Enhancement of Preoperative Mental Health Assessment Through Clinical Nurse Specialist Project Leadership.

PURPOSE/OBJECTIVES: The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery. DESCRIPTION OF PROJECT: The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates. OUTCOME: Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion. CONCLUSION: Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.

Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience.

BACKGROUND: Community-based participatory research (CBPR) can effectively address health disparities among groups that are historically difficult to reach, disadvantaged, of a minority status, or are otherwise underrepresented in research. Recent research has focused on the science of CBPR partnership constructs and on developing and testing tools for self-evaluation. Because CBPR requires substantial investment in human and material resources, specific factors that support successful and sustainable research partnerships must be identified. We sought to describe the evolution, implementation, and results of a self-evaluation of a CBPR partnership. METHODS: Academic and community members of the Rochester Healthy Community Partnership (RHCP) and researchers from the University of New Mexico-Center for Participatory Research collaborated to evaluate RHCP with qualitative and quantitative research methods and group analysis. RESULTS: The self-evaluation was used to provide an overall picture of the "health" of the partnership, in terms of sustainability and ability to effectively collaborate around community priorities. RHCP members revisited the partnership's mission and values; identified associations between partnership practices, dynamics, and outcomes; and elicited insight from community and academic partners to help guide decisions about future directions and the sustainability of the partnership. Positive partnership dynamics were associated with perceived improvements in health and equity outcomes. CONCLUSIONS: Although engaging in a comprehensive self-evaluation requires substantial investment from stakeholders, such assessments have significant value because they enable partners to reflect on the mission and values of the partnership, explore the history and context for its existence, identify factors that have contributed to outcomes, and plan strategically for the future.

Lay health worker as interventionist training: reflective writing in US family health promotion practice.

Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.

Health programs taught by lay health workers from within racial and ethnic communities are often more successful than those not taught by persons from these communities. Lay health workers are specifically trained in these programs. It is hard to know how lay health workers use this training. We asked lay health workers about how they used a specific approach of teaching and goal setting to help families change nutrition and physical activity behaviors. Four different lay health workers wrote notes after each time they met with families. We read these notes to see what we could learn about how they used their training. Lay health workers wrote that they followed their training by listening to each family so they could encourage families to set small goals that made sense to the family. They also followed their training by being flexible while doing the teaching and goal setting because there were many other things going on in the family. Lay health workers were personally changed and got better at teaching because of the relationships they had with each family. Writing these notes helped lay health workers focus on the skills and emotions needed to put their training into place.

Measuring Family Members' Experiences of Integrating Chronic Illness Into Family Life: Preliminary Validity and Reliability of the Family Integration Experience Scale:Chronic Illness (FIES:CI).

Measures of family members' experiences of integrating chronic conditions (CC) or chronic illnesses (CI) into family life are needed to optimize family care. This article reports development and psychometric testing of the Family Integration Experience Scale: Chronic Illness (FIES:CI), a measure of family member perceptions of integrating CC or CI into evolving family life. Family Systems Nursing (FSN), the Reintegration Within Families in the Context of Chronic Illness Model, and measurement theory guided the study. Participants were those (N = 328) managing a CC or CI. Concurrent validity (r = +.629; p < .001) and discriminant validity, F(1, 155) = 7.09; p < .05, were demonstrated. Exploratory factor analysis revealed a two-dimensional model explaining 63.8% variance. Scale internal reliability was α = .70 and .785, and factor reliabilities were α = .798 (Factor 1) and α = .847 (Factor 2). Test-retest item and subscale correlations, while accounting for intra-family correlation, were acceptable. The FIES:CI contributes a valuable new measure of family integration in the context of CC or CI with preliminary validity and reliability as tested in these samples.

Club Fit: Development of a Physical Activity and Healthy Eating Intervention at a Boys & Girls Club After School Program.

Children and adolescents from minority and low income backgrounds face social and environmental challenges to engaging in physical activity and healthy eating to maintain a healthy weight. In this study, we present pilot work to develop and implement a multi-component physical activity and healthy eating intervention at a Boys & Girls Club (BGC) afterschool program. Using a community-based participatory approach, BGC staff and academic researchers developed intervention components informed by formative studies and based on a Social Ecological Theory framework. Components included healthy eating and physical activity policy implementation, staff training, a challenge and self-monitoring program for healthy behaviors, a peer-coaching program for healthy behaviors, and a social marketing campaign. We assessed pilot feasibility through a single group, pre-post study design with measures collected at baseline and 6 months. The sample included 61 children with a mean age of 10.4 years. Mean (SD) body mass index (BMI) percentile was 72.8 (28.9); 47.5% were in the healthy weight range for their age. We found statistically significant improvements of self-efficacy and motivation for physical activity. Self-efficacy and motivation for fruit and vegetable consumption, sugary beverage consumption, and screen time improved but were not statistically different from baseline. We found no improvements of perceived social support, objectively measured physical activity, or self-reported dietary quality. Though BMI did not improve overall, a dose effect was observed such that attendance in Club Fit specific programming was significantly correlated with decreased BMI z scores. Processes and products from this study may be helpful to other communities aiming to address childhood obesity prevention through afterschool programs.

Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site.

BACKGROUND: Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (U.S.A) that disproportionally affect children from low income and minority families. OBJECTIVE: This mixed-method study focused on estimating levels of physical activity and sedentary behavior and prevalence of overweight and obesity among the child members served in one Boys and Girls Club in the Midwest U.S.A. We aimed to better understand opportunities for improving children's engagement in physical activity through focus groups with members, staff, and parents/caregivers of members. METHODS: Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity. RESULTS: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 minutes physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 hours or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity. CONCLUSIONS: Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.

The Development of a Collaborative Self-Evaluation Process for Community-Based Participatory Research Partnerships Using the Community-Based Participatory Research Conceptual Model and Other Adaptable Tools.

BACKGROUND: Established community-based participatory research (CBPR) partnerships need tools to assist with self-evaluation of the effectiveness and engagement with CBPR principles and to inform ongoing work. A growing part of the CBPR field is focused on the evaluation of partnering processes and outcomes. OBJECTIVES: The Rochester Healthy Community Partnership (RHCP), a partnership with more than a decade of engagement in health promotion research, performed a self-evaluation in collaboration with the University of New Mexico Center for Participatory Research (UNM-CPR). METHODS: We collaboratively developed and implemented a facilitated self-evaluation using adaptations of existing tools and the CBPR conceptual model. Partners contributed through surveys and qualitative interviews. Initially, data were analyzed collaboratively by members of RHCP and UNM-CPR, but RHCP partners further processed and consolidated findings, leading to the development of key questions that guided a full partnership discussion of action steps. RESULTS: Our process confirmed the adaptability of existing tools and the CBPR conceptual model for the purpose of partnership reflection and self-evaluation. We offer the key findings of our assessment of partnering practices and directions for the future, and share our approach to collaborative analysis and dissemination. Our discussion includes lessons learned, with applicability to other established partnerships. CONCLUSIONS: Our experience indicates that collective reflection is empowering for members of established partnerships, which can be facilitated by engagement in self-evaluation through the use of adapted, available tools. The incorporation of participatory processes adds complexity, but leads to a level of resonance and usefulness that would not have been obtained from a traditional evaluation.

Improving Patient and Caregiver New Medication Education Using an Innovative Teach-back Toolkit.

BACKGROUND: Patients and caregivers are often not adequately informed about new medications. Nurses can lead innovations that improve new medication education. LOCAL PROBLEM: Healthcare Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on medication questions trailed state and national levels in one Midwestern hospital. METHODS: This quality improvement project, guided by the Ottawa Model of Research Use and the Always Use Teach-back! innovative toolkit, used a 1-group pre- and posteducation design with RNs, patients, and caregivers. INTERVENTION: RNs (n = 25) were observed in patient/caregiver education and surveyed in confidence/con-viction in the teach-back method before and after education. Patients' (n = 74) and caregivers' (n = 33) knowledge was assessed. RESULTS: RNs reported significant increases in conviction in the importance of (P < .0001), confidence in using (P < .0001), and frequency in using (P < .0001) teach-back. With teach-back, both patients and caregivers recalled the purpose and side effects of new medications. Specific HCAHPS scores increased from 6% to 10%. CONCLUSION: The teach-back method strengthened safe nursing practice and enhanced quality in new medication education.

Development and Implementation of a Family-Focused Undergraduate Nursing Curriculum: Minnesota State University, Mankato.

Nurse educators have the responsibility to create learning experiences centered on the scientific and praxis foci of the nursing discipline to advance nursing practice with families. Although the nursing profession has ample knowledge about the importance of family nursing and the value of family-focused actions, there is a lack of curricular and teaching models that address nursing practice with families in numerous courses and learning experiences. This article describes the development of a family-focused undergraduate curriculum and teaching-learning practices at Minnesota State University, Mankato in the United States. A vision and mission centered on the nursing of families, a family care teaching model, a framework of family constructs, and taxonomy of significant learning strategies guided faculty in creating learner-centered experiences. Course objectives, competencies, and teaching-learning practices in this curriculum are described. This manuscript may guide the development of innovative teaching-learning practices that integrate family nursing constructs and family nursing actions from a variety of family nursing models and theories. Initial evaluation suggests that this curriculum can increase students' knowledge of family and instill a passion for family care in undergraduate programs.

Enhancing Self-management for Adults With Functional Abdominal Pain: A Registered Nurse-Led Cognitive-Behavioral Therapy Approach.

Chronic disease accounts for three-quarters of today's medical expenditures. Functional abdominal pain (FAP) syndrome and associated gastrointestinal symptoms affect 0.5% to 2% of North Americans. Persons with FAP routinely seek healthcare, with little resolution of symptoms, despite high costs. National reports advocate for innovative redesign of ambulatory care services. Cognitive-behavioral therapy (CBT) is a low-cost, effective self-management approach. The objective of this study was to implement a registered nurse-led CBT approach to enhance self-management and satisfaction with care for adults with functional gastrointestinal disorder (FGID). We conducted a pre- and postintervention group comparison study in an outpatient gastroenterology subspecialty clinic within a large medical center. Twelve patients (seen May to July 2015) received nurse-led education about the pain phenomenon and CBT techniques to self-manage pain and associated symptoms of FAP. Methods and effectiveness of CBT for promoting self-management of chronic pain symptoms were reviewed. Subsequently, we conducted a project that incorporated nurse-led CBT into standard practice. Pre- and post-CBT questionnaire data showed patients had improved symptoms, well-being, and satisfaction. Registered nurses practicing at the highest level of their scope of practice within ambulatory care service models can enhance care management by educating, coaching, and counseling to improve self-care for patients with FGID.

Use of Motivational Interviewing by Nurse Leaders: Coaching for Performance, Professional Development, and Career Goal Setting.

Motivational interviewing (MI) is a mentoring style used in various health care settings to guide patients toward health promotion and disease management. The aims of this project were (1) to identify evidence supporting the application of MI strategies and principles by nurse leaders to promote healthful leadership development among direct-report staff and (2) to report outcomes of an educational pilot project regarding MI use for new nurse leaders. Correlations between MI and the American Organization of Nurse Executives nurse executive competencies are reviewed and summarized. These competencies shape the roles, responsibilities, and skills required for nurse executives to function proficiently and successfully within health care organizations. Survey responses were gathered from new nurse supervisors and nurse managers following the MI educational session for nurse leaders. The results show acceptability for MI use in professional development of direct-report staff and in other aspects of nursing leadership roles.

Healthy Immigrant Families: Randomized Controlled Trial of a Family-Based Nutrition and Physical Activity Intervention.

PURPOSE: To evaluate a healthy eating and physical activity intervention for immigrant families, derived through community-based participatory research. DESIGN: The Healthy Immigrant Families study was a randomized controlled trial with delayed intervention control group, with families as the randomization unit. SETTING: US Midwest city. PARTICIPANTS: Participants were recruited by community partners from Hispanic, Somali, and Sudanese immigrant communities. INTERVENTION: Family health promoters from participating communities delivered 6 healthy eating modules, 4 physical activity modules, and 2 modules synthesizing information in 12 home visits (60-90 minutes) within the first 6 months. Up to 12 follow-up phone calls to each participant occurred within the second 6 months. MEASURES: Primary measures were dietary quality measured with weekday 24-hour recall and reported as Healthy Eating Index score (0-100) and physical activity measured with accelerometers (14 wear days) at baseline, 6, 12, and 24 months. RESULTS: In total, 151 persons (81 adolescents and 70 adults; 44 families) were randomly assigned. At 12 months, significant improvement occurred in Healthy Eating Index scores for adults in the intervention group compared with controls (change, +8.6 vs -4.4; P < .01) and persisted at 24 months (+7.4 from baseline; P < .01). No differences were observed for adolescents and no significant differences occurred between groups for physical activity. CONCLUSION: This intervention produced sustained dietary quality improvement among adults but not among adolescents. Program outcomes are relevant to communities working to decrease cardiovascular risk among immigrant populations.

Enhancing Care for Infants With Neonatal Abstinence Syndrome: An Evidence-Based Practice Approach in a Rural Midwestern Region.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Treatment Fidelity Among Family Health Promoters Delivering a Physical Activity and Nutrition Intervention to Immigrant and Refugee Families.

Lack of treatment fidelity can be an important source of variation affecting the credibility and utility of outcomes from behavioral intervention research. Development and implementation of a well-designed treatment fidelity plan, especially with research involving underserved populations, requires careful conceptualization of study needs in conjunction with what is feasible in the population. The purpose of this article is to review a fidelity-monitoring plan consistent with the National Institutes of Health Behavior Change Consortium guidelines (e.g., design, training, delivery, receipt, and enactment) for an intervention trial designed to improve physical activity and nutrition among immigrant and refugee families. Description of the fidelity monitoring plan is provided and challenges related to monitoring treatment fidelity in a community-based participatory intervention for immigrant and refugee families are discussed.

Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population.

Immigrants experience an escalation of negative health behaviors after arrival to the United States. Negative mood is associated with poorer health behaviors in the general population; however, this relationship is understudied in immigrant populations. Adolescent (n = 81) and adult (n = 70) participants completed a health behavior survey for immigrant families using a community-based participatory research approach. Data was collected for mood, nutrition, and physical activity. Adolescents with positive mood drank less regular soda, and demonstrated more minutes, higher levels, and greater social support for physical activity (all ps < .05). Adults with positive mood reported more snacking on fruits/vegetables, greater self-efficacy for physical activity, and better physical well-being (all ps < .05). Negative mood was associated with low physical activity level and poor nutritional habits in adolescent and adult immigrants. Designing community-based programs offering strategies for mood management and healthy lifestyle change may be efficacious for immigrant populations.

Erratum to: Lessons Learned from Community-Led Recruitment of Immigrants and Refugee Participants for a Randomized, Community-Based Participatory Research Study.

The original version of this article unfortunately contained an error in the author affiliation. The affiliations for the Authors Marcelo M. Hanza, Miriam Goodson, Ahmed Osman, Maria D. Porraz Capetillo, Abdullah Hared, Julie A. Nigon, Mark L. Wieland, and Irene G. Sia were published incorrectly. The correct affiliations are given in this erratum.

Lessons Learned from Community-Led Recruitment of Immigrants and Refugee Participants for a Randomized, Community-Based Participatory Research Study.

Ethnic minorities remain underrepresented in clinical trials despite efforts to increase their enrollment. Although community-based participatory research (CBPR) approaches have been effective for conducting research studies in minority and socially disadvantaged populations, protocols for CBPR recruitment design and implementation among immigrants and refugees have not been well described. We used a community-led and community-implemented CBPR strategy for recruiting 45 Hispanic, Somali, and Sudanese families (160 individuals) to participate in a large, randomized, community-based trial aimed at evaluating a physical activity and nutrition intervention. We achieved 97.7 % of our recruitment goal for families and 94.4 % for individuals. Use of a CBPR approach is an effective strategy for recruiting immigrant and refugee participants for clinical trials. We believe the lessons we learned during the process of participatory recruitment design and implementation will be helpful for others working with these populations.

Healthy immigrant families: Participatory development and baseline characteristics of a community-based physical activity and nutrition intervention.

BACKGROUND: US immigrants often have escalating cardiovascular risk. Barriers to optimal physical activity and diet have a significant role in this risk accumulation. METHODS: We developed a physical activity and nutrition intervention with immigrant and refugee families through a community-based participatory research approach. Work groups of community members and health scientists developed an intervention manual with 12 content modules that were based on social-learning theory. Family health promoters from the participating communities (Hispanic, Somali, Sudanese) were trained to deliver the intervention through 12 home visits during the first 6 months and up to 12 phone calls during the second 6 months. The intervention was tested through a randomized community-based trial with a delayed-intervention control group, with measurements at baseline, 6, 12, and 24 months. Primary measurements included accelerometer-based assessment of physical activity and 24-hour dietary recall. Secondary measures included biometrics and theory-based instruments. RESULTS: One hundred fifty-one individuals (81 adolescents, 70 adults; 44 families) were randomized. At baseline, mean (SD) time spent in moderate-to-vigorous physical activity was 64.7 (30.2) minutes/day for adolescents and 43.1 (35.4) minutes/day for adults. Moderate dietary quality was observed in both age groups. Biometric measures showed that 45.7% of adolescents and 80.0% of adults were overweight or obese. Moderate levels of self-efficacy and social support were reported for physical activity and nutrition. DISCUSSION: Processes and products from this program are relevant to other communities aiming to reduce cardiovascular risk and negative health behaviors among immigrants and refugees. TRIAL REGISTRATION: This trial was registered at Clinicaltrials.gov (NCT01952808).

Associations among fluid intake, cognitive function, and length of stay in psychogeriatric inpatients.

PURPOSE: The purpose of this study was to examine differences, interactions, and associations among cognition, fluid intake, and demographic variables that may affect length of stay (LOS) for psychogeriatric inpatients aged 65 years or older. DESIGN AND METHODS: Descriptive, comparative, correlational secondary analysis of data from a primary study of 202 inpatients. FINDINGS: Older adults with and without cognitive impairment had different fluid intake over time (F = 3.50; p = .03), but had no difference in LOS in relation to cognitive functioning (p = .23); additional factors may predict LOS. PRACTICE IMPLICATIONS: Care providers must monitor the fluid intake of elderly patients with and without cognitive impairment throughout their hospitalization.