Place and Policy: Secondhand Smoke Exposure in Bars and Restaurants.

BACKGROUND: Rural populations have been identified as having tobacco use disparities, with contributing factors including less demand for policy change than in urban areas, resulting in higher age-adjusted death rates related to tobacco use. In 2012, the rural state of North Dakota enacted a statewide comprehensive law requiring all bars and restaurants to be smoke-free. OBJECTIVES: The purpose of this longitudinal study, performed in three phases, was to assess the continued effects of a statewide comprehensive smoke-free law in a primarily rural state, using a stratified random sample. METHODS: Particulate matter and compliance indicators were assessed in restaurants and bars 21 months after enactment of the comprehensive law. Results were compared with the findings from the Phase 1 and Phase 2 samples, in which venues were assessed before passage of the law and approximately 3 months after enactment, respectively. RESULTS: The comprehensive, statewide, smoke-free law led to immediate, sustained, and substantial reductions in secondhand smoke and eliminated previous significant disparities in secondhand smoke exposure in rural communities. Although indoor smoke-free compliance with the law was generally high, compliance in required outdoor smoke-free areas was low. Compliance with signage requirements, both indoors and outdoors, was low. DISCUSSION: The comprehensive statewide smoke-free law created a just distribution of smoke-free laws statewide, resulting in increased protection of rural populations from secondhand smoke. Targeted public health interventions to address compliance may reduce secondhand smoke levels in outlier venues that continue to have high levels of secondhand smoke.

The family caregiver experience - examining the positive and negative aspects of compassion satisfaction and compassion fatigue as caregiving outcomes.

OBJECTIVES: Caregiving results in both positive and negative outcomes for caregivers. The purpose of this study was to examine compassion fatigue and compassion satisfaction in family caregivers. METHODS: Using a cross sectional descriptive survey design with a convenience sample, 168 family caregivers of individuals with chronic illness completed a web-based survey. Measures included a demographic questionnaire, Caregiver Burden Interview, Brief COPE inventory and Professional Quality of Life (ProQOL). RESULTS: The majority of participants (71%) reported high levels of caregiver burden, moderate to low levels of the compassion fatigue concepts of burnout (59.5%) and secondary traumatic stress (STS) (50%), and moderate levels of compassion satisfaction (82.7%). Regression analyses showed that caregiver burden, time caregiving, coping, social support, and caregiving demands explained a total variance of 57.1%, F(11,119) = 14.398, p < .00 in burnout and a total variance of 56%, F(11, 119) = 13.64, p < .00 in STS. Specifically, behavioral disengagement is a predicator that may indicate early compassion fatigue. CONCLUSION: Findings suggest that despite high caregiver burden and moderate compassion fatigue, family caregivers are able to provide care and find satisfaction in the role. This study supports the use of compassion fatigue and compassion satisfaction as alternative or additional outcomes to consider in future research.

Critical caring theory and public health nursing advocacy for comprehensive sexual health education.

Public health nurses (PHNs) often work with adolescent populations at risk for unplanned pregnancies who do not have access to comprehensive sexual health education (CSHE). Evidence-based CSHE can have a significant protective effect on adolescent sexual behaviors. This article applies critical caring theory to public health nursing advocacy for CSHE. Critical caring theory defines the social justice work of PHNs as an expression of their caring as nurses. The lack of CSHE in schools for adolescents is a social justice issue, and PHNs can be important advocates. The purpose of this article is to explore how critical caring theory can inform public health nursing practice regarding the importance of CSHE advocacy with the goal of creating equitable access to CSHE for all adolescents.

Tobacco Smoke Pollution in Hospitality Venues Before and After Passage of Statewide Smoke-Free Legislation.

OBJECTIVE: In 2012, North Dakota enacted a comprehensive statewide law prohibiting smoking in enclosed public places. Disparities in tobacco control exist in rural areas. This study's objective was to determine the extent to which the passage of a comprehensive, statewide, smoke-free law in a predominantly rural state influenced tobacco smoke pollution in rural and nonrural venues. DESIGN AND SAMPLE: A longitudinal cohort design study comparing the levels of tobacco smoke pollution before and after passage of the statewide smoke-free law was conducted in 64 restaurants and bars statewide in North Dakota. MEASURES: Particulate matter with a median aerodynamic diameter of <2.5 µm (a valid atmospheric marker of tobacco smoke pollution) was assessed. RESULTS: A significant 83% reduction in tobacco smoke pollution levels occurred after passage of the law. Significant reductions in tobacco smoke pollution levels occurred in each of the rural categories; however, no difference by rurality was noted in the analysis after passage of the law, in contrast to the study before passage. CONCLUSIONS: To our knowledge, this was the largest, single, rural postlaw study globally. A comprehensive statewide smoke-free law implemented in North Dakota dramatically decreased the level of tobacco smoke pollution in bars and restaurants.

Systematic review: Health care transition practice service models.

BACKGROUND: Nearly 750,000 adolescents and emerging adults with special health care needs (AEA-SHCN) enter into adulthood annually. The linkages to ensure the seamless transfer of care from pediatric to adult care and transition to adulthood for AEA-SHCN have yet to be realized. PURPOSE: The purpose of this systematic review was to investigate the state of the science of health care transition (HCT) service models as described in quantitative investigations. METHODS: A four-tier screening approach was used to obtain reviewed articles published from 2004 to 2013. A total of 17 articles were included in this review. DISCUSSION: Transfer of care was the most prominent intervention feature. Overall, using the Effective Public Health Practice Project criteria, the studies were rated as weak. Limitations included lack of control groups, rigorous designs and methodology, and incomplete intervention descriptions. CONCLUSION: As the findings indicate, HCT is an emerging field of practice that is largely in the exploratory stage of model development.

Mirror, Mirror on the Wall: Children's Preferences and Self-Perceptions of Weight in a Rural Hispanic Community.

INTRODUCTION: Although studies have documented parents' misperceptions regarding their children's weight, studies examining preadolescent children's self-perceptions of weight-in particular, Hispanic children's self-perceptions of weight-are limited. METHOD: A convenience sample of 424 children from a rural community, aged 8 to 11 years and in grades 3 through 5, participated in this cross-sectional, descriptive, nonexperimental study. Using the Children's Body Image Scale, the children were asked to select a figure representing their actual body perception and a figure representing their ideal body perception. The children were weighed and measured, body mass index (BMI) was calculated, and each child was assigned to one of the Centers for Disease Control and Prevention weight categories: underweight, normal or healthy weight, overweight, or obese. RESULTS: Only BMI category was found to be significantly associated with accurate perception, χ2(3) = 201.4, p < .001, with only 9% of overweight or obese children selecting figures representing their actual BMI category. Actual BMI category, χ2(3) = 8.8, p = .032, and grade level, χ2(2) = 6.7, p = .036, had a significant association with selection of an underweight ideal. Overall, 32% of children selected an underweight figure as ideal. DISCUSSION: Prepubertal children who are either overweight or obese do not accurately perceive their weight status. Rather than focusing solely on weight reduction programs, emphasis should be placed on promoting healthy lifestyles and choices.

Advancing the Development of the Guidelines for the Nursing of Children, Adolescents, and Families: 2014 Revision: Process, Development, and Dissemination.

This article details the process used to develop the revision of the original Guidelines that resulted in the development of the 2014 Health Care Quality and Outcomes Guidelines for Nursing of Children, Adolescents, and Families. Members of the 2014 Guidelines Revision Task Force conducted an extensive process of revision, which included the input and approval of 16 pediatric and child health nursing and affiliated organizational endorsements. The revised Guidelines were presented to and endorsed by the American Academy of Nursing Board. These Guidelines are designed for use by pediatric and child health nurses who work in a range of health care and community-based settings. The Guidelines are proposed to be used as a framework for nurse-directed services and intervention development and testing, as a model for undergraduate and graduate pediatric and child health nursing program curriculum development, and as the theoretical basis for nursing investigations on the care of children, adolescents, and families.

Transition Needs of Parents of Adolescents and Emerging Adults With Special Health Care Needs and Disabilities.

The period of health care transition (HCT) for adolescents and emerging adults with special health care needs and disabilities involves a complex realignment of the parent-child relationship, including alterations in role responsibilities and decision making. The purpose of this systematic review was to analyze the research designs, methodology, and findings reported in studies of parents during this transition period to provide new insights for research and clinical practice. Results showed that parents were unable to clearly envision what the future held for their children and were not well prepared by the service system to anticipate future prospects. These parents have a myriad of needs that are not yet fully understood, as HCT research is in the early stages of development.

Uncharted Territory: Systematic Review of Providers' Roles, Understanding, and Views Pertaining to Health Care Transition.

BACKGROUND: Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. METHODS: The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. RESULTS: Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. CONCLUSIONS: Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.

Tobacco smoke exposure and impact of smoking legislation on rural and non-rural hospitality venues in North Dakota.

The purpose of this cross-sectional study in a stratified random sample of 135 bars and restaurants in North Dakota was to describe factors that influenced tobacco smoke pollution levels in the venues; to compare the quantity of tobacco smoke pollution by rurality and by presence of local ordinances; and to assess compliance with state and local laws. In data collection in 2012, we measured the indoor air quality indicator of particulate matter (2.5 microns aerodynamic diameter or smaller), calculated average smoking density and occupant density, and determined compliance with state and local smoking ordinances using observational methods. As rurality increased, tobacco smoke pollution in bars increased. A significant association was found between stringency of local laws and level of tobacco smoke pollution, but the strength of the association varied by venue type. Compliance was significantly lower in venues in communities without local ordinances. Controlling for venue type, 69.2% of smoke-free policy's impact on tobacco smoke pollution levels was mediated by observed smoking. This study advances scientific knowledge on the factors influencing tobacco smoke pollution and informs public health advocates and decision makers on policy needs, especially in rural areas.

NEXus: evaluation of an innovative educational consortium for doctoral education in nursing.

The purpose of this article is to describe the evaluation of the Nursing Education Xchange (NEXus), a national consortium of doctor of philosophy in nursing (PhD) and doctor of nursing practice programs, administered by the Western Institute of Nursing, which offers courses on-line. An external evaluator surveyed and interviewed faculty and staff coordinators, students, and the Western Institute of Nursing Board Members about their experiences with NEXus. Overall, individuals' perceptions of the NEXus program were positive. Some challenges in registering at other universities were addressed. The program helped PhD in nursing students complete their programs of study on time. Expansion of the program was recommended to offer more opportunities for students to take courses with experts in their areas of interest. Challenges and successes are discussed to assist others contemplating a consortium approach.

Graduate nursing faculty workload in the United States.

Faculty workload is an ever-present issue in nursing education, but little is known about how workload is managed across institutions. Even less is known about faculty workload in the supervision of research and practice for graduate nursing students. The purpose of this study was to describe workload assignments for graduate nursing faculty supervising both research and advanced clinical nursing students. Using the American Association of Colleges of Nursing's list of schools, we sent 617 e-mails with links to an electronic survey to administrators of colleges of nursing. One hundred sixty (26%) administrators responded. Forty schools reported having a doctor of philosophy program, and 31 administrators answered the question about workload for dissertations, with 20 (65%) giving workload credit. Of the 36 respondents with a doctor of nursing practice (DNP) program, 22 (61%) gave credit for DNP project supervision. Great variability exists among schools of nursing in the United States for the amount of workload given for supervision of graduate student research and practice.

Voices not heard: a systematic review of adolescents' and emerging adults' perspectives of health care transition.

BACKGROUND: A better understanding of the needs of adolescents and emerging adults with special health care needs (AEA-SHCNs) is essential to provide health care transition services that represent best practices. The purpose of this systematic review was to evaluate the research on health care transition for AEA-SHCNs from their perspectives. METHODS: A comprehensive literature review of research publications since 2005 was performed using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and EBSCO databases. Thirty-five studies met the final review criteria. RESULTS: The process of transition from child to adult for AEA-SHCNs is complex. Individuals experiencing the transition desire to be a part of the process and want providers who will listen and be sensitive to their needs, which are often different from others receiving health care at the same facility. CONCLUSIONS: More research that considers the voice of the AEA-SHCNs related to transition from pediatric to adult care is needed.

Compassion fatigue in family caregivers: a Wilsonian concept analysis.

AIM: An analysis of the concept of compassion fatigue in family caregivers. BACKGROUND: The term 'compassion fatigue' is predominantly used with professional caregivers, such as nurses, doctors and social workers. Secondary traumatic stress, burnout, and other related terms are often cited in the literature in conjunction with compassion fatigue. Although compassion fatigue is linked to professional caregivers as a result of exposure to traumatizing events, minimal knowledge has been developed regarding its presence in family caregivers. DATA SOURCES: Literature published between 1980-2010 from the humanities, nursing and the social sciences, including psychology, sociology, social work, and religion, was reviewed. Data sources included dictionaries, newspapers and multiple academic databases, such as Academic Search Complete, Atla, CINAHL, PsychInfo, and PubMed. REVIEW METHODS: Wilson's concept analysis strategy was employed to frame the analysis of compassion fatigue, using model, contrary, related, and borderline cases to illustrate the concept's meaning in relation to family caregivers. RESULTS: Analysis revealed that the concept is predominantly used in relation to healthcare providers. Parallels are drawn between the role of healthcare providers and family caregivers. Compassion fatigue occurs when a care-giving relationship founded on empathy potentially results in a deep psychological response to stress that progresses to physical, psychological, spiritual, and social exhaustion in the family caregiver. CONCLUSION: This concept analysis clarified the definition and revealed that the concept of compassion fatigue has potential use with family caregivers. Implications for practice and research are identified.

Social justice: a concept analysis.

AIM: This article is a report of an analysis of the concept of social justice. BACKGROUND: Nursing's involvement in social justice has waned in the recent past. A resurgence of interest in nurses' roles about social justice requires a clear understanding of the concept. DATA SOURCES: Literature for this concept analysis included English language articles from CINAHL, PubMed, and broad multidisciplinary literature databases, within and outside of health-related literature, for the years 1968-2010. Two books and appropriate websites were also reviewed. The reference lists of the identified sources were reviewed for additional sources. REVIEW METHODS: The authors used Wilsonian methods of concept analysis as a guide. RESULTS: An efficient, synthesized definition of social justice was developed, based on the identification of its attributes, antecedents and consequences that provides clarification of the concept. Social justice was defined as full participation in society and the balancing of benefits and burdens by all citizens, resulting in equitable living and a just ordering of society. Its attributes included: (1) fairness; (2) equity in the distribution of power, resources, and processes that affect the sufficiency of the social determinants of health; (3) just institutions, systems, structures, policies, and processes; (4) equity in human development, rights, and sustainability; and (5) sufficiency of well-being. CONCLUSION: Nurses can have an important influence on the health of people globally by reinvesting in social justice. Implications for research, education, practice and policy, such as development of a social justice framework and educational competencies are presented.

Childhood obesity: a Wilsonian concept analysis.

The rate of childhood obesity in the United States has tripled since 1980, with approximately 17% of U.S. children between the ages of 2 and 19 years currently identified as obese. Although a multitude of programs have been implemented to prevent and treat childhood obesity, no single strategy has been identified as the most effective method. Part of the problem in identifying successful interventions is clarifying what is meant by the term obesity as it applies to children. This article provides a concept analysis of the term obesity in relation to children using a Wilsonian approach.

Recovery from serious mental illness: a concept analysis.

This paper examines the concept of recovery in the context of serious mental illness. The analysis uses literature from multiple health care disciplines and different uses of "recovery" in every- day language, technical applications, and popular culture. This iterative process concludes with a definition of recovery from serious mental illness: a nonlinear process of self-organization and adaptation that offsets the personal disintegration of mental illness and enables the individual to reconceive his or her sense of self and well-being on all biopsychosocial levels. The relevance of the concept is reevaluated with this definition for potential usage in the mental health care setting.

Disclosure: a concept analysis.

AIM: This article is a report of a concept analysis of disclosure. BACKGROUND: Disclosure of health concerns is often delayed or incomplete, resulting in a lack of appropriate care or inability to avoid complications. Disclosure is a poorly understood phenomenon in nursing, however, an understanding of the concept is critical to providing effective nursing care. DATA SOURCES: Literature from the humanities, social sciences, business, law, nursing and allied health fields in five search engines was reviewed for insight into a patient's decision to disclose health information to a healthcare provider. REVIEW METHODS: Wilson's method of concept analysis guided this study into the meaning of disclosure from the point of view of a patient seeking healthcare. Inclusive years of search ranged from 1991 to 2010. RESULTS: Disclosure is defined as the act of seeking care by revealing personally significant information that exposes the bearer to the risk of rejection or negative judgment. Attributes of disclosure are identified as: holding significant health-related information, assistance needed to cope, tolerance for unpredictable result, divulgence and expectation of serious response. Consequences of disclosure include resolution, reassurance or assistance gained, but may also include suffering rejection or negative repercussions. CONCLUSION: Implications for nursing practice are explored and include focused questioning, providing for safety concerns, acknowledging significance and sensitivity of disclosed information and acting on the disclosure.