Evidence into action: a policy brief exemplar supporting attainment of nursing now.

AIM: To provide a framework for the production of policy briefs, and offer a practical example of how evidence can be turned into a succinct document to inform policy and bring about change targeted at delivering universal health coverage. INTRODUCTION: Policymakers are too busy, or do not have the necessary expertise, to read and comprehend complex scientific papers. As a result, policy briefs that capture and present the essential points are needed if evidence-informed policy is to be developed and implemented. METHOD: A two-page example of how evidence from meta-analytical and systematic reviews can be presented to identify options and recommendations to address a major global disease burden. RESULTS: The example uses a simple, seven-section template for developing a policy brief. The essential characteristics of each section are provided. The briefing, targeted at the global level, provides information on the major challenges associated with the treatment of individuals with diabetes. DISCUSSION AND CONCLUSIONS: This paper demonstrates how to use existing research evidence to address the pursuit of UHC relevant to a wide range of geographies, settings or disadvantaged groups. IMPLICATIONS FOR POLICY: Gaps in universal health coverage and major disease burdens such as diabetes can be pursued through entities such as country-based Nursing Now groups. In addition, ongoing opportunities exist through the International Council of Nurses annual International Nurses Day and WHO's regular regional meetings to inform and influence policy discussions at national and subnational levels. By focusing on a small number of global topics each year, measurable changes in addressing the burden of disease can be achieved while simultaneously keeping the nursing profession's contribution centre stage.

Evidence-based policy: nursing now and the importance of research synthesis.

AIM: This study explores how scholarship relating to meta-analytical studies and systematic and integrative reviews can inform nursing's contribution to universal health coverage. INTRODUCTION: As nursing globally embraces the 200th anniversary of the birth of Florence Nightingale, the Nursing Now social movement has called for the profession to improve universal health coverage through increasing nursing's policy voice. METHODS: In determining how the Nursing Now social movement could pursue the aim of this study, researchers undertook a comparative bibliometric analysis of scholarship relating to the systematic curation of evidence. This study uses a mixed-method analysis of the bibliometric data available through extracting and synthesizing information from one of the commercially produced indexing and citation databases. RESULTS: Generally, medicine has contributed far more synthesized contributions than nursing, except in the case of integrative reviews. Co-occurrence analysis of nursing literature through examination of key terms yielded a complex visualization of 11 specific clusters of scholarship (Care of the Older Person, Nurse Education, Emergency and Critical Care, Occupational Health and Safety, Rural Services, Anxiety and Depression, Measurement, Newborn and Post-natal Health, Cardiovascular Disease, Preventative Health and Cancer Care). DISCUSSION AND CONCLUSIONS: Bibliometric analysis of curated evidence demonstrates that there is ample nursing-relevant material to inform evidence-based policy change directed towards the attainment of universal health coverage and several of the Sustainable Development Goals. IMPLICATIONS FOR POLICY: Nursing literature is available to support policy change directed towards the pursuit of universal health coverage and sustainable development goals. Leveraging existing networks of research collaboration to increase research capacity through communities of scholarship or by twinning experienced and neophyte contributors is possible. Further work is needed to equip nurses with the competencies to navigate the policy environment and develop and deliver impactful policy messaging.

Sustaining a Global Social Network: a quasi-experimental study.

AIM: To examine the longer term impact on the social network of participating nurses in the Global Nursing Leadership Institute (GNLI2013) through using differing frequencies of follow-up to assess impact on maintenance of network cohesion. BACKGROUND: Social network analysis is increasingly been used by nurse researchers, however, studies tend to use single point-in-time descriptive methods. METHOD: This study utilizes a repeated measures, block group, control-intervention, quasi-experimental design. Twenty-eight nurse leaders, competitively selected through a double-blind peer review process, were allocated to five action learning-based learning groups. Network architecture, measures of cohesion and node degree frequency were all used to assess programme impact. RESULTS: The programme initiated and sustained connections between nurse leaders drawn from a geographically dispersed heterogeneous group. Modest inputs of two to three e-mails over a 6-month period seem sufficient to maintain connectivity as indicated by measures of network density, diameter and path length. LIMITATIONS: Due to the teaching methodology used, the study sample was relatively small and the follow-up data collection took place after a relatively short time. Replication and further cohort data collection would be advantageous. CONCLUSIONS AND POLICY IMPLICATIONS: In an era where many policy solutions are being debated and initiated at the global level, action learning leadership development that utilizes new technology follow-up appears to show significant impact and is worthy of wider application. The approach warrants further inquiry and testing as to its longer term effects on nursing's influence on policy formulation and implementation.

Burn pain and anxiety: the use of music relaxation during rehabilitation.

Pain and anxiety are well-documented problems during the rehabilitation of patients with burns. This study examined the effect of music on anxiety and pain during range of motion. Eleven subjects with partial-thickness or deeper burns were randomly assigned to a control group (without music intervention) or experimental group (with music intervention). Vital signs, pain, and anxiety were recorded before and after treatments. There was no difference in pretest and posttest anxiety across the groups; however, there was a difference in anxiety between the groups. Conversely, there was a difference in pretest and posttest pain across the groups but no difference in pain between the groups. Results showed no significant reduction in anxiety and pain during therapy with music relaxation. Limitations included nonhomogenous groups, small sample size, potentially unrepresentative sample, variation in exercise protocol, and small musical selection. Further research is recommended.

An activist looks at nursing's role in health policy development.

Health care delivery systems are evolving and transforming rapidly. Nurses will need new leadership and policy skills to meet the challenge of ensuring patient care safety and quality health care delivery. Nurses bring a unique perspective to health care policy development because of their educational training, professional values and ethics, advocacy skills, and experiential background. Significant progress has occurred over the years toward advancing nursing's presence, role, and influence in the development of health care policy. However, more nurses need to learn how to identify issues strategically; work with decision makers; understand who holds the power in the workplace, communities, state and federal level organizations; and understand who controls the resources for health care services. In health care policy development, nurses are essential in ensuring quality health care that is accessible and affordable for all women and their infants. More nurses need to actively work as leaders in the health policy arena.

Every child deserves Bright Futures.

Bright Futures is a national program dedicated to promoting and improving the health of children in the United States. This article gives a brief historical perspective of Bright Futures, its mission, goals, available resources, and strategies that pediatric nurses can use in a variety of health care settings with children and families.

Communication of sexual risk behavior among late adolescents.

A grounded theory approach was used to describe how males and females in late adolescence communicate with their sexual partners about sexual risk behaviors. Interviews were audiotaped with 18 women and 15 men from a university in the southeastern United States. Verbatim transcripts were analyzed using constant comparative analysis. Building trust was identified as the core variable for both men and women. For women, prerequisites for building trust were being involved in caring relationships and indirectly gathering information about potential sexual partners. For men, prerequisites were being involved in caring relationships and using their instincts. Women usually initiated safe-sex talk, but men were willing to discuss it, once the conversation was initiated. Findings can serve as a guide for developing nursing strategies that promote more effective communication about sexual risk behavior in this age group.

PIP: The characteristics of communication about sexual risk behaviors between adolescent sexual partners were investigated in interviews with 14 sexually active females and 18 males attending a public university in southeastern US. Mean age at first intercourse was 17 years; respondents had had an average of 3 sexual partners. A review of the interview transcripts led to development of a model of the communication process. Building trust in one's partner emerged as the core variable for both males and females. A prerequisite for building trust was being involved in a caring relationship. Women built trust by indirectly gathering information about potential sexual partners, while men tended to rely on their instincts about their partners' appearance and demeanor. Once trust was established, both men and women were more likely to talk about sexual risk issues. Although males were willing to engage in safe sex talk if their female partner raised the topic, they rarely initiated such discussions. Alcohol use, previous sexual experience, knowledge about reproduction and contraception, conversations with friends, and the media were intervening conditions for safe sex conversations. Some participants believed that discussing safer sex practices indicated a lack of trust. Moreover, many participants demonstrated trust in their partners by engaging in high-risk sexual practices. This model can serve as a guide for developing strategies for promoting more effective communication about sexuality in late adolescence. For example, the finding that women tend to initiate discussions of safer sex practices suggests a need to empower women with the skills needed to negotiate risk-reduction behaviors.

Peer counseling in a culturally specific adolescent pregnancy prevention program.

This study evaluated the effects of peer counseling in a culturally specific adolescent pregnancy prevention program for African American females. A random pretest and multiple posttest experimental and comparison group design was used to obtain data on a sample of 63 female African American adolescents, ages 12 to 16, who lived in four public housing developments. Descriptive data and tests of significance revealed that none of the participants who received peer counseling became pregnant within three months of the intervention. Findings revealed a statistically significant increase in reproductive and other self-related knowledge topics among the experimental group when comparing pretest and eight-week posttest scores. Most participants had not had sexual intercourse; the average age of sexual onset was 12 years in the experimental group and 11 years in the controls. Designing and implementing culturally specific adolescent pregnancy prevention programs for adolescents younger than age 11 and/or before sexually active seems appropriate.

PIP: The potential of peer counseling as a strategy in culture-specific adolescent pregnancy prevention programs was assessed in a sample of 63 female African Americans 12-16 years of age recruited from four public housing developments in Charlottesville, Virginia (US). A randomized pretest and multiple post-test experimental and comparison group design was used. Adolescents in the experimental group participated in an 8-week peer counseling program that imparted information and skills from an Afrocentric perspective. There was no intervention in the comparison group. At baseline, 76% of adolescents in the experimental group and 60% in the comparison group reported never having been sexually active. Among sexually active adolescents, the average age at first intercourse was 12 years in the experimental group and 11 years in the comparison group. Contrary to the expectation that exposure to the intervention would decrease episodes of sexual intercourse, sexual activity remained stable in both groups during the study period. None of the participants in either group became pregnant, however. There was a statistically significant increase over baseline in knowledge about reproduction, contraception, and sexually transmitted diseases in the experimental group at the 8-week post-test and scores were maintained at the 3-month post-test. There was no program effect on use of effective contraception. Culturally specific pregnancy prevention programs may be more effective if they target adolescents younger than 11 years old, before they become sexually active.

Nurses' role in the prevention of teen pregnancy.

PIP: Working as they do in clinics, hospitals, and schools, nurses in the US can play a critical role in reducing the rate of teen pregnancy. Specifically, nurses can: 1) educate and counsel youth about sexuality, reproduction, sexually transmitted diseases, and contraception; 2) work with children before they become sexually active; and 3) develop, implement, and evaluate community-based adolescent pregnancy prevention programs. Nurses can promote sex education programs that use peer counselors to improve adolescents' sexual decision-making and general living skills. Cultural and ethnic sensitivity is a crucial component of all interventions in this area. Most effective are programs that continually reinforce and strengthen individual values and group norms in favor of delaying sexual intercourse, avoiding unprotected sex, using condoms, and avoiding high-risk partners. Finally, nurses should be active participants in school boards, parent-teacher associations, religious and youth organizations, and national and local teen pregnancy prevention coalitions.^ieng