An Integrative Review of the Use of the Individual and Family Self-Management Theory in Research.

The extent of the application of the Individual and Family Self-Management Theory (IFSMT) in research has yet to be determined. The purpose of this analysis was to review the use of the IFSMT in published research and evaluate posited constructs and relationships. Dimensions and categories of the IFSMT and the interrelationships were generally supported in the 77 articles reviewed. A majority focused on self-management of chronic conditions in the adult population. More research on the strength, direction, and interaction of relationships is needed. Defining and exploring social constructs, including race, ethnicity, and gender, should be prioritized in future IFSMT research.

A Center Experience with Common Data Elements in Chronic Illness Self-Management Research.

In recent decades, the use of common data elements has expanded across the health disciplines. This has included growth within programs of research focused on self-management and family nursing. Family nursing and self-management science may be expanded with the increased use of common concepts, measures, and theoretical frameworks. This article describes the experience of exploring the use of common data elements and identifying shared concepts from the perspective of one National Institute of Nursing Research funded Exploratory Center in Self-Management. Guidance offered by the Individual and Family Self-Management Theory is discussed, and implications for family research are presented.

Adolescent Characteristics, Suicide, and Bullying in High School.

Youth Risk Behavior Survey 2011-2017 data were examined for associations among high school population subsets who self-reported suicide risk behaviors and experiences with bullying. High-school students who reported suicidal risk behaviors were 4.64 times more likely to have experienced bullying electronically. Ninth grade and female students were more likely than others to experience suicide risk behaviors and bullying. At the interpersonal level, school nurses are able to identify students who are experiencing bullying and who exhibit suicide risk behaviors. At the systems level, bullying prevention efforts should target all students. School nurses, administrators, policy makers, and health providers should consider data-driven recommendations in bullying prevention programs.

Factors Influencing Self-Management of Chronic Obstructive Pulmonary Disease by Community-Dwelling Adults.

Individuals with chronic obstructive pulmonary disease (COPD) struggle with effective self-management, contributing to poor health outcomes and costly health care. More research is needed to understand the factors influencing COPD self-management better in order to improve outcomes and reduce health care costs for those living with this prevalent chronic illness. The purpose of this article is to describe factors influencing community-dwelling adults' COPD self-management. In-depth interviews were conducted with 28 people living with COPD. Braun and Clarke's thematic analysis approach was used to analyze interview data, and it resulted in the identification of themes providing insight into COPD self-management as described by those living with the disease. Specifically, factors impacting engagement in treatment recommendations are described. These findings have implications for informing evidence-based recommendations for self-management support and improving the quality of care provided to those with COPD.

Parent Readiness for Hospital Discharge Scale: Psychometrics and Association With Postdischarge Outcomes.

INTRODUCTION: The purpose of this study is to validate the Readiness for Hospital Discharge Scale (RHDS) for use with parents of hospitalized children. PedRHDS is a structured tool for a discharge readiness assessment before pediatric discharge. METHODS: Using combined data from four studies with 417 parents, psychometric testing and item reduction proceeded with principal component analysis for factor structure delineation, Cronbach's alpha for reliability estimation, and regression analysis for predictive validity. RESULTS: A 23-item PedRHDS retained the a priori factor structure. Reliability ranged from 0.73 to 0.85 for the 23-item and 10- and 8-item short scales. PedRHDS (all forms) was associated with postdischarge coping difficulty (explaining 12%-16% of variance) and readmission (odds ratio = 0.71-0.80). DISCUSSION: The PedRHDS and both short forms (PedRHDS-SF10 and PedRHDS-SF8) are reliable and valid measures of parental discharge readiness that can be used as outcome metrics of hospital care and risk indicators for postdischarge coping difficulty and readmission.

The Use of Technology to Support Precision Health in Nursing Science.

PURPOSE: This article outlines how current nursing research can utilize technology to advance symptom and self-management science for precision health and provides a roadmap for the development and use of technologies designed for this purpose. APPROACH: At the 2018 annual conference of the National Institute of Nursing Research (NINR) Research Centers, nursing and interdisciplinary scientists discussed the use of technology to support precision health in nursing research projects and programs of study. Key themes derived from the presentations and discussion were summarized to create a proposed roadmap for advancement of technologies to support health and well-being. CONCLUSIONS: Technology to support precision health must be centered on the user and designed to be desirable, feasible, and viable. The proposed roadmap is composed of five iterative steps for the development, testing, and implementation of technology-based/enhanced self-management interventions. These steps are (a) contextual inquiry, focused on the relationships among humans, and the tools and equipment used in day-to-day life; (b) value specification, translating end-user values into end-user requirements; (c) design, verifying that the technology/device can be created and developing the prototype(s); (d) operationalization, testing the intervention in a real-world setting; and (e) summative evaluation, collecting and analyzing viability metrics, including process data, to evaluate whether the technology and the intervention have the desired effect. CLINICAL RELEVANCE: Interventions using technology are increasingly popular in precision health. Use of a standard multistep process for the development and testing of technology is essential.

Evolution of the National Institute of Nursing Research logic model for center sustainability.

BACKGROUND: Logic models are tools to evaluate the effectiveness of programs. In 2013, the National Institute of Nursing Research (NINR) Logic Model for Center Sustainability was developed. PURPOSE: The purpose of this paper is to describe the process of revision and implementation of the NINR Logic Model across a continuum of NINR Exploratory Centers and Centers of Excellence. METHODS: The process for incorporating common data elements for symptom, self-management, biomarker science and precision health in the logic model is outlined. Information about the NINR Logic Model was gleaned from the National Institutes of Health Reporter, annual NINR Center Directors meetings, and from individual Center Directors. FINDINGS: Centers utilized the model for funding applications and to guide Core administration, evaluation, Center sustainability, and/or other Center metrics. DISCUSSION: The revised NINR Logic Model for Center Sustainability can be a useful tool for planning and implementing center activities for center impact and sustainability.

Negative Consequences of Providing Nursing Care in the Neonatal Intensive Care Unit.

BACKGROUND: Compassion fatigue, secondary traumatic stress, and burnout are negative consequences of providing nursing care among nurses. PURPOSE: This cross-sectional study examined a model of negative consequences of providing nursing care (i.e., compassion fatigue, secondary traumatic stress, and burnout) in the Neonatal Intensive Care Unit. METHODS: Data were collected from 174 registered nurses in the level III and IV NICUs in a Midwestern state. Moderated mediation analysis was conducted. FINDINGS: Self-compassion mediated the relationship between strength of the nurse-infant/family relationship and the negative consequences only when the nurse-physician-collegiality was high. There was no such relationship when the level was low. DISCUSSION: The study findings support the model of a mechanism for the development of negative consequences, involving self-compassion and nurse-physician collegiality. CONCLUSIONS: The findings may be applied to development of interventions to address negative consequences in nurses and help nursing administrators reduce staff nurses' negative consequences.

A Global Family Quality of Life Scale: Preliminary psychometric evidence.

PURPOSE: Psychometric data are reported for a new Global Family Quality of Life Scale (G-FQOLS) (3-items) evaluating family members, parents and adolescent/young adults (AYA). METHODS: Families (N= 209) were interviewed in a study addressing secondary conditions and adaptation in families of AYA with and without spina bifida (SB). Principal component factor analysis with Varimax rotation, Cronbach alpha, and Intraclass correlation (ICC) for parent-AYA agreement of FQOL assessment were conducted. RESULTS: A single factor with an eigenvalue greater than 1 was identified. Factor loadings were 0.79-0.94. Internal reliabilities were strong (α= 0.86-0.90). ICC coefficients between parent and AYA ratings were 0.38-0.48. CONCLUSION: This study provides preliminary support for the G-FQOLS. This global appraisal of Family Quality of Life (FQOL) reflects a participant's personal weighting of domains important to him/her.

Biomarkers as Common Data Elements for Symptom and Self-Management Science.

PURPOSE: Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance. DESIGN AND METHODS: From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas. FINDINGS: The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms. CONCLUSIONS: It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science. CLINICAL RELEVANCE: The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.

Development of a Self-Management Theory-Guided Discharge Intervention for Parents of Hospitalized Children.

BACKGROUND: Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. PROBLEM: No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. PURPOSE: To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. METHODS: Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. CONCLUSIONS: The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. CLINICAL RELEVANCE: Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention.

Factors associated with parent depressive symptoms and family quality of life in parents of adolescents and young adults with and without Spina Bifida.

PURPOSE: The purpose of this study was to explore factors related to parental depressive symptoms (PDS) and family quality of life (FQOL) in parents of adolescents and young adults (AYA) with and without a specific chronic health condition (CHC), spina bifida. METHODS: Two hundred and nine parents of AYA (112 with SB; and 97 without) and their AYA (46% males and 54% females) took part in a multi-site cross-sectional descriptive correlational study. In telephone interviews parents reported on measures of family satisfaction, resources, cohesion, stress, demographic and clinical data. RESULTS: In the multivariate analyses, 38% of the variance of PDS was explained by family income, family resources and parent stress. Having a child with SB was not predictive of PDS. However, having a child with SB, along with family satisfaction, parent stress and PDS explained 49% of the variance of FQOL. PDS partially mediate the relationship of family resources and FQOL. CONCLUSION: PDS, family stress, and resources should be evaluated routinely, especially for those with low income. Parents of AYA with SB who have elevated PDS are at increased risk of having lower reported FQOL.

Lessons Learned: Newly Hired Nurses' Perspectives on Transition Into Practice.

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes.

Transition of Experienced and New Graduate Nurses to a Pediatric Hospital.

This study reports on the 3-, 6-, 12-, and 18-month outcomes of 118 newly hired registered nurses (RNs) who completed a 12-month transition-to-practice program at a pediatric hospital. Experienced RNs (n = 42) and new graduate RNs (n = 76) showed improved organization, prioritization, communication, and leadership skills over time. The experienced RNs reported better communication and leadership skills than the new graduate nurses. Results inform transition program development for both new and experienced nurses.

EXAMINING LONG-TERM EFFECTS OF AN INFANT MENTAL HEALTH HOME-BASED EARLY HEAD START PROGRAM ON FAMILY STRENGTHS AND RESILIENCE.

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home-based Early Head Start (IMH-HB EHS) program on family functioning. The sample includes 152 low-income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH-HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH-HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH-HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH-HB EHS services are maintained after services cease.

Stability of biological father presence as a proxy for family stability: cross-racial associations with the longitudinal development of emotion regulation in toddlerhood.

The current study, utilizing data from the National Early Head Start Research and Evaluation Project (Love et al., 2005) explored the relationship between biological father presence and emotion regulation over toddlerhood among children from low-income families. Conceptualizing biological father presence as a proxy for family role development, results are interpreted from a role development theoretical perspective. The latent growth curve model was compared based on child ethnoracial status (African American, Caucasian, Hispanic) and child gender. Consistent biological father presence was associated with toddlers' regulatory development across toddlerhood, and this relationship was most robust among Caucasian toddlers as compared to African American toddlers. Findings for Hispanic toddlers were not significantly different from those of Caucasian or African American families. Results bolster the literature on father presence and child outcomes. Analyses address consistency in father presence as a proxy for coherent role development and define a link between consistent father presence and children's regulatory development, demonstrating ethnoracial differences which are likely attributed to the social construction of family roles.

Nurse researchers in children's hospitals.

Little is known about the role of nurse researchers (NRs) and the structure of nursing research programs in children's hospitals in the United States. This descriptive study obtained survey data from 33 NRs. Data suggest that the NR role is emerging and has both commonalities and unique components when compared with the previous studies of NRs in adult hospitals. Most participants have been in their position for less than 4 years. Conducting research, having staff development related to research, and facilitating evidence-based practice or research were common responsibilities. The structure of nursing research programs impacts both the NRs and the program outcomes.

Nutrition students improve attitudes after a guided experiential assignment with older adults.

OBJECTIVE: Develop, implement, and evaluate an intervention (a guided experiential assignment) to improve nutrition students' attitudes toward working with older adults. DESIGN: A quasi-experimental design with an additional qualitative component (mixed methods). SETTING: A North Central land-grant university. PARTICIPANTS: 100 college students from an upper-level community nutrition course. INTERVENTION: Students were randomly assigned to conduct a guided experiential assignment (dietary behavior change project) working with either an older adult (intervention, n = 52) or a younger adult (comparison, n = 48). Each student conducted 3 client interviews and completed a project report by responding to reflective questions about changes in beliefs, values, and self-efficacy in working with older adults. MAIN OUTCOME: The primary outcome was attitudes toward older adults as changed in reference to students' beliefs, values, and self-efficacy in working with other adults. Additional outcomes were knowledge of aging and interest in working with older adults. ANALYSIS: General linear model multivariate/univariate analysis and content analysis were conducted on the quantitative and qualitative data, respectively. RESULTS: The intervention group had significantly increased scores on attitudes toward older adults relative to the comparison group. This finding appeared as a result of changes in beliefs about older adults and the increased value and self-efficacy in working with this group by most students in the intervention group. CONCLUSION AND IMPLICATIONS: Completion of a guided experiential assignment with older adults in the community was an effective method to improve students' attitudes. Used in the curriculum for nutrition students, this technique might help to improve both attitudes toward and self-efficacy in working with older adults.

The influence of caregiver mastery on depressive symptoms.

PURPOSE: The purpose of this study was to explore how the relationship between care recipients' problem behaviors and caregivers' depressive symptoms varies as a function of caregiver mastery, controlling for the effects of caregiver age, gender, and relationship to the care recipient in caregivers of people with primary malignant brain tumor (PMBT). DESIGN: A cross-sectional design was used to gather data via telephone interviews from 95 caregivers of people with primary malignant brain tumor, recruited from 2003 to 2004 from a brain tumor treatment center, two national support groups, and a statewide cancer registry. METHODS: Measures for the study included the Neuropsychiatric Inventory-Questionnaire, Caregiver Mastery, and the Center for Epidemiologic Studies-Depression. A stepwise regression procedure was used to evaluate potential moderating and mediating relationships. FINDINGS: Data did not indicate that caregiver mastery was a moderating variable. The analysis showed caregiver mastery as a partial mediator, with both a direct effect of care recipients' problem behaviors on caregivers' depressive symptoms and an indirect effect through caregiver mastery. Concerning the indirect effect, care recipients' problem behaviors were related to lower levels of caregiver mastery, which in turn were related to more depressive symptoms in caregivers. CONCLUSIONS: Findings showed a link between care recipients' problem behaviors and caregivers' depressive symptoms, a relationship that has not been well established in oncology. This association indicates one mechanism through which problem behaviors in the care recipient might lead to caregiver depressive symptoms.