Perspectives on Online Resources for People Experiencing Pain: A Qualitative Study.

BACKGROUND: Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain. OBJECTIVES: This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs. METHODS: Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis. RESULTS: Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources. CONCLUSION: Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.

A National Survey Examining Manuscript Dissertation Formats Among Nursing PhD Programs in the United States.

PURPOSE: Among research-focused nursing doctoral (PhD) programs in the United States, the traditional dissertation format has recently given way to a series of publication-ready manuscripts, often bookended by introduction and conclusion chapters. To help programs make decisions about the use of these formats, this study undertook a national survey of programs offering PhDs in nursing. The purpose of this study was to explore the advantages and disadvantages of the traditional format versus manuscript option for dissertations among nursing PhD programs in the United States. DESIGN: Cross-sectional census survey of U.S. nursing PhD programs. METHODS: A web-based survey was administered to all U.S. nursing PhD programs. Respondents indicated formats offered, factors contributing to decisions of which formats to offer, and lessons learned. Descriptive statistics and inductive content analyses were used for analysis. FINDINGS: Of 121 eligible institutions, 79 provided eligible responses (66.7%). The majority (59%) offered both formats; 11% offered the manuscript option only, and 24% offered the traditional format only. Faculty support (or lack thereof) contributed to adoption (or not) of the manuscript option. Respondents' approaches to the manuscript option (e.g., number of papers) and advice are summarized. CONCLUSIONS: Manuscript option dissertations are commonly offered and provide benefits to students and faculty; however, thoughtful implementation is critical. Programs need to agree upon clear expectations and have graduate school support (e.g., formatting). Faculty need mentorship in advising manuscript option students who choose to use this format, and the time and support. Finally, students need additional writing skills that could be provided through coursework or via individual work with mentors. CLINICAL RELEVANCE: As nursing education continues to expand further into doctoral research, programs must examine dissertation formats in order to both prepare future nurse scholars and disseminate nursing research that is critical to improving nursing education, patient care, and clinical practice.

Student support in accelerated nursing programs: Gender-based perspectives and impact on academic outcomes.

BACKGROUND: Factors that contribute to student success in accelerated degree nursing programs are poorly understood and may vary by gender. PURPOSE: Examine associations between satisfaction with peer and mentor support, gender, and academic outcomes among students in accelerated degree nursing programs. METHODS: We used data (demographic variables, satisfaction with peer and mentor support, graduation, and attempts of National Council Licensure Examination for Registered Nurses) from the American Association of Colleges of Nursing and Robert Wood Johnson Foundation's New Career in Nursing Program. Multivariable mixed effects regression models were used to examine associations among gender, satisfaction with support, and academic outcomes. FINDINGS: Males had an increased probability of reporting high satisfaction with peer support. Both males and females who were very dissatisfied with peer support were less likely to graduate than students who were very satisfied with peer support. Gender did not moderate the relationships between satisfaction with peer and mentor support and academic outcomes. CONCLUSION: Peer support is an important aspect of graduation among students in accelerated degree nursing programs. Continuous quality improvement strategies to improve student peer support may be warranted.

A demonstration of mixed-methods research in the health sciences.

Background The growth of patient, community and population-centred nursing research is a rationale for the use of research methods that can examine complex healthcare issues, not only from a biophysical perspective, but also from cultural, psychosocial and political viewpoints. This need for multiple perspectives requires mixed-methods research. Philosophy and practicality are needed to plan, conduct, and make mixed-methods research more broadly accessible to the health sciences research community. The traditions and dichotomy between qualitative and quantitative research makes the application of mixed methods a challenge. Aim To propose an integrated model for a research project containing steps from start to finish, and to use the unique strengths brought by each approach to meet the health needs of patients and communities. Discussion Mixed-methods research is a practical approach to inquiry, that focuses on asking questions and how best to answer them to improve the health of individuals, communities and populations. An integrated model of research begins with the research question(s) and moves in a continuum. The lines dividing methods do not dissolve, but become permeable boundaries where two or more methods can be used to answer research questions more completely. Rigorous and expert methodologists work together to solve common problems. Conclusion Mixed-methods research enables discussion among researchers from varied traditions. There is a plethora of methodological approaches available. Combining expertise by communicating across disciplines and professions is one way to tackle large and complex healthcare issues. Implications for practice The model presented in this paper exemplifies the integration of multiple approaches in a unified focus on identified phenomena. The dynamic nature of the model signals a need to be open to the data generated and the methodological directions implied by findings.

A systematic review of the literature on screening for exercise-induced asthma: considerations for school nurses.

Asthma is a major cause of illness, missed school days, and hospitalization in children. One type of asthma common in children is exercise-induced asthma (EIA). EIA causes airway narrowing with symptoms of cough and shortness of breath during exercise. The purpose of this article is to review the literature relevant to screening children and adolescents for EIA and to inform development of a school nurse-led EIA screening program. A systematic review of EIA screening tests was conducted by searching PUBMED for key terms. Sixty-seven articles were identified; after review only seven met the inclusion criteria. The most common screening test was the 6-min exercise challenge. School-based screening programs have the potential to identify EIA among undiagnosed children and adolescents. School nurses are health professionals with the knowledge and skills necessary to develop successful screening programs in the school setting. Based on results of the literature review, we present implications for developing screening programs in schools to identify children with undiagnosed EIA.

Psychometric Testing of the Filipino Version of the Clients' Perceptions of Providers' Cultural Competency (CPOPCC) Instrument Among LGBTQ+ Population in the Philippines.

Background and Purpose: Cultural competence is significant in addressing the health needs of vulnerable populations. This study conducted psychometric testing of a cultural competency instrument in the Philippines. Methods: Brislin's translation and a cross-sectional online design were used. Exploratory factor analysis (EFA) with varimax rotation examined construct validity of the 23-item scale among 157 adult LGBTQ+ residents. The scale revealed overall reliability (α = .85) including two subscales (α = .87, α = .81, and α = .61). The EFA yielded three theoretical factorial solutions. Conclusion: The Filipino version of the instrument demonstrated reliability and validity. Measuring clients' perceptions of provider and organizational cultural competency can improve the utilization of healthcare in Filipino LGBTQ+ communities. Future research will examine the dimensional structures of the instrument among expanded LGBTQ+ communities.

Development of the Clients' Perceptions of Providers' Cultural Competency Instrument.

INTRODUCTION: This study developed and validated the Clients' Perceptions of Providers' Cultural Competency instrument. METHOD: A sequential exploratory mixed design identified three constructs derived from the studies of Leininger and others. Constructs were compared with publications on cultural competency. A panel of experts reviewed for content validity. RESULTS: Three hundred and nine mostly Asians and Native Hawaiians completed the questionnaire. Twenty-two items with item-to-total correlation coefficients >.2 were retained. Overall instrument Cronbach's alpha was .89. Construct validity demonstrated the three constructs accounted for 49.6% of variance supported by distinct items with Cronbach's alphas of .82, .83, and .76, respectively. Preliminary criterion validity revealed no statistically significant differences in scores based on the location of services received or race/ethnicity. DISCUSSION: The Clients' Perceptions of Providers' Cultural Competency instrument is congruent with nursing principles of equity and justice by measuring provider cultural competency from a client's perspective. Active client engagement in care contributes to transcultural nursing's goals to improve health equity.

Creating a path: American Indian/Alaska Native high school students pursuing college and a career in nursing.

The purpose of this quantitative descriptive pre- and post-survey study was to analyze four years of data documenting differences in pre- and post-test responses by American Indian/Alaska Native high school students attending a weeklong residency program. The program was designed to provide information and role models to motivate students to go to college and pursue a career in nursing. The survey measured student perceptions of college and nursing. In addition, the analysis included comparisons of responses between students who lived on reservations and those who did not. Results demonstrated that students changed their views of nursing as a profession, how they would be perceived by their tribe, and the financial security they could gain. Students living on their reservations were concerned that college might be too far from home. Recommendations include the need to provide indigenous students with role models and accurate information as well as mentors to support them.

Development and Psychometric Evaluation of a Community Program Capacity Scale for a Rural American Indian Tribe.

BACKGROUND AND PURPOSE: Community-based participatory research (CBPR) is often preferred in partnerships between universities and American Indian tribes. Central to CBPR is a strong impetus for capacity building. Community capacity includes capabilities and infrastructures to provide a service(s). METHODS: An American Indian community advisory board developed and tested an 11-item community capacity scale. A total of 128 tribal members or those who lived on the reservation completed the survey. Exploratory factor analysis assessed the factor structure and Cronbach's alpha estimated internal consistency. RESULTS: A one-factor model demonstrated adequate model fit (comparative fit index [CFI] = .92, root mean square error of approximation [RMSEA] = .06, standardized root mean square residual [SRMR] = .07), and items were internally consistent (alpha = .79). CONCLUSIONS: Survey development with academic and tribal partners was iterative, with time spent on partnership and consensus building, resulting in a psychometrically sound and culturally relevant community program capacity scale.

Evaluating a conceptual model-based assignment.

Although all faculty evaluate student assignments, fewer tackle the difficult issue of evaluating its actual usefulness. Wanting to know how their undergraduate community health nursing students were understanding and using a conceptual model in clinical practice, the authors used student journal assignments to evaluate learning and application of the model. They discuss the project's outcomes and subsequent strategies implemented to enhance their own understanding of the model and facilitate improved student learning.

A CBPR Approach to Finding Community Strengths and Challenges to Prevent Youth Suicide and Substance Abuse.

PURPOSE: To improve health and reduce health disparities, research partnerships with American Indian and Alaska Native communities should build on existing traditions and strengths. The overall goal of this pilot project was to clarify the needs of tribal community members and determine strengths and resources available to the community. DESIGN: Community-based participatory research was the approach used to obtain community input. Data collection methods included, Photovoice ( n = 16), digital storytelling ( n = 4), and community capacity surveys ( n = 128). RESULTS: Quantitative and qualitative findings supported the need to (1) address youth suicide and substance abuse on the reservation and (2) use preexisting resources available in the community. The results led to the development of a strengths-based intervention incorporating the Gathering of Native American's curriculum. CONCLUSION: Integral to the development, implementation, and sustainability of the intervention was the truly reciprocal relationship developed between community and university partners.

Native American high school students' perceptions of nursing.

A pilot study was conducted to determine changes in Native American high school students' knowledge and opinions about nursing after attending a 6-day residential summer nursing institute. To date, Native American high school students, particularly those interested in nursing, have not been well researched. Seventeen high school students affiliated with nine Northwest tribes participated in this study. A 66-item, investigator-constructed, pretest-posttest survey included 38 scaled (4-point Likert type) and 20 dichotomous items. Reliability estimates (Cronbach's alpha) were 0.72 and 0.85 for the pretest and posttest, respectively. This pilot study showed an increase in students' knowledge and opinions of professionalism, autonomy, and role importance in nursing after attending the summer nursing institute. A salient and culturally related reason for choosing nursing was to be important to one's tribe. Although the sample was small, the findings provide initial evidence supporting the effectiveness of a nursing education intervention with Native American high school students and an instrument that can measure its success.

Views on Exercise.

INTRODUCTION: There is a large prevalence of asthma, particularly among Hispanic children. Although physical activity is a good way to manage asthma, more Hispanic children with asthma lack activity than their healthy classmates. Given this, the purpose of this study was to explore the development of exercise perceptions in Hispanic children with asthma and to further develop an existing explanatory theory. METHOD: Grounded theory was the approach for the study. Grounded theory illuminated components of exercise perceptions from participants. Participants included Hispanic children with asthma, their families, and professionals who work with Hispanic children with asthma ( n = 29). RESULTS: Findings from this study supported the previously identified grounded theory called The Process of Creating Perceptions of Exercise. In addition, two new concepts ( cultural and peer influences) were identified that further explain the category of exercise influences. CONCLUSION: The revised theory can be used to assist in developing nursing interventions aimed at increasing exercise participation among Hispanic children with asthma.

Measuring the Success of a Pipeline Program to Increase Nursing Workforce Diversity.

The purpose of this study was to understand changes in knowledge and opinions of underserved American Indian and Hispanic high school students after attending a 2-week summer pipeline program using and testing a pre/postsurvey. The research aims were to (a) psychometrically analyze the survey to determine if scale items could be summed to create a total scale score or subscale scores; (b) assess change in scores pre/postprogram; and (c) examine the survey to make suggestions for modifications and further testing to develop a valid tool to measure changes in student perceptions about going to college and nursing as a result of pipeline programs. Psychometric analysis indicated poor model fit for a 1-factor model for the total scale and majority of subscales. Nonparametric tests indicated statistically significant increases in 13 items and decreases in 2 items. Therefore, while total scores or subscale scores cannot be used to assess changes in perceptions from pre- to postprogram, the survey can be used to examine changes over time in each item. Student did not have an accurate view of nursing and college and underestimated support needed to attend college. However students realized that nursing was a profession with autonomy, respect, and honor.

Culturally competent care of patients with acute chest pain.

PURPOSE: To inform nurse practitioners (NPs) about the influence of culture on patients' responses to pain using the example of acute chest pain. DATA SOURCES: Selected clinical and research articles on pain and culture and the authors' clinical experiences providing care across a variety of cultures. CONCLUSIONS: There is very little written and even fewer studies on the connection of culture and the response to acute chest pain. This topic needs more attention by nurse researchers. Implications for practice If NPs are not aware that some patients may not demonstrate behavior typically expected in acute myocardial infarction, they may miss the diagnosis and fail to treat or refer these patients for immediate treatment.

Nursing and health sciences workforce diversity research using PhotoVoice: a college and high school student participatory project.

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities.

Advanced practice nursing education: challenges and strategies.

Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicine's "Future of nursing" report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change.

Using the generative nursing model to reframe nursing student transition to practice.

New nurses are leaving hospitals in record numbers after fulfilling their initial employment obligations. Reasons for turnover relate to job dissatisfaction in the form of stressful working conditions, disempowerment, insufficient resources, difficult working relationships, and poor management. The authors discuss an approach for preparing students to manage factors that lead to burnout and new nurse turnover using the Generative Leadership Model as a framework.

Community-based participatory research and American Indian/Alaska Native nurse practitioners: a partnership to promote adolescent health.

PURPOSE: To make recommendations for American Indian/Alaska Native (AI/AN) nurse practitioners (NPs) and university partners who are partnering on community-based participatory (CBPR) research projects. An example of a CBPR study using focus groups to assess an important adolescent health problem is used to illustrate opportunities and challenges for AI/AN NPs. DATA SOURCES: Thirteen focus groups were held with 95 participants on the reservation where the AI/AN NP was a member and working. Results indicated that a majority of the community represented in the focus groups were concerned about substance abuse among its youth. CONCLUSIONS: The NP faced several challenges, including remembering emotional events recounted during focus groups differently than participants. This necessitated debriefing and a recommendation to carefully form policies and procedures before collecting data to anticipate such events. By far, the benefit of the NP's involvement was her ability to identify key members for focus groups, to assist in tribal council meetings, and to schedule meetings. IMPLICATIONS FOR PRACTICE: CBPR research partnerships are enhanced by NPs that are members of the community. CBPR partnerships present opportunities for NPs and university faculty to work on relevant community problems together.

Retention of Native American nurses working in their communities.

PURPOSE: The purpose of this study was to describe the experiences of Native American nurses working in their tribal communities to address retention. DESIGN: An interpretive phenomenological study guided by a Native American research agenda and a Native American nursing practice model. METHODS: In-depth interviews with nine Native American nurses were conducted. Data analysis used interpretive phenomenological procedures including an iterative process with Native American consultants and researchers to develop themes. CONCLUSIONS: Native American nurses experienced a great deal of stress and illness as they attempted to fulfill their mission to help their people. The three themes were: (a) paying the price to fulfill my mission, (b) being and connecting holistically, and (c) transcending the system. Recommendations include strategies for nurse educators, tracking the ethnicity of nurses in each Indian Health Service area, documenting their reasons for leaving, and conducting further research to develop community-based interventions to improve retention.