Healthcare Workers' Adherence and Attitudes Toward the Adherence to COVID-19 Precautionary Guidelines Post-Vaccination: A Cross-Sectional Pilot Study.

BACKGROUND: Healthcare workers (HCWs) have shown increased adherence to infection control practices during the COVID-19 pandemic. However, there is a need to assess their adherence to and attitude toward COVID-19 guidelines after being vaccinated. The purpose of this pilot study is to assess the adherence to and attitudes toward the adherence to COVID-19 guidelines among HCWs who have been vaccinated. METHODS: A retrospective cross-sectional design was employed. One hundred and eight participants were recruited via email from a medical center in the Midwest United States. The participants completed online surveys measuring the level of adherence to and attitudes toward the adherence to COVID-19 guidelines. The response rate was 5.4%. FINDINGS: Most participants were female (73.1%) and white (82.4%). The participants adhered to COVID-19 guidelines 79.7% of the time. The most frequently followed guidelines were performing hand hygiene, wearing a respirator or well-fitting mask in areas where patients may be present, and wearing eye protection when entering the room for a patient with suspected or confirmed COVID-19 infection. The least performed precautions were performing COVID-19 testing after exposure to a suspected or confirmed COVID-19 case and maintaining social distancing. There was a significant decrease in the perceived importance of adherence to COVID-19 precautions post-vaccination (p <.001, 95% CI [-0.78, -0.35]). CONCLUSIONS: The increased perception of safety after receiving COVID-19 vaccination may negatively influence HCWs' adherence to COVID-19 precautionary guidelines. Continuous education and monitoring of HCWs' safety practices are important to influence HCWs' attitudes to adhere to COVID-19 precautions, particularly after vaccination.

Characteristics of faculty mentoring in the Robert Wood Johnson Foundation Future of Nursing Scholars Program.

BACKGROUND: To address the need for faculty scientists, Robert Wood Johnson Foundation (RWJF) provided support for an accelerated PhD program: Future of Nursing Scholars (FNS). PURPOSE: To describe the experience of faculty mentoring PhD students in the RWJF FNS program pursuing a 3-year accelerated PhD degree, including faculty members' support activities for students, time commitment, student productivity in manuscript dissemination, and challenges and opportunities for supporting students. METHODS: Surveys were sent to faculty mentors of FNS to understand mentoring activities, strategies used, and mentee productivity. FINDINGS: Of 93 faculty mentors, they reported most FNS students (n = 61, 65.6%) completed a manuscript format dissertation. FNS students required academic/dissertation mentoring, with frequent emotional support and positive reinforcement. DISCUSSION AND CONCLUSION: Mentors reported providing more frequent mentoring and spent more time mentoring FNS students than with other PhD students. Alignment of the student's research to that of the faculty mentor was identified as valuable.

Workplace Violence Prevention Training, Safety Resources, and Commitment to HHCWs' Safety.

BACKGROUND: The threat of workplace violence (WPV) is a primary safety concern for home health care workers (HHCWs). WPV prevention training is a critical tool for HHCWs' safety. Yet, most existing WPV prevention training is limited or not specific to HHCWs' environment, the patient's home, and neighborhood. The purpose of this study was to describe WPV prevention training, resources used, and commitment to HHCWs' safety. METHODS: Using a cross-sectional design, HHCWs from two sites located in Southwestern Ohio completed the Violence Against Home Healthcare and Hospice Workers survey, a 37-item survey used to describe frequency and characteristics of WPV prevention training and resources. Descriptive statistics were used to analyze the data. FINDINGS: Half (n = 25) of the HHCWs received WPV prevention training. Training content focused on characteristics of aggressive/violent patients and family members (n = 19, 82.6%), but limited content about characteristics of hazardous neighborhoods (n = 15, 65.2%). Cellular phones (n = 43, 97.7%) were primarily used as a resource to promote safety, few cellular phones (n = 1, 2.3%) were provided by the agency. CONCLUSIONS/APPLICATION TO PRACTICE: HHCWs described WPV prevention training content and resources used to promote safety. WPV prevention training is deficient in procedures for seeking psychological care, screening patients for violent behavior, skills for self-protection, characteristics of hazardous neighborhoods, and physical maneuvers and verbal methods to diffuse or avoid aggressive behavior. Access to WPV prevention training and resources for HHCWs needs to be strengthened. Occupational Health Nurses can assist their employers with developing WPV prevention training for HHCWs.

Examining the Impact of Stressors during COVID-19 on Emergency Department Healthcare Workers: An International Perspective.

Emergency department healthcare workers are known to face a unique combination of pressures from their careers and work environments regularly. Caring for dying patients and making difficult lifesaving decisions not only continued but also became more prevalent for emergency department healthcare workers during the COVID-19 pandemic. A growing body of literature revealed that the mental and emotional toll of COVID-19 has been tremendous. However, the burden of COVID-19 on the overall physical health and work-life balance on this group needs to be understood. This study aimed to describe the impact of stress on wellbeing and health across the globe among emergency department healthcare workers. A cross-sectional survey comprising work-family and family-work conflict scale, work-life balance, physical symptoms inventory, Oldenburg Burnout Inventory, satisfaction with job and life, and life change index scale was distributed to a convenience sample through listservs and social media. In total, 287 participants responded, 109 completing all questions. Fatigue was the most common symptom reported to occur daily (28.4%, n = 31), followed by muscle pain (13.8%, n = 15) and backache (11.9%, n = 13). Nurse practitioners reported the highest number of physical symptoms and the highest average scores and counts of stressful life events, while registered nurses indicated the highest work-family conflict levels. Linear regressions showed that stressful life events are significantly associated with both physical symptoms and work-family conflict. Results underscore the need to better support emergency department workers to mitigate the risks associated with occupational stress. Protective organizational policies and increased support strategies may be employed to improve wellbeing and cultivate a more sustainable workforce.

Cost Analysis of Providing Overtime to Current Nurses Versus Hiring a Dedicated Nurse for COVID-19 Management in a Processing Plant.

BACKGROUND: U.S. meat and poultry processing workers experienced a disproportionate burden of COVID-19 illness following the declaration of the COVID-19 pandemic. Managing prevention and surveillance activities for COVID-19 prevention required additional work for occupational health nurses. The purpose of this project was to conduct a cost analysis for two staffing options to address the increased workload for occupational health nurses. METHODS: An economic quality improvement design was used for this study. The project was performed at a meat and poultry processing plant with 1,800 employees and six occupational health nurses. Two staffing options were considered. Option 1 was to continue to pay current occupational health nurses overtime, and Option 2 was to hire a COVID-dedicated nurse to manage the increased workload. A cost analysis was conducted for wages per hour plus benefits at three time points: 3 months, 1 year, and 3 years. FINDINGS: Costs for Option 1 (continuing overtime) at 3 months, 1 year, and 3 years were estimated at US$27,370, US$109,517, and US$328,550, respectively. Costs for Option 2 (hiring a COVID-dedicated nurse) at 3 months, 1 year, and 3 years were estimated at US$44,279, US$94,979, and US$230,179, respectively. CONCLUSIONS/APPLICATION TO PRACTICE: Hiring a dedicated COVID nurse would save the processing plant extensive salary costs by Year 3. Reducing overtime had the potential to decrease the COVID-19-related workload and potential experiences of fatigue and burnout in occupational health nurses.

Men's Perceptions of Violence against Women: Improving Cultural Literacy for Combating Violence within Family.

While research evidence exists about Jordanian men's perceptions and attitudes about violence against women (VAW), there is a scientific gap for addressing VAW as a Jordanian cultural norm. This study aimed to describe Jordanian men's perceptions and attitudes toward VAW, leading factors for VAW, and strategies to combat VAW. A qualitative descriptive design was used with 14 Jordanian men and semi-structured interviews. Nine themes emerged: men's definitions of VAW, men's beliefs and attitudes about VAW, men's feelings toward VAW, intensifying factors for VAW, men's justification for women staying in abusive relationships, the hazardous impact of VAW, experience of using violence against wives, men's strategies for combating VAW, and absence or limited role of services for victims of VAW. Men in many cultures including Jordan inherit structured patriarchal ideology, which gives men the perceived right to control women and to manage familial conflict. Inherited cultural beliefs about male roles within families should be restructured by collaborating with community stakeholders to combat VAW.

Interruption of initial patient assessment in the emergency department and its effect on patient perception of care quality.

BACKGROUND: Triage is a critical first step in appropriately caring for patients in the emergency department (ED). Patients' assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction. OBJECTIVE: The purpose of this study was to determine how the frequency and duration of interruptions during triage are associated with errors, patient satisfaction and patient's perception of the care they received. METHODS: Prospective, observational, cohort study conducted in the ED of a Level 1 trauma center. Interruptions were measured using time-and-motion observations of triage interviews performed by nurses and physicians. Patients were surveyed immediately after triage interviews were complete. RESULTS: Surveys were completed for 178 observations. In total, 62.9% of the observations were interrupted between 1 and 5 times. While interruptions did not significantly influence patient satisfaction directly, interruptions positively influenced triage duration, which was negatively associated with patient satisfaction. Increased errors were associated with increasing frequency of triage interruptions. Triage interruptions were not associated with either patient satisfaction or perceived caregiver competence. Overall, the majority (76.6%) of patients were satisfied with their care; patient satisfaction was associated with the perceived competency of caregivers but was not associated with errors. CONCLUSION: Interruptions are associated with increased errors and delays in patient care. Although increased triage duration adversely affected patient satisfaction, patients' perceptions were not influenced by interruptions. While patient satisfaction is essential, a lack of association between patient satisfaction and errors suggests that using patient satisfaction as a measure of care quality may omit important safety information.

"We cannot stop smoking": Female university students' experiences and perceptions.

BACKGROUND: While findings are available about smoking in young females, there is a dearth of research reporting this problem among Jordanian females, particularly university students. Also, there is lack of studies that describe the daily experience and the causative factors for smoking among female university students. PURPOSE: The purpose of this study is to describe the experience of smoking as perceived by female Jordanian university students. In addition, this study aimed to describe the predisposing factors for initiating smoking and feelings toward that experience. METHOD: A descriptive qualitative study was employed. A purposive sample of 12 female Jordanian university students who smoke cigarettes were asked to participate in this study. A semi-structured, face-to-face interviews were conducted. RESULTS: Five themes of the study included: (1) living and enjoying smoking with other females, (2) hazardous effect of smoking, (3) our culture stigmatizing female smoking, (4) why we don't stop smoking, and (5) strategies to combat smoking among females. CONCLUSION: Female university students disclosed peer pressure and stress as intensifying factors for smoking. Also they were unable to quit smoking because they were attached and addicted to smoking cigarettes. STUDY IMPLICATIONS: The findings of our study have several implications for nursing education, policymaking, and practice. An important target would be to motivate university students who are smokers to attempt smoking cessation leveraging cultural leaders as role models. Policy makers also should revise policies related to importing and taxation of cigarettes is essential. In addition, policy makers should enforce legislation for smoking fee areas and prevention of smoking in closed areas.

Impact of immersive virtual reality simulations for changing knowledge, attitudes, and behaviors.

BACKGROUND: Virtual reality has promise as a training method within the affective domain, but investigation is still needed for intention to change behaviors based on social determinants of health. OBJECTIVE: The objective of this study was to describe the self-reported changes in knowledge and/or attitudes and planned behavior changes by healthcare workers for their future care of persons with challenges to their social determinants of health following completion of a first-person virtual reality experience. DESIGN: A descriptive qualitative design was used. SETTINGS: This study was conducted in clinics and private practice settings in Ohio (United States). PARTICIPANTS: This study was conducted with 206 healthcare workers. METHODS: Participants completed a virtual reality simulation followed by qualitative, open-ended questions about changes to their knowledge, attitudes, and behaviors. Responses were analyzed using a content analysis method. RESULTS: Four overarching themes were derived from the qualitative data: (1) Acknowledgement of Social Determinants of Health, (2) An Improved Provider Experience for Patients, (3) Patient as a Person with Complex Needs, and (4) The Learning Experience. CONCLUSION: Findings suggest virtual reality has strong merits for impacting affective domain of learning demonstrated by increased empathy. Virtual reality along with increased empathy also helps improve attitudes and behaviors for the betterment of patients.

Residential surrounding greenness and self-reported symptoms of anxiety and depression in adolescents.

BACKGROUND: Evidence on the relationship between exposure to greenness and adolescent mental health is limited. The purpose of this study was to examine the association between greenness throughout childhood and mental health at age 12 years. METHODS: We assessed greenness using the satellite-based measure of Normalized Difference Vegetation Index (NDVI) within 200m, 400m, and 800m of home address at birth, age 12 years, and across childhood (averaged for each year from birth to age 12) among the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) cohort. Self-reported symptoms of anxiety and depression were assessed at age 12 years using the Spence Children's Anxiety Scale (SCAS) and Children's Depression Inventory 2 (CDI 2), respectively. Associations were estimated using linear regression, adjusting for covariates including traffic-related air pollution, neurological hazard exposure, blood lead level, household income, and community deprivation. RESULTS: In adjusted models, NDVI was largely not associated with self-reported anxiety and depression symptoms, except for the SCAS separation anxiety subscale at 400m and 800m (0.1 unit increase mean NDVI 400m: ß = -0.97, 95% CI: -1.86, -0.07; 800m: ß = -1.33, 95% CI: -2.32, -0.34). CONCLUSION: While we found no direct relationship between greenness and overall symptoms of anxiety and depression in adolescents upon adjustment for relevant covariates at the 200m distance, greenness may lesson symptoms of separation anxiety within 400m and 800m distance from the home address at age 12 years. Future research should examine mechanisms for these relationships at the community- and individual-level.

Workplace Violence Interventions Used by Home Healthcare Workers: An Integrative Review.

The threat of workplace violence (WPV) is a significant occupational hazard for home healthcare workers (HHCWs). The purpose of this integrative review is to examine WPV interventions used by HHCWs to stay safe while working in the patient's home and community. The methodology used was the integrative review by , which allows for inclusion of experimental and non-experimental research, reflecting the state of the science on interventions used by HHCWs to mitigate and prevent WPV. A total of 17 articles pertained to interventions used by HHCWs. Interventions were further categorized by WPV Type. There are a number of interventions used for Type I and II WPV. However, interventions for Type III WPV are minimal and interventions for Type IV WPV are obsolete. Safety and health training were shown to be significant in increasing HHCWs' confidence and knowledge about WPV prevention. Researchers demonstrated safety and health training are effective in promoting a safe work environment and reducing incidents of WPV. This review begins to fill the gap in the literature on interventions used by HHCWs to mitigate and prevent WPV.

Need and Capacity of a Toolkit for Occupational Health Nurses to Promote a New or Enhanced Drug-Free Workplace Program.

Background: A drug-free workplace program (DFWP) has been shown to be effective in reducing workers' drug misuse. The purpose of this project was to determine the need and capacity for a new or enhanced DFWP in a large health system. If determined to be needed, the next step would be to develop, implement, and evaluate a toolkit to assist occupational health nurses to promote a new or enhanced DFWP. Methods: A strategic prevention framework was used to assess the need and capacity for a toolkit to prepare occupational health nurses to promote a new or enhanced DFWP. The project was conducted in the occupational health services department at a large health system in the Midwest U.S. occupational health nurses and employee assistance counselors in the hospital system completed a survey assessing the need and capacity for a new or enhanced DFWP. Findings: A gap was identified in the perceived effectiveness of training about DFWP and current DFWP components. The findings reflect the need and capacity for a DFWP toolkit. Optimally, a DFWP toolkit would include evidence-based drug and alcohol screening tools. We found that a toolkit for occupational health nurses to promote a new or enhanced DFWP in the project site was warranted. Conclusion/Application to practice: A DFWP can be an effective method of promoting workplace health and safety. Occupational health nurses can contact state and national representatives to encourage monitoring of drug-related work injuries to provide evidence to influence health policies to support effective DFWPs.

Leveraging a Public Health Framework and Community Advisory Board to Innovate Workplace Violence Intervention Strategies.

Even with extensive evidence documenting the incidence, risk factors, and negative outcomes of workplace violence (WPV) against emergency department (ED) employees, there is a lack of intervention strategies reported that could be subjected to a clinical trial in the ED setting. The purpose of this article is to report the outcomes of a novel process adapted from the Framework for Program Evaluation in Public Health for soliciting intervention strategies from a WPV Community Advisory Board (CAB) organized by the U.S. Occupational Safety and Health Administration's WPV prevention guidelines. Ten professionals comprising both practitioners and researchers from a variety of disciplines ultimately constituted the WPV CAB. In total, 127 strategies to address WPV in ED settings organized by the Occupational Safety and Health Administration's WPV guideline elements were recommended. The use of a CAB and the Framework was shown to be effective for generating WPV intervention strategies.

Chart It to Stop It: Failure Modes and Effect Analysis for the Reporting of Workplace Aggression.

The purpose of this quality improvement study was to describe the process for workplace aggression (WPA) reporting and the potential failures for this process in a pediatric emergency department. Interviews were conducted with 10 interdisciplinary employees. Findings yielded 7 tasks following WPA: contact security, contact police, contact clinical manager, notify emergency department director, call safety hotline, complete electronic safety form, and complete paper safety form. Focusing actions to prevent failure modes and causes for (1) notification of the emergency department director and (2) completion of an electronic safety form can garner the greatest improvement in overall risk for WPA reporting.

Nurses on the move: Robert Wood Johnson Foundation nurse faculty scholars and their action on the social determinants of health.

OBJECTIVE: Medical care alone cannot adequately improve population health or eliminate inequities; social determinants of health (SDH) must be addressed. This study's purpose was to describe the research, teaching, service, and clinical practice activities implemented by RWJF Nurse Faculty Scholars to act on the SDH. DESIGN: A cross-sectional survey design was used with a sample of RWJF Nurse Faculty Scholars, chosen because they were provided specialized mentoring, grants, and other support that allowed them to explore SDH. RESULTS: Respondents (n = 57) addressed SDH in their research (86.0%), teaching (68.4%), service (66.7%), and clinical practice (33.3%). Leading research foci were quality of health care (56.1%), social and physical environmental stressors (54.4%), and access to health care services (49.1%). Leading SDH areas in teaching were discrimination in society against vulnerable populations (54.4%), quality of health care received by vulnerable populations (50.9%), and vulnerable populations' access to health care services (50.9%). Service activities included addressing discrimination against diverse populations. Leading SDH areas in clinical practice were quality of health care received by vulnerable populations (28.1%), vulnerable populations' access to health care services (22.8%), and discrimination in society against vulnerable populations (19.3%). Respondents also addressed SDH through personal mentoring (71.9%); efforts to recruit and/or retain underrepresented faculty (59.6%); developing a diverse pipeline of nurses (59.6%); and participation on a diversity committee (40.4%). CONCLUSION: The RWJF Nurse Faculty Scholars were able to leverage their awards to address SDH; however, further research is needed to assess the impact of the SDH work conducted. Knowledge from this study can be used as a road map for SDH elements and areas of professional work that nurses and other health professionals could address SDH in research, teaching, service, and practice.

Interventions against bullying of prelicensure students and nursing professionals: An integrative review.

The problem of bullying is of such significance, health care accreditation agencies such as The Joint Commission have reiterated that these behaviors compromise on patient safety. Researchers demonstrate that much is known about the existence of bullying behaviors in health care and its detrimental effects on the profession of nursing. Leaders in health care and nursing education are beginning to tackle this issue. Guided by the methodology of Whittemore and Knafl, the purpose of this integrative review was to analyze literature discussing the interventions against bullying directed towards prelicensure nursing students and professionals.

A summative evaluation of productivity and accomplishments of Robert Wood Johnson Foundation Nurse Faculty Scholars Program participants.

From 2008 to 2017, the Robert Wood Johnson Foundation Nurse Faculty Scholars Program inspired, developed, and supported cohorts of next generation national leaders in academic nursing through career development awards. With support from mentors, scholars in the program created individual development plans focused on scholarship, teaching, service, and leadership. The curriculum of the scholar development program combined goals and objectives related to leadership development, enhancement of nursing education skills, and focused programs of research and scholarship. In addition, program outcomes emphasized engagement in institutional, university, and professional governance systems. This article describes and recounts findings from the program participants regarding accomplishments, productivity, and facilitators contributing to their achievement of program outcomes.