Psychometric Testing of a Composite Score for Job Satisfaction of Newly Licensed Registered Nurses.

Background and Purpose: Inconsistent scaling and inadequate psychometrics on job satisfaction, organizational commitment, and intent to leave among nurses have resulted in studies using a single question to measure these outcomes. Our aim was to psychometrically test a composite measure. Methods: The scales for these variables in the Newly Licensed Registered Nurse Survey (NLRNS) and National Sample Survey of Registered Nurses were re-coded into a composite measure. Utilizing the 2016 NLRNS, we examined reliability and validity indexes. Results: Good internal consistency was demonstrated for the composite measure (α = .93) and the subscales of organizational commitment (α = .86) and intent to leave (α = .88). Exploratory and confirmatory factor analyses resulted in a two-factor solution. Conclusions: Our new composite measure is psychometrically sound and can be utilized for future studies.

Murdered Native and Indigenous Women: A Comparison Study of Victim and Perpetrator Patterns and Characteristics.

INTRODUCTION: The rate of violent crimes against Indigenous people, including murder and rape, is significantly higher than national averages. Even more concerning, Indigenous women and girls represent a large proportion of murdered and missing individuals in the United States. In addition to the murder rate of Indigenous women being higher than the national average, they are significantly more likely to experience rape or other types of sexual violence. The main goal of this study was to gain a better understanding of cases involving the homicide of Indigenous women and identify patterns associated with the violence committed against them. METHODS: Cases of Indigenous women between the ages of 18 and 55 years were pulled from the database. Cases were coded and analyzed for information pertaining to victim, perpetrator, and crime characteristics. Descriptive analysis and test of association were performed. RESULTS/FINDINGS: There was a statistical association between the nature of the relationship between perpetrators and victims and whether the crime occurred on a reservation, the race/ethnicity of the perpetrator, a victim's history of domestic violence, and the method and motive of murder. DISCUSSION/CONCLUSION: Indigenous women are at an increased risk of victimization, including intimate partner violence and homicide. They also represent a group that has been marginalized, receiving little attention from the media, clinicians, researchers, and policy makers. The findings in this study highlight specific factors that may help to mitigate risk factors and/or enhance culturally competent clinical and forensic nursing practice.

Expressions of Compassion Fatigue by Emergency Department Nurses Caring for Patients With Opioid and Substance Use Disorders.

INTRODUCTION: The misuse of and addiction to opioids are a national public health crisis. The complexity of delivering patient care in emergency departments exposes nurses to stressful work situations with complex patient loads and increasing levels of compassion fatigue. Emergency nurses were asked about their feelings of compassion fatigue while caring for patients with opioid use and/or substance use disorders. METHODS: Twenty-four focus groups with emergency nurses (N = 53) at a level I trauma center were conducted in late 2019 and early 2020 are used in this qualitative study using thematic analysis that identified 1 main theme of compassion fatigue with 3 subthemes (nurse frustration with addicted patients, emotional responses, and job satisfaction). RESULTS: Findings highlight that emergency nurses working with patients with opioid use and/or substance use disorders are dealing with a number of negative emotional stressors and frustrations, which in turn has increased their levels of compassion fatigue. These nurses repeatedly expressed feelings of increasing frustration with addicted patients, negative emotional responses, and decreasing levels of job satisfaction as components of their compassion fatigue. DISCUSSION: These emergency nurses identified 3 areas to improve their compassion: improved management support with encouragement across all work shifts, debriefing opportunities, and more education. Fostering a high level of self-awareness and understanding of how the work environment influences personal well-being are necessary strategies to avoid the frustrations and negative emotional responses associated with compassion fatigue.

Interventions for reducing weight bias in healthcare providers: An interprofessional systematic review and meta-analysis.

Weight bias is prevalent in many healthcare disciplines and negatively impacts the quality of care for patients with obesity. This warrants interventions to reduce weight bias shown by providers to improve care for individuals with obesity. However, past reviews have identified only marginal success in improving the attitudes and beliefs of healthcare providers about individuals with obesity. This systematic review and meta-analysis identifies and synthesizes recent peer-reviewed intervention studies aimed at reducing weight bias in healthcare students and professionals. The databases Embase, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, PubMed and Google Scholar were searched for peer-reviewed studies published between 2016 and August 2021. Search terms included a combination of surrogate terms for the concepts of weight bias, intervention and healthcare students or professionals. The search yielded 1136 articles, and 14 articles met the inclusion criteria for the systematic review. Nineteen effect sizes from nine studies were included in the meta-analysis. Overall, the interventions in the included studies result in a 0.38 SD reduction (Hedge's g) in obesity-bias with 95% confidence intervals from -0.52 to -0.24, indicating a small to moderate effect size in the reduction of weight bias. Most studies included students and focused on evoking empathy or educating on the causality/controllability of obesity. Measurement tools, intervention type, limitations of the studies and recommendations for future research are discussed.

CE: Trauma-Informed Care in Nursing Practice.

ABSTRACT: Over the past 30 years, researchers have found that childhood trauma and its subsequent stress have a strong and cumulative effect on health in adulthood. Trauma in childhood often leads to mental health problems, skeletal fractures, and early death from conditions such as heart disease, cancer, lung disease, and liver disease. Compounding the effects of traumatic stress, health care systems often create a population of "never-served" persons who avoid health care settings because they've been subject to judgment and marginalization. Trauma-informed care (TIC) is a skill underutilized by health care providers and organizations, yet nurse ethics and respect for human rights require us to care for all patients equally without judgment, including those living with the stress of complex trauma. The TIC approach respects human rights and supports nursing ethics, promoting a welcoming, inclusive environment in health care systems and patient-provider relationships that eschews implicit and explicit bias toward patients, regardless of presentation or personal circumstances. TIC foundational principles guide the application of the nursing process using patient-centered care to create safety, the first principle in TIC. Here, the authors discuss the application of these core principles in nursing through a deidentified case study.

Social media's influence on adolescents' food choices: A mixed studies systematic literature review.

Over 90% of adolescents have at least one social media account, and their presence on social media continues to grow. Food and beverage brands capitalize on this trend by marketing their products on social media to adolescents. Depending on the nutrition value of the products being marketed, social media advertisements' influence may contribute to the risk of developing unfavorable health outcomes such as obesity, hypertension, and type 2 diabetes. This review aimed to investigate social media's food and beverage advertisements' role in influencing adolescents' food choices by appraising published literature. A systematic literature review was conducted reporting on social media's role in adolescents' food choices. Articles were searched through CINAHL and PubMed from scholarly journals between 2015 and 2020, using the search terms: social media use, food advertisements, adolescents, and food choices. Eligible articles were selected based on inclusion criteria. PRISMA guidelines were followed, and study quality was assessed using the Mixed Methods Appraisal Tool. The analysis was conducted using narrative analysis to identify key findings. Of the 234 records, six articles met inclusion criteria. The studies revealed two major findings: adolescents were more likely to recall unhealthy food and celebrity influence was a common component of the advertisements. This review suggests that food and beverage companies use social media for marketing their products by targeting the adolescent population. The use of celebrities and influencers and the promotion of "unhealthy" products appear to be commonly used tactics. With these findings, healthcare professionals should consider screening adolescents routinely for social media use and current eating habits and educating the adolescents, parents, and families about health risk. Additionally, implementing legislation and policies may be beneficial in preventing this exposure.

Patients' and caregivers' perspectives in determining discharge readiness from home health.

There are no national, empirically derived clinical decision support tools to assist the interprofessional home health team in determining readiness for discharge from skilled home health. Eliciting patient and family caregiver perspectives around readiness for home health discharge is integral to developing tools that address their needs in this decision-making process. The purpose of this study was to describe the factors home health patients and their family caregivers perceive as critical when determining readiness for discharge from services. A qualitative descriptive study was conducted among skilled home health recipients and their family caregivers who were either recently discharged or recertified for additional care from two different Medicare-certified skilled home health agencies. Nine themes emerged: self-care ability, functional status, status of condition(s) and symptoms, presence of a caregiver, support for the caregiver, connection to community resources/support, safety needs of the home environment addressed, adherence to the prescribed regimen, and care coordination.

Developing Statewide Violence Prevention Programs in Health Care: An Exemplar From Massachusetts.

Workplace violence is on the rise in health care. This problem contributes to medical errors, ineffective delivery of care, conflict and stress among health professionals, and demoralizing and unsafe work conditions. There is no specific federal statute that requires workplace violence protections, but several states have enacted legislation or regulations to protect health care workers. To address this problem in their state, the Massachusetts Health & Hospital Association developed an action plan to increase communication, policy development, and strategic protocols to decrease workplace violence. The purpose of this article is to report on the quality and safety improvement work that has been done statewide by the Massachusetts Health & Hospital Association and to provide a roadmap for other organizations and systems at the local, regional, or state level to replicate the improvement process.

Nursing students' perspectives on observed weight bias in healthcare settings: A qualitative study.

BACKGROUND: Weight bias continues to be problematic within the healthcare setting among practicing healthcare providers (HCPs). These HCPs serve as influential role models for nursing students when immersed in the clinical environment. However, if HCPs are demonstrating bias toward patients with obesity, this may influence nursing students' beliefs and practices. AIMS: This study aimed to explore nursing students' reflections of observed weight bias within the healthcare setting. MATERIALS & METHODS: A descriptive qualitative study design was used involving reflective journaling and qualitative content analysis. Two cohorts of third-year baccalaureate nursing students (n = 197) participated in weight sensitivity training and submitted reflective journals over one academic semester. RESULTS: Reports of weight bias were categorized into three themes-(1) Direct Impact: Observed Implicit and Explicit Provider Weight Bias; (2) Indirect Impact: Weight Bias Due to Skills, Equipment, or Staffing/Environmental Deficits; and (3) Reactions toward HCP Weight Bias: Conflict Between Weight Bias Training and Real-World Healthcare Experiences. DISCUSSION: Weight bias was observed in some HCPs within the healthcare setting. Student reflections explored weight bias and the opposing messages between weight sensitivity training and real-world practices. CONCLUSION: Preventing bias through continuing education for HCPs is crucial to provide compassionate care and instill ethical values in the next generation nurses.

Health Risks and Outcomes of Homelessness in School-Age Children and Youth: A Scoping Review of the Literature.

Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.

Unintentional Gun Violence in the Home: A Survey of Pediatric Advanced Practice Nurses' Preventive Measures.

INTRODUCTION: Across the United States, unintentional shootings involving toddlers are on the rise. Pediatric nurses and nurse practitioners encounter families with toddlers regularly, allowing them the opportunity to make assessments and implement safety measures. The purpose of this study was to assess gun safety knowledge levels, health promotion strategies, and preventive interventions of advanced practice registered nurses (APRNs) METHODS: This quantitative study used an anonymous, online survey e-mailed to pediatric-focused APRNs using the National Association of Pediatric Nurse Practitioners e-mail list. RESULTS: The sample included 54 APRNs. The majority, 70.3%, reported asking parents about guns in the home; this was most often done with a new patient (62.3%, p = .05). APRNs were more likely (88.7%, p = .05) to believe that well-child practice standards should include questions about gun safety, but 56.4% (p = .033) responded that their workplace does not have a teaching plan or policy about gun safety. In addition, APRNs who are gun owners were more likely to screen for guns (62.5%, p = .05) and teach about safe gun storage (75.0%, p = .02). DISCUSSION: Overall, APRNs feel knowledgeable enough to assess and inform patients about safe gun storage, as well as interventions. One obstacle to effective promotion of gun safety may exist at the broader systemic level, as most of the practice settings do not have pertinent policies and resources for families of toddlers. Findings suggest that most APRNs are including gun safety teaching without an identified policy.

Interrupted sleep: College students sleeping with technology.

Objective: To examine the influence of cell phones and sleep quality among college students and the prevalence of sleep texting. Participants: Participants were 372 college students at two mid-size universities in 2013. Methods: A survey was used to ask about cell phone use during sleep and sleep quality. Students were asked about hours of sleep, both on a school night, and over the weekend in addition to location of cell phone. Results: A quarter of the sample (25.6%) reported sleep texting behavior along with poor sleep quality and the cell phone influencing their sleep (p < .05). Students that sleep text were more likely to report sleep interruption (p < .000), to place their phone in bed with them (p < .000), have no memory of texting (72%) or what they texted (25%). Conclusions: Sleep texting and its influence on poor sleep habits is a growing trend in a college student population.

Understanding Trauma Normativeness, Normalization, and Help Seeking in Homeless Mothers.

Although trauma-informed approaches guide services to families experiencing homelessness, more emphasis is placed on securing housing than addressing underlying trauma contributing to housing instability. Examining the stories of 29 homeless and/or unstably housed mothers within the broader literature on family trauma and violence, chronic illness, and cultural aspects of family functioning, we define the process of trauma normativeness and normalization that may occur with repeated trauma experiences and argue that rehousing efforts must include concomitant attention to trauma and to understanding how individual, family, community, and cultural factors influence help-seeking behaviors in this vulnerable and growing population.

Nurses' Perceptions of Victims of Human Trafficking in an Urban Emergency Department: A Qualitative Study.

INTRODUCTION: Human trafficking is estimated to surpass the drug trade as the leading illegal industry in the world. According to a recent study, over 87.8% of trafficking survivors came into contact with a healthcare professional while they were enslaved and were not identified as a victim of human trafficking. The aims of this study are to understand the perceptions of emergency nurses about human trafficking, victims of violence, and prostitution. METHODS: A qualitative, descriptive study using a semi-structured interview approach was done with ten registered nurses in a large, urban Emergency Department in the northeastern U.S. Interviews were recorded and transcribed; thematic analysis was performed. RESULTS: Six themes emerged from the interviews including, "human trafficking exists in the patient population" yet no nurse has screened or treated a victim; human trafficking victims are perceived to be "young, female, and foreign born"; all of the emergency nurses reported having worked with or screened a victim of violence; victims of violence were viewed as patients who present as "sad and grieving"; prostitutes are seen as "hard and tough"; and emergency nurses did not have education on human trafficking victims' needs or resources. DISCUSSION: Emergency nurses should be more aware about victims of human trafficking. The media portrayal of human trafficking victims had influenced the nurses' perceptions of this population. Victims of violence are perceived to be very different from prostitutes, but there is a desire for education about violence as well as information about specific resources open to victims.

Original research: online social networking patterns among adolescents, young adults, and sexual offenders.

OBJECTIVE: The use of online social networks like Facebook continues to increase rapidly among all age groups and segments of our society, presenting new opportunities for the exchange of sexual information as well as for potentially unsafe encounters between predators and the vulnerable or young. This study surveyed middle school, high school, and college-age students, as well as sexual offenders, regarding their use of social networking sites in order to provide information to better focus education and prevention efforts from nurses and other health care providers. METHODS: Written questionnaires asking about various characteristics of participants' use of social networking sites were distributed to each group and filled out by 404 middle school students, 2,077 high school students, 1,284 students drawn from five traditional four-year colleges, and 466 adults who had committed either an Internet sexual offense or a hands-on sexual offense (in some cases both). RESULTS: Notable findings emerging from our analysis of the questionnaire responses included the following: offenders and students both frequent social networking sites, although at the time of the study offenders reported that they preferred Myspace and students that they preferred Facebook; nearly two-thirds of the Internet offenders said they'd initiated the topic of sex in their first chat session; more than half of the Internet offenders disguised their identity when online; most Internet offenders we surveyed said they preferred communicating with teenage girls rather than teenage boys; high school students' experience with "sexting" (sharing nude photos of themselves or others on cell phones or online) differed significantly according to their sex; a small number of students are being threatened and assaulted by people they meet online; avatar sites such as Second Life were used both by students and offenders, with both child molesters and Internet offenders expressing interest in Second Life. CONCLUSIONS: The use of the Internet presents relatively new and complex issues related to the safety and privacy of adolescents and young adults, and it's crucial that our understanding keep pace with these changes. Possible nurse-initiated policy recommendations include designing technologies and educational programs to help in the identification of suspicious online behaviors; strengthening Internet filters and privacy options for protecting students online; and school outreach for students who are harassed, threatened, or assaulted as a consequence of meeting someone online.

Caregivers of victimized children: differences between biological parents and foster caregivers.

Caregivers of children who have been sexually abused often find the experience challenging, especially when the child begins to act out in the home. Many children who have engaged in sexually aggressive, sexually inappropriate, or coercive behaviors with other children are placed in foster care. The purpose of this article is to describe the characteristics of biological parents and their significant others and foster caregivers of sexually aggressive and abusive children. A descriptive, exploratory study was conducted involving 3,149 caregivers (1,764 of them foster caregivers) of more than 800 youth ages 3 to 20. Findings suggest that while the foster caregivers were a more stable group than the biological parents and their significant others, the children experienced significantly high levels of instability in foster care placement. Provision of emotional and psychosocial support, coupled with education and periodic health evaluations, for the foster caregivers may be focal points of interventions. Nurses are in an ideal position to provide positive health promotion strategies and lifestyle choices for both foster caregivers and the children.

Girls in foster care: a vulnerable and high-risk group.

PURPOSE: To describe the characteristics of girls in foster care who have exhibited sexually abusive behavior. STUDY DESIGN AND METHODS: This was a chart review and a descriptive, exploratory study of 155 female children and adolescents (age 4-17 years) who were in foster care and had been evaluated for their sexual abusive and aggressive behaviors. RESULTS: Findings indicated that these girls had significant histories of maltreatment, chronic health issues, and foster care placement instability; 84% of the girls had been physically abused; 95% were victims of ongoing abuse by the biological parents (78%). Sexual abuse was reported by 81%, and 68% were sexually abused by more than one individual. Ninety-five percent were neglected; 51% of the neglect was classified as severe and chronic. All of the girls (100%) had been shown to exhibit sexually abusive and inappropriate behaviors toward other children, including exposing themselves to age-mates, violation of body space, sexually aggressive remarks, sexual touching without permission, and sexual touching of much younger children. Ninety-two percent of the girls had two or more changes in caregivers by age 16 years. Over one-third of the girls (39.2%) experienced four or more different living situations that lasted less than 1 month. CLINICAL IMPLICATIONS: These girls demonstrated a variety of behavior problems that place them at high risk for multiple foster care placements, which can negatively impact upon their well-being and health. Whether in healthcare settings, schools, the workplace, community, in-patient, or psychiatric settings, nurses and other healthcare providers have access to children and their foster care caregivers. Nurses and other healthcare clinicians are in an ideal position to provide a safe clinical environment contributing to the health, education, and support to these girls.