONS: The provision of culturally competent patient- and family-centred care is an ethical imperative and professional mandate. Describing nurses' perspectives on challenges and barriers to providing culturally competent care is the first step in helping to redesign care delivery practices. RELEVANCE TO CLINICAL PRACTICE: Challenges to providing culturally competent care included diversity in patient populations, lack of resources to provide culturally competent care and biases/prejudices. Strategies to address these challenges in the areas of nursing education, nursing research and nursing policy were proposed.