Nursing leadership in tobacco dependence treatment to advance health equity: An American Academy of Nursing policy manuscript.

BACKGROUND: Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PURPOSE: The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing's Health Behavior Expert Panel Tobacco Control subcommittee. METHODS: Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FINDINGS: The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DISCUSSION: Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.

Pilot Intervention for Mindful Drinking and Eating for Patients on Hemodialysis with Fluid Restrictions: Lessons Learned.

Patients requiring hemodialysis would benefit from evidence-based strategies that improve adherence to fluid restrictions while concurrently improving quality of life (QOL). This pilot study examined the effect of a four-week mindful drinking and eating intervention on interdialytic weight gain and QOL in patients on hemodialysis. Using paired t tests, no significant differences from pre- to post-test were found in interdialytic weight gain, a measure of fluid restriction adherence, or QOL in either the intervention (n = 18) or wait list control (n = 19) group. However, there was positive qualitative feedback from participants in exit interviews, and there were other indications of feasibility (low drop out, engagement in at-home practice according to weekly checklists). Lessons learned from this pilot study about conducting research regarding fluid restrictions for patients on hemodialysis are presented.

An Interprofessional Approach to Advance Care Planning.

CONTEXT: Advance care planning (ACP) can improve patients' outcomes at end of life, and interprofessional collaboration has been recommended to facilitate ACP. However, role confusion in ACP facilitation among team members from different disciplines exists, and health professional disciplines' expectations for interprofessional collaboration in ACP are unclear. OBJECTIVE: To review expectations of major health professional organizations for ACP competencies, in order to identify gaps and opportunities for promoting interprofessional collaboration in ACP facilitation. METHODS: Guidelines and recommendations for ACP across disciplines including chaplaincy, medicine, nursing, psychology, and social work were identified and analyzed using content analysis. Main themes were then reviewed against national consensus statements on 4 ACP outcomes (process outcomes, action outcomes, quality of care outcomes, and healthcare outcomes) and mapped into existing domains for interprofessional education competency: values/ethics, roles/responsibilities, interprofessional communication, and teams and teamwork. RESULTS: Three major content themes were identified: professional commitment to advocating for patients' values and self-determination, professional responsibility to facilitate ACP, and specific tasks in ACP. These themes addressed mostly process and action outcomes of ACP but not quality of care outcomes or healthcare outcomes. Few disciplines included interprofessional collaboration as part of ACP competency. CONCLUSION: There is a need for standardized competency guidelines for interprofessional collaboration in ACP as an important first step in reducing confusion among roles and other challenges in facilitating ACP. Further efforts in practice, research, and policy are needed to facilitate interprofessional ACP, achieve competencies, and improve patients' outcomes.

Lessons learned from eight teams: The value of pilot and feasibility studies in self-management science.

Designing and conducting effective intervention research is an important domain of nursing science. Nurse scientists have long recognized people with chronic conditions need effective self-management strategies across the lifespan, so they have led the way in establishing theoretical and practical grounds for the science of self-management. Guidance from pilot and feasibility research for self-management interventions is scarce. Documented exemplars of successes and failures in pilot and feasibility study designs are scant in the literature. The purpose of this paper is to illustrate methodological approaches using pilot and feasibility examples. To maximize collective lessons learned in self-management science study design, features of our pilot and feasibility research strategies that yielded both desirable and undesirable outcomes are described, analyzed, and paired with alternative solutions. A National Institute of Nursing Research P30 grant center, awarded grants to 8 pilot investigators to pilot self-management interventions. A wide variety of chronic conditions were addressed, including heart failure, chronic kidney disease, multiple sclerosis, diabetes, and HIV. The investigators provided their experiences of study implementation. Common themes across the studies were identified. There were four lessons learned from these studies: 1) maximize resources and develop enough evidence for subsequent studies; 2) embed patient-centered feasibility within implementation testing with new patient populations; 3) develop a flexible participant recruitment plan to allow for adjustments when unexpected barriers arise; and 4) define study-specific data collection procedures to demonstrate feasibility. Researchers conducting preliminary small-scale self-management intervention research must balance resources to develop and implement interventions to meet pilot and feasibility objectives.

Quality of Life after Dietary Self-Management Intervention for Persons with Early Stage CKD.

Dietary recommendations that potentially delay the progression of chronic kidney disease (CKD) can be perceived as restrictive and unpalatable, negatively impacting quality of life (QOL). This pilot study examined the effect of a six-week small group intervention, "Self-Management of Dietary Intake Using Mindful Eating," on QOL, health literacy, and dietary self-efficacy among persons with CKD Stages 1-3. Improvements (n=19) were found from pre-test to post-test in total scores for Kidney Disease Quality of Life Short Form-36 (p=0.003), health literacy (p=0.001), and self-efficacy (p=0.003). The intervention had promising results for improving both diet management and QOL, which supports further testing in randomized control trials.

Using Videoconferencing for Verbal Reports to Improve Clinical Nurse Specialist Student Performance.

PURPOSE: Clear, concise verbal reports are essential to clinical nurse specialists' practice, yet current literature addressing the development of this skill is sparse. The purpose of this study is to determine the effectiveness of using videoconferencing for verbal reports as a learning strategy for improving clinical nurse specialist students' communication competencies and advanced practice decision making. DESCRIPTION OF THE PROJECT: Videoconferencing, using iPad minis issued to faculty and students, was used routinely for verbal reports on clinical cases to faculty, which included immediate faculty feedback. A verbal report template of patient chief complaint, applicable history, review of systems, physical examination/labs, differential diagnoses, and management was developed and provided to students. OUTCOME: Initial student verbal reports were disorganized, lengthy, lacking content, or containing extraneous details. After students routinely gave verbal reports via videoconferencing, verbal report time for the class decreased from more than 20 minutes to 3 to 5 minutes and the accuracy of reports also increased. CONCLUSION: A concise, clinically relevant verbal report template, combined with videoconferencing that allowed for frequent and immediate feedback from faculty, improved student communication competencies. Current technology, such as tablets and smart phones, provide videoconferencing opportunities that can be used to enhance learning for students.

Food Sources of Sodium in Korean Americans With Type 2 Diabetes: Implications for Cardiovascular Disease.

INTRODUCTION: Excess sodium intake can increase the risk of high blood pressure and cardiovascular disease, common comorbidities for those with type 2 diabetes mellitus (T2DM). The purpose of this study is to describe sodium intake and high sodium food sources among Korean Americans (KAs) with T2DM. METHOD: This study, a descriptive, secondary analysis of baseline data from a clinical trial for diabetes, recruited KAs with T2DM ( n = 232) from the community. RESULTS: Average dietary sodium intake was 3,433 mg. Major sources of dietary sodium were from bicultural diets: noodles and dumplings, Korean-style soups, kimchi, breads and snacks, and boiled or seasoned vegetables. Participants who consumed excessive sodium were more likely to consume more calories and be male, married, and more recently diagnosed with T2DM. DISCUSSION: High consumption of sodium among KAs with T2DM supports the need to develop effective, tailored interventions addressing dietary sodium that incorporates the individual's culture.

Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children.

PURPOSE: The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma. METHODS AND DESIGN: Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management. RESULTS: Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions. PRACTICE IMPLICATIONS: Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.

Factors Predicting Sodium Intake of Korean Americans with Type 2 Diabetes.

The increasing prevalence of type 2 diabetes mellitus (T2DM) and its complications including cardiovascular disease and chronic kidney disease threaten Korean Americans (KAs). High dietary sodium intake contributes to both conditions. The purpose of the study was to assess dietary sodium consumption and to examine the predictors of sodium intake among KA with T2DM. A total 232 KA who had uncontrolled diabetes participated in this study. The majority of the sample (69%) consumed more sodium than current national guidelines. A high level of energy intake was the strongest predictor for sodium intake with gender and marital status also related. Our findings identified predictive factors to excessive sodium intake and these data support the need for culturally-tailored education about appropriate dietary sodium and energy intake are needed for patients about T2DM.

Factors influencing dietary fat intake among black emerging adults.

OBJECTIVE: To determine what factors influenced dietary fat intake (DFI) among black emerging adults. PARTICIPANTS: Sample included 251 black emerging adults, ages 18-25 years, living in the US. METHODS: This was a nonexperimental cross-sectional study based on self-report data. RESULTS: The sample had high DFI. Factors related to DFI were gender (rpb = -.22, p < .001), perceived barriers for healthy eating (r = .32, p < .001), and perceived self-efficacy (r = -.33, p < .001). These variables were also significant predictors for DFI. Gender was significantly related to DFI (b = -5.894, p = .000). Religious commitment moderated the effect of stress on DFI. CONCLUSIONS: Gender, perceived barriers for healthy eating, and perceived self-efficacy were significant predictors for DFI. Religious commitment influenced the relationship of perceived stress and DFI. These findings may lead to interventions designed to reduce DFI and cardiovascular risks among black emerging adults.

A Multifaceted Model to Evaluate Interprofessional Education in Clinical Nurse Specialist Programs.

PURPOSE: Preparing students to engage in team-based healthcare is a major focus of clinical nurse specialist (CNS) education programs. A robust evaluation plan is needed to monitor achievement of key outcomes in this complex undertaking. DESCRIPTION: Informed by the work of Kirkpatrick and Stufflebeam, an evaluation model that incorporates multiple information sources about process and outcomes related to interprofessional (IP) education is proposed. OUTCOME: Improvements in scores on attitude and competency measures suggest that the program had the desired effects on students' attitudes and self-efficacy for IP collaboration and was validated by faculty clinical observations of IP communication and teamwork. Moreover, students indicated at both graduation and at 1-year follow-up surveys that they were prepared to function on IP teams, providing further evidence that the clinical nurse specialist (CNS) program prepared them in this key area of nursing practice. CONCLUSION: The evaluation plan guided the collection of quantitative and qualitative information that faculty could use to refine the CNS program. Congruent with the CNS role as change agents, future model refinements should incorporate systems change activities.

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease.

Using mindful eating to improve specific dietary recommendations has not been adequately studied. This feasibility study examined an intervention, self-management of dietary intake using mindful eating, with 19 participants that had mild to moderate chronic kidney disease, using a prospective, single group, pretest-posttest design. The intervention had six weekly classes focused on self-management using mindful eating, goal-setting, problem-solving, and food label reading. Weight, body mass index (BMI), 3-day 24-h dietary recalls and fasting blood samples were measured. Participants improved significantly in mean weight (203.21 ± 42.98 vs 199.91 ± 40.36 lbs; P = 0.03) and BMI (32.02 ± 5.22 vs 31.57 ± 5.27 kg/m2; P = 0.04), but not in dietary intake nor blood measures with the exception of cis-beta-carotene levels (0.020 + 0.012 vs 0.026 + 0.012 mcg/mL; P = 0.008), which correlates to fruit and vegetable servings. These promising results warrant further testing of the intervention in randomized control trials.

Managing Gestational Weight Gain: Obstetricians' Perceived Barriers and Interventions.

To support optimal health outcomes during pregnancy, understanding obstetricians' (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs' practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).

Use of an Objective Structured Clinical Examination in Clinical Nurse Specialist Education.

PURPOSE: Helping patients maximize their potential using expert coaching to facilitate lifestyle change is an important practice area for clinical nurse specialists (CNSs). The purpose is to determine the usefulness of objective structured clinical examinations (OSCEs) for evaluating CNS students' coaching competencies in the context of facilitating lifestyle change. DESCRIPTION OF THE PROJECT: Despite the use of OSCEs to assess competencies in clinical skills (eg, performance of procedures, decision making), its potential for evaluating coaching competencies for lifestyle change has not been demonstrated. We developed 4 OSCEs dealing with coaching patients in exercise, weight loss, stress reduction, or nonpharmacologic management of hyperlipidemia. Evaluation criteria included (1) approach to the patient, (2) information gathering, (3) motivational interviewing, and (4) management (medical and behavioral strategies). OUTCOME: Student performance ranged from highly organized with proficient coaching skills to disorganized and focused solely on clinical management and prescriptive communication. Student responses were positive. CONCLUSION: Objective structured clinical examinations were highly useful for evaluating CNS students' coaching competencies for lifestyle change. Using OSCEs early in the semester to provide students feedback on their performance and again at the end to determine improvement optimizes use of this teaching strategy.

Emotional Eating, Nonpurge Binge Eating, and Self-Efficacy in Healthy Perimenopausal Women.

PURPOSE: To examine the relationships among nonpurge binge eating, emotional eating, and diet-related self-efficacy in perimenopausal women, a population at risk for weight gain. DESIGN OF STUDY: Descriptive correlational study. METHOD: Secondary analysis of baseline data for a weight gain prevention intervention, Mindful Restaurant Eating, with a sample of healthy perimenopausal women (n = 43). FINDINGS: Controlling for age and body mass index, the binge eating severity was associated with emotional eating (partial r = .71; p ≤ .01) and was negatively associated with diet-related self-efficacy (partial r = -.49; p ≤ .05). There was a significant difference (p < .01) in emotional eating scores between women with moderate to high binge eating severity scores and those with low binge eating severity scores. Participants with higher binge eating severity also had less diet-related self-efficacy, especially with regard to resisting relapse and reducing calorie intake. CONCLUSIONS: Perhaps perceived loss of control, a central component to binge eating, negatively affects one's ability to consistently attain dietary goals, thus affecting self-efficacy. Interventions increasing diet-related self-efficacy may prove useful in decreasing the amount of excess calories consumed because of emotional eating and/or binge eating behavior.

Nursing journal clubs and the clinical nurse specialist.

PURPOSE/OBJECTIVES: The purpose of this article was to describe the clinical nurse specialist's role in developing and implementing a journal club. Tools for critiquing clinical and research articles with an application of each are provided. BACKGROUND: The journal club provides a forum through which nurses maintain their knowledge base about clinically relevant topics and developments in their specific clinical discipline, analyze and synthesize the relevant scientific literature as evidence, and engage in informal discussions about evidence-based and best practices. RATIONALE: The value of journal clubs includes nursing staff education, review of and support for evidence-based practice, promotion of nursing research, and fostering of organization-wide nursing practice changes. DESCRIPTION: The process for establishing a journal club and suggested appraisal tools are discussed. In addition, strategies for overcoming barriers to the implementation of a journal club are outlined. Suggested article review questions and a reporting format for clinical and research articles are provided with examples from 2 articles. Finally, a glossary of terms commonly used by research scientists and manuscript writers are listed and additional resources provided. OUTCOME/CONCLUSION: The clinical nurse specialist's role in developing and implementing a journal club will be facilitated through the use of this article. IMPLICATIONS: Enhanced nursing staff education, evidence-based practice, organization-wide nursing practice changes, and nursing research may be conducted following the implementation of a nursing journal club.

Correlates of body mass index in women with fibromyalgia.

BACKGROUND: Excess weight in women with fibromyalgia syndrome (FMS) may further contribute to joint pain and fatigue. However, there is little research addressing weight issues in this population. PURPOSE: This study examined the relationship of body mass index (BMI) to quality of life. METHODS: Quality of life was measured by the 36-Item Short Form Health Survey, severity of FMS, nutritional intake, Barriers to Health Promoting Behaviors for Disabled Persons Scale (BS), and self-efficacy for health-promoting behaviors (Self-Rated Abilities for Health Practices Scale) in women with FMS. Baseline data were collected on 179 women diagnosed with FMS. FINDINGS: Controlling for age, BMI was significantly (p < .05) correlated with 36-Item Short Form Health Survey subscales of physical functioning, bodily pain and vitality, severity of FMS using the Tender Point Index, calories, protein, fat, saturated fat, BS, and Self-Rated Abilities for Health Practices Scale subscale for exercise. The findings support a growing body of evidence that excess weight is negatively related to quality of life and pain in women with FMS.

Relationships among maternal nutrient intake and placental biomarkers during the 1st trimester in low-income women.

PURPOSE: Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester. METHODS: A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy. RESULTS: The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024]. CONCLUSIONS: Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.

The effect of a mindful restaurant eating intervention on weight management in women.

OBJECTIVE: To evaluate the effect of a Mindful Restaurant Eating intervention on weight management. DESIGN: Randomized control trial. SETTING: Greater metropolitan area of Austin, Texas. PARTICIPANTS: Women (n = 35) 40-59 years old who eat out at least 3 times per week. INTERVENTION: The intervention, using 6 weekly 2-hour, small group sessions, focused on reducing calorie and fat intake when eating out through education, behavior change strategies, and mindful eating meditations. MAIN OUTCOME MEASURES: Weight, waist circumference, self-reported daily calorie and fat intake, self-reported calories and fat consumed when eating out, emotional eating, diet related self-efficacy, and barriers to weight management when eating out. ANALYSIS: General linear models examined change from baseline to final endpoint to determine differences in outcomes between the intervention and control group. RESULTS: Participants in the intervention group lost significantly more weight (P =.03), had lower average daily caloric (P = .002) and fat intake (P = .001), had increased diet-related self-efficacy (P = .02), and had fewer barriers to weight management when eating out (P = .001). CONCLUSIONS AND IMPLICATIONS: Mindful Restaurant Eating intervention was effective in promoting weight management in perimenopausal women.

Predictors of dietary quality in low-income pregnant women: a path analysis.

BACKGROUND: Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. OBJECTIVE: The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. METHOD: A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. RESULTS: The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (ß = .36) and a direct (ß = -.23) and indirect effect on dietary quality (ß = -.30). Poor eating habits had a direct effect on dietary quality (ß = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (ß = .39) and nutritional knowledge (ß = .18) and an indirect effect on dietary quality (total effect, ß = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. DISCUSSION: Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.