Improving Data Integrity and Quality From Online Health Surveys of Women With Infant Children.

BACKGROUND: Online surveys have proven to be an efficient method to gather health information in studies of various populations, but these are accompanied by threats to data integrity and quality. We draw on our experience with a nefarious intrusion into an online survey and our efforts to protect data integrity and quality in a subsequent online survey. OBJECTIVES: We aim to share lessons learned regarding detecting and preventing threats to online survey data integrity and quality. METHODS: We examined data from two online surveys we conducted, as well as findings of others reported in the literature, to delineate threats to and prevention strategies for online health surveys. RESULTS: Our first survey was launched inadvertently without available security features engaged in Qualtrics, resulting in a number of threats to data integrity and quality. These threats included multiple submissions, often within seconds of each other, from the same internet protocol (IP) address; use of proxy servers or virtual private networks, often with suspicious or abusive IP address ratings and geolocations outside the United States; and incoherent text data or otherwise suspicious responses. After excluding fraudulent, suspicious, or ineligible cases, as well as cases that terminated before submitting data, 102 of 224 (45.5%) eligible survey respondents remained with partial or complete data. In a second online survey with security features in Qualtrics engaged, no IP addresses were associated with any duplicate submissions. To further protect data integrity and quality, we added items to detect inattentive or fraudulent respondents and applied a risk scoring system in which 23 survey respondents were high risk, 16 were moderate risk, and 289 of 464 (62.3%) were low or no risk and therefore considered eligible respondents. DISCUSSION: Technological safeguards, such as blocking repeat IP addresses and study design features to detect inattentive or fraudulent respondents, are strategies to support data integrity and quality in online survey research. For online data collection to make meaningful contributions to nursing research, it is important for nursing scientists to implement technological, study design, and methodological safeguards to protect data integrity and quality and for future research to focus on advancing data protection methodologies.

Qualitative Research on Self-Transcendence in Older Adults: A Scoping Review.

The current scoping review describes qualitative research on self-transcendence (ST) in older adults. Articles from five databases were independently screened and data were extracted from predetermined categories. Results were compared and consensus reached through discussion. The two leading theorists guiding the chosen studies were Pamela Reed and Lars Tornstam. Experiential language in the studies most often touched on intrapersonal and interpersonal ST. Two main gaps identified in the literature were: (a) limited coverage of transpersonal aspects of ST, and (b) limited inclusion of experiential language of study participants. More qualitative research, phenomenology in particular, can shed light on the topic of ST. A deeper understanding of all aspects of ST, including experiential language used to describe it, can lay a foundation for nursing to advance with theory formation, scale construction, and interventions to better promote spiritual and psychological well-being in older adults. [Journal of Gerontological Nursing, 49(9), 43-48.].

Modification and Psychometric Analyses of Stress and Coping Scales for the Extended Postpartum Period.

OBJECTIVE: To modify and psychometrically assess two scales that are used to measure stress and coping during the extended postpartum period. DESIGN: Instrument modification and psychometric assessment. SETTING: Online, community, and health care settings. PARTICIPANTS: Mothers with infants who were 2 to 22 months old: 20 in Phase 1 and 373 in Phase 2. METHODS: In Phase 1, participants from diverse backgrounds served as content experts to recommend modifications of items on two scales: Sources of Stress-Revised (SoS-R) and Postpartum Coping Scale (PCS). The results were 32-item modified versions of each scale. In Phase 2, we conducted a psychometric analysis of both revised scales using principal components analysis to identify dimensionality, Cronbach's alphas to estimate internal consistency reliability, and Pearson correlations to estimate validity of the SoS-R and PCS with the Perceived Stress Scale and the Brief COPE, respectively. RESULTS: We identified six components for the SoS-R: Overload, Changes After Pregnancy, Baby-Related Concerns, Working Mother Concerns, Low Support Resources, and Isolated Motherhood. The Cronbach's alpha for the SoS-R was .94. The SoS-R subscales demonstrated correlations with the Perceived Stress Scale that ranged from 0.55 to 0.30. We identified six components for the PCS: Self-Regulation, Spiritual Care, Self-Care, Use and Seek Support, Internal and External Resources, and Health Promotion. The Cronbach's alpha coefficients for the PCS ranged from .84 to .66. The highest correlations observed between the PCS subscales and the Brief COPE subscales ranged from 0.67 to 0.26. CONCLUSION: The SoS-R and PCS each include six components. Internal consistency reliability for all SoS-R subscales and four of six PCS subscales exceeded .70. The dimensions of each scale highlight areas of clinical and research concern.

The utility of an interprofessional education framework and its impacts upon perceived readiness of graduates for collaborative practice. A multimethod evaluation using the context, input, process, product (CIPP) model.

BACKGROUND: Frameworks in higher education can support strategic curriculum change in complex systems. The impact of these frameworks in achieving their stated purpose is less known. An interprofessional education (IPE) framework and related multi-activity curriculum designed to develop health profession graduates with the requisite skills for collaborative care, was introduced in a large university, across eleven health professions. OBJECTIVE: To determine the utility of an interprofessional framework and impact upon perceived work readiness for collaborative practice. METHOD: A multimethod design using the context, input, process, product (CIPP) evaluation model was selected taking a social constructivist theoretical stance. Data collection included staffing allocation to IPE, curriculum audit, and reflections from representatives of all health professions courses offered at the institution. Data was analyzed using framework analysis. PARTICIPANTS: Interviews or focus groups were undertaken with academic Faculty (n = 13), recent graduates (n = 24) and clinical supervisors/employers of recent graduates (n = 17). RESULTS: The framework assisted the systematic implementation of interprofessional curriculum across the different health courses at the university. Collaborative work-ready learning outcomes were identified in graduates where targeted curriculum had been implemented across all four domains of the framework. Gaps identified in framework implementation were consistent with gaps identified in graduate knowledge and skills related to collaborative practice. The combination of formal university-based IPE and informal workplace learning as part of clinical placements contributed to achieving the desired learning outcomes. CONCLUSIONS: These findings offer insights into the use of shared frameworks to drive specific learning activities related to collaborative practice.

Systematic Review of Health Promotion Frameworks Focused on Health in the Postpartum Period.

OBJECTIVE: To systematically review the scope and development of frameworks to promote health during the postpartum period. DATA SOURCES: We searched PubMed, CINAHL, and American Psychological Association PsycInfo during May 2021. STUDY SELECTION: We included English-language, peer-reviewed articles focused on frameworks for health promotion in the postpartum period. We placed no time limit on publication date. Our search resulted in 2,355 articles after we removed duplicates. After excluding articles based on titles and abstracts, we conducted full-text reviews of 23 articles. Three articles met inclusion criteria and addressed the following frameworks: Integrated Perinatal Health Framework, Perinatal Maternal Health Promotion Model, and Maternal Self-Care Framework. DATA EXTRACTION: We extracted data into analytic tables that included categories for the scope, such as time frame, and criteria for the level of development of the frameworks, including the origins, concept definitions and theoretical linkages among concepts, and evidence of application in research or practice. DATA SYNTHESIS: The three frameworks described in the articles included in our review covered various periods, including the reproductive life span, the first year after birth, and the first 6 weeks after birth. Overall, the frameworks were comprehensive. Most key concepts in the frameworks were defined, and some degree of relationships linking concepts was specified. Empirical referents were provided for most but not all concepts in the frameworks. Developers of the three frameworks elaborated on application in practice or health services, but only the developers of the Maternal Self-Care Framework indicated how their framework might be used in research. The Integrated Perinatal Health Framework and Maternal Self-Care Framework were partially derived from existing general theories; the methods used to develop the Perinatal Maternal Health Promotion Model were less clear. CONCLUSION: The frameworks met most criteria and together provided a comprehensive strategy for health promotion during the postpartum period. Elaboration of the frameworks for application in research is needed.

Factors Associated With Undergraduate Nursing Students' Academic and Clinical Performance: A Mixed-Methods Study.

BACKGROUND: There is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice. OBJECTIVE: To identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course. DESIGN: Mixed methods study utilizing a retrospective cohort and a qualitative study. SETTING: Monash University, Melbourne, Australia. PARTICIPANTS: Longitudinal existing data of nursing undergraduate students who commenced in 2017 (n = 176) and 2018 (n = 76), and two focus groups with final year nursing students were analyzed. METHODS: Retrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed. RESULTS: More than two-thirds of the students were aged 18-20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance. CONCLUSIONS: A supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance.

Maternal Stressors and Coping Strategies During the Extended Postpartum Period: A Retrospective Analysis with Contemporary Implications.

Background: Despite recent emphasis on the "fourth trimester" and beyond, most knowledge of stressors affecting women is focused on the first 6 postpartum weeks. Our aim was to identify postpartum-specific stressors and coping over the extended postpartum period. Methods: We analyzed data from two surveys for a combined sample of 346 postpartum women. Principal components analysis of survey items on sources of stress was used to identify categories of postpartum-specific stressors. Content analysis was used to categorize text data on coping strategies. Results: Seven stressors were identified: Overload, Working mother concerns, Isolated motherhood, Limited supportive resources, Exhaustion, Parenting demands, and Changes in body and sexuality. Overload was the most frequent stressor (F = 49.32, p < 0.001) and was significantly higher at 9-12 months than at 5-8 months or at 13 months or more (F = 6.42, p = 0.002). Fulltime employment and having more than one child were associated with elevated scores on several stressors. Content analysis yielded seven coping strategies, such as Take time alone or with others, Manage emotions and thoughts, and Maintain a manageable workload. Five of the seven stressors were associated with at least one of the top five coping strategies; none was associated with Overload or Limited supportive resources. Conclusions: Women's predominant source of stress was from overload and was highest at 9 to 12 months postpartum. Community resources and public health policy and programming are needed to prepare and support women during the challenging first postpartum year.

Strategies Australian Hospitals Utilize to Incorporate Patient Feedback in the Delivery and Measurement of Person-Centered Care: A Scoping Review.

Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient's voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures.

Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment.

BACKGROUND: Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. PURPOSE: To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. METHODS: A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. RESULTS: Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. IMPLICATIONS FOR PRACTICE: There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. IMPLICATIONS FOR RESEARCH: Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

Dietary Information to Support a Healthy Pregnancy in Vietnamese Americans.

Because optimal nutrition is vital during pregnancy, there are specific U.S. dietary guidelines and recommendations for pregnant individuals. However, Vietnamese Americans often have insufficient access to dietary recommendations for pregnancy that pertain specifically to their culture and cuisine. Healthful components of the traditional Vietnamese diet include vegetables, herbs, fruits, fish, and some unsaturated fats. Adjustments to the traditional and acculturated Vietnamese diet, such as reduced sodium intake from fermented foods and sauces, less sugar, more diverse carbohydrate consumption, more fiber, and less fat intake, would improve overall health and potentially reduce the common pregnancy complications pregnant Vietnamese women face, including gestational diabetes and certain micronutrient deficiencies. Understanding the traditional Vietnamese diet can help nurses provide culturally competent care to Vietnamese Americans.

Mobile Apps as Audience-Centered Health Communication Platforms.

Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms-particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father's Playbook, a mobile app designed to encourage men to be more involved during their partner's pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father's Playbook as a vehicle for their messages.

Helping Individuals Achieve a Healthy Weight Gain During Pregnancy: A Multipronged Approach.

Approximately half of pregnant individuals in the United States exceed recommendations for gestational weight gain (GWG). Excessive GWG is associated with negative outcomes for maternal and infant health. In this article, we provide guidance to nurses who counsel patients about GWG. Because of negative bias toward persons with obesity, nurses need to understand their own attitudes toward obesity to provide supportive GWG counseling. The use of words such as weight is preferred to obese, and recommended GWG goals should be consistent with established guidelines. The setting of specific, measurable, attainable, realistic, and trackable behavioral goals can help translate a goal for GWG into practical actions in daily living. Mobile phone apps, if carefully chosen, may help individuals learn about and track GWG.

Critical Analysis of the Nursing Metaparadigm in Spanish-Speaking Countries: Is the Nursing Metaparadigm Universal?

This critical analysis examines the definitions of concepts in the nursing metaparadigm presented in English language literature in relation to the perspective of published Spanish-speaking nurse researchers in Spanish-speaking countries. Because language shapes our understanding, nurses who are taught in Spanish to become nurses possess a distinctive disciplinary perspective, based on the notion of nursing as the science of caring. This article is intended to facilitate an awareness with which researchers can overcome language barriers in theoretical development. For settings in which English-speaking and Spanish-speaking nurses must work together, sensitivity to differences in linguistic nuances is important.

Understanding the elements of a quality rural/remote interprofessional education activity: A rough guide.

AIMS: To offer a rough guide to a quality rural/remote interprofessional educational activity. CONTEXT: Australian remote and rural interprofessional undergraduate placements offered in Modified Monash Model 3-6 locations. APPROACH: Biggs' triple P framework from the interprofessional educational literature and Allport's contact hypothesis are used to describe map, and explore the educational dimensions and positive elements, of a quality rural/remote interprofessional educational activity. CONCLUSION: Delivery of a quality interprofessional educational activity requires attention to all dimensions of the activity with acknowledgement of the value of the remote or rural contexts. Interprofessional learning requires constructive alignment and positive contact conditions to ensure a quality and sustained experience.

Adapting a health behavioral change and psychosocial toolkit to the context of physical disabilities: Lessons learned from disabled women with young children.

BACKGROUND: Mothers with physical disabilities (MPDs) face the behavioral and psychosocial changes of the motherhood transition with fewer resources, additional barriers, and higher risks than nondisabled mothers. In this study we sought guidance from MPDs on adaptations needed to a health promotion toolkit for behavioral and psychosocial health that was originally developed for nondisabled, primarily low-income, women. OBJECTIVE: To identify general themes for adaptations that would increase the suitability of the toolkit for MPDs. METHODS: 11 MPDs were interviewed by videoconferencing in a mixed-methods study about their perspectives on improving relevance of the existing toolkit for this population. The toolkit contained three components: assessment scale, feedback template on assessment results, and a decision aid related to behavior change. Interviews were analyzed using qualitative content analysis. RESULTS: Nine themes for improving suitability of the toolkit for MPDs were identified. Themes covered: Using non-judgment language; including strengths, not just risks; using exercise items applicable to persons with physical disabilities; being aware that functional ability was the key body image concern; considering motivational stages of behavioral change; providing choice in goal-setting for change; including suggestions for social support; identifying resources for health and adaptive parenting; and making health promotion resources available in alternative platforms (paper, electronic). CONCLUSIONS: The MPDs' feedback revealed ways that our toolkit for behavioral and psychosocial health could be improved to be inclusive of MPDs. The participatory methods utilized here are also recommended in designing new or revising existing materials aimed at enhancing health promotion for people with disabilities.

Health and Well-Being among Women with Physical Disabilities After Childbirth: An Exploratory Study.

PURPOSE: Although research about pregnancy for women with disabilities has increased, their postpartum experience has received little attention. Studies generally focus on parenting, not on the health of the mothers themselves, despite recent studies underscoring the health risks they may face. Thus, our purpose was to examine postpartum health among women with physical disabilities, including how they maintain or improve their health. METHODS: Semistructured interviews were conducted with eleven new mothers with physically disabling conditions. A qualitative descriptive approach was used to analyze the transcribed interviews and identify themes. RESULTS: Nine women had delivered via cesarean section, and most had mobility impairments. Their average age was 35 years; 91% were college educated and 82% had a partner. Six overarching themes were identified: paying a price to have the baby, focus on the baby, supports-or a lack thereof, feelings of isolation, getting challenges under control/overcoming barriers, and not quite there yet/getting back to health promotion. CONCLUSIONS: Despite their resilience in dealing with the challenges of caring for their babies within the context of their disabling conditions (including recovery from complications from the birth experience), these women clearly identified the need for additional resources and supports. They also recognized limitations to their own health that came along with their parenting responsibilities. Health care providers should be more attuned to the postpartum needs of women with physical disabilities, and policies should provide additional supports such as insurance coverage for home visits to help maximize women's health and well-being during this important life transition.

Beliefs, Attitudes, and Practices of Latinas Related to Gestational Weight Gain: A Qualitative Meta-Synthesis.

INTRODUCTION: Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic. METHODS: Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas. RESULTS: Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008). DISCUSSION: The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.

Analysis of the Tidal Model and Its Implications in Late-Life Suicidality.

Late-life suicide is a public health issue in the United States, and recent CDC data show that the number of deaths related to suicide in older adults continue to increase. Still, few researchers focus on a theoretical framework for the clinical assessment and care of older adults at risk for suicide. We performed a review and critical analysis of the Tidal Model, using Fawcett and DeSanto-Madeya's framework, to increase our understanding of the clinical presentation of older adults with suicidal ideation and present strategies for caring for this population. The Tidal Model is a well-structured theory with relevant concepts and propositions founded on a highly patient-centered and pragmatic approach that facilitates its application in late-life suicidality. The model provides a framework for nursing and healthcare practice in psychiatry and mental health with goals and boundaries that help promote a better assessment of the clinical picture of older adults with suicidal ideation.

Education for sustainable healthcare: A transdisciplinary approach to transversal environmental threats.

Global Environmental Changes are dynamic and complex, crossing disciplines, sectors, regions, and populations and shaping the health of current and future generations. GECs present an unprecedented challenge demanding a response of equal scale and complexity involving unfettered collaboration beyond disciplines with implications for global health. At this critical point, health professions' education should have moved on from building consensus about the relevance of education for sustainable healthcare (ESH) to active implementation. In this commentary, we discuss why transdisciplinary problem-solving and interprofessional education should be considered in education for sustainable healthcare. We review types of collaborative educational practices, outline opportunities, challenges, and resources to enable implementation.