Music in Academia for Undergraduate Nursing Students: A Randomized Controlled Study.

ABSTRACT: Over time, unmanaged stress and anxiety can potentially impact nursing students' health and academic performance. A randomized controlled approach explored the effects music has on stress and anxiety levels in undergraduate nursing students. Students ( n = 89) were randomized into two recording groups, and variables such as demographics, heart rate, blood pressure, and State-Trait Anxiety (STAI) scores were measured and compared. There were significant differences in mean STAI scores ( p < .001), in heart rate means ( p < .000), and in mean blood pressures ( p < .001). Music can have an influence on students' physiological and/or psychological responses while also promoting them to engage in self-care.

Role of Magnet®-recognized hospital nurse managers in implementing evidence-based practice: A mixed-method study.

BACKGROUND: Healthcare systems recognize evidence-based practice (EBP) as the prestigious standard for providing safe and high-quality patient care, nursing excellence, and Magnet Recognition. Despite the well-documented benefits, implementation of EBP is inconsistent and remains elusive in the US and throughout the world and many patients still fail to receive evidence-based care. The literature revealed a huge gap between nursing science and practice but provided evidence that nurse managers (NMs) had a pivotal leadership role in implementing EBP. AIM: To gain a deeper understanding of Magnet-recognized hospital nurse managers' (MRHNMs) leadership roles, the influencing factors, and their experience in implementing EBP to enhance EBP initiatives and sustain Magnet recognition. METHOD: This mixed-method study guided by Goodall's (Australasian Psychiatry, 2016. 24, 231) theory of expert leadership used a sequential explanatory method with a quantitative-driven design based on a national correlational survey augmented by a qualitative descriptive component using semi-structured interviews. RESULTS: The findings of the study demonstrated that MRHNMs had a 54.6% effective leadership role in implementing EBP and produced numerous themes indicating that MRHNMs did implement EBP with struggle. MRHNMs in this study viewed EBP as a healthcare priority and leadership of NMs is necessary to promote EBP. However, lack of knowledge, difficulties with the EBP process, time constraints, and staffing issues negatively impacted EBP. Postgraduate degree, formal EBP education, critical care units as workplace, collaboration with doctorally prepared nurses, and Magnet culture enhanced EBP among MRHNMs. LINKING EVIDENCE TO ACTION: EBP is essential for Magnet recognition and is a hallmark of nursing excellence, however, is a complex and challenging process. The leadership of NMs is necessary to shape evidence-based care, and NMs require EBP preparation during leadership training, necessary resources, and time to complete the EBP process. EBP cannot become a reality without leaders being engaged, supportive, and persistent.

Moral distress in clinical research nurses.

Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses.Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses.Research design: This was a descriptive quantitative study to measure moral distress in clinical research nurses using the Measure of Moral Distress - Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected.Participants and research context: Registered nurses working in the clinical research nurse role (N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson's correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables.Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman's University. A consent statement was included, and completion of the questionnaire was construed as consent.Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0-354. Moral distress scores were negatively correlated with clinical research nurse age (r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach's alpha of 0.93.Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis.

BACKGROUND: Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. METHODS: A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. RESULTS: Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. CONCLUSION: WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.

RESUMEN: ANTECEDENTES: Las mujeres que viven con el VIH (MVV) carecen de información basada en evidencias sobre las opciones reproductivas mientras son presionadas por la familia, los profesionales de la salud y los miembros de la comunidad para renunciar a la idea de tener hijos. Como las intenciones reproductivas de las MVV no son comprendidas, las conductas estigmatizantes las obligan a ocultar su enfermedad para evitar el rechazo de su familia, pareja y grupos sociales. El cumplimiento de las normas sociales, el miedo al estigma y la discriminación influyen en su experiencia. La presente investigación está compuesta por estudios cualitativos que de forma individual carecen de la perspectiva de síntesis necesaria para guiar el desarrollo de las intervenciones. El propósito de este estudio fue sintetizar la evidencia para explicar el proceso de toma de decisiones reproductivas para las MVV en los países desarrollados. MéTODOS: Se realizó una revisión sistemática con síntesis de investigación cualitativa mediante búsquedas en 10 bases de datos electrónicas (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo y SciELO). Los estudios publicados en revistas de entre 1995 y 2019 que contuvieran datos cualitativos sobre la toma de decisiones reproductivas entre las MVV en países desarrollados fueron elegibles para su inclusión. Se consideraron países desarrollados aquellos que pertenecieran a la OCDE con el objetivo de comparar condiciones de bienestar social y estabilidad económica. Las listas de verificación CASP y JBI para la investigación cualitativa se utilizaron para evaluar la calidad del estudio y la integridad metodológica. Para la síntesis se utilizaron técnicas de análisis temático y metanálisis cualitativo. RESULTADOS: En la síntesis se incluyeron veinte estudios de 12 países desarrollados. Los hallazgos se organizaron en 3 metatemas de 15 temas y 45 subtemas, incluyendo: (1) Identidad fragmentada, (2) Barreras, inequidades y desinformación, (3) Afrontamiento, resiliencia y apoyo. La toma de decisiones reproductivas se percibió como un proceso complejo influenciado por factores facilitadores y barrera. Los facilitadores ayudaron a las MVV a afrontar su nueva realidad para volverse más resilientes, mientras que las barreras hicieron que su situación fuera más difícil de manejar. CONCLUSIóN: Las MVV enfrentan la toma de decisiones reproductivas con déficits de conocimiento y apoyo social limitado. Es necesario adoptar un enfoque holístico de atención integral con asesoramiento multidisciplinario para acompañar a las MVV. Los clínicos podrían beneficiarse del desarrollo profesional para aprender a estar verdaderamente presentes para las MVV, participando en reflexiones, demostrando compasión y comprendiendo sus situaciones. Las guías de práctica clínica basadas en la evidencia deben adaptarse a las necesidades de planificación familiar y salud sexual y reproductiva de las MVV. Plain Language Summary Women living with HIV can become pregnant and deliver a healthy baby due to advances in medicine. Being a mother is an important role that gives meaning to life for most women. For women living with HIV thinking about having a baby is difficult because HIV complicates many areas of daily living. When women living with HIV try to speak with physicians and nurses about having a baby, they often do not feel supported and report feeling stigmatized. This review of the scientific literature summarizes the experiences of women living with HIV in developed countries as they considered having a baby. Ten electronic databases were searched for studies published between 1995 and 2019 reporting interviews with women living with HIV about becoming pregnant and having a baby. From the 4519 articles identified, 20 were included for review with 1395 participants from 12 developed countries. After abstracting and analyzing the interviews, three themes were developed to summarize the process described by women living with HIV as they considered pregnancy and the possibility of having a baby, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, and (3) Coping, resiliency, and support. When women living with HIV consider having a baby, they need to feel comfortable and safe speaking with physicians and nurses about family planning. They also need more support from their partner, as well as family and friends. Strategies need to be implemented to improve the family planning process for women living with HIV, including education health care providers about speaking to women about pregnancy and having a healthy baby.

"Moms and babies first"-A historical overview of the Association of Women's Health Obstetric and Neonatal Nurses.

Professional nursing bodies have had a well-established, collective history of advancing the nursing profession through career development, advocacy, and continuing education. The purpose of this review paper is to provide a historical overview of these entities, leading up to the formation of specialty nursing associations and the emergence of the Association of Women's Health Obstetric and Neonatal Nurses (AWHONN). The Association of Women's Health Obstetric and Neonatal Nurses is a leader in research, education, and advocacy in the field of women's health, obstetric, and neonatal nursing that has focused on promoting the health and well-being of women, newborns, and their families for the past fifty years.

The Decision-Making Experiences of Caregivers Regarding Feeding Tube Placement in Community-Dwelling Adults: A Descriptive Phenomenological Study.

Percutaneous endoscopic gastrostomy feeding tube placement is multifactorial and considered a lifesaving mechanism, which leads to a host of thoughts and feelings that affect the decision-making experience. As people live longer and the population ages, these decisions often involve the caregivers who have their own experience and therefore can result in caregiver burden and anxiety. A descriptive phenomenological study was conducted to describe and understand the caregiver's decision-making experience regarding percutaneous endoscopic gastrostomy feeding tube placement in community-dwelling adults. Edmund Husserl's philosophical underpinnings were utilized in conjunction with Colaizzi's (1978) method of data analysis to maintain the rigor of the study. Sixteen adult caregivers of patients from six rehabilitation and skilled nursing facilities were interviewed using a semistructured interview guide. The audio-recorded interviews were transcribed and thematic analysis was conducted. The study results yield four main themes: "Survival ... that was the determining factor"; "The doctor decided"; "More education ... just make sure they understand"; and "It makes me very scared." Implications for practice, policy, and future research are thoroughly discussed.

A Systematic Review of the Literature on Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a multi-organ system autoimmune disease of significant complexity, morbidity, and mortality. It is estimated that SLE affects nearly 1.5 million persons in the United States and is 3 to 4 times more prevalent in Black females than White females. The purpose of this literature review is to appraise relevant evidence on the epidemiology, burden, mortality rate, clinical manifestations, and impact of delayed diagnosis in at-risk populations; also to gain insight into the barriers to early diagnosis of SLE by primary healthcare providers. The literature was searched using scientific databases such as PubMed and EMBASE for relevant peer-reviewed articles. A total of 24 articles were included in the synthesis of data. The literature review provided evidence-based findings of the effects of SLE with delayed diagnosis. There remains a paucity of high-quality research studies examining the significance of early recognition and diagnosis of systemic lupus.

Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014.

BACKGROUND: Variations in care for pregnant women have been reported to affect pregnancy outcomes. METHODS: This study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored. RESULTS: Medicaid beneficiaries enrolled at AABC sites had diverse socio-behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low-risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery-led prenatal care, and 84% with midwifery- attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4-times greater risk of cesarean birth among medically low-risk childbearing Medicaid beneficiaries. CONCLUSIONS: The birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.

Journey to Becoming a Neonatal Nurse Practitioner: Making the Decision to Enter Graduate School.

BACKGROUND: Neonatal nurse practitioners (NNPs) play an important role in caring for premature and ill infants. Currently, there is a shortage of NNPs to fill open positions. Understanding how nurses decide to become NNPs will help practicing nurse practitioners, managers, and faculty encourage and support nurses in considering the NNP role as a career choice. PURPOSE: To describe how nurses decide to enter graduate school to become nurse practitioners. METHODS: A qualitative study using semistructured interviews to explore how 11 neonatal intensive care unit nurses decided to enter graduate school to become NNPs. RESULTS: Key elements of specialization, discovery, career decision, and readiness were identified. Conditions leading to choosing the NNP role include working in a neonatal intensive care unit and deciding to stay in the neonatal area, discovering the NNP role, deciding to become an NNP, and readiness to enter graduate school. Important aspects of readiness are developing professional self-confidence and managing home, work, and financial obligations and selecting the NNP program. IMPLICATIONS FOR PRACTICE: Neonatal nurse practitioners are both positive role models and mentors to nurses considering the role. Unit managers are obligated to provide nurses with opportunities to obtain leadership skills. Faculty of NNP programs must be aware of the impact NNP students and graduates have on choices of career and schools. IMPLICATIONS FOR RESEARCH: Exploring the decision to become an NNP in more geographically diverse populations will enhance understanding how neonatal intensive care unit nurses decide to become NNPs.

Rapid assessment to identify and quantify the risk of intimate partner violence during pregnancy.

BACKGROUND: Abuse during pregnancy is common and affects upwards of one in six pregnant women worldwide. The objective of this study is to describe the demographics, frequency, and severity of abuse, and the risk of murder for women who report abuse during pregnancy compared with women who do not report abuse. METHODS: A total of 300 women seeking assistance for partner abuse were recruited to participate in a 7-year prospective study. Of the 300 women, 50 reported they had been pregnant within the last 4 months; 25 of the women (50%) reported they were "beaten" during the pregnancy; and 25 women (50%) reported they had not been "beaten." Analysis was completed on differential severity for abuse and risk for murder between the two groups. RESULTS: Women reporting abuse during pregnancy had statistically significant (p < 0.001) higher scores for Threat of abuse, F(1, 49) = 14.37, p < 0.001; Physical abuse, F(1, 49) = 21.21, p < 0.001; and Danger for murder weighted F(1, 49) = 22.99, p < 0.001. All effects sizes were large. CONCLUSION: Women abused during pregnancy are at greater risk for further abuse and in severe danger for murder. To ensure the safety of pregnant women, screening policies are essential.

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention.

OBJECTIVE: To measure the impact of shelter intervention and protection orders on the mental health functioning, resiliency, and further abuse of documented and undocumented immigrant women and their children in Houston, Texas, United States. METHODS: A prospective cohort study initiated in 2011 examined a subsample of 106 immigrant mothers, primarily from Mexico and Central America, and evaluated their functioning with a battery of 13 well-established instruments as they accessed either shelter or justice services; followed-up was conducted 4 months later to measure improvement. Data were analyzed with a series of repeated measures 2 x 2 x 2 factorial analysis of variance tests. RESULTS: Large effect size improvements were observed in abused immigrant women's mental health, resiliency, and safety, regardless of whether the intervention accessed was safe shelter or justice services, and regardless of duration of shelter stay and whether or not a protection order was issued. Similarly, large effect size improvements were observed in child functioning, independent of which type of intervention, the duration of shelter stay, or the issuance of a protection order. CONCLUSIONS: Accessing protective services has the potential to improve the health of immigrant women and their children, regardless of documentation status. Global policy for improved access and acceptability of shelter and justice services is essential to promote immigrant women's safety and to maximize functioning of women and children.

Light for nurses' work in the 21st century: a review of lighting, human vision limitations, and medication administration.

A literature review was conducted to determine the state of the science related to medication errors and light. The limited literature is discussed in relationship to human vision and light needs. Little systematic action has been taken to increase nurses' awareness of the connection between lighting and potential medication errors. Implications for nursing practice and research about light conditions are provided. Interventions from other industries may aid nursing in making decisions about light conditions.

Women's functioning following an intervention for partner violence: new knowledge for clinical practice from a 7-year study.

Intimate partner violence affects one in three women worldwide, with women who experience violence almost twice as likely to experience poor mental health, especially depression, compared with women who are not abused. To learn the impact of interventions of safe shelter and justice services on improved mental health and behavior functioning, 300 abused women are interviewed every 4 months in a 7-year prospective study. For this paper, abuse, mental health and resiliency status of these women, 1 year after accessing services for the first time, are reported. Measures of mental health (depression, anxiety, post-traumatic stress disorder (PTSD), somatization), and adult behavioral functioning are reported. At 4 months following a shelter stay or justice services, a large effect size was measured for improvement in all mental health measures; however, improvement was the lowest for PTSD. All mental health measures plateaued at 4 months with minimum further improvement at 12 months. Both internal behavioral dysfunctions (withdrawal and somatic complaints) were worse with increased depressive symptoms, as were external behavioral dysfunctions (aggressive and rule-breaking behaviors). A concerning 39.2% of the women had clinical PTSD scores at 12 months following receipt of safe shelter or justice services, compared with a much lower percentage of women with clinical depression (14.2%), clinical somatization (9.4%), and clinical anxiety (13.5%). Depression was a significant positive predictor of internal and external behavioral dysfunctions, indicating that women who had higher levels of depression tended to report more internal dysfunctions (withdrawal, anxiety, somatization) and more external behaviors (aggression and rule-breaking).

Review of the literature: Acuity-adaptable patient room.

The acuity-adaptable patient room concept is an emerging care model in which a patient is cared for in the same room through discharge regardless of the patient level of acuity. Such transfer contributes to errors in communication, patient disorientation, dissatisfaction, and falls. In the acuity-adaptable patient room model, the varying levels of care are brought to the patient to eliminate or minimize these adverse outcomes. Comprehensive literature search was conducted through search engines, web pages of regulatory bodies, institution of authority and other disciplines, research, abstract presentations, and anecdotal reports as well as hand searches focusing on the outcomes of the acuity-adaptable patient room on patients. Forty eight articles were written presenting evidence of positive impact of the acuity-adaptable patient room on patients.

Acuity-adaptable patient room improves length of stay and cost of patients undergoing renal transplant: a pilot study.

The acuity-adaptable patient room concept is an emerging care model where patient is cared for in the same room from admission through discharge regardless of the patient level of acuity. After implementation of the care cluster strategy to support the implementation of an acuity-adaptable patient room, a descriptive study was conducted looking at so whether there will be a decreased length of stay and cost on patient cared for in the acuity-adaptable patient room compared to patients cared for in a transitional care process. Result of the study showed decreased length of stay of kidney transplant patients from 9.6 (11.0) days (before acuity-adaptable patient room) to 4.1 (1.3) days (acuity-adaptable patient room). Not only that the acuity-adaptable patient room improves patient outcome and cost but with the nursing competency preparation to support the implementation of the acuity-adaptable patient room, a hybrid nurse was created who possessed both critical care and medical-surgical skills. This can be a potential trend in the professional nurse model to address the health care challenges we face today in terms of nursing shortage, abbreviated plan of care, and facility operation efficiency.

Experiences of the transplant nurses caring for renal transplant patients in an acuity-adaptable patient room.

This article describes transplant nurses' experiences in caring for renal transplant patients in the acuity-adaptable patient room using Husserl's descriptive phenomenology. The setting was a twice-redesignated magnet urban tertiary center in the Southwest United States with 14 acuity-adaptable patient rooms. Audiotaped interviews were analyzed using Colaizzi's method and a purposive sample of 10 transplant nurses. Three theme clusters emerged that described the essence of the transplant nurses' experiences in caring for renal transplant patients in the acuity-adaptable patient room: Patient and family comfort: "...I think their anxiety of just not knowing what's going on-that need is being met." Nurse empowerment: "...Her urine output was going down to the 40s and so I had to call the surgeon recommending that we maybe change the normal saline to half normal for replacement." Acuity-adaptable patient room future potential: "I wish that all patients had this kind of access." The nurses felt empowered in caring for renal transplant patients in the acuity-adaptable patient room thereby creating a healing environment for the patient and the family.

Investigator reflections: A final debriefing following emotionally sensitive mirror research.

Peer debriefing in sensitive qualitative research is important for 2 reasons: study rigor and researcher emotional support. In this case study, the authors share a final debriefing following a study of the experience of viewing self in the mirror after a mastectomy. Each author/researcher shares, in her own words, her recollections of prestudy thoughts about the study. These thoughts stand in sharp contrast to poststudy realizations. These pre- and poststudy thoughts are a continuation of an audit trail that was maintained throughout the study. What was notable in this last debriefing was how the study shifted the researchers' understanding of the phenomenon under study and their use and discussion of the mirror in clinical practice. Lessons learned and implications for nursing are shared with the nursing community.

The lived experience of Chinese medical tourists receiving cancer care: A qualitative study.

AIM: The purpose of this study was to describe and explore the lived experience of Chinese medical tourists receiving cancer care in clinical settings in the United States. DESIGN: A qualitative phenomenological design. METHODS: In this study, Hermeneutic phenomenology was used to interview 11 participants on WeChat, a popular social media platform of China. Hermeneutic phenomenology methods and hermeneutic circles were used to analyse data. RESULTS: Five themes identified were: the application process involves various challenges; overcoming transportation and language barriers; feeling content with healthcare received in the United States; nearly perfect experience, except for long waiting times; and high cost of being a medical tourist. CONCLUSION: Despite the cost and complexity of cancer treatment, Chinese medical tourists valued their experience in US clinical settings. Although, they experienced real challenges, they overcame obstacles with self-determination and varied resources. Therefore, culturally appropriate healthcare is highly recommended. RELEVANCE TO CLINICAL PRACTICE: The findings of this study are relevant for clinical practice, particularly cancer care to medical tourists in the United States. To better support the Chinese medical tourists with cancer, various strategies and techniques, as reported in this study, could be helpful. It is highly recommended to provide healthcare providers to enable them to understand and respect the diversity norms of other cultures.