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.

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.

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.

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.

Reflective Responses Following a Role-play Simulation of Nurse Bullying.

A qualitative exploratory design was used for this study to evaluate role-play simulation as an active learning strategy. The context for the role-play was bullying in nursing practice. Following a simulation, 333 students from five college campuses of three universities completed a reflection worksheet. Qualitative thematic findings were personal responses, nonverbal communications exhibited, actions taken by participants, and the perceived impact of bullying during the simulation. Role-play simulation was a highly effective pedagogy, eliciting learning at both the cognitive and affective domains.

An evaluation of forums for discussions on inclusion in a college of nursing.

BACKGROUND: The lack of diversity in the nursing profession could be an outcome of unconscious biases. Forums allowing the personal reflection and discourse of these unconscious biases are needed in order for a diverse and inclusive learning environment to exist. PURPOSE: The purpose of this study was to describe the experiences of students, staff, faculty members, and guests participating in a forum on diversity and inclusion. METHODS: An exploratory design was used to understand the experiences of college of nursing students, staff, faculty members, and guests who participated in a diversity and inclusion intervention sponsored by the college of nursing's Diversity Advisory Council. Attendees to 12 diversity book club, movie night, and speaker series' sessions completed a program evaluation tool. Responses to open-ended items were analyzed using a constant comparative analysis method.Responses from 197 participants were analyzed. Eight book club, seven movie night, and six speaker series' themes were derived from the data including Humanness is Universal, Personal Connection, The Problem, Awareness of Disparity, Make a Difference, and No Change. DISCUSSION: Participants at each session critically dialogued about their conscious and unconscious biases. The study findings show that participants also were able to document changes to their knowledge, attitudes, and behaviors in relation to the historically oppressed populations focused on during the intervention activities. CONCLUSION: Education entertainment as used in this study was a valuable mechanism for hosting conversations about diversity and inclusion.

Chart It to Stop It: A Quality Improvement Study to Increase the Reporting of Workplace Aggression.

A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (P = .06). Reasons for reporting were severity of incident and being asked to report. Reasons for not reporting were incidents being too minor and no action would be taken. Future change efforts need to consider multiple modes of communication to promote adoption of reporting and inclusion of administrators in efforts to improve reporting.

Standardizing the care of occupational blood-borne pathogen exposures to reduce unnecessary use of the emergency department.

PROBLEM: Care of health care workers with a blood-borne pathogen (BBP) exposure who seek treatment in emergency departments needs to be standardized. A standardized system may lead to better care for exposed individuals. METHODS: An interprofessional process was developed to standardize care of occupational BBP exposures in nonemployees. A health planning program design was conducted to compare outcomes before and after the standardized process was enacted. RESULTS: Standardizing treatment of occupational exposures provided more efficient care for exposed nonemployee workers and allowed an improved use of ED resources. IMPLICATIONS FOR PRACTICE: Programs developed to improve utilization of the emergency department have a greater chance of success when developed using an interprofessional, collaborative approach.

Implementation of a comprehensive intervention to reduce physical assaults and threats in the emergency department.

INTRODUCTION: The purpose of this study was to test the effectiveness of a comprehensive program to reduce the incidence of workplace violence (WPV) against ED providers by patients and visitors. METHODS: An intervention study was conducted with 3 intervention and 3 comparison emergency departments. Participants completed monthly surveys during an 18-month period to measure violent event rates before and after the WPV intervention implementation. Descriptive statistics were used to describe violent events. Analysis of variance was used to assess if the emergency departments participating in the WPV intervention experienced a significant reduction in violence rates compared with nonintervention emergency departments. RESULTS: On average, participants experienced more than 6 incidents of violence during the 18-month study period. Although the study hypothesis was not supported, 2 intervention sites had a significant decrease in violence. DISCUSSION: This study emphasizes the risk of WPV to ED workers and highlights the need for prevention programs. Future research needs to be conducted to test additional comprehensive WPV prevention interventions.

Healthcare Workers' Adherence and Attitudes Toward the Adherence to COVID-19 Precautionary Guidelines Post-Vaccination: A Cross-Sectional Pilot Study.

BACKGROUND: Healthcare workers (HCWs) have shown increased adherence to infection control practices during the COVID-19 pandemic. However, there is a need to assess their adherence to and attitude toward COVID-19 guidelines after being vaccinated. The purpose of this pilot study is to assess the adherence to and attitudes toward the adherence to COVID-19 guidelines among HCWs who have been vaccinated. METHODS: A retrospective cross-sectional design was employed. One hundred and eight participants were recruited via email from a medical center in the Midwest United States. The participants completed online surveys measuring the level of adherence to and attitudes toward the adherence to COVID-19 guidelines. The response rate was 5.4%. FINDINGS: Most participants were female (73.1%) and white (82.4%). The participants adhered to COVID-19 guidelines 79.7% of the time. The most frequently followed guidelines were performing hand hygiene, wearing a respirator or well-fitting mask in areas where patients may be present, and wearing eye protection when entering the room for a patient with suspected or confirmed COVID-19 infection. The least performed precautions were performing COVID-19 testing after exposure to a suspected or confirmed COVID-19 case and maintaining social distancing. There was a significant decrease in the perceived importance of adherence to COVID-19 precautions post-vaccination (p <.001, 95% CI [-0.78, -0.35]). CONCLUSIONS: The increased perception of safety after receiving COVID-19 vaccination may negatively influence HCWs' adherence to COVID-19 precautionary guidelines. Continuous education and monitoring of HCWs' safety practices are important to influence HCWs' attitudes to adhere to COVID-19 precautions, particularly after vaccination.

OHIO FARMWORKERS AND HEAT-RELATED ILLNESS PREVENTION: A FOCUSED ETHNOGRAPHY.

OBJECTIVE: Understand farmworkers' knowledge of heat-related illness prevention and behavioral and cultural factors related to HRI prevention. METHODS: The Theory of Planned Behavior and an ethnographic study design were used. Data collection consisted of observations and interviews. Recorded interviews were conducted with participants and transcribed verbatim. Transcribed interviews were analyzed using thematic analysis. RESULTS: Overall, 14 interviews were conducted, and four themes emerged: acquisition and interpretation, perception, interoception, and action. Other findings included an insufficiency of formal training and the absence of knowledge of a protocol for acclimatization. CONCLUSION: Better education and training are needed in this occupation, especially regarding acclimatization. Occupational health professionals must lead efforts to develop HRI plans and measures to ensure acclimatization protocols are adopted in the workforce.

Prospective study of violence against ED workers.

BACKGROUND: Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events. OBJECTIVE: The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity. METHODS: A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used. RESULTS: Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) (P = .0017) and patient care assistants (P < .05). The RNs felt less safe than the MDs (P = .0041). The MDs felt more confident than the RNs in dealing with violent patients (P = .013). The RNs were more likely to experience acute stress than the MDs (P < .001). Acute stress reduced productivity (P < .001). CONCLUSION: Emergency department HCWs are frequent victims of violence perpetrated by visitors and patients. This results in injuries, acute stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties.

Pediatric emergency nurses' self-reported medication safety practices.

Preventable adverse events occur more frequently in areas such as the emergency department with medication errors as the most frequently reported errors. A cross-sectional survey design was used to gather descriptive data of medication safety practices used by pediatric emergency nurses in the Midwest U.S. Participants completed an anonymous survey to identify nurses' understanding, implementation, and barriers to implementing the National Patient Safety Goals (NPSGs) for medication safety. Data were analyzed using descriptive statistics. Participants identified several barriers to adopting and implementing the NPSGs. Additional interventions are needed to reduce the barriers to medication safety practices for pediatric emergency nurses.

Stressful incidents of physical violence against emergency nurses.

Physical violence against nurses has become an endemic problem affecting nurses in all settings. The purpose of this study was to describe acts of physical violence against emergency nurses perceived as stressful using a qualitative descriptive design with a national sample of emergency nurses. The guiding conceptual model for the study was the Ecological Occupational Health Model of Workplace Assault. Narrative accounts of physical violence were analyzed using a constant comparative analysis method. Key findings included risks related to employee, workplace, and aggressor factors, and descriptions of physical violence. Discussion of the study findings suggests that efforts to prevent violence and promote workplace safety need to focus on designing work environments that allow for the quick egress of employees, establishing and consistently enforcing policies aimed at violence prevention, and maintaining positive working relationships with security officers. While patients with mental health or substance use complaints are deemed most likely to commit physical violence, they are not the only patients to become violent. Risk reduction efforts should target all patients and visitors.

Using proactive coping to manage the stress of trauma patient care.

Some emergency nurses are resilient following trauma patient care, while others report severe traumatic stress. The purpose of this study was to determine proactive coping behaviors used by emergency nurses to prevent traumatic stress. A cross-sectional research design was used with a national sample of emergency nurses. Participants completed a 5-component Web-based survey. Data analyses included 1-tailed partial correlations. The correlation of proactive coping score to traumatic stress was significant. Proactive coping strategies that focus on the planning and preparation to provide care for traumatically injured patients may be effective at preventing traumatic stress.