Nursing students' resilience, depression, well-being, and academic distress: Testing a moderated mediation model.

AIM: Academic distress is a leading cause of attrition among nursing students. The present study tested a positive psychology-oriented model detailing the potential links between nursing students': (a) psychological resilience; (b) depressive symptoms; (c) intrapersonal well-being; (d) interpersonal well-being; and (e) academic distress. Additionally, we tested whether the academic benefits of resilience were conditional upon nursing students' perceptions of their campus climate as supportive of mental health and well-being. DESIGN: A correlational, cross-sectional design was employed. METHOD: Nursing students (N = 933) were selected from the national 2017-2018 Healthy Minds Study (HMS). Students completed measures of resilience, depressive symptoms, intrapersonal well-being (flourishing), interpersonal well-being (belonging), and academic distress. RESULTS: Conditional process modelling tested depression, belonging, and flourishing as mediators of the associations between resilience and academic distress variables. Furthermore, perceptions of campus climate were included as potential moderators of these mediation effects. Results indicated that the protective academic benefits of resilience were primarily explained by decreases in depression but that this effect was strongest for nursing students with negative perceptions of their campus climate. CONCLUSION: Findings highlight the psychological and academic benefits of greater resilience and the moderated mediation results suggest that such benefits were conditional on the broader campus climate. IMPACT: Nurse educators and policymakers should consider addressing contextual factors, such as campus climate, in addition to resilience training in their efforts to reduce the negative academic impacts of mental health problems and stress in nursing school.

The Family Meal Challenge: A Faith-Based Intervention to Empower Families.

African Americans have increased rates of overweight and obesity and are least likely to participate in family meals compared with other racial groups. A Family Meal Challenge (FMC) was developed with the objective of empowering individuals to eat healthy meals together as a family. The FMC was presented through four classes in three churches, two faith-based ministries, and two community service programs in health disparity zip codes. Surveys (N = 257) indicated a positive response. Engaging participants and teaching the benefits of eating healthy family meals in a faith-based environment are feasible and may increase the frequency of family meals. Information is provided to create and implement an FMC in any faith setting.

Obesity Stigma and Bias.

Overweight and obesity are escalating in epidemic proportions in the United States. Individuals with overweight and obesity are often reluctant to seek medical help, not only for weight reduction but also for any health issue because of perceived provider discrimination. Providers who are biased against individuals with obesity can hinder our nation's effort to effectively fight the obesity epidemic. By addressing weight bias in the provider setting, individuals affected by obesity may be more likely to engage in a meaningful and productive discussion of weight. Providers need to be the go-to source for obesity-focused information on new and emerging treatments.

Effects of the Perceived Risk of Contracting COVID-19 on Nursing Students' Well-Being.

BACKGROUND: Although mental health symptoms increased during the coronavirus disease 2019 (COVID-19) pandemic, little is known about the associations between nursing students' perceived risk of contracting COVID-19 and their academic and psychological well-being. This study examined associations between perceived COVID-19 risk, likelihood of completing nursing education, and mental health factors of nursing students. METHOD: A total of 979 nursing students completed self-report measures of perceived COVID-19 risk, anticipated academic completion, anxiety and depressive symptoms, stress, coping self-efficacy, hope, and social support. RESULTS: Students with higher perceived COVID-19 risk reported increased anxiety and depression as well as decreased likelihood of graduating, coping self-efficacy, and levels of social support. CONCLUSION: Findings indicate the need for increased mental health support for nursing students for successful completion of their programs. Educators should increase support and proactively strengthen positive psychology factors to mitigate the effects of COVID-19 and other crises on nursing students' well-being. [J Nurs Educ. 2022;61(11):641-645.].

Undergraduate versus graduate nursing students: Differences in nutrition, physical activity, and self-reported body mass index.

ObjectiveThis study compared self-reported nutrition, physical activity, and body mass index (BMI) in undergraduate versus graduate nursing students.ParticipantsRespondents included 233 undergraduate and 230 graduate nursing students in a Southeastern public university.MethodsThe study was an exploratory, descriptive, cross-sectional comparison administered via online questionnaire including self-reported demographics, nutritional intake, physical activity, and BMI.ResultsUndergraduates reported exercising more than graduate students. Graduate students reported consuming significantly more vegetables than undergraduates; however, more graduate students self-reported BMIs in overweight and obese categories than undergraduates.ConclusionsFindings provide a foundational understanding that interventions or educational programs to improve self-care behaviors of nursing students should be tailored depending on the educational level of the students. Educators must establish self-care skills within nursing students at all levels to help them preserve their health in the fast-paced, strenuous, and stressful work of all echelons of nursing upon completion of the educational program.

Concept mapping a baccalaureate nursing program: a method for success.

The understanding of curricular design and development is paramount for faculty. For novice faculty, learning teaching methods commonly takes precedence over understanding curriculum development. Professional accrediting bodies of nursing programs require curriculum course content to be pertinent and flow logically. Baccalaureate nursing programs can choose to be accredited by the Commission on Collegiate Nursing Education. The purpose of this article is to describe an educational innovation that one College of Nursing implemented to orient new faculty to the curriculum and prepare for an accreditation renewal. Assigned faculty developed and implemented a concept mapping process aimed to evaluate and revise course content based on national standards and guidelines. Undergraduate faculty understanding and ownership of the curriculum was evident throughout the process. The concept mapping process proved to be an innovative approach to enhance the curriculum and equip faculty with an understanding of the relationship between concepts and course content.

Weight Bias and Stigma: Impact on Health.

Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider. Within the health care setting, it is important that health care providers strategically focus on reducing obesity bias and provide high-quality obesity management. People-first language should be used and waiting rooms and examination rooms should be accommodating to people of all sizes.

Sleep, screen time, and family meal frequency in preschool children: A pilot study.

This exploratory pilot study identified the prevalence and perceptions of three healthy habits in preschool-age children by surveying their parents/caregivers. Researchers examined children's hours of sleep, screen time, and number of family meals per week.

Nurse practitioner students' observations of preceptor engagement in obesity management and weight bias: A mixed-methods approach.

BACKGROUND: Obesity is considered a growing epidemic in the United States. Nurse practitioners (NPs) have the opportunity to serve as leaders in addressing concerns related to disease management, particularly obesity. Currently, we lack an awareness of how NP students are learning obesity management from their preceptors. PURPOSE: Thus, the current study sought to explore how NP students perceive preceptors' behaviors when managing patients with obesity. METHODOLOGICAL ORIENTATION: This study used a mixed-methods design. Participants were asked to report how often they observed their preceptors engage in different strategies when interacting with patients with obesity (e.g., calculate body mass index, identify goals). Students were then asked to respond to the statement: "share observations you made of how patients with obesity were treated in this environment." Students completed 2 clinical rotations during this period and, thus, were asked to answer the questions twice to capture experiences at both clinical sites. SAMPLE: Researchers surveyed 225 NP students completing clinical rotations in 3 settings (Family Practice, Pediatrics, and Obstetrics/Gynecology). CONCLUSIONS: Quantitative results revealed significant differences in the frequency of observed obesity management behaviors by all preceptors. Qualitative results revealed that NP students most often observed preceptors displaying interpersonal warmth without weight bias when working with patients with obesity. Contrary to current literature, this sample of NP students observed their preceptors engaging in positive interactions with individuals with obesity. IMPLICATIONS FOR PRACTICE: Educators must continue to teach students to engage in unbiased behavior toward patients. It is critical to continue to improve obesity management content offered in NP programs.

Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study.

BACKGROUND: Obesity, the most prevalent chronic disease affecting multiple systems, is associated with increased mortality and a decreased life expectancy. OBJECTIVES: The purpose of this study was to identify Advanced Practice Nursing (APN) students' confidence of obesity management as well as satisfaction of APN curriculum on and curricular recommendations regarding obesity management. DESIGN: Modified convergent mixed-methods design. SETTING: A university-based college of nursing in the Deep South. PARTICIPANTS: Graduate APN Students. METHODS: An exploratory mixed methods online survey was administered to APN students. The survey included demographics; confidence in obesity management; knowledge of pharmacological treatment; self-reported height and weight; experiences and challenges related to obesity management; and suggestions of curricular content changes for the treatment of obesity that would increase student expertise and confidence. RESULTS: Ninety-nine surveys were completed by 94 female and five male APN students aged 26 to 61 years. The majority (70.7%) were white with BMIs ranging from 19.57 to 51.37 (x̅=27.81). Areas where students were least comfortable were prescribing anti-obesity medications and accurately billing for obesity management. Fourteen percent of APN students reported feeling that their graduate nursing education program did not prepare them well in obesity management, 25.3% reported feeling slightly well prepared, 32% reported feeling moderately well prepared, and 27.8% reported feeling very well or extremely well prepared. Qualitative responses accentuated insecurity in areas such as initiating a discussion on obesity management with patients who have obesity. CONCLUSIONS: Overall, APN students requested that their curriculum incorporate more instruction on how to begin the discussion of weight loss and provide clear evidence-based guidelines that include diet, exercise, and medication options. An efficient way to affect the management and treatment of obesity is to ensure that the next generation of providers is thoroughly prepared to implement the best evidence-based obesity management for patients.

NP student encounters with obesity bias in clinical practice.

This study explores NP students' encounters with obesity stigma and bias in their clinical environment as well as recommendations to decrease obesity stigma and bias. Results indicate a need for continued education on the topic of weight management within NP curricula.

Competency in obesity management: An educational intervention study with nurse practitioner students.

BACKGROUND: The National Center for Health Statistics reported that obesity is at epidemic levels in the United States, with an estimated 70.7% of adults affected by overweight and obesity. The disease state of obesity affects all generations and is pervasive among all socioeconomic groups. PURPOSE: This study was designed to examine the impact of implementing educational modules to determine if the intervention improved knowledge and comfort levels for Nurse Practitioner students when managing patients with obesity. METHODS: Nurse Practitioner students completed a survey regarding knowledge and comfort level in managing patients with obesity. Students then completed modules designed to train health care providers on the management of obesity. A postmodule assessment was administered to determine if the obesity management modules improved competency and perceived skills when treating patients with overweight and obesity. RESULTS: Participants' mean score on the knowledge test represented a significant improvement following training. Their comfort level in managing patients with obesity increased. IMPLICATIONS FOR PRACTICE: Implementing these modules in graduate education may be a helpful avenue to improve competency in obesity management. Acknowledging that obesity is a disease and requires a multifaceted approach when helping patients improve their health. This change in perception may lead to better goal-setting with the patient, empathetic understanding, and broader patient involvement in the treatment.

Families of children with autism: behaviors of children, community support and coping.

BACKGROUND: The diagnosis of autism for children (from birth to age 21) continues to increase, with the current rate being 1 in 110 children in the US. Besides financial strain, families often experience reduced quality of life due to disruptive behaviors related to autism. Research indicates that social support for families of children with autism improves family coping and adaptation. METHOD: A descriptive, correlational, cross-sectional study was conducted with 38 parents of children with autism. Using the McCubbin and Patterson (1983) model of family behavior, associations among behaviors of children with autism, community support for family, and family coping were analyzed. RESULTS: Findings of this study indicate an association between increased community supports and increased family coping strategies (r=.451; p=.005). Results also suggest the levels of disruptive behaviors associated with autism vary, community support can be but is not always helpful, and that the family's ability to cope with the challenges of autism is important to the family.

Maladaptive behaviors of children with autism: parent support, stress, and coping.

BACKGROUND: The estimated prevalence of Autism Spectrum Disorder (ASD) is one in 88. Autism Spectrum Disorders are nearly five times more common among boys than girls. Children with autism may develop a variety of socially unacceptable maladaptive behaviors beyond the defining symptoms of the spectrum disorder. AIMS: It is necessary to conduct research to examine maladaptive behaviors of children with autism, family supports, parental stress, and parental coping. METHODS: Data used were collected during an earlier descriptive, correlational, cross-sectional study. Using the Double ABCX Model of family behavior as the framework, this study evaluated parents' views of the adaptive behaviors of their children diagnosed with autism using the networks of support for their family, parental stress, and parental coping patterns. RESULTS: Results indicate an association between increased Internalizing maladaptive behaviors and increased parental stress (r = .547, p = .000). CONCLUSIONS: The findings of this study suggest that parents of children with autism report that their children have clinically significant maladaptive behaviors. Healthcare providers could use results from this study to provide appropriate intervention for maladaptive behaviors to support children with autism and their families.

Parental stress in families of children with a genetic disorder/disability and the resiliency model of family stress, adjustment, and adaptation.

BACKGROUND: Research suggests that parents of children with disabilities endure increased amounts of stress but also experience positive outcomes. PURPOSE: To further investigate findings from focus group interviews that explored parental stress in families of children with disabilities using a sequential mixed methods design. METHOD: This study sought to model parental stress using the McCubbin and McCubbin (1993) Resiliency Model of Stress, Adjustment, and Adaptation using qualitative and quantitative data collected sequentially. Twenty-five parents of children with autism spectrum disorder, cerebral palsy, Down syndrome, and sickle cell disease participated in a 2-step study that encompassed qualitative followed by quantitative data ascertainment. RESULTS: Parents who quantitatively experienced high stress or low stress used different behavioral themes to describe their experience qualitatively. Positive appraisals, resources, and ability to engage in problem solving and coping were associated with family resiliency.

The relationships among adaptive behaviors of children with autism, family support, parenting stress, and coping.

BACKGROUND: As the number of children diagnosed with autism continues to rise, resources must be available to support parents of children with autism and their families. Parents need help as they assess their unique situations, reach out for help in their communities, and work to decrease their stress levels by using appropriate coping strategies that will benefit their entire family. METHODS: A descriptive, correlational, cross-sectional study was conducted with 75 parents/primary caregivers of children with autism. Using the McCubbin and Patterson model of family behavior, adaptive behaviors of children with autism, family support networks, parenting stress, and parent coping were measured. FINDINGS AND CONCLUSIONS: An association between low adaptive functioning in children with autism and increased parenting stress creates a need for additional family support as parents search for different coping strategies to assist the family with ongoing and new challenges. Professionals should have up-to-date knowledge of the supports available to families and refer families to appropriate resources to avoid overwhelming them with unnecessary and inappropriate referrals.

Parenting challenges in families of children with autism: a pilot study.

A pilot study was conducted using a focus group interview with parents of children with autism to provide parents with the opportunity to express their concerns related to parenting a child with autism and to discuss strategies parents can use to manage these challenges. Parents' desire and need for information related to autism is evident. Parents' identified supports and resources in need of expansion and development to assist with their child's needs. These findings support previous research with families communicating a need for partnership with healthcare providers. Nurses are often the first contact with children with autism and their families; they can support the partnership between parents and healthcare professionals. Using the Double ABCX Model of family behavior as the conceptual framework, a study investigating the findings of this pilot study has been completed.

Exploring parent-sibling communication in families of children with sickle cell disease.

BACKGROUND: Communication within families of children with sickle cell disease is important yet has not been adequately investigated. METHODS: Focus group interviews were conducted with parents of children with sickle cell disease to explore parent-sibling communication about sickle cell disease. RESULTS: Communication was influenced by attributes and behaviors of the parent, the child with sickle cell disease, and the sibling; extended family, neighbors, friends, and church members or social networks; and available, accessible resources related to the child's health, child's school, and parent employment. Outcomes that influenced and were influenced by factors within and outside the parent-sibling dyad and nuclear family included parent satisfaction, parent roles, family intactness, and status attainment. CONCLUSIONS: These findings support previous research with African-American families and expand our views of the importance of educating parents, family members, and others about sickle cell disease. The findings suggest a need to explore sibling perception of this communication, parent and sibling perception of the impact of frequent hospitalizations and clinic visits on the sibling and family, and variations within families of children with sickle cell disease.