Racism as a Public Health Issue for Nurses of Color in Clinical and Academic Settings: Ten Nurses Tell Their Stories.

AIM: The aim of this study was to bring awareness to how racism and discrimination, accompanied by bullying and incivility, negatively impact the health of nurses of color. BACKGROUND: Racism and discrimination encountered in the daily lives of nurses of color present risk for psychological and physiological damage to their health. Repeated exposure to racism and discrimination leads to cumulative stress that may pose a negative impact on the health status of affected nurses. METHODS: Phenomenology served as the methodology for this research study. The principal investigator transcribed and coded data from 10 nurse participants. RESULTS: Data illustrate a pattern of nurses of color experiencing discrimination and racism, with racism being a potential public health issue. Their stories may empower others to make positive, productive decisions and persevere. CONCLUSION: Long-term exposure to racism and its related potential effects on nurses' health presents a grave concern for nurses of color.

Bullied: Exploring the concepts of territorialism and groupthink involvement in workplace bullying.

AIMS: To educate nurse managers on territorialism and groupthink as being factors within workplace bullying among nurses within the clinical and academic settings that can psychologically and physically harm affected persons. DESIGN: Territorialism and groupthink are explored as being factors within workplace bullying used by a bully or bullies to target others for personal gain and power. Workplace bullying has become habitual practice in nursing and nursing academia. Workplace bullying is identified not only as unethical behaviour but also as a dangerous practice that can lead to depression, anxiety, stress, and posttraumatic distress syndrome. Persons affected are subjected to emotional abuse that can lead to isolation, low self-esteem, and self-doubt. METHODS: Methods by which persons in the workplace can identify bullying that involves territorialism and groupthink are examined. Nurse managers are identified as being instrumental in the identification of workplace bullying involving territorialism and groupthink, and in working with the affected person(s) and bully or bullies to seek mediation through a human resource representative. For nursing managers, it is imperative that workplace bullying is immediately addressed. Workplace bullying creates a hostile and intimidating working environment that affects the physical and mental health of affected persons. RESULTS: Early identification and resolution of workplace bullying could alleviate the development of physiological and psychological health problems by affected persons. After workplace bullying has been reported, the affected persons should focus on the healing of mind, spirit, and body. New circumstances (e.g., a new place of employment or a promotion) may trigger feelings of anger, intimidation or fear; therefore, it' is important for persons who have experienced bullying in the workplace to understand the abusive environment itself was not directly associated with any wrongdoing by them. NO PATIENT OR PUBLIC CONTRIBUTION: Workplace bullying is disruptive to the workplace and affects productivity, absenteeism from work and turnover intentions. Persons impacted by territorialism and groupthink within the context of workplace bullying can develop psychological and physiological health problems.

Mental Health and Harassment in the Workplace.

Harassment in the workplace has become all too common in today's society. Acts of uncivil behavior and bullying create stressful and difficult working environments. Individuals or groups are targeted without legitimate cause, thus creating feelings of stress, fear, anger, and anxiety that can affect mental health. Fear of speaking up owing to retaliation allows the uncivil behavior to continue. Emergency nurses should take action to stop the behavior and may need to seek professional help for mental health care.

Applying the Nightingale Pledge in Reducing Health Disparities: A Hospital-Acquired Pressure Injury Case Study.

ABSTRACT: Professional nurses, by virtue of their training, pledge to care for individuals who are sick or infirm. This commitment is confirmed via the Nightingale Pledge, which focuses on public health and equity and deems the nurse to be a missioner of health. Health disparities exist in direct conflict with the nursing responsibility of caritas, or love. Accordingly, it is imperative that nurse educators create learning environments that are conducive to comfortably discussing differences in physical assessments performed on diverse populations as part of their work to eliminate health disparities and in accordance with the Nightingale Pledge.

Use of implementation science to plan adoption of a tobacco-free policy on a historically black college/university (HBCU) campus.

Objective: Implementation science tools were used to identify facilitators and barriers to adopting a tobacco-free policy on a historically Black college/university (HBCU). Participants: Study participants included 13 University staff, two students, and two public health educators/school alumni. Data were collected in 2015-2016. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop questions for focus groups and individual interviews. The CFIR was also used by two research team members to code transcripts independently, using an iterative deduction process to achieve ≥85% agreement on CFIR domains. Coded quotations were evaluated using the Qualitative Implementation Framework (QIF) to ascertain next adoption planning steps. Results: Qualitative data suggested that building capacity for tobacco control, linking policy to HBCU identity and priorities such as addressing marijuana use might facilitate adoption of a tobacco-free campus policy. Conclusions: Implementation science tools may be useful for planning adoption of comprehensive tobacco-free policies at HBCUs.

Spiritual Health First Aid for Self-Care: Nursing During COVID-19.

ABSTRACT: Nurses who provided care to patients with coronavirus (COVID-19) and supported patients in their transition from life to death in the absence of patients' families have been especially needful of spiritual self-care. A spiritual first aid kit can help nurses cope with these difficult times. Spiritual self-care is vital for all nurses to renew and preserve the psychological, spiritual, and physical self.

Narrative orphaned: When grief overwhelms.

WHAT IS KNOWN ON THE SUBJECT?: The loss of a parent for an adult can be devastating and can impact other relationships. The adult, in absence of parental love and support, may question their own identity. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A narrative is used to explain the adults' experience of parental death and their new identity of being orphaned. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Increased awareness for adults grieving the loss of a parent(s), as to the normalcy of feeling orphaned Adults grieving the death of a parent(s) are provided resources and support in addressing their grieving process. ABSTRACT: Introduction When a parent dies during their child's adulthood, the life of the adult is altered as the familiarity of parental love and safety changes. The isolation and loneliness penetrates deeply as the orphaned adult must now navigate their world in absence of the most significant people in their lives, their parents. Aim To assist persons affected by parental death in understanding the normalcy of feeling orphaned while grieving. Method The use of a personal narrative to provide mental health support to others. Results The resumption of a routine that existed before parental death is possible, but takes time. Intermittent periods of grief can occur throughout one's life. Discussion When grief interrupts one's ability to function daily and the affected adult has relationships impacted by their parent's death, it is recommended that the adult seek mental health treatment. Implications for Practice Narratives can be used with persons affected by parental loss, to provide an example of normal versus complicated grieving and identify when mental health treatment is needed.

The hollow: A theory on workplace bullying in nursing practice.

BACKGROUND: Incivility and bullying within the profession of nursing remains a problem within the workplace. As a result, healthcare workplaces can become unhealthy and difficult for nurses to function within. Work productivity is impacted and patients' healthcare is placed at risk when nurses are emotionally and physically affected by workplace incivility and bullying. Clinical nurse leaders (CNLs) applying theoretical reasoning and nursing competencies' in addressing bullying and incivility within the workplace, can provide an organized and effective organizational approach to addressing bullying and incivility in work environments. METHODS: Theoretical reasoning and nursing competencies in addressing bullying and incivility within the workplace, will be examined as a means to identify nurses exhibiting signs and symptoms of bullying and incivility in work environments. The theory of The Hollow will identify the origins of affected nurses' behaviors and the physiological and psychological impact of bullying and incivility. The CNL role will be used as a facilitator of change at the microsystem level. And competencies for addressing behaviors associated with bullying and incivility will be addressed. APPROACH: Innovation adapted from prior research and literature developed by the author, extrapolated from the literature on workplace bullying and incivility in nursing practice. OUTCOMES: Bullying and incivility can be resolved in the workplace when competencies are set forth by nursing leaders to educate and empower nursing staff on expectations of healthy work environments. CONCLUSION: Healthy workplaces are achievable when nurse leaders, such as CNLs, educate and empower nurses to have the expectation of healthy work environments not only for themselves, but for all nurses.

Nurses and Patients' Perspectives on Spiritual Health Assessment.

Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.

Association of Reversal of Anticoagulation Preoperatively on 30-Day Mortality and Outcomes for Hip Fracture Surgery.

BACKGROUND: Hip fracture is common in the elderly, many of whom are on anticoagulation. However, data are limited on outcomes with anticoagulation reversal in patients undergoing hip fracture surgery. METHODS: Adults ≥60 years old on oral anticoagulation who underwent hip fracture surgery at 21 hospitals in Northern California from 2006 to 2016 were identified through electronic databases. Outcomes were compared among patients treated and untreated with anticoagulation reversal preoperatively. RESULTS: Of 1984 patients on oral anticoagulation who underwent hip fracture surgery, 1943 (97.9%) were on warfarin and 41 (2.1%) were on direct oral anticoagulants. Reversal agents were administered to 1635 (82.4%). Compared to a watch-and-wait strategy, patients receiving reversal agents were more likely to be white, male, comorbid, and with higher admission and preoperative international normalized ratios (P <0.001 for all comparisons). No difference for 30-day mortality was detected between reversal vs non-reversal (7.8% vs 6.0%, respectively; hazard ratio [HR], 1.30 [95% confidence interval (CI), 0.82-2.07]). For secondary outcomes, reversal was associated with higher risk of delirium (8.6% vs 4.9%, risk ratio [RR], 1.77 [95% CI, 1.08-2.89]) and increased mean length of stay (6.4 vs 5.8 days, P <0.05). After adjustment, associations were no longer significant for delirium (RR 1.60, 95% CI, 0.97-2.65) or length of stay (mean difference 0.08, 95% CI, -0.55-0.71). No associations were detected between reversal and other secondary outcomes. CONCLUSION: No significant associations were found between reversal agents and 30-day mortality or other outcomes in patients on oral anticoagulation who underwent hip fracture surgery. Further investigation is needed.

Should nursing be considered a STEM profession?

BACKGROUND: The National Science and Technology Council developed a 5-year plan in 2013 to ensure that science, technology, engineering, and mathematics (STEM) experienced sustained growth within the United States (US). Nursing is comprised of multiple sciences that include chemistry, physics, biology, microbiology, anatomy and physiology, pharmacology, and the social and behavioral sciences of sociology, developmental lifespan psychology, and psychology. Science, technology, engineering, and math constitute the traditional STEM acronym. Nursing programs graduate nurses with both the rigorous academic coursework and diverse clinical skills necessary to provide patient care. These skills employed by nurses in the clinical setting can serve as the basis for the inclusion of the nursing profession as a STEM-designated profession by the federal government and educational institutions within the US. PROBLEM: Currently, the US government does not acknowledge the profession of nursing as a STEM-designated profession. Acknowledgment of nursing as a STEM profession could potentially make more funding available for nursing education within the US and address nursing shortages both in clinical and academic settings. As well as position professional nurses for careers not only within the health sector but that of business and industry because of nurses' STEM knowledge. Hence, enhancing the growth of STEM within the US and creating global market economic competitiveness with new innovation development. APPROACH: In the practice of nursing, nurses apply the sciences, math, and innovative technology in the assessments, diagnoses, and planning of patients' care. Nurses implement scientifically-based interventions to treat illness and sustain human life and to ultimately evaluate the outcomes of the care provided to patients. OUTCOMES: Methodologies of evaluation of outcomes of patient care status post nursing interventions (ie, administration of intravenous antibiotics to treat pneumonia) are based upon rationales that have been derived from evidenced-based practice and nursing research; both originating from applied STEM knowledge. CONCLUSION: The formal designation by the US federal government, for nursing to be recognized as a STEM profession, can increase funding to the nursing profession and enhance the diversity of employment opportunities for nurses in industry and business. Thereby potentially decreasing nursing shortages and bringing national and worldwide recognition to nursing in both academia, industry, business, and clinical settings, as a profession contributing to the science of improvement of the health of all people through STEM knowledge.

Teaching accelerated nursing students' self-care: A pilot project.

Aim: A benchmark of 4 has been determined for the reduction of self-reported stress by nursing students' status post 5 weeks of holistic educational activities and interventions provided by a nurse educator. Design: Provision 5 in the American Nurses Association Code of Ethics for Nurses with Interpretive Statements emphasizes the duty of the nurse to not only promote the health and safety of others, but to self as well (ANA, 2015, Code of ethics with interpretive statements, http://Nursebooks.org). A self-care for nurses' pilot project was trialled with 25 accelerated nursing students over the course of 5 weeks. Holistic education programmes were facilitated by a nurse educator uninvolved in providing clinical or classroom education to the students. Methods: The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines are used in this pilot project as a framework to explore standardization of education of nursing students about self-care in nursing programmes and to promote positive health behaviours and student nurses' insight into how nurses' self-care can have an impact on patient outcomes. The self-care pilot project introduced the importance of self-care for the pre-licensure nursing student by teaching healthy eating, physical exercise, the value of sleep, use of positive affirmations and aromatherapy to a cohort of accelerated nursing students over the course of 5 weeks. The Star Model of Knowledge Transformation was the theoretical framework for the pilot study. Two questionnaires were used by the principal investigator to obtain participant data, the Project Participant Questionnaire and the Final-Year Group Questionnaire. Results: On completion of the self-care for nurses' pilot, the nursing students reported a reduction in stress and an increased ability to cope with stress after exposure to different holistic stress reduction strategies. An average benchmark of 4.36 was achieved indicating that the nursing students' self-care had improved status post the interactive teaching intervention.Self-care taught to pre-licensure nursing students by nurse educators can enhance their self-awareness of the importance of stress reduction and care of themselves while enduring the academic rigour and simultaneous clinical practicum experiences in nursing programmes.Applying self-care behaviours to reduction of stress for nursing students may be of benefit to of students as they transition from the pre-licensure to graduate nurse roles. Hence, teaching health behaviours that are self-protective and contribute to maintaining safe clinical environments for nurses and the patients in their care.

Cultural Considerations in the Care of Psychiatric Patients: A Case Study on Fright.

When providing psychiatric care to patients, cultural considerations are necessary to ensure that patients' individual healthcare needs are known and addressed. Failure to incorporate cultural considerations such as food preferences, gender congruency with nursing care, awareness of faith and religious practices, and the use of alternative medicinal and herbal approaches to healthcare treatment, can result in poor treatment engagement and outcomes for patients. The provision of culturally competent health care for psychiatric patients must be patient-centered; with nurses and all healthcare team members collaborating with patients and their families (significant others) in the delivery of safe, high quality, and effective care.

Using Case Study Methodology to Explore the Role of Discrimination in Workplace Incivility.

Exclusionary behaviors can be detrimental to the health and well-being of faculty in the workplace. When colleagues are judged by their peers because of the color of their skin, the language they speak, their gender, or who they choose to love (lesbian, gay, bisexual, transgender, asexual, or questioning), affected faculty are left emotionally and physically vulnerable. Institutions of higher learning must set standards of zero tolerance for faculty-to-faculty incivility. With standards taken from each faculty discipline, codes of conduct can be implemented not only at a departmental level, but also throughout the educational system.

Using instrumentation in psychiatric nursing to assess documentation of the nursing process for emergent non-psychiatric patient events.

Ongoing education of experienced psychiatric nurses is imperative given the historically complex health presentations of psychiatric patients. Psychiatric patients tend to have medical co-morbidities and often do not have the financial resources for preventative health care. The hospitalization for acute psychiatric stabilization, is an opportunity for psychiatric nurses to teach and advocate for patients' physiological and psychological health. Documentation of patients' changes in condition and overall clinical presentation, is necessary to ensure patients' health care needs are met.

Contemporary issues: The pre-licensure nursing student and medication errors.

In Modern health care, the creation of cultures of safety for patients is of the upmost importance. Impacting the institutional stabilization of health care facilities safety initiatives, is the preparation of pre-licensure nursing students to safely administer medications to patients. Therefore, preparation of the pre-licensure nursing student must be evidence-based practice focused and incorporate innovative ways to reduce the potential for medication errors.