Transitioning From a Traditional to a Concept-Based Curriculum: Faculty's Experience.

Nursing education is transforming from traditional systems paradigms to concept-based curricula. We explored how this change impacts faculty using focus groups with questions adapted from Bridges' transitions model. Results revealed that many faculty did not feel there was a clear vision for the transition and felt inadequately prepared for the change. Uncertainty about their new role led some to feel displaced. To ease future transitions, we suggest that leadership clearly communicate the rationale for the change, ensure that there is a shared vision, provide an appropriate timeline for the transition, and support faculty as their roles are redefined.

A Scoping Review of Transitions, Stress, and Adaptation Among Emerging Adults.

This scoping review examined research on transitions among emerging adults, 18- to 30-year-olds, to identify designs, populations, frameworks, transition types, and transition outcomes. A librarian conducted the search, yielding 2067 articles. Using predefined criteria, teams screened abstracts and reviewed articles, with 82% to 100% interrater agreement. Data from the final 160 articles were placed in evidence tables and summarized. Most frequently, the studies had exploratory-descriptive designs (69%), nondiagnosed samples (58%), no theoretical frameworks (58%), developmental transitions (34%), and health-related behavior outcomes (34%). This transition research is in an early stage of knowledge development and would benefit from further theory development.

Recruitment and retention challenges and successes.

OBJECTIVE: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention. DESIGN: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women ≥ 15 years old) were recruited through a regional hospital. RESULTS: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study. DISCUSSION: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.

Student-Perceived Influences on Performance During Simulation.

BACKGROUND: Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing. METHOD: This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data. RESULTS: Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance. CONCLUSIONS: More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].

Evaluating motivational interviewing to promote breastfeeding by rural Mexican-American mothers: the challenge of attrition.

Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their children's risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.

Exploration of factors influencing initiation and continuation of breastfeeding among Hispanic women living in rural settings: a multi-methods study.

INTRODUCTION: Healthy People 2020 has the important goal of increasing the number of breastfed babies in the USA. The purpose of this pilot study was to explore factors that influence breastfeeding initiation and continuation among Hispanic women living in rural settings. Further, the objective of this study was to develop a framework for an educational breastfeeding program to meet the needs of Hispanic women living in rural settings. METHODS: A convenience sample of 12 Hispanic women, age 19 years or older, was enrolled from the Regional West Medical Center, Scottsbluff, a rural setting in Nebraska, during October 2012. A multimethod approach was used to gather both quantitative and qualitative data. Two focus groups were conducted to collect qualitative data, and various quantitative variables included study population characteristics, Breastfeeding Self-efficacy Scale Short Form (BSES-SF) and Breastfeeding Attrition Prediction Tool (BAPT). RESULTS: The majority of the mothers did not take prenatal breastfeeding classes and did not intend to (83%, n=10). Half of the participants decided at the time they were pregnant to breastfeed their children. The most common factors for deciding to breastfeed were the perceived benefits for the health of the baby, and family influence. The average BSES-SF score was 55 (s=12), with the scores ranging from 36 to 67. BAPT results indicated an above-average intention to breastfeed with an average of 31 (standard deviation 4). Results of the focus group, BSES-SF and BAPT helped to develop submodules such as breastfeeding initiation, feeding cues, nutrition for breastfeeding mother and cost-effectiveness of breastfeeding. CONCLUSIONS: The study describes the factors that impact on breastfeeding practices among Hispanic rural women. Further, assessment of BSES and BAPT scales facilitate the development of the breastfeeding educational content. The study highlights the importance of behavioral and cultural factors that might be essential to increase adoption of breastfeeding among Hispanic rural women.

An interactive, bilingual touch screen program to promote breastfeeding among Hispanic rural women: usability study.

BACKGROUND: Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior. Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful. OBJECTIVE: The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings. METHODS: A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed. Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS). RESULTS: The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90%, 9/10), and 60% (6/10) had breastfed less than 6 months. There were 90% (9/10) of the study participants that had no prior history of taking prenatal classes and 80% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks. CONCLUSIONS: The study participants were able to navigate through the multimedia program with ease and obtain relevant breastfeeding related health information. The interactive, touch screen computer-based breastfeeding program had high acceptance among 10 Hispanic women living in rural settings.

Assessment of technology access and preference for health education of a rural Hispanic community.

In the United States, Hispanic populations tend to have higher incidences of chronic disease such as diabetes, cardiovascular disease, hypertension, obesity and hyperlipidemias [1]. They are also more likely to be underinsured or uninsured than other populations [2]. The purpose of this descriptive technology assessment survey study was to determine computer and internet access, skill level and health education information preferences of a rural Hispanic (primarily Mexican-American) population in the United States. Among the sample, 81% of individuals who answered the survey had a computer and internet access in their home. Nineteen percent did not have computers or internet access in their homes. Compared to the average 54% home internet access found by the Pew Hispanic Research Center the rural convenience sample in this study had a high percentage of technology access. Recommendations include using multimedia to improve the health information accessability among Hispanic persons.

Web-based SBIRT skills training for health professional students and primary care providers.

The authors have developed and assessed 2 innovative, case-based, interactive training programs on substance abuse, one for health professional students on alcohol and one for primary care providers on screening, brief intervention, and referral to treatment (SBIRT). Both programs build skills in substance abuse SBIRT. Real-world effectiveness trials involving medical students (n = 10) and nursing students (n = 60) were completed; trials involving primary care providers (n = 65) are in progress during 2011. Medical students and nursing students had similarly low baseline scores on assessments that benefited from training: knowledge, confidence, and clinical performance measured via an online standardized patient case and encounter note all improved post-training. Preliminary results indicate that practicing providers improved on knowledge, attitude, and brief intervention skill performance after a similar training. Results suggest that SBIRT skills can be improved with this model for case-based interactive training programs, and thus, that this training has the potential to impact patient outcomes.

Mexican American mothers' eating and child feeding behaviors.

OBJECTIVE: The purpose of this study of Mexican-American mothers of 2-6 year old children was to explore the relationships among maternal attitude, perceived behavioral controls, mother's intent, mother's regulation of her own Simple Carbohydrate Intake (SCI), and mother's child feeding behaviors. The overall objective was to increase understanding of the complex process of intention to eat healthy. METHODS: A prospective exploratory design using a convenience sample of a cohort of 82 Mexican-American mothers was used in this study. Structured questionnaires were selected to measure cognitive restraint, disinhibition, hunger, intent to regulate SCI, and mothers' monitoring, restricting, and pressuring of children's diets. Descriptive statistics and correlations were analyzed for each relationship. RESULTS: The relationships between disinhibition, hunger, cognitive restraint, and the intent variable were significant. More than half of these mothers reported limiting soda and candy for themselves. According to the Food Frequency Questionnaire, mothers were regulating only one-third of simple carbohydrate items they intended to regulate. Significant relationships were found between mothers' regulation of her specific SCI and her control of child feeding behaviors including pressuring, monitoring, and restricting. CONCLUSION: The findings support the idea that mother's eating behaviors, attitudes, and intent may affect how they feed their pre-school children. Nurses need to develop and test interventions targeted at educating Mexican-American mothers about healthy food choices and healthy child feeding behaviors.

Lessons learned conducting breastfeeding intervention research in two northern plains tribal communities.

AIM: The overall purpose of this article was to describe the challenges and benefits of conducting breastfeeding intervention research with two Native American Tribal communities. METHODS: A focus group with an interpretive approach was used to collect data within this qualitative study as a means of incorporating a complex, holistic, subjective interpretation of the case managers' perceptions and experiences. In addition, researchers' field notes were used. Findings are discussed in relation to Rogers' Diffusion of Innovation Framework. RESULTS: Themes that emerged during the focus group discussions were related to innovation, relative advantage, complexity, compatibility, trialability, and observability. CONCLUSIONS: Conducting research in Native American Tribal communities was both enriching and challenging. The research protocol needs to be culturally appropriate, and complex components need to be videotaped for review on an ongoing basis. Time constraints of case managers need to be examined prior to development of the research protocol.

The relationship between breastfeeding test weights and postpartum breastfeeding rates.

This secondary analysis was conducted to determine the relationship between test weights and days of breastfeeding. Test weights were performed with a scale (accurate to 2 grams) before and after feeding. Days of breastfeeding was measured by self-reporting. All test weights were interrelated and were associated with higher days of breastfeeding. Test weights at day 2 to 4 and at 2 weeks were not correlated significantly with either intention or self-efficacy at any time. However, 6-week test weights were correlated with intention at all 3 times, and self-efficacy at 6 weeks. Women with higher breastfeeding self-efficacy scores tended to report higher intention to breastfeed for 6 months.

Screening Native American children for asthma: findings from focus group discussions.

CONTEXT: Because of the past history among the Indian people related to research, it is incumbent upon those of us who wish to conduct research with these groups to protect them from exploitation, to conduct research that will be beneficial to the tribal community, and to work together to make the research as meaningful and as successful as possible. The process of conducting research among Native American tribes can appear to the novice as very time-consuming and full of barriers. These are necessary guards to protect their people. Additionally, many people of these tribes want to make sure that the research is going to benefit them. Focus groups provide a way for researchers to identify what the wishes of the tribal communities are in relation to the proposed research. PURPOSE: The overall purpose of this study was to understand some of the concerns the tribal communities had regarding asthma among their children, as well as their perceptions of how best to implement an asthma screening program in their community. METHODS: This was a qualitative study. An interpretative approach was selected for this research because such an approach emphasizes how a phenomenon is perceived and how meaning is constructed in situations. FINDINGS: Findings from the focus group are discussed according to themes that surfaced during the focus group discussion. CONCLUSIONS: Tribal community leaders and parents are interested in their children's health and do want to be involved in research to help children and others in their communities. Nurses working in tribal communities need to gain an understanding of the tribal communities' perspective prior to conducting research.

Testing protocols: care of biological samples in a rural setting.

The purpose of this study is to evaluate collection, transport, and storage protocols of urine and air allergen samples from infants in a rural setting. Infant urine and aeroallergen samples (n = 21) are collected in the home setting in rural areas where time and distance to the central laboratory is a consideration. Urine samples are analyzed using ELISA tests after being transported using three different techniques: (a) ambient temperature, (b) dry ice, and (c) packaged on dry ice and shipped commercially. Following initial ELISA testing for levels of cytokines, urine samples are frozen at -70 degrees Celsius for 6 months. Samples are then reanalyzed for levels of cytokines. Dust samples are analyzed for levels of aeroallergens, stored at 4 degrees for 6 months, and reanalyzed. The integrity of samples varies by biomarker, shipment temperature, and storage time, creating a high degree of variability in results.

Negotiating three worlds: academia, nursing science, and tribal communities.

PURPOSE: The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. METHOD: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. RESULTS: Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. DISCUSSION: Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Influence of intention and self-efficacy levels on duration of breastfeeding for midwest rural mothers.

OBJECTIVES: The purpose of this study was to explore the relationship of two modifiable factors (intention to breastfeed for 6 months and breastfeeding self-efficacy) with the duration of breastfeeding in primiparous women. FINDINGS: Analyzed by logistic regression in a single prediction model, stronger intention (odds ratio = 1.89) and higher levels of self-efficacy at 2 weeks postpartum (odds ratio = 1.04) were significantly (p < .05) associated with an increased probability of breastfeeding for 6 months. CONCLUSIONS: The combined influence of higher intention and self-efficacy increased the likelihood of breastfeeding for the recommended 6 months. Interventions to reinforce both should be designed and evaluated.

Screening for asthma: results from a rural cohort.

BACKGROUND: Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management. PURPOSE: The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF(25-75)); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma. FRAMEWORK: The Vulnerable Populations Framework (Flaskerud and Winslow, 1998) was used to organize this study. METHODOLOGY: A prospective descriptive design was utilized for this research. RESULTS: Approximately 12% of the children screened were referred to their primary care provider (PCP) for follow-up care. Of these approximately half of the children were seen by their PCP. Barriers to seeking follow-up care were: a) the child was not symptomatic all the time, b) reluctance to be diagnosed with asthma, and c) others, such as cost and time. Children who were not well controlled identified that they ran out of medicine and their parents did not refill their prescription. CONCLUSION: Results from this descriptive study indicate that screening for asthma in school may be a way to identify those children who are at risk for asthma, and who are not diagnosed as well as those who are diagnosed with asthma but are not optimally managed. While many parents wanted their children to be screened, follow-up care was not critical to them. IMPLICATIONS: Nurses working in a school setting are in a prime position to help identify those children with signs and symptoms of asthma. In addition, use of written screenings with or without spirometry may be helpful in identifying children at risk for asthma. Further studies need to be undertaken to determine if written screening is as efficacious as spirometry for school and other ambulatory care settings.

Smoking hygiene: reducing infant exposure to tobacco.

The American Academy of Pediatrics recently removed nicotine from the list of drugs contraindicated during breastfeeding. The objective of this study was to evaluate the feasibility of determining the effect of a smoking hygiene intervention on infants of breastfeeding mothers who smoke cigarettes. An experimental design with repeated measures was used. A convenience sample of 35 mother-infant dyads from seven sites was recruited and randomly assigned to the intervention or control group. Of the 27 dyads completing the study, 16 were in the experimental group and 11 were in the control group. Smoking hygiene was introduced when infants were 2 weeks old and reinforced when they were 3 and 5 weeks old. At these three data points, infant health and urinary nicotine and cotinine levels were measured, as well as the mothers' breast-milk nicotine and cotinine levels and smoking hygiene behaviors. Recruiting and retaining a sample of breastfeeding mothers who smoke proved difficult. Only 27% of women in the intervention group implemented all aspects of the smoking hygiene intervention behaviors. Repeated-measures ANOVA revealed no difference in a) infant urinary nicotine and cotinine levels or b) breast-milk nicotine and cotinine levels between the two groups. The McNemar test for related samples revealed no difference between frequency of respiratory symptoms in either the control or intervention groups when Week 2 levels were compared with levels at Weeks 3 and 5. Mothers were not successful in adhering to the smoking hygiene intervention. To adequately test interventions, strategies must be developed to help women incorporate health-promoting behaviors into their lives.

Motivational interviewing to promote sustained breastfeeding.

OBJECTIVE: To explore the feasibility of using motivational interviewing to promote sustained breastfeeding by increasing a mother's intent to breastfeed for 6 months and increasing her breastfeeding self-efficacy. DESIGN: A longitudinal experimental two-group design with repeated measures was selected to explore the feasibility of using motivational interviewing to promote sustained breastfeeding in primiparous mothers. SETTING: Three Western rural community hospital sites. PARTICIPANTS: Convenience sample of 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38, M = 25 (SD = 4.5). MAIN OUTCOME MEASURE: Mothers reported the date of their last day of breastfeeding, defined as any breastfeeding during the previous 24-hour period. Breastfeeding behavior was confirmed at each visit by infant test weights. RESULTS: The motivational interviewing group (M = 98.1 days, SD = 75.2) breastfed longer than the comparison group (M= 80.7 days, SD = 71.9); however, this difference was not significant, t(69) = 0.991, p = .325, Cohen's d = 0.24, related to the variability in the sample. CONCLUSIONS: Although not a statistically significant difference, the mean number of days that mothers in the intervention group breastfed was 98 days compared to the mean of 81 days by the comparison group; therefore, motivational interviewing may be useful as a strategy to test in a comprehensive intervention plan.

Modification of fibrinogen by homocysteine thiolactone increases resistance to fibrinolysis: a potential mechanism of the thrombotic tendency in hyperhomocysteinemia.

We have previously shown functional differences in fibrinogen from hyperhomocysteinemic rabbits compared to that in control rabbits. This acquired dysfibrinogenemia is characterized by fibrin clots that are composed of abnormally thin, tightly packed fibers with increased resistance to fibrinolysis. Homocysteine thiolactone is a metabolite of homocysteine (Hcys) that can react with primary amines. Recent evidence suggests that Hcys thiolactone-lysine adducts form in vivo. We now demonstrate that the reaction of Hcys thiolactone with purified fibrinogen in vitro produces fibrinogen (Hcys fibrinogen) with functional properties that are strikingly similar to those we have observed in homocysteinemic rabbits. Fibrinogen purified from homocysteinemic rabbits and Hcys fibrinogen are similar in that (1) they both form clots composed of thinner, more tightly packed fibers than their respective control rabbit and human fibrinogens; (2) the clot structure could be made to be more like the control fibrinogens by increased calcium; and (3) they both form clots that are more resistant to fibrinolysis than those formed by the control fibrinogens. Further characterization of human fibrinogens showed that Hcys fibrin had similar plasminogen binding to that of the control and an increased capacity for binding tPA. However, tPA activation of plasminogen on Hcys fibrin was slower than that of the control. Mass spectrometric analysis of Hcys fibrinogen revealed twelve lysines that were homocysteinylated. Several of these are close to tPA and plasminogen binding sites. Lysines are major binding sites for fibrinolytic enzymes and are also sites of plasmin cleavage. Thus, modification of lysines in fibrinogen could plausibly lead to impaired fibrinolysis. We hypothesize that the modification of lysine by Hcys thiolactone might occur in vivo, lead to abnormal resistance of clots to lysis, and thereby contribute to the prothrombotic state associated with homocysteinemia.