Testing Race Differences in Risk of Gestational Diabetes Mellitus Associated with Household Food Insecurity (Using NHANES 2007-2018).

OBJECTIVE: This study aimed to estimate the association of household food insecurity with gestational diabetes mellitus (GDM) risk by race and ethnic group. STUDY DESIGN: The study was a secondary analysis from the National Health and Nutrition Examination Survey from 2007 to 2018. A survey-weighted logistic regression model was constructed with self-reported GDM as the response. The primary independent variable was a four-level food security indicator, defined as the inability to obtain food in a socially acceptable way due to the lack of financial resources and controlled for several established risk factors. Analyses were stratified by race (White and Black) and ethnicity (Hispanic) to provide insight into how gestational diabetes risk differs by subpopulation. RESULTS: Results indicated that family history of diabetes is a risk factor across all races (adjusted odds ratio [aOR]: 4.22-16.26), while household food insecurity is a significant risk factor for only Hispanic women living with a partner (aOR: 8.50 for very low food security). CONCLUSION: In the United States, Hispanic women's GDM risk may be uniquely impacted by food insecurity. KEY POINTS: · This study provides a national estimate of the GDM risk from food insecurity by race and ethnicity.. · The results in this study suggest a statistically significant relationship between household food insecurity and an increasing risk of developing GDM for Hispanic individuals.. · White women who live alone (without spouse or partner) were also at elevated risk of GDM.. · Age at delivery, poverty ratio, and family history of diabetes are also risk factors for the disease..

State of Mental Health, Healthy Behaviors, and Wellness Support in Big 10 University Nursing and Health Sciences Faculty, Staff, and Students During COVID-19.

BACKGROUND: Federal and national entities urge organizations to assess healthcare professionals' mental health and well-being as the COVID-19 pandemic has compounded the issue. AIMS: This study aimed to (1) describe rates of mental health issues, healthy lifestyle behaviors, and perceptions of COVID-19's impact among Big 10 University nursing and health sciences faculty, staff, and students; (2) identify predictors of depression, anxiety, stress, and burnout; and (3) assess the relationships among perceived school wellness support, healthy lifestyle behaviors, physical/mental health, and mattering. METHODS: A cross-sectional descriptive correlational design was used. Nursing and health science deans emailed invitations to faculty, staff, and students concerning an anonymous wellness assessment survey. Correlation coefficients tested associations among mental health indicators and wellness cultures. Multiple linear regression examined factors associated with mental health indicators. RESULTS: Faculty, staff, and students responded (N = 1345). Findings indicated that most respondents were not getting adequate sleep, meeting physical activity recommendations, or eating the daily recommended number of fruits/vegetables. Fourteen to 54.9 % of participants reported depression, anxiety, and burnout. Overall, students, faculty and staff at colleges that operated under a strong wellness culture had better outcomes. CONCLUSION: Wellness cultures impact the mental and physical health of faculty, staff, and students.

Compassion fatigue and COVID-19: A global view from nurses.

BACKGROUND: Due to the rapid spread of COVID-19 variants, the number of people hospitalized for COVID-19 may create psychological burdens on nurses. Nurses with high levels of compassion fatigue (CF) are more likely to make work errors, deliver poor-quality care, and have greater intent to leave their position. OBJECTIVES: This study utilized the social-ecological model to examine factors associated with nurses' CF and compassion satisfaction (CS) during the COVID-19 pandemic. METHODS: Data were collected from the United States, Japan, and South Korea from July to December 2020. The Professional Quality of Life Scale was used to measure burnout (BO), secondary traumatic stress (STS), and CS. RESULTS: Data from 662 responses were used in the analysis. Mean scores were 25.04 (±6.44) for BO, 24.81 (±6.43) for STS, and 37.85 (±7.67) for CS. Multiple regression analyses indicated that resilience and intention to leave nursing were related to each study outcome (i.e., BO, STS, and CS). Greater resilience predicted lower BO and STS but greater CS, whereas intention to leave nursing indicated greater BO and STS, but lower CS. Furthermore, intrapersonal factors and organizational factors (i.e., nurses involved in developing policies to prepare for COVID-19 patients, organizational support, and personal protective equipment [PPE] provisions) were related to BO, STS, and CS. LINKING EVIDENCE TO PRACTICE: To promote nurses' psychological well-being, improvement of organizational factors such as support, PPE, and programs to enhance resilience is recommended to prepare for future emerging infectious disease crises.

Application of the PERMA Model of Well-being in Undergraduate Students.

The PERMA model was introduced by Seligman in 2011 to increase and measure well-being. This model defines well-being in terms of Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA). Mental health concerns are common in undergraduate students and may prevent them from obtaining optimal well-being. The purpose of this study was to test whether all five PERMA elements of well-being could be constructed from items within the 2018 Purdue University Student Experience at a Research University (SERU) survey. Using confirmatory factor analysis, all five PERMA constructs were supported and demonstrated good model fit statistics. A second order PERMA well-being construct was built and demonstrated adequate model fit with RMSEA = 0.04. All five constructs were significant at p < .001. Accomplishment had the highest factor loading (0.76) and Meaning had the lowest factor loading (0.25). Results for this study support use of well-being theory in the context of undergraduate students and provides enhanced understanding of well-being characteristics in this population.

Subjective Well-Being, Depression, and Delays in Care Among Older Adults: Dual-Eligible Versus Medicare-Only Beneficiaries.

We aimed to (a) determine the role of subjective well-being and depression in care delays among Medicare beneficiaries and (b) examine whether subjective well-being and depression play a differential role among Medicare-only and dual-eligible beneficiaries. A nationally representative sample of 1,696 older adults participated in the study. Roughly, 22% of participants reported often or sometimes experiencing care delays, with more delays among dual eligibles. We found that higher levels of subjective well-being were significantly related to less frequent care delays. In contrast, higher levels of depression were significantly related to more frequent care delays. Moreover, as depression increased, the predicted probability of delays increased to a greater extent among dual eligibles than Medicare-only beneficiaries. These findings signify the importance of identifying and implementing strategies to enhance subjective well-being and reduce depression in older adults, particularly dual eligibles, to improve access to timely care.

Understanding the Development, Evaluation, and Sustainability of Community Health Networks Using Social Network Analysis: A Scoping Review.

OBJECTIVE: Identify the scope of the literature which reports use of social network analysis to inform, support, or evaluate health promotion-focused community network/partnership development. DATA SOURCE: A comprehensive search (not date-limited) of PubMed, CINAHL, Web of Science Core Collection, PsycInfo, and the Cochrane Library Database for Systematic Reviews. INCLUSION AND EXCLUSION CRITERIA: Criteria for inclusion included published in the English language and used social network analysis to inform, support, or evaluate development of community networks/partnerships aiding health promotion efforts. Studies were excluded if they did not use social network analysis or were not focused upon health promotion. DATA EXTRACTION: Three of the four authors extracted data using a summary chart to document information regarding study aims, target issue/population, methods, and key outcomes of the social network analysis. DATA SYNTHESIS: The extracted data were qualitatively analyzed by 3 authors to categorize key social network analysis outcomes into categories. RESULTS: Ninety-seven studies representing 9 geographical regions were included, with the majority (69) published after 2010. Key outcomes included the effectiveness of social network analysis to identify network characteristics, track network change over time, compare similar networks across locations, and correlate network attributes with outcomes. CONCLUSION: Findings support the utility of social network analysis to inform, support, and evaluate development of sustainable health promotion-focused networks/partnerships.

The state of mental health and healthy lifestyle behaviors in nursing, medicine and health sciences faculty and students at Big 10 Universities with implications for action.

BACKGROUND: High rates of mental health conditions and poor healthy lifestyle behaviors are reported in nurses, other clinicians, and health science students but have not been compared across different professions. PURPOSE: The purpose of this study was threefold: (1) describe rates of mental health problems and healthy lifestyle behaviors across the Big 10 health professional faculty and students, (2) compare the health and healthy lifestyle behaviors of the Big 10 health sciences faculty and students across health sciences' professions, and (3) identify factors predictive of depression, stress, and anxiety. METHODS: Faculty and students from eight health science colleges at the Big 10 Universities responded to the study survey, which included: demographics, healthy lifestyle behavior questions, and three valid/reliable mental health scales. Descriptive statistics described the findings and multiple linear regression identified factors associated with mental health conditions. RESULTS: Eight-hundred and sixty-nine faculty and 1087 students responded. Approximately 50% of faculty and students reported 7 h of sleep/night, a third achieved 150 min of physical activity/week; 5.5%-9.9% screened positive for depression; and 11.5%-25.5% had anxiety. Age, sleep, and physical activity were associated with lower depression and anxiety. CONCLUSIONS: University leadership must build wellness cultures that make healthy lifestyle behaviors easy to engage in and enhance mental well-being.

Nurses' resilience in the face of coronavirus (COVID-19): An international view.

The purpose of this cross-sectional study was to examine factors associated with nurses' resilience during the COVID-19 pandemic. Data were collected in the latter half of 2020 from 904 nurses across Japan, Republic of Korea, Republic of Turkey, and the United States. The questionnaire included the Connor-Davidson Resilience Scale 10, plus demographics and 20 questions about practice environment, workplace safety concerning infection control, COVID-related experience, and organizational support. Fear of becoming infected, intention to leave nursing, and having had a positive COVID-19 test were inversely associated with resilience (p < 0.05). Regression analysis indicated that U.S. nurses had significantly greater resilience than nurses in the other countries examined (p < 0.001). Nurses reporting organization support and those who participated in policy and procedure development had higher resilience scores (p < 0.01). Organizational support, involving nurses in policy development, and country of practice were found to be important resilience factors in our research, which aligns with other findings. Further research is recommended to determine the optimal practice environment to support nurse resilience.

Healthy Food Access and Low-Income Teens: A Photovoice Approach.

Lack of access to healthy foods disproportionately impacts adolescents. This mixed-methods study used photovoice to explore everyday lived experiences of food access among teens from low-income families, empowering them to share their stories. Sixty-three diverse teens (12-17 years) from across one Midwest state took images and created narratives to support community presentations. Independent content analysis identified themes. Researchers used t tests to compare pre-post differences (p < 0.05) for two scales related to empowerment and positive youth development. Themes suggest teens take on adult responsibilities relative to food access, generally selecting unhealthy foods. Families and after-school programs were critical to food-related experiences, with cultural differences noted. A statistically significant increase, t(58) = -2.225, p = .032, was noted for "most community leaders in my city would listen to me." Findings support the need to address factors contributing to difficulties accessing healthy foods in home and community settings.

Conversations about wellness: A qualitative analysis of patient narratives post annual wellness visit.

Support for successful aging in place requires an understanding of the factors that impede or support health promotion behaviors. Nurse-led monthly follow-up calls between annual wellness visits (AWV) offer the opportunity to both provide support and collect data which can inform development of effective health promotion strategies. The aim of this research was to provide ongoing support for health promotion efforts and explore factors playing a role in meeting AWV recommendations. A total of 144 visit summaries for 47 Medicare beneficiaries (65+) who had completed an AWV within the last year were analyzed using a thematic approach. Themes were organized into 7 categories with findings indicating the complexity of factors which influence health promotion behaviors. The importance of ensuring personalization of health promotion recommendations using data collected during the AWV and provision of ongoing support between visits may enhance health outcomes.

Difficulties with health self-management by older adults: The role of well-being.

The purpose of this study was to investigate the association between three aspects of well-being (positive and negative affect, self-realization, and self-efficacy and resilience) and disease self-management or difficulties in managing care. Logistic regression models were used to analyze data from a sample of community-dwelling Medicare beneficiaries 65-years or older who participated in the National Health and Aging Trends Study and responded to well-being and engagement in health care questions (n = 1663). All three aspects of well-being were significantly associated with reduced difficulties in care management for both the participants and their family and friends who assist them. Self-efficacy and resilience had the strongest association; older adults with higher levels of self-efficacy and resilience were more likely to handle care by self. Our findings highlight the importance of incorporating strategies to enhance well-being of older adults to reduce the difficulties of managing activities necessary to stay healthy.

Creating healthier policies, systems, and environments: Using the CDC CHANGE tool to evaluate the impact of a coalition provided community-based wellness program.

OBJECTIVES: This manuscript describes policy, systems, and environments (PSE) changes made to support health secondary to a county-based coalition nurse-led program targeting vulnerable populations at five community-based sites in a single rural Midwest county. DESIGN: A mixed-methods pre-post approach was used to evaluate the PSE changes occurring over a 1-year period secondary to wellness programming. SAMPLE: Five community sites including three predominantly manufacturing worksites and two faith-based sites were included in this study. MEASUREMENTS: The Centers for Disease Control and Prevention Community Health Assessment aNd Group Evaluation tool was used to collect PSE data both at site initiation and 1 year later. Logs kept by program staff which included discussions with site leaders and program participants were also used to measure PSE changes. INTERVENTION: Monthly wellness programming which included intentional feedback to site leadership concerning participant feedback and coalition staff observations of the impact of site specific PSEs on healthy lifestyle behaviors. OUTCOMES: Positive changes reflecting improvement in policy and environments were noted for 99.2% of the scores with a total of 13 PSE changes documented across the sites. The greatest change noted related to leadership, indicating increased commitment by site leadership to support health.

Individual health outcomes secondary to a nurse-led coalition-based health promotion program for underserved diverse populations.

OBJECTIVE: This study describes the impact of various levels of participation in a nurse-led coalition-based wellness program on participant outcomes related to body mass index, blood pressure, diabetes risk, and lifestyle behaviors in a Midwest rural county. DESIGN: This descriptive study used de-identified data collected by program staff over a 26-month period to evaluate participant outcomes. SAMPLE: Participants were predominantly female with a mean age of 49 years; 41% identified as Hispanic. MEASUREMENTS/ANALYSIS: Lifestyle behavior surveys and biometric screenings were used to collect data. Latent Growth Class Analysis and logistic regression were used to analyze the data. INTERVENTION: Monthly wellness programming including screenings, health education and referrals were provided to participants at various sites in a rural community. RESULTS: Over a 26-month period, 3,004 visits were made by 820 participants. Four clusters for participants (n = 287) who had made three visits or more were identified, providing insight into meaningful interindividual differences for repeat participants. Overall, repeat participants either maintained or improved their blood pressure over time. Indirect outcomes including policy, system, and environmental changes were also noted. CONCLUSIONS: Coalitions can positively affect the health of populations through these types of programs at the individual and population level.

Outcomes of primary care-based Medicare annual wellness visits with older adults: A scoping review.

The increasing aging population creates many challenges for countries around the world. Keeping this population healthy to prevent frailty and functional decline requires a stronger focus on health promotion and disease prevention. Maximization of well-being and quality of life of older adults can occur if determinants of health are addressed and preventive behaviors are supported. Primary care-based preventive visits such as the Medicare annual wellness visit can be used with older adults to enhance health promotion efforts. A scoping review of studies was conducted to identify current evidence concerning the impact of this visit on preventive practices, risk reduction and lifestyle behavior changes for community-dwelling older adults. A total of 11 studies were included in this review. Preventive services use outcomes including vaccinations and screenings were most frequently reported. Visits such as these can provide a platform for development of strategies to provide ongoing support for health promotion efforts.

Health Risk Appraisals With Aging Adults: An Integrative Review.

Identification of risk factors unique to the aging experience is vital to support health promotion efforts and prevent loss of independence for the increasing aging population. Health risk appraisals are tools capable of identifying a broad range of factors that affect health; however, these tools were designed for use with predominantly healthy working-age adults. The purpose of this integrative review was to describe uses and adaptations of health risk appraisals with aging adults. A total of 43 articles met inclusion criteria, identifying multiple adaptations necessary to effectively identify the risks faced by aging adults, including those related to activities of daily living, pain, depression, social support/network, vision, hearing, and cognitive status. Uses included support for health promotion efforts and to determine risk for depression, falls, and loss of independence. Further research needs to be done to evaluate impact when used as a health promotion and prevention tool for aging adults.

Perception, Interpretation, and Impact of Health Risk Appraisal Feedback: Pilot Studies of an Assessment Tool.

One mandate of the Affordable Care Act is continued support of workplace wellness programs. A tool used to encourage behavior change is a health risk appraisal (HRA). However, research indicates there is limited benefit to HRAs unless supported by additional health interventions. The purpose of these two pilot studies was to examine effects of the individual HRA personalized feedback, including the perceived value of the feedback and its influence on behavior change. Six months after completing and receiving HRA personalized feedback, participants in two separate Indiana organizations answered survey questions about the HRA value, motivational influence, and ability to prompt behavior change. Descriptive statistics, chi-square tests, analyses of variance, and factor analysis were used to analyze the influence of various factors and test the relationship between HRA generated feedback and these characteristics. The majority of respondents indicated the HRA was helpful with 69% (Study 1, n = 51) and 63% (Study 2, n = 116) of the respondents reporting an attempted behavior change. Preliminary results indicate that completion of an HRA with feedback alone may be beneficial in prompting behavior change.

Enhancing Critical Thinking Via a Clinical Scholar Approach.

BACKGROUND: Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. METHOD: A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. RESULTS: Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. CONCLUSION: Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.].

Enhancement of Professional Development of Front-Line Nurse Preceptors in a Dedicated Education Unit.

BACKGROUND: Dedicated education units (DEUs) have been well established throughout the country as a means of developing clinical skills in nursing students. In a DEU, maintaining an adequate number of well-prepared clinical nurse preceptors is essential for unit sustainability and effective student perception. METHOD: This study was a quasi-experimental design using self-reported survey data. A comparison analysis was conducted using the initial results of the Revised Professional Practice Environment (RPPE) survey (i.e., pre-participation and no orientation) after completion of an orientation program and participation as preceptor in a DEU. RESULTS: Front-line nurses who participated as preceptors for one semester in a DEU demonstrated statistically significant improvement in two of the eight components of professional practice measured by the RPPE. CONCLUSION: This study lends support to the notion that preceptors do experience improvement in professional practice as a result of participation in a DEU. J Contin Educ Nurs. 2017;48(1):40-46.

Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review.

Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.