Health-promoting behaviors and self-efficacy among nursing students in times of uncertainty.

BACKGROUND: Nursing students are often faced with academic and personal stressors that threaten their Health-Promoting Behaviors (HPB) and well-being. Research on how living in a context of high political uncertainty can impact nursing students' HPB is limited. The aim of this study was to investigate the associations between HPB and self-efficacy among nursing students in a context of high political uncertainty. METHODS: This was a cross-sectional, descriptive study that included 120 undergraduate nursing students from Lebanon who completed an electronic self-reported questionnaire. RESULTS: The results indicated that HPB measured by HPLP-II scores were negatively correlated with overall uncertainty scores (r = -.29, p < .01) and positively correlated with the General Self-Efficacy (GSE) scale scores (r = .41, p < .001). Results from the multiple linear regression model indicated that physical activity frequency and GSE were independent predictors of the total health-promoting lifestyle profile and the model explained 30.28% of the variance in the total HPLP-II scale. LINKING EVIDENCE TO ACTION: This study further emphasizes the importance of regular physical activity (at least 3 h a week) as a strategy to improve HPB among nursing students. Culturally sensitive strategies that aim to enhance HPB should be embedded in undergraduate nursing curricula. Public health nurses and university counselors should join efforts to develop strategies to maintain or enhance self-efficacy and to promote regular physical activity among nursing students. Future research should further study the association between self-efficacy, resilience, and uncertainty in contexts of ongoing conflicts.

Health-promoting behaviors among American and Lebanese nursing students.

BACKGROUND: Although there are well-known benefits of maintaining a healthy lifestyle, few nursing students practice health-promoting behaviors (HPBs). AIMS: The aim of this study was to compare the HPBs of undergraduate nursing students from two different cultures-the United States of America (U.S.), a high-income country, and Lebanon, a low-income country. METHODS: A cross-sectional, descriptive study included 320 undergraduate nursing students, of which 200 were from the U.S. and 120 were from Lebanon. RESULTS: The results indicated significant differences between the groups in their HPBs, as measured by the total Health-Promoting Lifestyle Profile-II score of t(318) = 6.66, p = .001, and its subscales of health responsibility, t(318) = 5.06, p = .001; physical activity, t(318) = 6.29, p = .001; interpersonal relations, t(318) = 4.24, p = .001; nutrition, t(318) = 3.54, p = .001; spiritual growth, t (318) = 3.05, p = .002; and stress management, t(318) = 3, p = .003. LINKING EVIDENCE TO ACTION: The significant differences in HPBs of nursing students from two different countries indicated that cultural factors may influence students' healthy lifestyle. Therefore, nursing education should consider exploring strategies that promote student participation in health-promoting activities.

Comparison of Health-Promoting Behaviors of Nursing Students From Different Racial/Ethnic Groups.

BACKGROUND: Despite the known benefits of maintaining a healthy lifestyle in preventing many health-related issues, few nursing students practice health-promoting behaviors (HPB). METHOD: This cross-sectional, descriptive, correlational study included 866 undergraduate nursing students who were members of the National Student Nurses' Association. RESULTS: The difference in mean Health-Promoting Lifestyle Profile-II scores between White people and Asian Americans was statistically significant (F [4, 861]) = 2.95, p = .019). The difference in the mean self-efficacy scores between Black people and Asian Americans also was statistically significant (F [4, 861] = 4.41, p = .002). The regression model was significant (F [1, 862] = 6.683, p = .001, R2 =.235)], and self-efficacy (ß = .457, t = 15.178, p = .001) significantly predicted nursing students' HPB. CONCLUSION: The differences between racial/ethnic groups noted in this study indicate nursing faculty need to render culturally sensitive interventions to promote self-efficacy and HPB among undergraduate nursing students. [J Nurs Educ. 2021;60(9):500-508.].

Integrative Review of Dietary Choice Revealed by fMRI: Considerations for Obesity Prevention and Weight-Loss Education.

BACKGROUND: Emerging findings from neuroimaging studies investigating brain activity associated with dietary behavior are illuminating the interaction of biological and behavioral mechanisms that have implications for obesity prevention. Globally, A total of 1.9 billion adults are overweight, and 650 million are obese. Obesity and being overweight are major risk factors for chronic illness and death. Behaviorally based health interventions have had limited success in curbing the obesity epidemic. Greater understanding of brain responses to food cues will contribute to new knowledge and shape public health efforts in obesity prevention. However, an integration of this knowledge for obesity prevention education has not been published. AIMS: This study links evidence generated from brain activation studies generated in response to diet and food images and highlights educational recommendations for nurses engaged in obesity prevention and weight-loss education. METHODS: An integrative review of the literature was conducted using the MeSH keywords "magnetic resonance imaging," "diet," and "food images" in PubMed, MEDLINE Complete, CINAHL, and Cochrane databases from their first appearance in 2006 through March 2018. Studies published in English and using functional magnetic resonance imaging to measure brain response to diet, and food images were initially identified. Animal models, those whose primary focus was a specific disease, and intervention studies were excluded. RESULTS: Of 159 studies identified, 26 met inclusion criteria. Findings from neuroimaging studies may help explain the relationship between brain mechanisms and behavioral aspects of dietary choice and inform patient education in obesity prevention. Awareness of this evidence is applicable to nursing education efforts. This review contributes several recommendations that should be considered by nurses providing individualized weight-loss education. LINKING EVIDENCE TO ACTION: Nurses engaged in patient education for obesity prevention should consider personalized interventions that cultivate internal awareness for dietary adherence, self-care, exercise, hydration, and mood state; avoid using caloric deprivation approaches, such as skipping breakfast, for weight-loss interventions; and note the importance of individualized obesity prevention and weight-loss education.

COPE for Adolescent Syrian Refugees in Lebanon: A Brief Cognitive-Behavioral Skill-Building Intervention to Improve Quality of Life and Promote Positive Mental Health.

Lebanon has the highest per-capita concentration of refugees worldwide. There is an urgent need to offer psychosocial interventions to vulnerable groups such as Syrian refugee adolescents. To assess the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (Creating Opportunities for Patient Empowerment [COPE]) on depression, anxiety, and quality of life (QOL) in a sample of adolescent refugees (13-17 years) living in Lebanon. A preexperimental study design was used. COPE 7-Session was delivered to 31 adolescent Syrian refugees. Participants were assessed for depression (Personal Health Questionnaire-9), anxiety (General Anxiety Disorders Scale), and QOL (Pediatric Quality of Life Inventory). Feasibility and acceptability findings indicated that the COPE program was a positive experience for teens. Significant decreases in depression and anxiety, and increases in QOL were also reported. COPE is an effective cognitive-behavioral intervention that can be delivered in an Arabic/Middle-Eastern setting for teen refugees to improve mental health and QOL.

Sex Differences on Quality of Life and Mental Health Outcomes When Using a Brief Cognitive-Behavioral Skill Building Intervention with Adolescent Syrian Refugees: A Secondary Analysis.

Little is known about how sex as a biological variable may contribute to differences in quality of life (QOL) and mental health outcomes following a brief intervention among adolescent Syrian refugees. This paper explores the results of a secondary data analysis to investigate differences by sex on self-reported QOL and mental health outcomes among Syrian refugees who participated in a 7-session cognitive behavioral skills building intervention. A one group pretest-posttest design was used to deliver the intervention to 31 adolescent refugees (13-17 years; 15 male, and 16 female). At baseline, there were no significant differences between males and females on mean scores of depression, anxiety, or QOL. Post-intervention, self-reported scores for QOL and mental health were significantly different between sexes. Males demonstrated a significant decrease in anxiety scores compared to females. Among males only, significant decreases in depression and anxiety scores were observed with significant improvement in total QOL.

Media, Technology Use, and Attitudes: Associations With Physical and Mental Well-Being in Youth With Implications for Evidence-Based Practice.

BACKGROUND: Previous research has shown that the use of technology and media, in their different available forms, may have detrimental effects on the physical and mental well-being of adolescents and young adults. AIMS: The present study aimed to investigate the use of different types of technology and media, attitudes toward them, and how they relate to physical and mental well-being in Lebanese university students. METHODS: A descriptive, correlational, cross-sectional design was used. A sample of 244 undergraduates completed a self-report measuring media and technology use and attitudes, eating-related variables (e.g., healthy eating, body image dissatisfaction [BID], and eating disorders [EDs] risk), trait emotional intelligence (TEI), and psychopathology indicators (stress, anxiety, and depression). RESULTS: The use of mobile phone multimedia (music, pictures, and videos) correlated with unhealthy eating and stress. Social media use was associated with BID, EDs risk, and the self-control construct of TEI. Anxiety of separation from technological devices and dependence on them was associated with increased BID, EDs risk, depression, and anxiety. LINKING EVIDENCE TO ACTION: Practical implications are discussed in terms of setting limits and boundaries on technology use during childhood and adolescence, and encouraging healthy eating and physical activity at home and on college campuses. Moreover, social media could be used as a platform for intervention and prevention programs to decrease BID, EDs, depression, and anxiety.

Predictors of Pressure Injuries in a Critical Care Unit in Lebanon: Prevalence, Characteristics, and Associated Factors.

PURPOSE: The purpose of this study was to identify factors associated with pressure injury in a medical-surgical intensive care unit (MSICU). DESIGN: Retrospective review of medical records. SUBJECTS AND SETTING: We reviewed the medical records of 145 patients who developed a new pressure injury in the MSICU of a 420-bed university medical center in Lebanon. METHODS: Medical records of all patients cared for in the MSICU from December 2014 to June 2017 were reviewed by a research assistant using a standardized form. We extracted potential risk factors for pressure injury including sex, age, weight upon admission, weight at discharge, length of MSICU stay, episodes of hypotension, administration of inotropes/vasopressors, admitting diagnosis, comorbid conditions, and cumulative scores on the Braden Scale for Pressure Sore Risk. The outcome variable was development of any new pressure injury during their stay in our intensive care unit. RESULTS: Forty-nine patents (33.7%) developed a new pressure injury. Bivariate analysis found statistically significant associations between pressure injury occurrences and administration of vasopressors (odds ratio [OR] = 0.42; 95% confidence interval = 0.29-0.87; P = .02), the administration of dopamine (OR = 0.20; 95% confidence interval = 0.04-0.94; P = .04), and hospital-acquired pressure injury. Among the continuous variables, analysis revealed significant relationships between weight at discharge (t = 2.31, P = .02), MSICU length of stay (t = 5.30; P = .000), cumulative Braden Scale score (t = 3.06; P = .002), hypotension (t =-2.74; P = .007), and development a new pressure injury. Multivariate analysis indicated that length of stay (ß= -.110; P = .002), administration of vasopressors (ß=-.266; P = .029), and total hours of hypotension (ß=-.53; P = .041) were significant predictors of pressure injury. CONCLUSIONS: Vasopressor use, hypotension, and length of stay were associated with an increased likelihood of pressure injury in adults managed in an MSICU. None of these factors is specifically evaluated during completion of the Braden Scale for Pressure Sore Risk. Based on these findings we recommend development of a pressure injury scale specific to critically ill adults.

Investigating Vulnerability for Developing Eating Disorders in a Multi-confessional Population.

The present study aimed to examine the vulnerability to eating disorders (ED) among 949 Lebanese female young adults as well as its association with stress, anxiety, depression, body image dissatisfaction (BID), dysfunctional eating, body mass index, religious affiliation (Christian, Muslim, Druze or Other), religiosity and activity level. Results showed that anxiety had the greatest effect on increasing the predisposition to ED, followed by stress level, BID, depression and restrained eating. Affiliating as Christian was found to significantly decrease the vulnerability to developing an ED. Furthermore, the interaction of anxiety with intrinsic religiosity was found to have a protective role on reducing ED. The current study emphasized a buffering role of intrinsic religiosity against anxiety and ED vulnerability.

Eating Disorders in Lebanon: Directions for Public Health Action.

Research in the field of eating disorders (ED) is limited in the Middle East. The aim of the present study was to profile Lebanese ED outpatients. A mixed-method design was used. Clinicians across Lebanon filled individual questionnaires about their 2013 ED outpatients (n = 104) and participated in focus groups. Results showed that bulimia nervosa was the most prevalent ED (46.1 %) followed by anorexia nervosa (39.4 %) and binge eating (14.4 %). The emerging socio-demographic profile of the Lebanese ED patient was that of a single female young adult of middle to high socio-economic status with severe ED symptoms (amenorrhea, multiple purging behaviors) and depression. Also, there was a general delay in seeking help which made patient recovery more difficult. The present study emphasizes the critical need for a public health approach to ED awareness and could help in developing preventive and remedial educational programs targeting youth in Lebanon and the Middle East.

Effectiveness of a Technology-Based Intervention to Teach Evidence-Based Practice: The EBR Tool.

BACKGROUND: As the world becomes increasingly digital, advances in technology have changed how students access evidence-based information. Research suggests that students overestimate their ability to locate quality online research and lack the skills needed to evaluate the scientific literature. Clinical nurses report relying on personal experience to answer clinical questions rather than searching evidence-based sources. To address the problem, a web-based, evidence-based research (EBR) tool that is usable from a computer, smartphone, or iPad was developed and tested. The purpose of the EBR tool is to guide students through the basic steps needed to locate and critically appraise the online scientific literature while linking users to quality electronic resources to support evidence-based practice (EBP). METHODS: Testing of the tool took place in a mixed-method, quasi-experimental, and two-population randomized controlled trial (RCT) design in a U.S. and Middle East university. RESULTS: A statistically significant improvement in overall research skills was supported in the quasi-experimental nursing student group and RCT nutrition student group using the EBR tool. A statistically significant proportional difference was supported in the RCT nutrition and PharmD intervention groups in participants' ability to distinguish the credibility of online source materials compared with controls. The majority of participants could correctly apply PICOTS to a case study when using the tool. CONCLUSIONS: The data from this preliminary study suggests that the EBR tool enhanced student overall research skills and selected EBP skills while generating data for assessment of learning outcomes. LINKING EVIDENCE TO ACTION: The EBR tool places evidence-based resources at the fingertips of users by addressing some of the most commonly cited barriers to research utilization while exposing users to information and online literacy standards of practice, meeting a growing need within nursing curricula.

Anxiety as a Moderator of the Relationship Between Body Image and Restrained Eating.

PURPOSE: To examine three indicators of psychopathology (stress, anxiety, and depression) as potential moderators of the relationship between body image dissatisfaction (BID) and restrained, emotional, and external eating, while controlling for family-related variables (i.e., household income, living situation, and psychopathology in the family) and individual variables (i.e., body mass index, physical activity, and major life events). DESIGN AND METHODS: A descriptive, correlational cross-sectional design was used. A sample of 894 female undergraduates aged between 18 and 25 completed a self-reported questionnaire. FINDINGS: Moderation analyses indicated that anxiety significantly moderated the relationship between BID and restrained eating, whereas depression and stress did not. PRACTICE IMPLICATIONS: Findings may be used in the development and implementation of education and prevention programs for disordered eating in college campuses. The usefulness of these findings for nursing practice is discussed.

Effects of Recording Food Intake Using Cell Phone Camera Pictures on Energy Intake and Food Choice.

BACKGROUND: The well-documented increases in obesity and unhealthy dietary practices substantiate the need for evidence-based tools that can help people improve their dietary habits. The current spread of mobile phone-embedded cameras offers new opportunities for recording food intake. Moreover, the act of taking pictures of food consumed may enhance visual consciousness of food choice and quantity. The present study aimed to assess the effect of using cell phone pictures to record food intake on energy intake and food choice in college students. The effectiveness and acceptability of cell phone picture-based diet recording also was assessed. METHODS: A repeated measures crossover design was used. One group of participants entered their food intake online during 3 days based on their memory, although a second group recorded their food intake using cell phone pictures as their reference. Participants then crossed over to complete 3 more days of diet recording using the alternate method. Focus groups were conducted to obtain feedback on the effectiveness and acceptability of cell phone picture-based diet recording. RESULTS: Intake of meat and vegetable servings were significantly higher in the memory period compared with the cell phone period, regardless of the order. Results from the focus group indicated a positive attitude toward the use of cell phone pictures in recording food intake and an increased awareness of food choice and portion size. LINKING EVIDENCE TO ACTION: Cell phone pictures may be an easy, relevant, and accessible method of diet self-monitoring when aiming at dietary changes. Future trials should combine this technique with healthy eating education.

Serenity in political uncertainty.

College students are often faced with academic and personal stressors that threaten their well-being. Added to that may be political and environmental stressors such as acts of violence on the streets, interruptions in schooling, car bombings, targeted religious intimidations, financial hardship, and uncertainty of obtaining a job after graduation. Research on how college students adapt to the latter stressors is limited. The aims of this study were (1) to investigate the associations between stress, uncertainty, resilience, social support, withdrawal coping, and well-being for Lebanese youth during their first year of college and (2) to determine whether these variables predicted well-being. A sample of 293 first-year students enrolled in a private university in Lebanon completed a self-reported questionnaire in the classroom setting. The mean age of sample participants was 18.1 years, with nearly an equal percentage of males and females (53.2% vs 46.8%), who lived with their family (92.5%), and whose family reported high income levels (68.4%). Multiple regression analyses revealed that best determinants of well-being are resilience, uncertainty, social support, and gender that accounted for 54.1% of the variance. Despite living in an environment of frequent violence and political uncertainty, Lebanese youth in this study have a strong sense of well-being and are able to go on with their lives. This research adds to our understanding on how adolescents can adapt to stressors of frequent violence and political uncertainty. Further research is recommended to understand the mechanisms through which young people cope with political uncertainty and violence.

Pediatric obesity and asthma quality of life.

Widely researched as separate entities, our understanding of the comorbid effects of childhood obesity and asthma on quality of life is limited. This article discusses the effects of childhood obesity and asthma on self-reported quality of life in low-income African American teens with asthma. When controlling for the influence of symptom frequency, asthma classification, asthma self-efficacy, and asthma self-care levels, body mass index remains a most important factor in determining self-reported quality of life among teens with asthma. Although overweight and obesity did not change the effectiveness of the asthma intervention program, obesity did affect participants quality of life scores.