Taking High-Fidelity Simulation to the Next Level: Nursing in Nontraditional Environments.

ABSTRACT: Nurse educators must prepare nursing students to be competent first responders and providers in nontraditional situations. We developed a course that provides in-depth experiential instruction in disaster nursing, remote/austere nursing, and global health. The Nursing in Nontraditional Environments course provides nursing students with the knowledge and skills to provide quality care to patients in environments outside traditional hospitals and clinics. The course merges survival skills with austere care using evidence-based practice derived from the US Military and the Wilderness Medical Society.

Hospital nurses' perceptions of human factors contributing to nursing errors.

OBJECTIVE: The aim of this study is to understand the human factors associated with hospital errors to provide a framework to discuss why errors occur. BACKGROUND: Patient safety in hospitals has been a major focus in healthcare for the past 15 years. Errors still occur at an alarming rate. METHODS: A cross-sectional survey of 393 hospital-based registered nurses provided perceptions of 24 items relating to human errors in hospitals. Errors were assessed for likelihood, intervenability, importance, and common occurrence. RESULTS: Data revealed 4 themes that explained 55% of the variance in likelihood to cause an error: loss of focus, unhealthy environment, interpersonal deficits, and overwhelmed. Feeling swamped was most important but was not seen as intervenable. CONCLUSION: Managers must provide a way for nurses to feel empowered to intervene on error situations they believe are most likely, common, and important.

Expectations and self-efficacy of African American parents who discuss sexuality with their adolescent sons: an intervention study.

OBJECTIVE: Despite research that suggests parental communication may help deter high-risk sexual behavior among adolescents, parents report a lack of confidence in their ability to answer sexually related questions. The purpose of this study was to test the effect of a multimedia intervention on outcome expectations and perceived self-efficacy for the sex educator role for parents of African American adolescent males. DESIGN AND SAMPLE: A pilot study using mixed methods was conducted. A nonprobability sample (N = 61) was obtained from a large urban community using a combination of convenience and snowball recruitment methods. MEASURES: Self-efficacy and outcome expectations were measured using self-reported questionnaires. INTERVENTION: A multimedia intervention for use at home and incorporating an audio CD and associated activities was implemented over a 3-week time period. RESULTS: Outcome expectations and self-efficacy both significantly improved after the intervention (p < .001). CONCLUSIONS: Findings indicate that using a multimedia approach may be effective in improving parents' outcome expectancy and self-efficacy for talking about sex with adolescent sons.

The role of exercise in cancer treatment: bridging the gap.

In recent years, there has been a burgeoning amount of evidence-based scientific data demonstrating the benefit of exercise during and following cancer treatment. This compelling evidence has resulted in major stakeholders in cancer management, including the American College of Sports Medicine, American Society of Clinical Oncology, National Comprehensive Cancer Network, American Cancer Society, Oncology Nursing Society, and the Commission on Cancer, advocating exercise as an integral component of cancer care. Despite the acknowledgment of exercise as an essential component, it remains virtually absent in routine cancer treatment. This article discusses the role of exercise in cancer treatment utilizing a community-based program. The rationale presented is that a scalable and replicable standard of care model is a plausible avenue to assimilate exercise into routine oncology practice.

Pain management knowledge and attitudes of baccalaureate nursing students and faculty.

Pain affects approximately 76 million adults in the US. Though pain management has been targeted as a top priority, it continues to be inadequately addressed. Nursing faculty are in a unique position to significantly address the problem through facilitating the acquisition and utilization of knowledge by student nurses. The purpose of this study was to determine the knowledge of and attitudes toward pain in baccalaureate nursing students and faculty to establish a foundation for a systematic and comprehensive integration of pain content in the curricula. The descriptive design included a sample of 162 junior and senior students enrolled in a baccalaureate nursing program in Texas and 16 nursing faculty. The Knowledge and Attitudes Survey Regarding Pain (KASRP) was used to measure knowledge and attitudes toward pain. A direct correlation was found between the level of education and the percentage correct score. Differences found in knowledge and attitudes among the three levels of students and faculty were significant (df = 3.173; F = 14.07, p < .001). Senior students nearing graduation scored only 68% (SD = 6.8) with faculty scoring only slightly better with a mean of 71% (SD = 13). Significant differences also were found in assessment of pain through case scenarios of a patient who was smiling and talking as compared to a patient who was lying quietly and grimacing (X2 = 37.13, p < .05 (df = 24). Reevaluation of the way pain assessment and treatment are taught is indicated. Further studies are needed to assess changes in knowledge and attitudes toward pain as curricular revisions are made.

Breast Cancer-Related Lymphedema in Hispanic Women: A Phenomenological Study.

Introduction: Breast cancer-related lymphedema (BCRL), a long-term side effect of treatment, can occur at any point in time. With the extensive physical and psychological effects of BCRL, few studies have focused on the lived experience. The purpose of this study was to examine the lived experience of Hispanic women dealing with BCRL, particularly women of Mexican descent or origin. Method: Using interpretive phenomenology, 13 Hispanic women with BCRL, 42 to 80 years, were individually interviewed. Data analysis was conducted using interpretive reading of field notes, journal entries, and transcribed interviews. Results: Three central themes emerged from the findings, "sense of loss," "resignation to the new self," and "not knowing." Further subthemes highlight the physical, psychological, and spiritual aspects of living with BCRL. Discussion: Cultural awareness of the impact BCRL has on activities of daily living of Hispanic women should be part of a holistic plan of nursing care when caring for this population.

Experiences of African American Mothers Following the Death of Their Infants.

OBJECTIVE: To explore the lived experiences of African American mothers after the death of their infants. DESIGN: Qualitative, interpretive phenomenologic study. SETTING: Northeast Louisiana. PARTICIPANTS: Seven self-identified African American women whose infants died during the first year of life; the women's ages ranged from 18 to 38 years at the time of the infant's death. METHODS: Heidegger's interpretive phenomenologic approach guided the data collection and analysis. The women were interviewed using in-depth questioning to determine the meaning of the infant loss experience and their subsequent efforts to cope. RESULTS: Six themes represented the experiences of loss for the mothers: Shattered Dreams, Questioning God, Dissociation, Paralyzing Fear, Left in the Dark, and Uniqueness of Grieving. Three themes affected the women's efforts to cope after their loss: Authentic Presence, Spiritual Empowerment, and Disconnectedness. CONCLUSION: African American women who experienced infant death described intense feelings of loss, guilt, and isolation. These negative emotions can potentially affect their physical and psychological health. These findings may help health care providers develop culturally sensitive understanding of African American mothers' experiences of loss and equip providers to provide holistic assessment, appropriate support, and treatment for these vulnerable women.

Nurses Consuming Energy Drinks Report Poorer Sleep and Higher Stress.

The energy drink consumption habits of nurses working in clinical settings is unknown. Utilizing a descriptive-comparison design, researchers examined the caffeine and energy drink habits of clinical nurses and relationships or differences that existed with their sleep quantity, sleep quality, and perceived stress levels. Data were analyzed using descriptive and inferential statistics. Significant relationships existed between energy drink consumption and sleep quality, sleep quantity, and perceived stress levels. Nurses who consumed energy drinks had poorer sleep quality and fewer sleep hours compared with caffeine-only consumers and noncaffeine consumers. Nurses who consumed energy drinks also had increased levels of perceived stress than noncaffeine consumers. Educating nurses regarding energy drink ingredients and relationships that exist between energy drink consumption, sleep, and perceived stress could be beneficial. Future studies are needed to examine motivational factors related to energy drink consumption as well as any health or safety implications that might be associated.

Engaging Older Adults With Parkinson's Disease in Physical Activity Using Technology: A Feasibility Study.

Parkinson's disease (PD), a progressive neurodegenerative disorder, presents unique and daily challenges. Living with PD may limit one's physical activity and negatively affect quality of life (QOL). No studies were identified that utilized online technology to promote health in this population. The purposes of this study were to (a) assess the feasibility of an intervention that requires wearing a physical activity tracker and participating in an online support group, and (b) examine the effect of this intervention on the self-efficacy for physical activity and QOL of older adults with PD. A 12-week longitudinal pretest/posttest design was used to assess physical activity, engagement in an online support group, self-efficacy, and QOL. A postintervention questionnaire was used to capture the participants' (n = 5) experience using the physical activity tracker and an electronic tablet to engage in an online support group. The sample size of this feasibility study precluded robust quantitative analysis of QOL or self-efficacy. Findings from the open-ended questionnaire suggest technology was challenging for most participants, yet it did provide social support. Teaching effective interventions to promote self-management for increasing physical activity, and consequently improving QOL, is recommended. While technology can assist, older persons with PD may experience technological challenges.

Effects of a sleep hygiene text message intervention on sleep in college students.

OBJECTIVE: To test the effectiveness of a text-message intervention to promote sleep hygiene to improve sleep in young adult college students. PARTICIPANTS: A convenience sample of undergraduate students from one Southwestern university (n = 96), 18-26 years old, recruited in August 2015. METHODS: A 2-group pretest-posttest experimental design assigned participants to receive biweekly text messages about sleep hygiene or healthy behaviors for 6 weeks. Survey questions addressed sleep knowledge, sleep hygiene, self-efficacy for sleep hygiene, and sleep quality at baseline and posttest. RESULTS: Though not significant, sleep quality, sleep hygiene, and sleep knowledge improved in both groups. CONCLUSIONS: Self-efficacy for sleep hygiene is a modifiable factor that may serve to improve sleep quality. Sleep quality improved in both groups. Text messaging is a feasible approach to delivering an intervention to promote healthy behaviors among young adults.

Development of the Self-Efficacy for Sleep Hygiene Inventory.

BACKGROUND AND PURPOSE: Few studies have examined how self-efficacy is related to sleep behaviors in young adults. The purpose of this study was to develop and test an instrument specifically designed to measure self-efficacy for sleep hygiene in young adults. METHODS: The Self-Efficacy for Sleep Hygiene Inventory (SESHI) was developed in three phases using principal components analysis. The 30-item scale was pilot tested with a sample of 305 young adults. A second study with a sample of 96 young adults confirmed reliability. RESULTS: A 24-item three-factor solution: time management, disruptive influences, and sleep influences. Cronbach's alphas were 0.83 (total SESHI), 0.87 (time management), 0.69 (disruptive influences), and 0.73 (sleep influences). CONCLUSIONS: Initial psychometric testing indicated the SESHI may be a reliable measure of self-efficacy for sleep hygiene in this population.

Development of the Self-Rated Abilities for Health Practices-Adolescent Version: A Self-Efficacy Measure.

BACKGROUND AND PURPOSE: An instrument to measure wellness behaviors in adolescent females did not appear in the literature. The purpose of this article is to describe the development and evaluation of the Self-Rated Abilities for Health and Practices Scale-Adolescent Version (SRAHP-A). METHODS: Initial psychometric testing was conducted with a sample of 265 adolescents and young adults aged 13-24 years. Data collection occurred through paper and pencil surveys. RESULTS: Exploratory factor analysis using maximum likelihood factor extraction method and oblique ration was conducted. A four-factor structure consisting of Exercise, Nutrition, Health Practices, and Well-Being emerged. CONCLUSIONS: Initial psychometric testing suggested that it is a valid and reliable measure of wellness behaviors in adolescent females. Further testing is necessary; however, it appears this instrument has the potential to move wellness care for adolescents and young adults forward.

Impact of Tai Chi on Peripheral Neuropathy Revisited: A Mixed-Methods Study.

Exercise may be beneficial to older persons living with peripheral neuropathy (PN), but maintaining an exercise program is challenging. After participating in a 12-week tai chi (TC) study, 12 participants requested classes continue. A mixed-methods design was used to explore long-term engagement of older persons with bilateral PN enrolled in a TC class for 18 months beyond the original 3-month study. Pre- and posttest measures of functional status and quality of life (QOL) were conducted. Focus groups were held after 18 months of twice-weekly classes. Psychosocial support was critical to participants' long-term commitment to exercise. Participants reported, and objective assessments confirmed, increased strength, balance, and stamina beyond that experienced in the original 12-week study. Changes in QOL scores were nonsignificant; however, qualitative data supported clinical significance across QOL domains. Results from this study support psychosocial and physical benefits of TC to older persons.

Results of an Oncology Clinical Trial Nurse Role Delineation Study.

PURPOSE/OBJECTIVES: To evaluate the relevance of a five-dimensional model of clinical trial nursing practice in an oncology clinical trial nurse population. 
. DESIGN: Web-based cross-sectional survey.
. SETTING: Online via Qualtrics.
. SAMPLE: 167 oncology nurses throughout the United States, including 41 study coordinators, 35 direct care providers, and 91 dual-role nurses who provide direct patient care and trial coordination.
. METHODS: Principal components analysis was used to determine the dimensions of oncology clinical trial nursing practice.
. MAIN RESEARCH VARIABLES: Self-reported frequency of 59 activities.
. FINDINGS: The results did not support the original five-dimensional model of nursing care but revealed a more multidimensional model.
. CONCLUSIONS: An analysis of frequency data revealed an eight-dimensional model of oncology research nursing, including care, manage study, expert, lead, prepare, data, advance science, and ethics.
. IMPLICATIONS FOR NURSING: This evidence-based model expands understanding of the multidimensional roles of oncology nurses caring for patients with cancer enrolled in clinical trials.

Incorporating Exercise Into the Cancer Treatment Paradigm.

BACKGROUND: The benefits of exercise for patients with cancer are well documented. However, exercise is still not a standard of care for this population. Several factors contribute to the lack of exercise prescriptions for patients with cancer, including challenges posed by treatment-related side effects, lack of knowledge among healthcare providers and the laypeople, and inadequate resources. OBJECTIVES: This article reviews the benefits of exercise in general and specifically to patients with cancer, discusses the specific challenges and considerations required in recommending exercise to this population, and provides specific recommendations for healthcare providers to incorporate exercise into treatment plans. METHODS: Using a case study exemplar, this article discusses the benefits and challenges to exercise while undergoing treatment for cancer and proposes specific solutions and recommendations. FINDINGS: Oncology practitioners can provide the opportunity for patients to safely engage in exercise with the appropriate resources and trained personnel using a successful model of delivering exercise to patients undergoing treatment for cancer. Exercise improves quality of life in all patients, including those with advanced-stage cancers and those actively receiving treatment.

NEXus: Making Efficient Use of Limited Resources.

Faculty to teach and mentor doctoral nursing students are and will continue to be in short supply. Coupled with ever-increasing resource-constricted educational environments, doctoral programs are challenged to provide high-quality education with limited resources. The Nursing Education Exchange (NEXus) is a viable solution to help meet that challenge. This article presents an overview of the origins and evolution of NEXus, financial considerations, and basic steps for joining NEXus, along with 4 exemplars. NEXus has continued to grow since its inception in 2007. In 2015, the number of NEXus schools reached 20, with 11 schools offering both doctor of philosophy and doctor of nursing practice courses. Currently, NEXus offers over 160 courses, organized into 14 clusters such as gerontology and chronic illness. Recently, a collaboration between the National Hartford Centers of Gerontological Nursing Excellence and NEXus was formalized. This collaboration prepares faculty to address an aging population. In summary, in an era of increased demand for doctoral prepared nurses, a lack of qualified doctoral nursing faculty, and limited financial resources, the NEXus collaborative provides a model for optimal resource sharing.

NEXus: evaluation of an innovative educational consortium for doctoral education in nursing.

The purpose of this article is to describe the evaluation of the Nursing Education Xchange (NEXus), a national consortium of doctor of philosophy in nursing (PhD) and doctor of nursing practice programs, administered by the Western Institute of Nursing, which offers courses on-line. An external evaluator surveyed and interviewed faculty and staff coordinators, students, and the Western Institute of Nursing Board Members about their experiences with NEXus. Overall, individuals' perceptions of the NEXus program were positive. Some challenges in registering at other universities were addressed. The program helped PhD in nursing students complete their programs of study on time. Expansion of the program was recommended to offer more opportunities for students to take courses with experts in their areas of interest. Challenges and successes are discussed to assist others contemplating a consortium approach.

Creating a collaborative partnership between academia and service.

This article discusses how the experience of instituting preceptored clinical experiences throughout an undergraduate baccalaureate nursing curriculum resulted in a partnership between academia and service. The collaboration between academia and service built on the strengths of each institution to reach a common goal. Integration of the preceptor clinical model is unique in that implementation occurs in the second semester of a four-semester curriculum. Advantages and disadvantages to the model for students, preceptors, and faculty are presented. Unanticipated benefits to both institutions and ideas to help other programs and facilities develop a collaborative partnership for the education of baccalaureate nursing students are provided.

The effect of a wellness program on adolescent females.

Guided by Bandura's Social Cognitive Theory, the purpose of this study was to examine the effect of a comprehensive wellness intervention on total wellness, physical fitness, and self-efficacy for health promoting behaviors in adolescent females, ages 14 to 19, enrolled in physical education (PE) classes in Grades 9 to 12. The intervention was administered in an experimental pre-test, post-test, two group design in rural east Texas. Participants (n = 153) were randomly assigned to a 12-week intervention or control group. Independent t-tests to determine differences between the intervention and control groups were nonsignificant for overall wellness and physical fitness. The Wellness Essential-Self subscale score was significantly higher in the intervention group, t(64, 36) = 2.67, p = .005, d = .84. Self-Efficacy Health Promotion subscale scores for the intervention group were also significantly higher, t(20,28) = 2.60, p = .006, d = .74. The intervention has potential to improve overall wellness in adolescent females.

Using a strengths model to build an on-line nursing education program.

The on-line environment is the new frontier for academia struggling to define its place in the evolving economy. A concern is how to engage students who maximize their on-line experience and graduate in a timely manner. A strengths model was used as the basis for development of an on-line doctoral nursing program. Upon entering the program, students were given a strengths assessment that focused both students and faculty on the positive attributes students were bringing to their doctoral studies. A positive feedback methodology using on-line discussions in each course was used to support the identified strengths. The optimal picture of a successful entering doctoral student appears to be a person whose top five strengths are learner, achiever, input, connectedness and responsibility. A strengths model promotes a positive learning environment and supports a teacher-learner dynamic where faculty members are encouraged to focus on the students' strengths rather than their challenges.