Cultivating Sense of Belongingness Among Graduate Nursing Students: A Virtual Fitness Challenge.

ABSTRACT: Sense of belongingness in the academic environment has been associated with positive student outcomes and increased student success. To cultivate belongingness, graduate nursing students were invited to participate in a virtual fitness challenge. Sense of belongingness was measured through pre- ( n = 103) and post-intervention ( n = 64) surveys with three subscales: other students, faculty, and the university. Students reported improved sense of belongingness following the intervention for all subscales, with statistically significant improvements related to other students ( p = .007) and the university ( p = .023). A virtual fitness challenge may improve sense of belongingness among graduate nursing students.

Workplace Violence and Worker Well-Being: A Preliminary Cross-Sectional Study.

PURPOSE: To investigate the prevalence of workplace violence (WPV) in home health care and long-term care facilities (LTCFs) and explore the relationship between WPV and worker well-being. METHOD: A cross-sectional survey was conducted with health care workers in an agency that provided care in homes or LTCFs. Six measures of worker well-being were collected: satisfaction with work and life, work-related rumination, work/family conflict, burnout, and turnover intention. Surveys also assessed type and frequency of WPV. RESULTS: Seventeen participants completed surveys. Verbal abuse by patients was the most often experienced type of WPV. Employees who reported experiencing WPV had higher burnout and lower satisfaction with work and life. CONCLUSION: WPV routinely occurs in home health care and LTCFs and appears to be related to worker well-being. Facility managers who can control WPV will likely impact the well-being of employees. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Defining Research Funding Priorities: Emergency Nurses Association Foundation.

INTRODUCTION: Establishing research priorities provides focus and direction for limited resources among organizations and increasing impact in a focused area. The Emergency Nurses Association (ENA) Foundation sought to identify research priorities to guide funding decisions in its extramural grants program. METHODS: A modified Delphi research strategy was used to build consensus among ENA members and key leaders to determine research focus areas. Two Delphi rounds were conducted. In the first round, 81 emergency nurses participated in providing a list of potential research foci. In the second round, 221 emergency nurse leaders recommended which research topics should be prioritized. Descriptive statistics (frequencies, percentages) were calculated for each research topic. The topics were clustered together and rank ordered by frequency/percentage. RESULTS: Eight research priorities were identified: emergency department overcrowding, workplace violence, nurse well-being, appropriate use of the emergency department, new graduate training, mental health care, disaster training, and diversity, equity, and inclusion research. DISCUSSION: These identified research priorities offer direction for determining ENA Foundation funding priorities. In addition, the research priorities provide strategic direction to emergency nurse researchers to promote a rich depth of research that can make a meaningful impact to science and emergency nursing practice.

Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach.

BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

Characteristics of faculty mentoring in the Robert Wood Johnson Foundation Future of Nursing Scholars Program.

BACKGROUND: To address the need for faculty scientists, Robert Wood Johnson Foundation (RWJF) provided support for an accelerated PhD program: Future of Nursing Scholars (FNS). PURPOSE: To describe the experience of faculty mentoring PhD students in the RWJF FNS program pursuing a 3-year accelerated PhD degree, including faculty members' support activities for students, time commitment, student productivity in manuscript dissemination, and challenges and opportunities for supporting students. METHODS: Surveys were sent to faculty mentors of FNS to understand mentoring activities, strategies used, and mentee productivity. FINDINGS: Of 93 faculty mentors, they reported most FNS students (n = 61, 65.6%) completed a manuscript format dissertation. FNS students required academic/dissertation mentoring, with frequent emotional support and positive reinforcement. DISCUSSION AND CONCLUSION: Mentors reported providing more frequent mentoring and spent more time mentoring FNS students than with other PhD students. Alignment of the student's research to that of the faculty mentor was identified as valuable.

Qualitative Analysis of Workplace Assault Outcomes from the Perspectives of Emergency Nurses.

INTRODUCTION: Emergency nurses experience a myriad of negative consequences associated with workplace assault. The purpose of this study was to explore the experiences of emergency nurses using the Ecological Occupational Health Model of Workplace Assault. METHODS: A descriptive qualitative design was used for this study. Data from 167 emergency nurse participants who described an episode of workplace assault were analyzed using a conventional content analysis method. RESULTS: Fourteen codes emerged from the qualitative data that related to 4 categories for the theme, Outcomes of Workplace Assault. The category "Consequences of Assault to Patients and Visitors" was supported by the following codes: use of limit setting; being evicted or removed from the emergency department; having charges pressed or being arrested; use of restraints; and retaliation against aggressor. "Effects on the Worker" was supported by the following codes: physical outcomes and response; psychological outcomes and response; physical support from peers; apologies; and debriefing/supportive care. "Effects on the Workplace" was supported by the following codes: calling for and response by police or security; and visitor response, support, or assistance. "Effects on Patient Care" was supported by the following codes: impact to treatment and work productivity. DISCUSSION: Workplace assault in the ED setting is associated with consequences of workplace assault to patients and visitors as well as negative effects to emergency nurses, the workplace, and patient care. Emergency nurses need to seek and also offer emotional support after workplace assault. Providing support could serve as a deterrent to retaliation while minimizing potential adverse impacts to nurses' psychological health and work productivity.

Residential greenness, asthma, and lung function among children at high risk of allergic sensitization: a prospective cohort study.

BACKGROUND: While benefits of greenness to health have been reported, findings specific to child respiratory health are inconsistent. METHODS: We utilized a prospective birth cohort followed from birth to age 7 years (n = 617). Residential surrounding greenness was quantified via Normalized Difference Vegetation Index (NDVI) within 200, 400, and 800 m distances from geocoded home addresses at birth, age 7 years, and across childhood. Respiratory health outcomes were assessed at age 7 years, including asthma and lung function [percent predicted forced expiratory volume in the first second (%FEV1), percent predicted forced vital capacity (%FVC), and percent predicted ratio of forced expiratory volume in the first second to forced vital capacity (%FEV1/FVC)]. We assessed associations using linear and logistic regression models adjusted for community deprivation, household income, and traffic-related air pollution. We tested for effect measure modification by atopic status. RESULTS: We noted evidence of positive confounding as inverse associations were attenuated upon adjustment in the multivariable models. We found evidence of effect measure modification of NDVI and asthma within 400 m at age 7 years by atopic status (p = 0.04), whereby children sensitized to common allergens were more likely to develop asthma as exposure to greenness increased (OR = 1.3, 95% CI: 0.9, 2.0) versus children not sensitized to common allergens (OR = 0.8, 95% CI: 0.5, 1.2). We found consistently positive associations between NDVI and %FEV1 and %FVC which similarly evidenced positive confounding upon adjustment. In the adjusted regression models, NDVI at 7 years of age was associated with %FEV1 (200 m: ß = 2.1, 95% CI: 0.1, 3.3; 400 m: ß = 1.6, 95% CI: 0.3, 2.9) and %FVC (200 m: ß = 1.8, 95% CI: 0.7, 3.0; 400 m: ß = 1.6, 95% CI: 0.3, 2.8; 800 m: ß = 1.5, 95% CI: 0.1, 2.8). Adjusted results for %FEV1/FVC were non-significant except exposure at birth in the 400 m buffer (ß = 0.81, 95% CI: 0.1, 1.5). We found no evidence of effect measure modification of NDVI by atopic status for objective measures of lung function. CONCLUSION: Sensitivity to allergens may modify the effect of greenness on risk for asthma in children but greenness is likely beneficial for concurrent lung function regardless of allergic status.

Critical Clinical Events and Resilience Among Emergency Nurses in 3 Trauma Hospital-Based Emergency Departments: A Cross-Sectional Study.

INTRODUCTION: Emergency nurses experience occupational stressors resulting from exposures to critical clinical events. The purpose of this study was to identify the critical clinical events for emergency nurses serving 3 patient populations (general, adult, pediatric) and whether the resilience of these nurses differed by the patient population served. METHODS: This study used a cross-sectional survey design. A total of 48 emergency nurses were recruited from 3 trauma hospital-based emergency departments (general, adult, pediatric). Clinical Events Questionnaire, Connor-Davidson Resilience scale, and an investigator-developed demographic questionnaire were used to collect data from respondents. RESULTS: All respondents were female (n = 48, 100%), and most were White (n = 46, 96%). The average age of participants was 39.6 years, the average number of years as a registered nurse was 12.7 years, and the average number of years as an emergency nurse was 8.8 years. Clinical events considered most critical were providing care to a sexually abused child, experiencing the death of a coworker, and lack of responsiveness by a colleague during a serious situation. The least stress-provoking event was incidents with excessive media coverage. Nurses were less affected by the critical events they experienced more frequently at work. Nurses in the 3 trauma settings had high level of resilience, with no statistically significant differences between groups. DISCUSSION: The occupational stress from exposure to significant clinical events varied with the patient population served by emergency nurses. It is important that interventions be adopted to alleviate the effect of work-related stressors and promote the psychological health of emergency nurses.

Residential surrounding greenness and self-reported symptoms of anxiety and depression in adolescents.

BACKGROUND: Evidence on the relationship between exposure to greenness and adolescent mental health is limited. The purpose of this study was to examine the association between greenness throughout childhood and mental health at age 12 years. METHODS: We assessed greenness using the satellite-based measure of Normalized Difference Vegetation Index (NDVI) within 200m, 400m, and 800m of home address at birth, age 12 years, and across childhood (averaged for each year from birth to age 12) among the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) cohort. Self-reported symptoms of anxiety and depression were assessed at age 12 years using the Spence Children's Anxiety Scale (SCAS) and Children's Depression Inventory 2 (CDI 2), respectively. Associations were estimated using linear regression, adjusting for covariates including traffic-related air pollution, neurological hazard exposure, blood lead level, household income, and community deprivation. RESULTS: In adjusted models, NDVI was largely not associated with self-reported anxiety and depression symptoms, except for the SCAS separation anxiety subscale at 400m and 800m (0.1 unit increase mean NDVI 400m: ß = -0.97, 95% CI: -1.86, -0.07; 800m: ß = -1.33, 95% CI: -2.32, -0.34). CONCLUSION: While we found no direct relationship between greenness and overall symptoms of anxiety and depression in adolescents upon adjustment for relevant covariates at the 200m distance, greenness may lesson symptoms of separation anxiety within 400m and 800m distance from the home address at age 12 years. Future research should examine mechanisms for these relationships at the community- and individual-level.

Interruption of initial patient assessment in the emergency department and its effect on patient perception of care quality.

BACKGROUND: Triage is a critical first step in appropriately caring for patients in the emergency department (ED). Patients' assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction. OBJECTIVE: The purpose of this study was to determine how the frequency and duration of interruptions during triage are associated with errors, patient satisfaction and patient's perception of the care they received. METHODS: Prospective, observational, cohort study conducted in the ED of a Level 1 trauma center. Interruptions were measured using time-and-motion observations of triage interviews performed by nurses and physicians. Patients were surveyed immediately after triage interviews were complete. RESULTS: Surveys were completed for 178 observations. In total, 62.9% of the observations were interrupted between 1 and 5 times. While interruptions did not significantly influence patient satisfaction directly, interruptions positively influenced triage duration, which was negatively associated with patient satisfaction. Increased errors were associated with increasing frequency of triage interruptions. Triage interruptions were not associated with either patient satisfaction or perceived caregiver competence. Overall, the majority (76.6%) of patients were satisfied with their care; patient satisfaction was associated with the perceived competency of caregivers but was not associated with errors. CONCLUSION: Interruptions are associated with increased errors and delays in patient care. Although increased triage duration adversely affected patient satisfaction, patients' perceptions were not influenced by interruptions. While patient satisfaction is essential, a lack of association between patient satisfaction and errors suggests that using patient satisfaction as a measure of care quality may omit important safety information.

"We cannot stop smoking": Female university students' experiences and perceptions.

BACKGROUND: While findings are available about smoking in young females, there is a dearth of research reporting this problem among Jordanian females, particularly university students. Also, there is lack of studies that describe the daily experience and the causative factors for smoking among female university students. PURPOSE: The purpose of this study is to describe the experience of smoking as perceived by female Jordanian university students. In addition, this study aimed to describe the predisposing factors for initiating smoking and feelings toward that experience. METHOD: A descriptive qualitative study was employed. A purposive sample of 12 female Jordanian university students who smoke cigarettes were asked to participate in this study. A semi-structured, face-to-face interviews were conducted. RESULTS: Five themes of the study included: (1) living and enjoying smoking with other females, (2) hazardous effect of smoking, (3) our culture stigmatizing female smoking, (4) why we don't stop smoking, and (5) strategies to combat smoking among females. CONCLUSION: Female university students disclosed peer pressure and stress as intensifying factors for smoking. Also they were unable to quit smoking because they were attached and addicted to smoking cigarettes. STUDY IMPLICATIONS: The findings of our study have several implications for nursing education, policymaking, and practice. An important target would be to motivate university students who are smokers to attempt smoking cessation leveraging cultural leaders as role models. Policy makers also should revise policies related to importing and taxation of cigarettes is essential. In addition, policy makers should enforce legislation for smoking fee areas and prevention of smoking in closed areas.

A National Survey of Secondary Traumatic Stress and Work Productivity of Emergency Nurses Following Trauma Patient Care.

BACKGROUND: Secondary traumatic stress is common for emergency nurses working in trauma care, but it is unknown whether this secondary traumatic stress negatively correlates to work productivity. OBJECTIVE: The purpose of this research was to examine the relationship between secondary traumatic stress and work productivity of emergency nurses who provide trauma patient care in the emergency department. METHODS: This study used a cross-sectional survey design with a systematic random sample of emergency nurses. Respondents (N = 255) completed the Impact of Events Scale-Revised (IES-R) and the Healthcare Productivity Survey (HPS) on the basis of trauma patient care within the preceding 30 days. A 2-tailed Pearson correlation was calculated to explore the relationship between secondary traumatic stress and work productivity for emergency nurses providing trauma patient care. RESULTS: Mean IES-R score was 19.1, and HPS score was 2.7. About 38% of respondents reported high secondary traumatic stress, and 29% reported decreased work productivity. Although overall correlation between IES-R and HPS was not significant, IES-R-Intrusion was significantly correlated with HPS-Cognitive Demands (p = .003) and HPS-Safety and Competency (p = .011), IES-R-Avoidance with HPS-Safety and Competency (p = .003), and IES-R-Hyperarousal with HPS-Cognitive Demands (p = .002) and HPS-Handle/Manage Workload (p = .015). CONCLUSIONS: Secondary traumatic stress and decreased work productivity were significant problems for some emergency nurses. To address this problem, employers can provide stress reduction and management techniques to emergency nurses providing trauma patient care. In addition, emergency nurses need to be proactive in seeking social support and using stress mitigation and reduction programs.

How does workplace bullying influence nurses' abilities to provide patient care? A nurse perspective.

AIMS AND OBJECTIVES: To explore how workplace bullying influences nurses' abilities to provide patient care. BACKGROUND: Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. DESIGN: Qualitative descriptive study. METHODS: Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. RESULTS: Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. CONCLUSIONS: Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. RELEVANCE TO CLINICAL PRACTICE: Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.

Effect of greenness on asthma in children: A systematic review.

Greenness such as trees, plants, and shrubs may positively influence mental and physical health, but the relationship between greenness and asthma is poorly understood. Because asthma is the most prevalent child respiratory disease internationally, elucidating the role of greenness may substantially benefit public health. The purpose of this systematic review was to synthesize findings related to effects of greenness on asthma in children. Following PRISMA guidelines, six databases were searched for international publication of primary research results relevant to the relationship between greenness and child asthma. Of 82 initial results, seven articles remained after removal of duplicates and applying exclusion criteria. Six reported no direct association between greenness and child asthma, while one found increased greenness protective for asthma. None found a negative direct association between greenness and child asthma. Evidence supported benefits of greenness on child asthma through mediation of factors such as exposure to tobacco smoke, high traffic volume, and difficult family relationships. Even without a direct association, greenness can be considered a public health asset as it may mediate other factors contributing to asthma in children. Public health nurses can use these findings to educate clients and partners while advocating for policies to protect greenness.

Nurses on the move: Robert Wood Johnson Foundation nurse faculty scholars and their action on the social determinants of health.

OBJECTIVE: Medical care alone cannot adequately improve population health or eliminate inequities; social determinants of health (SDH) must be addressed. This study's purpose was to describe the research, teaching, service, and clinical practice activities implemented by RWJF Nurse Faculty Scholars to act on the SDH. DESIGN: A cross-sectional survey design was used with a sample of RWJF Nurse Faculty Scholars, chosen because they were provided specialized mentoring, grants, and other support that allowed them to explore SDH. RESULTS: Respondents (n = 57) addressed SDH in their research (86.0%), teaching (68.4%), service (66.7%), and clinical practice (33.3%). Leading research foci were quality of health care (56.1%), social and physical environmental stressors (54.4%), and access to health care services (49.1%). Leading SDH areas in teaching were discrimination in society against vulnerable populations (54.4%), quality of health care received by vulnerable populations (50.9%), and vulnerable populations' access to health care services (50.9%). Service activities included addressing discrimination against diverse populations. Leading SDH areas in clinical practice were quality of health care received by vulnerable populations (28.1%), vulnerable populations' access to health care services (22.8%), and discrimination in society against vulnerable populations (19.3%). Respondents also addressed SDH through personal mentoring (71.9%); efforts to recruit and/or retain underrepresented faculty (59.6%); developing a diverse pipeline of nurses (59.6%); and participation on a diversity committee (40.4%). CONCLUSION: The RWJF Nurse Faculty Scholars were able to leverage their awards to address SDH; however, further research is needed to assess the impact of the SDH work conducted. Knowledge from this study can be used as a road map for SDH elements and areas of professional work that nurses and other health professionals could address SDH in research, teaching, service, and practice.

Effects of Interruptions on Triage Process in Emergency Department: A Prospective, Observational Study.

For 130 million people seeking emergency treatment in the United States, incomplete or inaccurate triage examination can result in delays, which could compromise patient outcomes. The purpose of this study was to identify triage interruptions and determine how interruptions affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes will allow nurses and other health care providers to develop interventions to mitigate the impact.

Review and application of the National Academies of Sciences, Engineering, and Medicine bullying or cyberbullying recommendations for screening and lesbian, gay, bisexual, and transgender youth.

Bullying has been long seen as a natural part of childhood and adolescence. However, a growing body of evidence suggests bullying and now cyberbullying may inflict harm or distress on targeted youth including physical, psychological, social, or educational harm. The purpose of this paper is to endorse the National Academies of Sciences, Engineering, and Medicine statement, summarize the report, and apply the recommendations to screening lesbian, gay, bisexual and transgender youth related to bullying and cyberbullying; line 11 change exemplified to discussed. Screening for bullying against youth; lesbian, gay, bisexual, and transgender youth as a high-risk group for bullying victimization; and implications to address bullying against youth are exemplified. Nurses need to promote policies that foster inclusive, supportive, safe, and healthy schools and environments for youth.

A Review of the Management of Loss of Pregnancy in the Emergency Department.

INTRODUCTION: Women frequently seek ED care for complications in early pregnancy, including loss of pregnancy. This review evaluates the current literature and discusses the care of patients experiencing loss of pregnancy in the emergency department. METHODS: A review of pertinent studies identified through multiple database searches was conducted to determine the existing body of knowledge for the care of ED patients diagnosed with loss of pregnancy. Each of the studies was examined for inclusion criteria and a subsequent analysis of the included studies identified themes related to the care of the women. RESULTS: Thirty-two original research articles and systematic reviews published between 1990 and 2016 were included in the review. Eleven articles addressed recommendations for clinical practice, 5 reported statistics related to pregnancy outcome and clinical presentation, 4 discussed the use of speculum examinations, 4 discussed interventions to decrease ED length of stay, and 3 investigated the use of ultrasound in the emergency department. Only 5 of the articles reviewed discussed emotional support and/or experiences of women with loss of pregnancy in the emergency department. CONCLUSION: Although there are multiple recommendations for the clinical management of loss of pregnancy in the emergency department, the psychological and emotional support of women was addressed infrequently. Additional studies investigating holistic care would be beneficial for ED providers in the management of early loss of pregnancy.