Exploring the Roles, Functions, and Work Experiences of Nurse Scientists in the Veterans Health Administration.

OBJECTIVE: The aim of this project was to describe nurse scientists' roles, functions, and work experiences in the Veterans Health Administration (VHA). BACKGROUND: Nurse scientists play a critical role in shaping the culture of clinical inquiry and closing the gap between knowledge and practice. METHODS: A cross-sectional survey was used to collect information on sociodemographics, workload, research, clinical practice, education, and time/effort. Data were examined using descriptive statistics and χ2 analyses. RESULTS: One hundred forty-four nurse scientists completed the survey. These nurse scientists serve dynamic and critical roles in conducting research, implementing evidence-based practice, and reforming policy. Research effort was limited due to workload and infrastructure constraints. Better research infrastructure was associated with higher research productivity and funding. CONCLUSIONS: This survey highlights the needs and challenges nurse scientists experience in conducting research and advancing VHA's mission. Given the national shortage of PhD-prepared nurses, long-term strategies are needed to attract, hire, and retain nurse scientists in healthcare systems.

Development of the Ready to Care Survey for VA Women's Health Primary Care Provider.

INTRODUCTION: Women Veterans are at increased risk for poor pregnancy outcomes and are increasingly using Veteran Affairs (VA) for maternity benefits. VA Women's Health Primary Care Providers (WH-PCPs) are well positioned to improve maternal outcomes for women Veterans, yet little is understood about their experience and comfort with perinatal care. The objective of this study was to develop and validate a survey that could be utilized to assess WH-PCPs' experience, comfort, and attitudes towards perinatal care. METHODS: After a review of the literature, we adapted a previously published survey to address four content areas including clinical experience, comfort level, and attitudes towards perinatal care and knowledge of VA specific maternity services. This survey was piloted with five WH-PCPs before undergoing two rounds of content validation with content experts. Content validity indexes (CVI) were calculated based on the content experts' ratings. Qualitative feedback from the content experts were summarized and reviewed by the research team. The CVI and qualitative responses were utilized to guide the decision to revise, refine, or delete survey questions. RESULTS: After the first round of content validation, we deleted three questions, revised three questions, and add three questions to the content areas of clinical experience and comfort. In the domain of attitudes towards perinatal care, we deleted one question and revised two questions and three questions were added to the knowledge of VA specific maternity services domain. After the second round of content validation, only one question was deleted from the attitudes domain. DISCUSSION: We developed and validated the Ready to Care Survey for VA WH-PCP using two rounds of content validation. The final survey had face and content validity. This survey tool can be used to assess VA WH-PCP's knowledge and readiness in caring for Veterans of child-bearing age for operational and research needs.

Survey Analysis of Quantitative and Qualitative Menstrual Cycle Tracking Technologies.

Background and Objectives: Digital health and personalized medicine are advancing at an unprecedented pace. Users can document their menstrual cycle data in a variety of ways, including smartphone applications (apps), temperature tracking devices, and at-home urine hormone tests. Understanding the needs and goals of women using menstrual cycle tracking technologies is the first step to making these technologies more evidence based. The purpose of this study was to examine the current use of these technologies and explore how they are being used within the context of common hormonal and reproductive disorders, like polycystic ovary syndrome (PCOS), endometriosis, and infertility. Materials and Methods: This was a cross-sectional study evaluating menstrual cycle tracking technology use. Participants were recruited in January-March 2023 using social media groups and a Marquette Method instructor email listserv. Data were collected using an electronic survey with Qualtrics. Data collected included participant demographics, menstrual cycle characteristics, reproductive health history, and menstrual cycle tracking behavior. Results: Three-hundred and sixty-eight participants were included in the analysis. Women had various motivations for tracking their menstrual cycles. Most participants (72.8%) selected "to avoid getting pregnant" as the primary motivation. Three hundred and fifty-six participants (96.7%) reported using a fertility awareness-based method to track and interpret their menstrual cycle data. The Marquette Method, which utilizes urine hormone tracking, was the most frequently used method (n = 274, 68.2%). The most frequently used cycle technology was a urine hormone test or monitor (n = 299, 81.3%), followed by a smartphone app (n = 253, 68.8%), and a temperature tracking device (n = 116, 31.5%). Women with PCOS (63.6%), endometriosis (61.8%), and infertility (75%) in our study reported that the use of tracking technologies aided in the diagnosis. Most participants (87.2%) reported a high degree of satisfaction with their use and that they contributed to their reproductive health knowledge (73.9%). Conclusions: Women in our study reported avoiding pregnancy as their primary motivation for using menstrual cycle tracking technologies, with the most frequently used being a urine hormone test or monitor. Our study results emphasize the need to validate these technologies to support their use for family planning. Given that most women in this study reported using a fertility awareness-based method, the results cannot be generalized to all users of menstrual cycle tracking technologies.

A Comparison of Two Hormonal Fertility Monitoring Systems for Ovulation Detection: A Pilot Study.

Background and Objectives: Accuracy in detecting ovulation and estimating the fertile window in the menstrual cycle is essential for women to avoid or achieve pregnancy. There has been a rapid growth in fertility apps and home ovulation testing kits in recent years. Nevertheless, there lacks information on how well these apps perform in helping users understand their fertility in the menstrual cycle. This pilot study aimed to evaluate and compare the beginning, peak, and length of the fertile window as determined by a new luteinizing hormone (LH) fertility tracking app with the Clearblue Fertility Monitor (CBFM). Materials and Methods: A total of 30 women were randomized into either a quantitative Premom or a qualitative Easy@Home (EAH) LH testing system. The results of the two testing systems were compared with the results from the CBFM over three menstrual cycles of use. Potential LH levels for estimating the beginning of the fertile window were calculated along with user acceptability and satisfaction. Results: The estimates of peak fertility by the Premom and EAH LH testing were highly correlated with the CBFM peak results (R = 0.99, p < 0.001). The participants had higher satisfaction and ease-of-use ratings with the CBFM compared to the Premom and EAH LH testing systems. LH 95% confidence levels for estimating the beginning of the fertile window were provided for both the Premom and EAH LH testing results. Conclusions: Our pilot study findings suggest that the Premom and EAH LH fertility testing app can accurately detect impending ovulation for women and are easy to use at home. However, successful utilization of these low-cost LH testing tools and apps for fertility self-monitoring and family planning needs further evaluation with a large and more diverse population.

Multisite Effectiveness Study of the Marquette Method of Natural Family Planning Program.

Women of reproductive age need reliable and effective family planning methods to manage their fertility. Natural family planning (NFP) methods or fertility awareness-based methods (FABMs) have been increasingly used by women due to their health benefits. Nevertheless, effectiveness of these natural methods remains inconsistent, and these methods are difficult for healthcare providers to implement in their clinical practice. The purpose of this study is to evaluate the effectiveness of the Marquette Model NFP system to avoid pregnancy for women at multiple teaching sites using twelve months of retrospectively collected teaching data. Survival analysis (Kaplan-Meier) was used to determine typical unintended pregnancy rates for a total of 1,221 women. There were forty-two unintended pregnancies which provided a typical use unintended pregnancy rate of 6.7 per 100 women over twelve months of use. Eleven of the forty-two unintended pregnancies were associated with correct use of the method. The total unintended pregnancy rate over twelve months of use was 2.8 per 100 for women with regular cycles, 8.0 per 100 women for the postpartum and breastfeeding women, and 4.3 per 100 for women with irregular menstrual cycles. The Marquette Model system of NFP was effective when provided by health professionals who completed the Marquette Model NFP teacher training program. Summary: This study involved determining whether healthcare professionals at ten sites across the United States and Canada trained to provide the Marquette Method NFP services can replicate the effectiveness demonstrated in previous studies of the method. We found a high level of effectiveness (i.e., very low pregnancy rates) in using the Marquette Method among women from various regions across North America with diverse reproductive backgrounds and in particular when using hormonal fertility marker. Healthcare providers who have been trained to teach NFP can successfully incorporate NFP services in their practice and assist their clients in choosing appropriate family planning methods.

Quantitative versus qualitative estrogen and luteinizing hormone testing for personal fertility monitoring.

BACKGROUND: A new fertility monitor is now available that provides quantitative measurement of urinary hormones, but clinical use requires validation against an established fertility monitor that provides only qualitative results. RESEARCH DESIGN AND METHODS: Two fertility monitors were compared using daily first morning urine samples over 3 cycles of use in 21 women users with experience using a fertility monitor with the Marquette Method of Natural Family Planning. RESULTS: Women were aged 33.4 ± 5.5 years and had menstrual cycles ranging between 23 and 41 days. The quantitative Mira Monitor estimates of ovulation were highly correlated with the qualitative ClearBlue Fertility Monitor (CBFM) estimates of ovulation. Both monitors provided an accurate estimate of the fertile window. CONCLUSIONS: In this preliminary trial, the Mira monitor was shown to be effective at delineating the fertile window and ovulation. We demonstrated the feasibility of applying the Marquette Method algorithm with the use of the Mira monitor. Satisfaction differences between the two monitors did not reach statistical significance. We anticipate that quantitative fertility monitoring will give couples and health-care providers new and unprecedented insights into the menstrual cycle and fertility.

Diverse students collaborating to address social determinants of health using listening sessions.

In this article, a Nursing Workforce Diversity grant-funded project examined the social determinants of health (SDH) including diverse high school and baccalaureate nursing students. All involved students were from educationally and/or economically disadvantaged backgrounds and/or underrepresented minority groups. The purpose of this article is to report the project outcome data and analysis gathered from students' experiences of SDH, using the collaborative method, listening sessions. The project staff and student nurses discussed SDH with high school students, who then identified and prioritized key SDH in their neighborhoods during a series of facilitated listening sessions in their schools. Initial analysis included reviewing, with the students, the notes taken during the sessions, resulting in a list of SDH to address. As a secondary analysis, the listening session tapes were transcribed and independently coded and examined by project staff. Six themes evolved that illustrate the depth of understanding of the complex challenges of SDH experienced by students in their local communities. Based on student-determined priorities, the project staff developed programs to meet the identified SDH needs at both high schools. Nursing and other health professionals are in ideal positions to collaborate with schools to create programming interventions for addressing SDH effectively into the future.

Outcomes of an Interprofessional Patient Safety Fellowship Program.

BACKGROUND: Interprofessional training for patient safety is essential in developing leaders and advocates who are versed in patient safety science and interprofessional collaboration. We describe an interprofessional patient safety fellowship program and its outcomes over 8 years. METHODS: Programmatic data were reviewed and a survey was sent to all program graduates with a known email address (N = 18). RESULTS: Fellows obtained interprofessional skills, knowledge, and methods of patient safety science, as well as preparation as patient safety experts through didactic and experiential training. Program outcomes included sustained quality improvements, publications (n = 8), presentations (n = 29), and recruitment of graduates into quality and safety leadership positions (67%). DISCUSSION: Facilitators and barriers that influenced the success of the fellowship program were noted at institutional and individual levels. The development and sustainability of interprofessional safety training programs depends on concerted efforts by leadership, academic-practice partnerships, and committed faculty and learners.

Young Women's Knowledge About Fertility and Their Fertility Health Risk Factors.

OBJECTIVE: To explore the relationships among young women's demographic characteristics, their self-perceived and actual knowledge about fertility, and their fertility health risk factors. DESIGN: A quantitative, cross-sectional study. SETTING: Online survey. PARTICIPANTS: Young women between the ages of 18 and 24 years (N = 342). METHODS: We used an online survey to collect data from young women regarding their demographic characteristics, their self-perceived and actual knowledge about fertility, and their fertility health risk factors. We used multiple linear regression to explore the relationships among these factors. RESULTS: Participants were mainly White, had some form of college education, and used a variety of contraception methods. Regression modeling indicated that participants' self-perceived knowledge and actual knowledge about fertility and their methods of contraception were significantly associated with their fertility health risks (R2 = .13, p < .001). Participants who had higher actual scores of knowledge about fertility and who used fertility awareness methods had fewer self-reported fertility health risk factors. A greater level of self-perceived knowledge about fertility was associated with more fertility health risk factors. Age, education level, and pregnancy history were not significantly associated with fertility health risks. CONCLUSION: Our findings provide evidence that knowledge about fertility is important to enhance fertility self-care for young women. The significant relationship between young women's knowledge about fertility and their fertility health risks highlights the need to assess their knowledge and teach them about fertility as important components of preconception care. Such education may help them avoid fertility health risks and protect young women's current and future fertility.

Cohort efficacy study of natural family planning among perimenopause age women.

OBJECTIVE: To determine the efficacy of using natural family planning (NFP) methods to avoid unintended pregnancy among women of perimenopause age (i.e., age 40-55 years). DESIGN: A secondary analysis of subset data from two prospective observational cohort studies. SETTING: A university based in-person and online NFP service program. PARTICIPANTS: One hundred and sixty couples who used either a website or an in-person NFP service to learn how to avoid pregnancy from January 2001 to November 2012. METHODS: A prospective 12-month effectiveness study among 160 women (between ages 40-55) who used NFP to avoid pregnancy. The women used either a hormonal fertility monitor, cervical mucus monitoring, or both to estimate the fertile phase of their menstrual cycles. Survival analysis was used to determine the pregnancy rate over 12 months of use. RESULTS: There were a total of five unintended pregnancies among the participants. The typical use pregnancy rate was six per 100 women over 12 months. The monitor alone participants (n = 35) had a 12-month pregnancy rate of three, the participants (n = 73) who used mucus alone had a pregnancy rate of four, and the participants (n = 42) who used the fertility monitor plus mucus had a pregnancy rate of six. CONCLUSION: Natural family planning methods can be effective for older women to avoid an unintended pregnancy with correct use and adequate instructions. The pregnancy rate most likely was affected by diminished fertility and motivation to limit family size.

Efficacy of achieving pregnancy with fertility-focused intercourse.

PURPOSE: To compare pregnancy rates when women have intercourse on self-estimated high and peak fertile days and when they only have intercourse on low fertile days during the fertile window (FW). STUDY DESIGN AND METHODS: We used a prospective observational cohort study design. Our convenience sample included 124 women who utilized our online charting Web sites to achieve pregnancy from January 2010 to November 2012. Participants used an electronic hormonal fertility monitor (EHFM) or self-observed cervical mucus or both to determine fertility during the estimated FW. Pregnancy rates were determined with Kaplan-Meier survival analysis. Chi square analysis was used to evaluate the efficacy of achieving pregnancy between two different intercourse patterns. RESULTS: The pregnancy rate was 87 per 100 women at 12 months when intercourse happened on high or peak days and 5 per 100 when intercourse occurred only on low days of the FW. Chi square analysis showed a greater proportion of pregnancies with intercourse on high and peak fertile days of the menstrual cycle (x2 = 40.2, p < .001, df = 1). NURSING IMPLICATIONS: Focusing intercourse on high or peak fertile days during the estimated FW enhances the probability of achieving a desired pregnancy. Fertility awareness-based online charting system is effective in helping women to determine their FW and target intercourse accordingly to achieve pregnancy.