Engaging Clinical Partners in Curricular Initiatives to Improve Practice Readiness.

BACKGROUND: The release of the American Association of Colleges of Nursing's updated Essentials creates an opportunity for nursing programs and clinical partners to collaborate on strengthening curricula and improving new graduate practice readiness. This scoping literature review examined published models for collaborating with clinical partners on curricular initiatives to guide this process. METHOD: Three electronic databases were searched for peer-reviewed articles describing models for collaborating with clinical partners when revising nursing curricula to improve practice readiness. The final sample included seven articles representing five models developed for prelicensure undergraduate education. RESULTS: Themes identified among the models were creating a shared mission, leadership support and involvement, representative committees with regular meetings, clear role expectations, collaboratively determining concepts and competencies, and developing training and resources for consistent implementation of changes. CONCLUSION: These themes provide recommendations for engaging clinical partners in the process of integrating the new Essentials in curricula and improving graduates' practice readiness. [J Nurs Educ. 2023;62(12):706-710.].

Standardized Nursing Examination Remediation: A Program Evaluation.

BACKGROUND: Nurse educators at a public university expanded their standardized examination program in Spring 2020 to include more specialty examinations, required remediation, and retesting for students who did not attain benchmark scores. This study conducted a remediation-focused program evaluation. METHOD: A mixed-methods design was used. Aggregated deidentified Health Education Systems, Inc. (HESI) specialty examination scores (n = 907) were analyzed. Feedback from nursing students and recent alumni (n = 70) was collected using a Qualtrics survey. RESULTS: For students scoring under benchmark, higher remediation time requirements led to greater increases in second-attempt specialty examination scores. More alumni than current students reported remediation was helpful (p = .029). Participants' perspectives regarding remediation barriers, helpful strategies, and motivating policies were identified. Five themes emerged from open-ended survey comments, adding depth to the quantitative findings. CONCLUSION: Recommendations for standardized examination remediation strategies and policies are offered. [J Nurs Educ. 2023;62(9):519-522.].

Examining Students' Online Learning Satisfaction during COVID-19 to Inform Post-Pandemic Program Planning.

BACKGROUND: Student satisfaction is one of five pillars of quality online learning and is associated with academic achievement. This study aimed to examine nursing students' satisfaction with online learning during COVID-19, their desire to continue online classes, and associated factors. METHODS: A cross-sectional survey was completed by 125 nursing students from a public university. The students' satisfaction was measured with the Student's Satisfaction Towards Online Learning Questionnaire. Demographics, stress, and resilience were also measured. Data were analyzed using descriptive statistics and multiple logistic regression. RESULTS: Fewer than half (41.8%) of students were satisfied with online learning. Just over half (51.2%) did not want to continue with online classes. The strongest predictor of satisfaction was course management and coordination. The strongest predictor for a preference to continue with online classes was the instructor's characteristics. CONCLUSIONS: Considering the trend of providing more online education to nursing students, instructors should be prepared for excellence in online course management and coordination as the instructors have a fundamental role in students' satisfaction with online learning. Further examination of nursing students' satisfaction with online learning during the pandemic may yield valuable insights for post-pandemic program planning.

Investigating Adverse Childhood Experiences and Nutrition and Physical Activity Behaviors Using the Omaha System.

The aim of the current study was to examine the relationship between adverse childhood experiences (ACEs) and nutrition and physical activity behaviors using the Omaha System. A descriptive cross-sectional design was used with 227 women recruited from three vocational institutes. Measures included Omaha System Knowledge, Behavior, and Status ratings for nutrition and physical activity; sociodemographic information; and the ACE Questionnaire. Results demonstrated that more than one half of participants had a history of at least one ACE (n = 132; 58.1%), and 33 (14.5%) had four or more. ACEs score was significantly associated with nutrition, but not physical activity behavior. Understanding the links between ACEs and health behaviors and including a brief screening for ACEs in primary care practice settings may help nurses holistically customize health promotion interventions and lead to better health outcomes. The Omaha System can efficiently measure health-related behaviors; examine their relationship to risk factors, such as ACEs; and capture individual and population-level changes. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 23-30.].

Exploring women's perspectives on prenatal screening for adverse childhood experiences.

OBJECTIVE: To learn more about women's views on screening for adverse childhood experiences (ACEs) during healthcare visits in pregnancy. DESIGN: Mixed methods with an online survey. SAMPLE: A convenience sample of 154 women with a history of one or more pregnancies was recruited through public health department social media pages in one predominantly rural region of a Midwest state. MEASUREMENTS: Quantitative measures included demographic variables, ACE scores, and preferences regarding screening format, strategies, and resources. Additional perspectives were captured through open-ended questions. RESULTS: Women's mean ACE score was 2.56 (SD = 2.37) with 68% reporting 0-3 ACEs and 32% reporting four or more. Routine screening for ACEs during prenatal care was supported by 67.5% of women with 9.1% indicating sometimes, 20.8% unsure, and 2.6% against. Strong preference was indicated for screening by one's physician or midwife (80.3%), in an exam room (83.1%), using an independently completed questionnaire (64.2%). Preferred approaches for screening and post-screening interventions also were identified with qualitative themes providing additional insights. CONCLUSIONS: Findings inform strategies for efficiently and sensitively screening for ACEs during pregnancy, highlight the importance of using a trauma-informed approach, and provide direction for educational and interventional resource development.

Women's Use of Self-Care Interventions for Endometriosis Pain in the United States.

OBJECTIVE: To identify self-care interventions women living in the United States are using to manage endometriosis-related pain, describe frequency of use, and determine perceived effectiveness. DESIGN: Mixed-methods design with an online survey. SETTING: A survey link was posted on endometriosis support group Facebook pages. PARTICIPANTS: The online survey was completed by 98 women living in the United States who were members of Facebook support groups. MEASUREMENTS: Quantitative measures included demographic and health-related characteristics; self-care intervention frequency of use and perceived effectiveness; knowledge, confidence, and support managing endometriosis symptoms; pain intensity; and quality of life (QOL) operationalized with the Endometriosis Health Profile-30. Descriptive statistics and correlation coefficients were used to analyze data. Qualitative perspectives were captured through open-ended questions and analyzed for themes. RESULTS: Women used an average of 5.8 self-care interventions more than once per week. Heat, rest, over-the-counter pain medications, and diet changes were perceived as most effective, with >75% reporting at least slight improvement. Frequent use of multiple strategies was significantly correlated with worse scores for pain-related QOL (p < .01), all other QOL dimensions (p < .01), and less confidence in one's ability to control symptoms (p < .05). Endometriosis pain management perspectives showed three themes: Daily Struggle With Mental and Physical Health, Lack of Knowledge and Understanding From Health Care Providers, and Lack of Understanding From Everybody Else. CONCLUSION: These results strengthen evidence for the effectiveness of heat, rest, and dietary changes for endometriosis-related pain and underscore an individual's desire for support and understanding from health care professionals, family, and friends. Nurses can provide evidence-based self-care intervention teaching to help mitigate endometriosis-related pain, prevent adverse effects, and assist individuals in discovering what works for them. It is imperative that nurses deliver and advocate for well-informed, empathetic, and supportive care from all health care professionals.

A Mixed-Methods Systematic Review of Interventions to Address Incivility in Nursing.

BACKGROUND: Incivility negatively affects patient safety, academic performance, and staff retention. This systematic review aimed to identify effective intervention strategies for addressing incivility in nursing education and practice. METHOD: Joanna Briggs Institute methodology for mixed-methods systematic reviews was used. Six databases were searched for incivility intervention studies with nurses or nursing students in academic or health care settings. Data from 39 studies were extracted and thematically synthesized. RESULTS: Two intervention categories, educational and administrative, were identified and used to cluster six intervention strategy themes. Six outcome themes were synthesized to examine strategy effectiveness. CONCLUSION: Findings indicated strong support for multicomponent interventions that incorporate educational strategies of sharing information, skill application, and reflective processing of learning with both nursing students and practicing nurses. Minimal evidence exists on how to increase civility among nursing faculty or enhance faculty role-modeling and coaching for students. Addressing this gap may improve civility in the profession. [J Nurs Educ. 2020;59(6):319-326.].

An investigation of physical activity among adults in Turkey using the Omaha System.

OBJECTIVES: The aim of this study was to investigate the physical activity (PA) and associated factors among insufficiently active adults attending Family Health Centers in Istanbul, Turkey using the Omaha System. DESIGN AND SAMPLE: This descriptive-correlational study guided by the Ecological Model for Health Promotion used a convenience sample of 335 Turkish adults with insufficient PA behavior defined as an Omaha System PA Behavior rating <4. MEASUREMENTS: Measures included Omaha System problems; Knowledge, Behavior, and Status ratings; demographics; and ecological factors operationalized with the Omaha System Problem Classification Scheme. Data were analyzed using chi-square, independent t tests, and logistic regression. RESULTS: Participants were females (76.7%) and males (23.3%) with a mean age of 38.5 years. Almost half (43.6%) engaged in no appropriate PA Behavior. The most common Physiological, Psychosocial, and Environmental domain problem were oral health (61.2%), mental health (21.5%), and neighborhood/workplace safety (41.2%), respectively. Logistic regression revealed marital status, age, sex, and physiological and environmental domain problems significantly predicted PA behavior. CONCLUSIONS: Interventions tailored to insufficiently active Turkish adults should include assessing for physiological health problems; targeting older, married adults; and advocating for policy change that supports the provision of safe, affordable, accessible, and culturally appropriate places for physical activity.

Integrative Review of Pregnancy Health Risks and Outcomes Associated With Adverse Childhood Experiences.

OBJECTIVE: To identify pregnancy risk factors and outcomes associated with a woman's history of adverse childhood experiences (ACEs) and summarize what is known about routine screening for ACEs as part of prenatal care. DATA SOURCES: The Academic Search Premier, Academic Search Complete, CINAHL, Health Source: Nursing Academic Edition, MEDLINE, PsychINFO, and PubMed databases were searched. The terms adverse childhood experiences or ACEs, trauma informed care, and childhood trauma were each paired individually with the terms pregnancy or pregnant or prenatal or antenatal or perinatal or maternal; obstetrics; and maternal-child health. STUDY SELECTION: Database and reference list searches resulted in 1,626 articles with 230 retained for full review and 17 included in the final sample. Studies were included if results were reported specific to pregnancy and ACEs as operationally defined in the ACE Study. DATA EXTRACTION: Studies were evaluated for methodologic quality using Joanna Briggs Institute appraisal tools. Data were extracted with the matrix method. Tabular synthesis was used to cluster and compare findings and identify themes. DATA SYNTHESIS: Five categories of pregnancy health risks and outcomes related to ACEs were identified: physiologic risk, psychologic risk, social risk, behavioral risk, and negative pregnancy outcomes. Limited research was found on routine screening for ACEs as part of prenatal care, but findings indicated women's support for ACE screening during prenatal appointments. CONCLUSION: Routine prenatal ACE screening may be accepted by women and may help identify significant pregnancy health risks. This could provide opportunities for interventions that improve pregnancy outcomes. More research is needed to determine the most effective and efficient methods to screen pregnant women for ACEs and intervene for those with high screening scores. To optimally advance science in this area, conceptual and operational clarity in ACE research is important. Nurses should be at the forefront of these research and practice translation efforts.

Description of public health nursing nutrition assessment and interventions for home-visited women.

OBJECTIVE(S): The purpose of this manuscript was to describe: Public Health Nurse (PHN) home-visited, female client Nutrition Knowledge (K), Behavior (B), and Status (S); the number and types of nutrition interventions PHNs used with these clients; and the types of clients receiving nutrition interventions. DESIGN AND SAMPLE: This descriptive study used PHN-generated Omaha System, electronic health record data from January 2012 to July 2015. The analytic sample contains 558 women who received home visits in a rural Midwestern U.S. county that employed universal nutrition assessment for clients. MEASUREMENTS: Omaha System data included nutrition KBS scores (from 1 = low to 5 = high) and nutrition interventions delivered. Analyses included descriptive, bivariate, and multivariate analyses (means, frequencies, chi-squares, general linear models). RESULTS: PHNs assessed nutrition KBS scores for 84.1% of clients; average Nutrition Knowledge was 3.4 (SD = 0.7), Behavior 3.7 (SD = 0.8), and Status 4.3 (SD = 1.0). PHNs provided 0-36 nutrition interventions per client. Nutrition intervention patterns were detected by the type of visit clients received. CONCLUSIONS: Results suggest home-visited women have room to improve Nutrition KBS and PHNs utilize myriad nutrition interventions. Results also point to opportunities to improve home-visited client care by providing more nutrition interventions, especially to those not receiving interventions, and revising standard care plans to reflect important Case Management nutrition interventions.

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior.

AIM: The purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients. BACKGROUND: Physical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes. METHODS: This quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010-June 2016 (N=419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined. RESULTS: Younger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p<0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n=1639) or Surveillance (n=1183). Few were Case Management (n=46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p=0.03) and change in Physical activity Knowledge (p<0.001). CONCLUSION: This study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected.

Interprofessional Education on Adverse Childhood Experiences for Associate Degree Nursing Students.

BACKGROUND: The health impact of adverse childhood experiences (ACEs) is significant. Nurses need knowledge and must work in multidisciplinary teams to address this problem. This study examined the effects of an interprofessional education (IPE) activity with nonhealth care students on associate degree nursing (ADN) students' ACEs knowledge and perspectives on IPE. METHOD: The mixed-methods approach used a quasi-experimental pretest-posttest design with an intervention and control group and thematic analysis of focus group data. RESULTS: Readiness for Interprofessional Learning scale mean scores indicated positive baseline IPE perspectives. Scores changed minimally for most measures in both the intervention and control groups on posttest. However, four major relevant themes related to ACEs knowledge and two related to interprofessional learning were identified. CONCLUSION: IPE with nonhealth care students is an effective way to teach ADN students about ACEs and infuse interprofessional learning in a nonuniversity setting. However, outcomes are best captured with qualitative data. [J Nurs Educ. 2018;57(2):101-105.].

Integrative Review of Admission Factors Related to Associate Degree Nursing Program Success.

BACKGROUND: High attrition in associate degree nursing (ADN) programs contributes to the nursing shortage and causes hardship for students, families, faculty, colleges, and taxpayers. The purpose of this integrative literature review is to identify admission criteria related to ADN program success to inform evidence-based admission policies and reduce attrition. METHOD: Integrative review methodology, suggested by Whittemore and Knafl, was used. A systematic search of existing professional literature was conducted using five databases and key word searches. The final sample included 26 documents that were analyzed and synthesized with the matrix method. RESULTS: Five categories of admission criteria and factors related to success in ADN programs were revealed from the analysis of findings: academic aptitude, demographic factors, psychological hardiness, specialty skills and experience, and socioeconomic support. CONCLUSION: ADN programs with a goal of decreasing attrition may want to implement admission selection guidelines that consider applicant criteria and attributes across all five dimensions. [J Nurs Educ. 2017;56(2):85-93.].

Interpretation of Ecological Theory for Physical Activity with the Omaha System.

Physical inactivity is a global health problem. Public health nurses (PHNs) have great potential to influence population health outcomes in this area. However, methods are needed to increase understanding of the problem and the impact PHNs may have on measuring and changing health behavior. One promising option is PHN documentation of client health data. However, literature examining how health behavior theories align with nursing documentation systems that use standardized terminology is sparse. The purpose of this article was to operationalize an ecological theory with the Omaha System standardized terminology using physical activity as an exemplar. The goal was to provide a method for using PHN clinical documentation to examine physical activity from a theoretical perspective in research and practice. We designed and used a three-phase process informed by the literature to conceptually map the ecological model for health promotion and the Omaha System. The results of the mapping process reveal the ecological nature of the Omaha System and provide support for measuring and analyzing health-related behavior problems from an ecological perspective with Omaha System data. This process could be replicated with other health-related problems and standardized terminologies to guide theoretically based nursing care and research.

Using Omaha System Documentation to Understand Physical Activity among Rural Women.

OBJECTIVE(S): Examine factors related to physical activity among rural women using Omaha System data. DESIGN AND SAMPLE: Mixed methods: quantitative analysis of de-identified clinical data and thematic analysis of public health nurse (PHN) focus group data. Rural women who received PHN services (N = 852) and purposively selected PHNs (N = 12). MEASURES: Omaha System problems; signs/symptoms; knowledge, behavior, and status ratings; demographics. RESULTS: Physical activity behavior among rural women was inconsistently appropriate (M = 3.27). Age, body mass index, physiological, psychosocial, and environmental domain problems, and physical activity knowledge explained 33.2% of physical activity behavior variance. Almost all women for whom specific problems were documented had insufficient physical activity. This included physiological problems of cognition and pregnancy; psychosocial problems of abuse, caretaking/parenting, mental health, and interpersonal relationship; and environmental problems of neighborhood/workplace safety and income. Having problems in two or more domains was significantly associated with insufficient physical activity behavior (p < .001). PHNs validated findings and expressed concerns that client complexity, priorities, and time constraints may affect client assessment and documentation. CONCLUSIONS: PHNs should assess rural women who are not physically active for potentially serious physiological, psychosocial, and environmental problems. Departmental policies requiring assessment of Omaha System data across programs enabled population health measurement and research.

Health coaching: a concept analysis.

PURPOSE: Variations in the use of health coaching documented in the literature indicate a lack of conceptual clarity. The purpose of this article was to clarify the meaning of health coaching and propose an operational definition. CONCLUSIONS: Seven attributes were identified and used to propose an operational definition of health coaching as a goal-oriented, client-centered partnership that is health-focused and occurs through a process of client enlightenment and empowerment. PRACTICE IMPLICATION: This operational definition and the proposed empirical measures of each attribute can be used to validate the presence of health coaching, develop theory-based applications, and consistently test the effectiveness of interventions using this concept.

An integrative review of literature on the determinants of physical activity among rural women.

OBJECTIVES: The purpose of this integrative review is to analyze current, non-experimental literature to identify factors that influence physical activity levels in rural women with a goal of informing nurses and improving the effectiveness of future physical activity interventions in this population. DESIGN AND SAMPLE: Whittemore and Knafl's (2005) integrative review methodology was used. The sample included 11 quantitative articles, seven qualitative studies, two studies that incorporated both methodologies, and one explanatory case study. MEASURES: Each article was evaluated for quality using the American Association of Critical-Care Nurses revised evidence leveling system. Data were analyzed and then synthesized using the Matrix Method. RESULTS: The terms "rural" and "physical activity" were diversely defined in the reviewed articles. The results revealed three categories of determinants: personal factors, socio-economic factors, and physical environment factors. CONCLUSIONS: Effective nursing interventions to promote physical activity should address barriers and motivating factors in all three categories of determinants for maximum efficacy. Additional research that clearly defines and consistently applies the terms "rural" and "physical activity" is needed to strengthen knowledge in this area.

Health coaching to improve healthy lifestyle behaviors: an integrative review.

OBJECTIVE: Chronic diseases account for 70% of U.S. deaths. Health coaching may help patients adopt healthy lifestyle behaviors that prevent and control diseases. This integrative review analyzed health coaching studies for evidence of effectiveness and to identify key program features. DATA SOURCE: Multiple electronic databases were utilized, yielding a final sample of 15 documents. STUDY INCLUSION AND EXCLUSION CRITERIA: The search was limited to peer-reviewed research articles published between 1999 and 2008. Studies were further analyzed if they (1) specifically cited coaching as a program intervention, and (2) applied the intervention to research. DATA EXTRACTION: Articles describing various quantitative and qualitative methodologies were critically analyzed using a systematic method. DATA SYNTHESIS: Data were synthesized using a matrix format according to purpose, method, intervention, findings, critique, and quality rating. RESULTS: All 15 studies utilized nonprobability sampling, 7 (47%) with randomized intervention and control groups. Significant improvements in one or more of the behaviors of nutrition, physical activity, weight management, or medication adherence were identified in six (40%) of the studies. Common features of effective programs were goal setting (73%), motivational interviewing (27%), and collaboration with health care providers (20%). CONCLUSIONS: Health coaching studies with well-specified methodologies and more rigorous designs are needed to strengthen findings; however, this behavioral change intervention suggests promise.