Teaching Evidence-Based Practice Competencies to Meet Professional Practice Needs.

BACKGROUND: Evidence-based practice (EBP) is a major concept threaded throughout nursing education, yet competencies are not clearly identified in The Essentials. PURPOSE: Nurse leaders' EBP competency expectations for professional practice were explored to inform competency-based education for students and practicing nurses. A secondary aim explored potential effects of misinformation on EBP. METHODS: Descriptive qualitative inquiry was performed with a focus group of 6 clinical nurse leaders. RESULTS: EBP expectations were identified, discriminating between novice entry level and advanced-level nurses. Participants emphasized asking questions, linking evidence to practice, and acknowledging that evidence changes over time. All advanced-level nurses were expected to apply, lead, and teach EBP. Post pandemic, nurses need to reclaim evidence-based practices, critically appraise evidence, and educate patients and families to address misinformation. CONCLUSIONS: Information learned will inform competency-based EBP education for students and nurses in academic and clinical settings.

Trends in publication impact of evidence-based healthcare terminology (2013-2022).

AIMS: This article explored the publication impact of evidence-based healthcare terminology to determine usage and discuss options for low usage terms. BACKGROUND: A plethora of terms describe the scholarship of evidence-based healthcare. Several terms are synonyms, creating redundancy and confusion. The abundance and overlap of terms may impede the discovery of evidence. DESIGN: This discursive article explored and discussed publication impact of evidence-based healthcare terms. METHODS: Evidence-based healthcare terms were identified, and their 10-year (2013-2022) publication impact was assessed in the CINAHL and Medline databases. A card sort method was also used to identify terms with low usage. RESULTS: A total of 18/32 terms were included in the review. The terms evidence-based practice, quality improvement, research and translational research were the most highly published terms. Publication data were presented yearly over a 10-year period. Most terms increased in publication use over time, except for three terms whose use decreased. Several terms related to translational research have multiple synonyms. It remains unknown whether these terms are interchangeable and possibly redundant, or if there are nuanced differences between terms. CONCLUSION: We suggest a follow-up review in 3-5 years to identify publication trends to assess context and terms with continued low publication usage. Terms with persistent low usage should be considered for retirement in the reporting of scholarly activities. Additionally, terms with increasing publication trends should be treated as emerging terms that contribute to evidence-based healthcare terminology. IMPLICATIONS FOR NURSING: Confusion about the use of appropriate terminology may hinder progress in the scholarship of evidence-based healthcare. We encourage scholars to be aware of publication impact as it relates to the use of specific terminology and be purposeful in the selection of terms used in scholarly projects and publications.

Lived experiences of older male caregivers: "That was the Worst!"

INTRODUCTION: Although caregiving is a traditional female role, older men represent an increasing proportion of family caregivers. This study's aim was to describe lived experiences of men who engaged in later-life caregiving. METHOD: Streubert's phenomenological method, inclusive of unstructured interviews and respondent validation of a single formalized description, was applied to explore lived experiences of eight older male caregivers. RESULTS: Three overarching themes characterized older male caregiving: 1) role and life changes, 2) "taking care of business," and 3) getting over "the worst". All caregivers spent extensive time in anticipatory planning for potential problems and were dissatisfied with existing resources and services. Each man described a profound, mentally-challenging caregiving crisis that triggered important caregiving decisions. DISCUSSION: Study findings support an urgent need for research to clarify the mental health needs of older male caregivers and to test interventions that better meet the unique needs of this growing caregiver demographic.

Body composition, fear of falling and balance performance in community-dwelling older adults.

Objectives: We aimed to 1) assess body composition using a portable technology, bioelectrical impedance analysis, (BIA) and 2) examine the associations between body composition and the discrepancy of fear of falling (FOF) and balance performance. Methods: A cross-sectional study included 121 older adults 60 years and older, 78% were female, 41% lived alone, and 71% had no history of falls. The discrepancy between fear of falling and balance performance was categorized into four groups. We found 47% rational (low FOF and normal balance), 19% incongruent (low FOF despite poor balance), 18% irrational (high FOF despite normal balance), and 16% congruent (high FOF and poor balance). Results: Body Fat Mass (BFM), Percent Body Fat (PBF), and Body Mass Index (BMI) were correlated with fear of falling and balance performance. BMI was significantly different in the rational group (p = 0.004) and incongruent group (p = 0.02) compared to the congruent group. PBF was significantly different between the incongruent (p = 0.002), irrational (p = 0.014), and rational (p < 0.001) groups, compared to the congruent group. Conclusions: The study found that body BFM, PBF, and BMI were correlated with fear of falling and balance impairment. High Body Mass Index and Body Fat Mass were associated with a discrepancy between FOF and balance. Body composition analysis devices, such as BIA and other portable technologies, could be taken to underserved communities and may help identify community-dwelling older adults who are frail and may be at high risk of falling.

Quality of life of parents of children with Autism Spectrum Disorder: An integrative literature review.

PURPOSE: This paper presents an integrated literature review of the quality of life (QOL) in parents of individuals with Autism Spectrum Disorder (ASD). The rate of ASD is increasing. Parents of children with ASD have higher levels of stress and burden, which may lead to lower QOL. DESIGN AND METHODS: A comprehensive, electronic search was performed to retrieve 15 relevant articles, including 5565 participants. An integrative review was performed to appraise and synthesize findings. RESULTS: QOL was found to be lower in parents of children with ASD in physical, psychological, and social health and in spirituality, as compared with adults who were not parents of children with ASD. The strongest risk factor for parental QOL was the severity of the diagnosis of ASD. Protective factors for parental QOL were parent education level and levels of severity of ASD in the child. PRACTICE IMPLICATIONS: Nurses can support families impacted by ASD, particularly severe ASD, through tailored resources to support early diagnosis and intervention, through the support of policies affecting low-income families, and through increased awareness of severe ASD and its' impact on the child and the family.

Access to Mental Healthcare in the 21st Century: An Evolutionary Concept Analysis.

BACKGROUND: One of the most important aspects of receiving medical care is access to that care. For people with mental illness who have greater healthcare needs and are at risk for poor health outcomes, reduced access to care constitutes a crisis. While the COVID-19 (coronavirus disease 2019) pandemic continues to affect the United States, specifying what it means to have access to mental healthcare is more critical than ever. AIMS: The aims of this concept analysis are to review definitions and descriptions of access to mental healthcare in the literature and to synthesize the relevance of these findings to inform future research, theory development, policy, and practice. METHODS: The concept of access to mental healthcare was analyzed using Rodgers's evolutionary concept analysis method. CINAHL, PsycINFO, and MEDLINE were queried for peer-reviewed articles about access to mental healthcare published from January 2010 to April 2020 (n = 72). Data were reviewed for concept antecedents, attributes, consequences, surrogate, and related terms. RESULTS: Five models of access to mental healthcare were identified, with several antecedents and consequences: utilization, economic loss/gain, incarceration, and patient/provider satisfaction. Cross-sectional and predictive studies highlighted three interrelated attributes: clinical management, healthcare delivery, and connectedness. CONCLUSIONS: The concept of access to mental healthcare is often used stagnantly across disciplines to create health policies, yet the concept is transformative. Future research requires up-to-date operational definitions of access to mental healthcare to target interdisciplinary approaches.

Determinants of Nephrology Provider Engagement in Comprehensive Pre-Dialysis Discussions with Older Adults: Scale Development and Psychometric Evaluation.

Comprehensive pre-dialysis discussions between providers and older adults over age 75 years are needed but often lacking. The aim of this study was to develop an instrument to assess behavioral determinants of nephrology provider use of comprehensive pre-dialysis discussions with older adults. Study design consisted of cross-sectional development of the instrument and preliminary psychometric evaluation. Items were based on an integrated literature review, expert clinician input, and the Theory of Planned Behavior. Nephrologists, nurse practitioners, and physician assistants completed the instrument (n = 71). Baseline demographic data, exploratory factor analysis, and Cronbach's alpha were analyzed. Initial factor analysis using principal components analysis and subsequent orthogonal rotation revealed loading on a four-factor model. Cronbach's alphas for the instrument/items were 0.89/0.83 to 0.94. Variance explained by the four factors was 58%.

Concept of overweight bias among healthcare professionals: An evolutionary concept analysis.

The aim of this concept analysis was to identify the attributes of overweight bias among healthcare providers (HCPs) and create a clear definition to guide the recognition of overweight bias among HCPs. Settings within the healthcare system are not exempt from bias and the stigmatization of persons with obesity. Overweight bias among HCPs may negatively impact health care and health outcomes. Rodger's evolutionary method was used to guide this concept analysis. The databases CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, and PsycINFO were searched. The analysis provided clarification of the concept to facilitate HCP self-awareness of overweight bias. A definition of the concept of overweight bias among HCPs is provided along with its attributes, antecedents, and consequences.

Flourishing: An Evolutionary Concept Analysis.

PURPOSE: Mental health is an important measure of public health (WHO, 2004); however, nursing practice and research continues to prioritize mental illness, rather than well-being (Wand, 2011). Flourishing is a recent concept in the field of well-being. The term has been used sparingly in nursing practice and research, and conceptual clarification is needed to promote comprehensive understanding of the phenomenon. The purpose of this study is to critically analyze flourishing, assess the maturity of the concept, and provide recommendations for future research, education, and practice. METHOD: The concept of flourishing was analyzed using the evolutionary approach to concept analysis (Rodgers, 2000). A search for articles on flourishing within the context of well-being was conducted through CINAHL, MEDLINE, and PsycINFO. A sample of 32 articles and 1 book was reviewed. Data were reviewed for concept attributes, antecedents, consequences, surrogate terms and related concepts. FINDINGS: Four models of flourishing were identified with six overlapping attributes: meaning, positive relationships, engagement, competence, positive emotion, and self-esteem. Limited longitudinal and predictive studies have been conducted, but there is evidence for several antecedents and outcomes of flourishing. Research is ongoing primarily in psychology and sociology and is lacking in other disciplines. DISCUSSION: The concept of flourishing is immature; however, evidence is building for related concepts. A lack of consistent terminology regarding flourishing prevents knowledge development of flourishing as a distinct concept. Further multidisciplinary research is needed to establish standard operational and conceptual definitions and develop effective interventions.

When Employment and Caregiving Collide: Predictors of Labor Force Participation in Prospective and Current Caregivers.

OBJECTIVE: Female caregivers often reduce time spent at work to care for aging family members, which precipitates financial hardship and other adverse outcomes. Little is known about psychosocial correlates of labor force participation (LFP) among female caregivers. The theory of planned behavior posits that social norms, attitudes, and perceived control predict intentions and volitional behaviors, but also that the compelling influence of situational variables undermines enactment of behaviors consistent with one's intentions. The objective of this study was to employ the theory of planned behavior to examine how psychosocial characteristics predict willingness to reduce LFP among prospective caregivers and actual LFP reduction among active caregivers. METHODS: Subsamples of 165 female prospective caregivers and 97 active female caregivers responded to a survey assessing filial beliefs and LFP. RESULTS: Filial obligation and caregiver preparedness predicted intentions to reduce LFP among prospective caregivers, but did not predict actual reduction in LFP in active caregivers. Weekly care demands exceeding 20 hours emerged as the sole correlate of LFP among active caregivers. CONCLUSIONS: Domains of the theory of planned behavior predict LFP intentions, but LFP decisions are subject to external pressures, specifically, time demands of the caregiving relationship. Prospective caregivers may benefit from proactive interventions aimed at reducing conflict between situational demands and filial beliefs.

Ciência & Saúde Coletiva: scientific production analysis and collaborative research networks. / Ciência & Saúde Coletiva: análise da produção científica e redes colaborativas de pesquisa.

The purpose of this metric and descriptive study was to identify the most productive authors and their collaborative research networks from articles published in Ciência & Saúde Coletiva between, 2005, and 2014. Authors meeting the cutoff criteria of at least 10 articles were considered the most productive authors. VOSviewer and Network Workbench technologies were applied for visual representations of collaborative research networks involving the most productive authors in the period. Initial analysis recovered 2511 distinct articles, with 8920 total authors with an average of 3.55 authors per article. Author analysis revealed 6288 distinct authors, 24 of these authors were identified as the most productive. These 24 authors generated 287 articles with an average of 4.31 authors per article, and represented 8 separate collaborative partnerships, the largest of which had 14 authors, indicating a significant degree of collaboration among these authors. This analysis provides a visual representation of networks of knowledge development in public health and demonstrates the usefulness of VOSviewer and Network Workbench technologies in future research.

Ciência & Saúde Coletiva: análise da produção científica e redes colaborativas de pesquisa / Ciência & Saúde Coletiva: scientific production analysis and collaborative research networks

Resumo O objetivo deste estudo métrico e descritivo foi identificar os autores mais produtivos e suas redes colaborativas de pesquisa a partir de artigos publicados na Revista Ciência & Saúde Coletiva entre 2005 e 2014. Os autores que satisfazem o critério de corte de pelo menos 10 artigos no período foram considerados os mais produtivos. Os programas VOSviewer e Network Workbench foram aplicados para as representações visuais das redes colaborativas de pesquisa envolvendo os autores mais produtivos no período. Uma análise inicial recuperou 2511 artigos distintos com 8920 autores no total e uma média de 3,55 autores por artigo. A análise de autores revelou 6288 autores distintos, sendo 24 destes identificados como os mais produtivos. Esses 24 autores produziram 287 artigos com uma média de 4,31 autores por artigo, e representaram 8 parcerias colaborativas separadas, a maior delas com 14 autores, indicando um grau significativo de colaboração entre eles. Esta análise oferece uma representação visual das redes de conhecimento desenvolvidas na área de saúde coletiva e demonstra a importância das tecnologias aplicadas em pesquisa futura.

Abstract The purpose of this metric and descriptive study was to identify the most productive authors and their collaborative research networks from articles published in Ciência & Saúde Coletiva between, 2005, and 2014. Authors meeting the cutoff criteria of at least 10 articles were considered the most productive authors. VOSviewer and Network Workbench technologies were applied for visual representations of collaborative research networks involving the most productive authors in the period. Initial analysis recovered 2511 distinct articles, with 8920 total authors with an average of 3.55 authors per article. Author analysis revealed 6288 distinct authors, 24 of these authors were identified as the most productive. These 24 authors generated 287 articles with an average of 4.31 authors per article, and represented 8 separate collaborative partnerships, the largest of which had 14 authors, indicating a significant degree of collaboration among these authors. This analysis provides a visual representation of networks of knowledge development in public health and demonstrates the usefulness of VOSviewer and Network Workbench technologies in future research.

Advances and Challenges: Student Reflections From an Online Death and Dying Course.

This study describes nursing students' reflections on taking an online course on death and dying. In a semistructured paper, students described fears of caring for clients at end of life (EOL), important content learned, and remaining discomforts. Data were analyzed using directed content analysis. Consistent themes were noted among the papers. Student reflections on the knowledge they gained closely followed initial fears. Several students appreciated the ability to reflect on their experiences in a nonjudgmental setting. Overall, the data showed that nursing students can become more confident in EOL care through online education. Knowledge gains and continued fears about the same topics suggest EOL confidence lies along a continuum and may require ongoing education. Future research should focus on offering online continuing education on EOL to practicing nurses.

Predictors of Intention to Refer to Pediatric Palliative or Hospice Care.

The purpose of this descriptive correlational study was to determine whether nurse characteristics, level of comfort with care of the dying, and spirituality predict intention to refer and timing of referral to pediatric palliative/hospice care. The Behavioral Model of Health Services Use served as the framework for this study. Data were collected from 105 pediatric nurses recruited from 7 patient units of one pediatric hospital. Regression analysis revealed several nurse factors (practice unit, years of experience, age, race/ethnicity) that predicted intent to refer and timing of referral to pediatric palliative/hospice care. The relationship between nurse characteristics and intent to refer was specific to certain medical conditions (HIV, extreme prematurity, brain injuries). Healthcare providers can use these findings to improve care for children with life-limiting illnesses.

Decisions and caregiving: end of life among blacks from the perspective of informal caregivers and decision makers.

This focus group study describes end-of-life caregiving and decision making among blacks from the perspective of the informal caregivers and decision makers. The Behavioral Model of Health Services Use framed the study. Five focus groups with a total of 53 informal caregivers/decision makers were conducted. A qualitative phenomenological approach was used for the data analysis. Findings are presented under the themes of end of life caregiving and decision making roles, dynamics and process, and beliefs and values. The common thread of care giving and decision-making within relationship and six subthemes were identified. Findings also suggest the need for support and inclusion of designated informal caregivers and decision-makers in the advance care planning process early in the disease trajectory.

Resilient ageing: a concept analysis.

AIM: This paper is a report of an analysis of the concept resilient ageing. Unique in comparison with other healthy ageing concepts, resilient ageing can be applied to all older people, regardless of age or affliction. BACKGROUND: The state of global population expansion in older people over the next 50 years calls for increased health promotion research efforts to ensure the maintenance of health and optimal quality of life for all older people. DATA SOURCES: Literature for this concept analysis was retrieved from several databases, CINAHL, PubMed PsycINFO, for the years 1990-2012. DESIGN: Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. METHODS: An integrative research review methodology was applied to peer-reviewed journal articles (n = 46) for an inductive analysis of the concept of resilient ageing. RESULTS: The antecedents, defining attributes, and consequence of resilient ageing were identified. Antecedents to resilient ageing were found to be adversity and protective factors, while the core attributes include coping, hardiness and self-concept. The consequence of the process of resilient ageing was optimal quality of life. Sense of coherence was found to be the surrogate term. The results obtained were further substantiated using Antonovsky's (1979) theory of salutogenesis. CONCLUSION: A theoretical definition and a model of resilient ageing were developed. In addition, a discussion was provided on the practice, policy and research implications for promoting the development of protective factors and resilient ageing.

RN-BSN completion programs: equipping nurses for the future.

The Institute of Medicine has outlined important components needed in nursing education to prepare the nursing workforce of the future. Previously published work on RN to BSN education has focused mainly on mode of delivery. The purpose of this paper is to examine RN to BSN program components for the facilitation of academic progression, innovative mechanisms of student engagement, and the curricular components that prepare graduates to meet future nursing challenges. Academic progression factors discussed include those relevant to recruiting RNs to BSN completion programs and factors important to retaining them through graduation. Recommendations for student engagement include the creation of honors programs, ethics teams, and practicum and service learning experiences. Suggestions for curriculum possibilities specifically address meeting the call of the Institute of Medicine report including content in community/public health, informatics, evidence-based practice, ethics, and health policy.

Predictive factors of hospice use among Blacks: applying Andersen's Behavioral Model.

The purpose of this prospective, correlational study was to examine the differential ability of demographic variables, beliefs, and values about end-of-life, spirituality, and social relationships to predict hospice use among blacks. The framework for this study was the Behavioral Model of Health Services Use. Data were collected from 104 terminally ill black men and women recruited from 6 inpatient and outpatient settings. Only 34% of the individuals participated in hospice services. Chi-square, sequential, and stepwise logistic regressions revealed that the best predictive model consisted of presence of a caregiver, having a religious affiliation, and male gender. Together these factors predicted 13.7% to 19% of hospice use among blacks. Health care providers can use these findings in planning care for patients early in their disease trajectory.

Spiritual perspectives, needs and nursing interventions of Christian African-Americans.

BACKGROUND: Although the amount of literature on spiritual needs and care has increased, in practice there has been little change in how nurses assess spiritual need. This suggests that not all spiritual needs of patients are being addressed. Based on the assumption that spiritual needs vary by culture, this study focused on one subgroup, namely Christian African-Americans. AIMS: The aim of this paper is to report a study examining spiritual perspectives, spiritual needs and desired nursing interventions during hospitalization identified by Christian African-Americans. METHODS: A descriptive correlational design was employed. A convenience sample (n = 44) was recruited from three African-American churches. Descriptive statistics were calculated, and one-way anovas used to examine spiritual perspectives and spiritual values. Content analysis was used to analyse and summarize qualitative data. Instruments included the Spiritual Perspective Scale (SPS) and two open-ended questions. RESULTS: The mean age of participants was 56 years (range 19-84). The majority was female (86%); 71% of respondents strongly agreed that they had spiritual needs to be met during hospitalization. Mean score for the SPS was 5.7 (sd = 0.36). Respondents used a total of 103 phrases to describe spiritual needs, based on three dimensions of connectedness: connectedness to God (50 phrases), connectedness to others (37 phrases) and connectedness to self (16 phrases). Desired nursing interventions included: participating in spiritual activities (n = 41); demonstrating caring qualities (n = 27); providing comforting measures (n = 13); providing reassurance (n = 9); recognizing the spiritual caregiver role (n = 7); and incorporating diversity in care (n = 3). CONCLUSIONS: The findings provide information for nurses to facilitate development of culturally appropriate spiritual nursing interventions.