Incivility in the Online and Hybrid Learning Environment During the COVID-19 Pandemic Era.

ABSTRACT: With the surge in online learning since the onset of the COVID-19 pandemic, fostering civil behavior in this environment is essential. This mixed-methods study examined online incivility among faculty and students at two schools of nursing using a quantitative survey instrument with several open-ended questions addressing the impact of the pandemic. Survey results suggested that faculty ( n = 23) and students ( n = 74) experienced a low frequency of online incivility that remained potentially disruptive. Qualitative analyses suggested that the pandemic placed considerable strain on nursing faculty and students while providing increased flexibility for working and learning.

Using Simulation to Facilitate Transition to the Nurse Educator Role: An Integrative Review.

BACKGROUND: Nurse clinicians transitioning to the educator role require competency development. Simulation methods may increase knowledge and skill development in nurse educators. PURPOSE: The purpose of this review was to examine what is known about using simulation to facilitate transition to the nurse educator role. METHODS: A literature search was completed including simulation methods at any level of fidelity with nurse educators as learners. RESULTS: Using Meleis' Transitions Theory, the outcomes of reviewed reports demonstrated properties of transitions, facilitators of transitions, and indicators of successful transitions to the nurse educator role. Transition outcomes related to mastery of the role were not evident in the reports. CONCLUSIONS: Simulation learning has the potential to support the nurse educator in role transition and development.

Partnership integration for rural health resource access.

Increasing numbers of older adults are residing in rural areas of the USA. Many of these individuals experience greater rates of chronic diseases and lower income levels compared to their urban-residing counterparts. Aging in rural environments creates greater challenges in the provision of funding, staff and resources to meet the needs of these older adults, and contributes to immense health disparities and health inequities. Urban and rural older adult residents alike need healthcare, gerontological and public health resources to promote successful aging in place. Due to the nature of rural environments, many of these resources often exist great distances from these residents, which creates access challenges. There are also limitations in locally available facilities and trained practitioners, resulting in resource shortages for addressing chronic health conditions. The creation and use of interdisciplinary partnerships provides this much-needed support while addressing ever-increasing funding and staffing limitations. This article provides an innovative conceptual interdisciplinary partnership model that combines nursing, public health and gerontology to address the health and social challenges that rural-residing older adults face. Although well-trained practitioners who work within their discipline are an important contributor to assist with the needs of rural-residing older adults, this silo approach is expensive, inefficient, and clearly cannot support all of the needs for older adults in this type of environment. There is a need to blend the complementary skills provided by each of the presented disciplines so that the focus of the interdisciplinary partnership is on person-centered care addressing the health disparities and health inequities experienced by these older adults. To illustrate the integration of nursing, public health and gerontology disciplines, these disciplines are initially combined and presented as dyads, and are then incorporated into the full conceptual model. The dyads are public health and gerontology, public health and nursing, and gerontology and nursing. Steps are provided for the development of this (or any) interdisciplinary partnership. An example of the model's use through clinical and non-clinical disciplines and a community engagement framework is also described. Interdisciplinary approaches focused on person-centered care provide more well-rounded health and social support for rural older adults than any one discipline in isolation. Allocation of shared resources, roles, responsibilities and expenses allows practitioners engaged in interdisciplinary teams to provide superior economic and capacity efficiency. This efficiency is crucial at a time when many entities experience limitations in sustainable resources. Thus, practitioners and community agencies collaborating through interdisciplinary partnerships are better able to address the complex issues experienced by rural-residing community members.

Development of the Spanish Language Houston Pain Outcome Instrument for Spanish Speakers.

PURPOSE: To address reported disparities in pain management among Hispanic patients, this article reports the psychometrics of the newly developed Spanish language Houston Pain Outcome Instrument (HPOI) with postoperative Hispanic patients. METHODS: Findings from qualitative interviews conducted with 35 self-identified Hispanics in Phase 1 of the overall project were used to generate items for a new Spanish language instrument, Cuestionario de Houston Sobre el Dolor (HPOI). The second phase tested the psychometric properties with 95 self-identified Hispanic postoperative inpatients in three Texas hospitals. RESULTS: HPOI subscale reliabilities ranged from .63 to .91, with similar reliabilities for Spanish and English versions. Concurrent validity was demonstrated by moderate significant correlations with similar items on the Brief Pain Inventory. Participants reported moderate and severe worst pain in the last 24 hours; 38% were undertreated for pain according to the Pain Management Index; and 75% reported nonpharmacologic strategies including family support, prayer, and position change as highly effective in managing pain. CONCLUSIONS: The HPOI is a reliable instrument for addressing disparities in pain management for the rapidly growing Hispanic population in the United States. Subscales for interference with mood and physical function and patient-reported nonpharmacologic strategies facilitate a more comprehensive assessment of the pain experience.

Reflective practice: providing safe quality patient-centered pain management.

Effective pain management continues to baffle clinicians in spite of numerous evidence-based guidelines and standards, focused clinical interventions and standardized assessments. Reflective practice is a mindful approach to practice that grounds clinicians in the moment with the individual patient to ask questions and then to listen to the patient's message about their pain experience. Reflective practice helps meld theoretical knowledge with lessons from experience to rethink mechanistic responses to patient pain. The subjective nature of pain means no two patients have the same experience, and, evidence based best practices are to be applied within the patient's preferences and context. The paper uses a case study to illustrate how to apply reflective practice to integrate the interprofessional quality and safety competencies to provide patient-centered pain management. Applying reflective questions throughout the care experience by all members of the healthcare team provides a mindful approach that focuses care on the individual patient.

Implementation of Best Practices in Simulation Debriefing.

ABSTRACT: This article describes how one school of nursing responded to the need to educate faculty in the pedagogy of simulation debriefing and how the International Association for Clinical Simulation and Learning Standard VI was implemented. Thirty faculty received training and were evaluated using the Debriefing Assessment for Simulation in Healthcare tool. Lessons learned and examples of student feedback are shared. Plans for future work are also described.

Building Cultural Sensitivity and Interprofessional Collaboration Through a Study Abroad Experience.

BACKGROUND: Study abroad (SA) experiences for health professions students may be used to heighten cultural sensitivity to future patients and incorporate interprofessional education (IPE). METHOD: Two groups of nursing and pharmacy students participated in an SA elective over a 2-year period, traveling to China and India. RESULTS: Both groups improved significantly in knowledge, awareness, and skills following the travel experiences. Student reflections indicate that the SA experience was transformative, changing their views of travel, other cultures, personal environment, collaboration with other health professionals, and themselves. CONCLUSION: Use of SA programs is a novel method to encourage IPE, with a focus on enhancing the acquisition of cultural competency skills.

Developing nurse educator competency in the pedagogy of simulation.

Faculty development is needed for nurse educators to effectively use simulation as a learning tool. A synthesis of research evidence regarding current practices in preparing educators to use simulation provided a foundation for faculty development. Implementation of a two-pronged approach within a regional collaboration of four schools of nursing is described; results of the evaluation of the approaches are presented. Use of the National League for Nursing Core Competencies of Nurse Educators as the organizing framework and Roger's Diffusion of Innovations Model as the theoretical framework is discussed. An overview is provided of the two prongs: (a) a short course for novice educators, and (b) examples of continuing education programming for experienced faculty members new to simulation to enhance effective application of this pedagogy. Recommendations include designing faculty development for simulation within a framework for systems change, maintaining flexibility to meet diverse needs, and using existing online resources.

Use of high-fidelity simulation to teach end-of-life care to pharmacy students in an interdisciplinary course.

OBJECTIVE: To assess the effect of high-fidelity simulation on pharmacy students' attitudes and perceived competencies in providing end-of-life care in an interdisciplinary palliative care course. DESIGN: Thirty pharmacy students participated in a high-fidelity simulation of the 15 minutes before and 15 minutes after the death of a patient with end-stage renal disease. ASSESSMENT: Students completed the Attitudes Toward Death Survey and the End of Life Competency Survey prior to and after experiencing the simulation. A reflections journal exercise was used to capture post-simulation subjective reactions, and a course evaluation was used to assess students' satisfaction with the simulation experience. Students' post-simulation attitudes toward death significantly improved compared to pre-simulation attitudes and they felt significantly more competent to take care of dying patients. Students were satisfied with this teaching method. CONCLUSION: High-fidelity simulation is an innovative way to challenge pharmacy students' attitudes and help them with knowledge acquisition about end-of-life care.

A family history intervention: enhancing cardiovascular risk assessment.

This article describes the effect of individualized counseling using family history data and objective cardiovascular risk factors on intent to change and actual exercise behavior in a diverse sample of working adults. Using a longitudinal, quasi-experimental, crossover design, objective data (blood lipids, glucose, blood pressure, and body mass index) and subjective data (awareness of heart disease risk, depression, spirituality, and knowledge of family history) were collected from 91 (mostly female and with a mean age of 45 years) primary and secondary teachers in a southwestern city. The Transtheoretical Model of Change guided the study and measured intent to exercise. Objective risks in this sample mirrored national indices of risk for obesity and abnormal lipids. Although some participants increased their exercise, no significant differences were found between the groups in exercise behavior at 6 and 12 months. Using knowledge of family history to raise awareness and encourage lifestyle changes related to cardiovascular risk warrants further study.

Pediatric clinical simulation: a pilot project.

With increased enrollment, nursing faculty are finding clinical placement for students more difficult, especially in clinical areas such as child health. Simulation using moderate-fidelity and high-fidelity manikins offers evidence-based and innovative approaches to augment traditional clinical experiences. However, few studies quantitatively examine student outcomes associated with clinical simulation. This article describes student learning outcomes related to traditional and hybrid (part simulation and part traditional clinical) undergraduate clinical experiences in a baccalaureate nursing program. In addition, the use of faculty-developed simulation scenarios integration of Quality and Safety Education for Nurses (QSEN) competencies into four pediatric scenarios, as well as the educational development of faculty at a simulation center, are presented.

A primer of ethical issues involving opioid therapy for chronic nonmalignant pain in a multidisciplinary setting.

OBJECTIVE: This forum presents a clinical vignette of orofacial pain and expounds on ethical issues related to opioid therapy in the context of multidisciplinary treatment. The purpose of this forum is to assist health care providers from different disciplines in identifying ethical issues and conflicts regarding opioid therapy encountered in multidisciplinary clinical pain practices. DESIGN: We use the case vignette and opioid therapy as a backdrop for a discussion of 1) an overview of ethics terminology; 2) a presentation of key ethics principles; 3) our conceptualization of ethical obligations of patients regarding opioid therapy; and 4) the process of developing an appropriate treatment plan within the context of the discussed ethical principles.

Comparison of factors affecting repeat mammography screening of low-income Mexican American women.

PURPOSE/OBJECTIVES: To examine the level of cancer fatalism and other sociocognitive behavioral determinants in Mexican American women categorized as regular mammography screeners and infrequent mammography screeners. DESIGN: Cross-sectional, descriptive. SETTING: A southwestern American city on the U. S.-Mexico border. SAMPLE: 68 Mexican American women with low incomes recruited from a cancer consortium database. METHODS: Women who had been identified as regular or infrequent screeners based on screening history were contacted and invited to participate in a telephone survey. Participation consisted of completing the Powe Fatalism Inventory (PFI) and the Mammography Beliefs and Attitudes Questionnaire (MBAQ) in English or Spanish. MAIN RESEARCH VARIABLES: Total scores on the PFI and total scores on each of the MBAQ subscales. FINDINGS: Differences between the two groups were noted in cancer fatalism, perceived control over their participation in screening activities, and family history of cancer. No significant differences were noted in demographic characteristics. CONCLUSIONS: Cancer fatalism, generally believed to be highly related to socioeconomic status, may be mediated by women's perceptions of control over screening behavior or choices and by family history of cancer. IMPLICATIONS FOR NURSING: Further research is needed to explore cancer fatalism among Hispanic women, including other factors that can affect the level of cancer fatalism and perceived control over mammography screening participation. With this knowledge, culturally sensitive interventions may be developed to increase self-efficacy and facilitate perceived control.

Family history: value-added information in assessing cardiac health.

The purpose of this study was to describe family health history profiles and objective indices of cardiac health among ethnically diverse working adults. Family history of disease is an important predictor of individual health, yet is underused by clinicians. Participants were staff in an elder-care facility and completed a web-enabled program capturing family history, objective cardiovascular measures (blood lipids, blood pressure, height, weight, and waist-to-hip ratio), and subjective measures (anxiety, spirituality, and health status appraisal). Of the 44 participants, 89% were unable to provide complete information about their family health and mortality for the three-generation genogram; 25% had one or more first-degree relatives with cardiac disease; and more than two thirds had first-degree relatives with diabetes. More than 80% of the sample exhibited objective indices of risk including body mass indexes in the overweight or obese categories. Family history information was incorporated into health screening and enabled more appropriate health counseling for these employees.

Postoperative pain management outcome in Chinese inpatients.

In the absence of pain management outcome reports representing mainland China, the purposes of this study were to describe the outcome of postoperative pain management and the relationship between patient satisfaction and clinical outcomes in an indigenous Chinese population. From a sample of 388 second-day-postoperative inpatients, 304 (78%) reported pain in the past 24 hours and were enrolled in the study. Mean ratings for pain were moderate to severe. Patients reported mild to moderate pain-related interference with mood and physical activities. There were significant differences on worst pain intensity and pain interference with daily activity in the past 24 hours for different types of surgery. Top-ranked nonpharmacologic methods for managing pain were tolerating pain, changing positions, and family support. As measured by the Pain Management Index, 60.2% of patients were inadequately treated for pain, yet patients reported high satisfaction with pain management. Patient satisfaction, however, was inversely and significantly correlated with pain intensity. Study results indicate a need for standardized policies and guidelines about pain management and education among providers and for patients and families to overcome the suboptimal pain outcomes among this Chinese population.

Unequal quality of cancer pain management: disparity in perceived control and proposed solutions.

PURPOSE/OBJECTIVES: To examine poverty-related and racial and ethnic disparity in cancer pain management. DATA SOURCES: Published articles, conference proceedings, testimony, and clinical case studies. DATA SYNTHESIS: Disparity in the quality of cancer pain management exists resulting from interactions among patient, provider, and environmental factors. Irrespective of etiology, disparity results in inadequate management of cancer pain for vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care. Inadequate symptom management affects cancer treatment tolerance, exacerbating disparity in treatment outcomes and affecting end-of-life care. CONCLUSIONS: Evidence-based solutions include a systems approach, quality-improvement and quality-assurance processes that expose disparities and enforce evidence-based treatment per national guidelines, and statewide comprehensive cancer planning to target pain management outcomes. IMPLICATIONS FOR NURSING: Oncology nurses and interdisciplinary teams must be aware of disparities in cancer pain management for vulnerable groups, intervene to empower patients through customized educational approaches, and simultaneously implement systemwide strategies to ensure effective pain management and targeted monitoring for high-risk patients.

Multicultural influences on pain medication attitudes and beliefs in patients with nonmalignant chronic pain syndromes.

The objective was to develop an integrated review of quantitative and qualitative research regarding the influence of patients' beliefs and attitudes toward pain medication prescribed for the treatment of nonmalignant chronic pain on use of the pain medication. Studies involving patients at least 18 years old with nonmalignant chronic pain were included. Studies of patients with acquired immune deficiency syndrome, cancer, and acute pain were excluded. Medline, CINAHL, PsychInfo, and Cochrane databases from 1985 to 2005 were searched. Reference lists were screened for relevant articles. Abstracts were screened for compliance with the study criteria, and the articles were obtained for those that met criteria. By using a systematic process, each article was subjected to repeated review and data abstracted to the collection sheets. Evidence tables were created to assist with data review. High levels of concern positively correlate with nonadherence, preconceived ideas about when the drug should start working can cause the patient to discontinue it before it begins to work, and patients may perceive that if medication is taken on a regular basis to control pain it may not be effective in the future if the pain increases. Research also showed that if patients perceived the benefits of taking the pain medication to be high, they were willing to risk the side effects.

Surgical management of testicular cancer.

Surgery is an integral component in the management of testicular cancer. Prior to the advent of cisplatin chemotherapy, a retroperitoneal lymph node dissection (RPLND) was the only chance for cure of testicular cancer. Over the years, the surgical techniques have been improved greatly to decrease the occurrence of complications (e.g., incidence of retrograde ejaculation). Currently, RPLND can be done as the initial therapy or after chemotherapy. In either situation, the postoperative management of patients with testicular cancer can be complicated and requires thorough, ongoing assessment. This article presents the surgical indications for RPLND and the nursing management.

The hidden error of mismanaged pain: a systems approach.

Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0-10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.