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Resumen Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.

Resumo Objetivo: o objetivo deste estudo de pré-viabilidade foi examinar percepções e experiências da atividade de Sit-to-stand com idosos brasileiros residentes em suas casas, no meio urbano. Método: o método exploratório foi etnografia focada. Foi utilizada a amostragem intencional para recrutar 20 idosos. Foram utilizados cinco meios de geração de dados: inquéritos sociodemográficos, observações participantes, entrevistas informais, entrevistas formais semiestruturadas e notas de campo. Os dados foram analisados mediante análise de conteúdo qualitativo. Resultados: a experiência dos idosos com problemas de mobilidade na realização da atividade Sit-to-stand dependia de suas expectativas de mobilidade envolvendo muitos fatores coordenados que, de forma conjunta, influenciaram suas crenças e atitudes em relação à atividade, suas preferências, seus comportamentos e percepções culturais. Os participantes deste estudo pareciam considerar a atividade aprazível; no entanto, as deficiências mais perceptíveis para o engajamento dos participantes na atividade Sit-to-stand surgiram de falhas em suas necessidades pessoais e intrapessoais. Conclusão: as recomendações geradas a partir dos achados do estudo convocam a concepção de estratégias de implementação da intervenção Sit-to-stand adaptadas às necessidades dessa população em particular.

A decline in routine vaccination was reported by some countries early in the COVID-19 pandemic. In the context of the pandemic, determinants of routine childhood vaccination may have changed. Changes over time in parents' perceptions of routine vaccines and intentions for their children during the pandemic have not been fully explored. Understanding changes provides opportunities to promote routine childhood vaccines and address factors that may compromise parents' acceptance.We conducted longitudinal analysis of two sequential national surveys during the pandemic (Dec 2020 and Oct/Nov 2021) to assess changes over time in Canadian parents' perceptions of routine childhood vaccines, intentions to vaccinate, access for their children ≤ 17 years, and differences among sociodemographic characteristics. McNemar-Bowker tests were used to determine changes in parents' responses collected at two time points.Of the 650 parents in the sample, 25.1% with a child ≤ 6 years and 20.5% with a child 7-17 years perceived that routine childhood vaccines were more important because of the pandemic. Between the two time points, parents' confidence in the safety (72.8% to 80.2%, p .001) and effectiveness (81.7% to 85.2%, p =.007) of routine vaccines increased, parents were more engaged in vaccine decision-making (73.4% to 79.8%, p =.006), and everyday stress preventing vaccination decreased (78.8% to 68.5%, p .001). Acceptance of routine vaccines increased (82.9% to 86.5%, p =.021), but more parents were undecided about influenza vaccination (12.6% to 20.3%, p =.002). Compared to parents with 1 child, those with 2 children reported increased vaccination acceptance (82.6% to 87.4%, p =.024).Under the spotlight of COVID-19, parents' confidence in routine vaccines, engagement in decision-making, and vaccination acceptance increased. Vaccination providers should support parents' decision-making as they navigate routine childhood vaccine uncertainties. Differences in parents' acceptance of routine and influenza vaccines for their children highlight the need for targeted communication strategies for specific vaccines.

Climate change-related eco-anxiety in young people has made headlines around the world, but most study of this phenomenon has been limited to adults. Eco-anxiety is still not well defined in the literature, but generally refers to distress, worry, or concern related to the climate change crisis. Young people will be chronologically more exposed to climate change-related harms and problems, and this may be causing increased eco-anxiety in this population. This literature review aimed to summarize the relevant works on eco-anxiety in young people, provide a critique of the literature, identify gaps, and discuss the relevance to nursing practice. A literature search using multiple databases and other sources was completed, using applicable key terms and resulted in 23 sources to inform the review. Key themes of eco-anxiety definition variation, hopelessness and burden in young people, and responses to eco-anxiety are discussed, and critical analysis is undertaken. The main conclusions include a broad working definition of eco-anxiety that does not pathologize the eco-anxiety experience but recognizes that it can cause suffering. Also discussed is the role of nurses in reducing the potential or actual suffering of youth through hope promotion, challenging binary thinking patterns, building emotional resilience, encouraging action or involvement in climate change spheres, and promoting climate justice and advocacy. Recommendations for further research are offered.

Gerontological nursing is not a career choice for most new graduates. Nurse educators, who influence students' career decisions, lack expertise in older person care. The academic culture may affect educators developing gerontological expertise.The study explored the culture of a Canadian pre-licensure nursing education program in relation to educators' expertise in gerontological nursing.In a focused ethnography, 22 nurse educators/researchers/administrators participated in interviews and/or observations conducted from March 2018 to December 2018. Content analysis of interview transcripts and fieldnotes occurred concurrently with data collection.Themes characterizing the culture were: Structure and Hierarchy, Losing Gerontology, Teaching Challenges, and Valuing Older Persons and Their Care. Participants felt: a hierarchy limited gerontologists' support for undergraduate educators and the curriculum; the integrated curriculum reduced the focus on gerontology; limited professional development opportunities and excessive workload constrained building gerontology expertise; and valuing older persons and their care influenced access to gerontology resources.The culture of a pre-licensure nursing program impacted educators building expertise in older person care. More research is needed to overcome barriers that constrain educators' proficiency in gerontological nursing. Increasing the number of educators adept in gerontology will develop nurse graduates with an appreciation for working with older persons.

The purpose of this scoping review was to assess the state of the literature concerning the experiences of new PhD-prepared tenure-track faculty, with a keen interest in nursing faculty. Effective recruitment and retention strategies for new nursing academic faculty need to be found and implemented. A literature review based on Arksey and O’Malley’s five-stage framework for scoping reviews was undertaken. Using the PRISMA protocol, a systematic literature search was conducted in seven databases of studies published in English. Based upon inclusion criteria and relevance, 13 studies out of 90 papers were included in this study. Themes identified from the studies were transitioning to academia, developing a research program, balancing work and life, and perceived inequity. The research was predominately American and Canadian based. Several gaps in the literature were identified. Further research is critical to make recommendations to key stakeholders for recruitment and retention strategies.

Structural competency is a concept that offers a way to understand and respond to health inequities and work toward antiracism in health care. This article undertakes a concept analysis of structural competency using Rodgers' evolutionary method. Based on this analysis, structural competency refers to the ability to recognize and act on structural inequities, skill development, multidisciplinary collaboration, and the reproduction of inequity over time. The meanings and use of this concept differ among disciplines. Multidisciplinary applications of structural competency offer insight into how this concept can foster health equity and antiracism in nursing care, education, research, and health services delivery.

This paper aims to describe how healthcare providers perceived spirituality and spiritual care while caring for dying patients and their families in a hospice setting in Karachi, Pakistan. Using a qualitative interpretive description design, individual in-depth interviews were conducted among healthcare providers. Thematic analysis approach was used for data analysis. Spirituality and spiritual care were perceived as shared human connections, relating to each other, acts of compassion, showing mutual respect while maintaining dignity in care and empowering patients and families. Developing spiritual competency, self-awareness, training and education, and self-care strategies for healthcare providers are essential components promoting spiritual care in a hospice setting.

Purpose: This study explored the underlying process faith community nurses (FCNs) experience in developing their spiritual nursing practice. Design: A qualitative, exploratory design was used. Method: Data from interviews with six FCNs were generated and analyzed using Glaserian grounded theory. Findings: The basic social psychological process, cultivating the soul to become a channel of God, explains the steps these nurses take to achieve stages of presence. Going through these stages of presence, FCNs develop a foundation of God-related beliefs and values, presence with self, presence with God, presence with others, presence with God and others, and become a channel of God. Conclusions: Developing spiritual care competence in assessing and meeting clients’ spiritual needs is necessary to enhance person-centered practice, a vital aspect of holistic care. The model of presence can inform the development of spiritual care competencies and link to other nursing theories including Watson’s theory of caring and Benner’s novice to expert theory. Workplace support is needed for nurses to refine spiritual nursing care practices and integrate spiritual care into practice. Further research regarding the stages of presence could foster deeper understanding of how foundations of God-related values develop.

Mobility challenges may indicate functional decline and are a relevant problem faced by older people. An individual's perception of mobility is affected and moderated by several factors and varies significantly from one community to another. Providing an improved understanding of how older people perceive and experience mobility is a step towards better preparing nurses for roles they are increasingly expected to play.The purpose of the study was to investigate perceptions and experiences of mobility in a group of Brazilian community-dwelling older people living with mobility challenges.Data were generated between June and October 2018 through in-depth interviews, socio-demographic surveys and field notes. Purposive sampling strategies were used to recruit 23 Brazilian older people to participate in this focused ethnographic study. Data were analysed using qualitative content analysis.Perceptions of Brazilian community-dwelling older people living with mobility challenges were culturally learned and influenced by the social, physical and health environments. Participants' previous experiences with mobility had significant implications on values they attributed to mobility challenges. In addition, older people's experiences with mobility challenges were an integral part of sense of self and strongly related to contextual factors.This study contributes new information to the field of inquiry on mobility of older people as it focuses on the perceptions of a specific age group and culture and attends to the interrelationships between health conditions and contextual factors affecting the mobility of older people.This study's particular contributions to the nursing discipline are related to improving care by revealing the significance of the context of mobility in which nursing actions are applied.

Family caregivers experience multiple transitions, resolutions, loss, and grief where their search for meaning becomes evident. Spirituality is an important dimension of palliative care, yet little attention has been given to this important aspect of spirituality especially among the family caregivers in a hospice setting. The study aimed to bring the hidden voices of family caregivers, their own spiritual experiences caring for their dying patients in a hospice setting, to guide and direct the care practices of health care professionals. An interpretive descriptive approach guided the study using a purposive sample of 18 family caregivers from a hospice in Karachi, Pakistan. Major themes were family love, attachment, and belongingness; honoring family values and dignity; acts of compassion and selfless service; and seeking God's kindness and grace. Spirituality enabled family caregivers to uncover meaningful engagement and provided strength and peace while serving a dying family member in challenging caregiving situations such as adversity and limited resources. They highly valued the love, respect, and honor of the family; showed compassion; believed in God's blessings; and experienced spiritual growth and self-transcendence. Spirituality was found to be a major resource of coping among family caregivers. Health care professionals need to integrate spirituality while developing family-centered interventions in hospice care.

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.

Introduction: Data show that maternal stress triggered by exposure to a natural disaster before, during or just after pregnancy is associated with adverse pregnancy and newborn outcomes. In this paper, the first aim is to describe our efforts to test a simple, low-cost intervention to large numbers of women following a major natural disaster. The second aim is to outline the challenges faced and lessons learned during the execution of this natural disaster study.Methods: The setting was the May 2016 Fort McMurray Wood Buffalo wildfire in northern Alberta, Canada. Women who were pregnant or preconception at the time of the disaster were invited to participate via social media. This prospective cohort study included a randomized controlled trial to test the effectiveness of an expressive writing intervention on the levels of prenatal maternal stress and maternal, birth, and early childhood outcomes. At recruitment and at multiple timepoints postpartum, a battery of questionnaires was administered to evaluate objective and subjective stress exposure to the fire as well as maternal mental health, resilience and its contributing factors as well as infant developmental milestones. Qualitative content analysis of the expressive writing was conducted.Discussion: There is an increasing need to develop effective, wide-spread, rapid, and low-cost interventions to reduce prenatal maternal stress, increase resilience, and improve pregnancy outcomes following a natural disaster. Though analysis of data is ongoing, we highlight the strengths of this study which include strong community participation, rapid recruitment of eligible participants, low-cost intervention and data acquisition, and successful testing of the intervention. We acknowledge the challenges we encountered including the high rate of participant disqualifications or losses due to incomplete collection of online data; evacuation, dispersal, and inconsistent return to homes; and the high levels of stress accumulated post-disaster which led to inability to complete the study. Despite potential challenges, there remains a need for such research amid natural disasters.

The goal of this descriptive qualitative study was to examine the views of students about their experience and development as scholars during the first two years of an online cohort nursing doctoral program. A secondary goal was to seek the views of faculty members very involved in the program. Semi-structured interviews were conducted with 10 of the 13 students of the first two online cohorts and five faculty members. Four themes emerged from the data: adjusting to the program; the group as emotional and academic support; reflections on teaching and learning; and becoming a scholar. The findings suggest that the students were developing as scholars, and that the cohort model was a source of support for them. Similar to other PhD students, transition into doctoral education necessitated finding a new balance between other commitments and doctoral studies. Providing opportunities to engage with faculty outside of courses is important.

Increasing attention has been paid to the environment and experiences of the mother during pregnancy; consequently, prenatal maternal stress (PNMS) has become an important subject of research. Reviews on PNMS suggest that stress during pregnancy or preconception or maternal exposure to depression or adverse life events, including adverse childhood experience or chronic abuse, is associated with a host of negative pregnancy outcomes (e.g., preterm birth, pre-eclampsia, intrauterine growth retardation and gestational diabetes) and adverse developmental trajectories for the newborn, especially neurodevelopmental and metabolic, that include childhood and adult obesity, diabetes and neurodevelopmental impairments including anxiety disorder, conduct disorder, attention-deficient hyperactive disorder and even impaired adaptive immunity. Collectively these conditions, along with cardiovascular disorders (e.g., hypertension), cancer and others, are labelled non-communicable diseases. Modern-day stressors include high stress and post-traumatic stress syndrome, postnatal depression, maternal obesity, abuse at any time in life, natural disasters, conflict, poverty, famine, rapid urbanization and migration combined with historical stressors of colonialism in indigenous populations. The ability of a pregnant woman to cope with these stressors is dependent upon the levels and balance of her allostatic load and resilience. The risk for developing an adverse pregnancy outcome is a function of modifiable risk factors (e.g., clinical, individual or population level risk factors) and non-modifiable risk factors (e.g., genetics). A recent international program, OPERA (Optimal Pregnancy Environment Risk Assessment; www.operamtg.org), is attempting to develop simple tools in jurisdictions around the world for early detection of risk, thereby leading to early intervention and mitigation in order to improve newborn developmental trajectories.

The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors – those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.

This paper offers a theoretical discussion on why the nursing profession has had a delayed response to the issue of climate change. We suggest this delay may have been influenced by the early days of nursing's professionalization. Specifically, we examine nursing's professional mandate, the generally accepted metaparadigm, and the grand theorists' conceptualizations of both the environment and the nurse-environment relationship. We conclude that these works may have encouraged nurses to conceptualize the environment, as well as their relationship with it, mainly in terms of the individual patient, and as such, nurses have not been encouraged to understand these concepts from a broader perspective. By not having the philosophical and theoretical foundations to understand the environment in relation to society, it is not surprising that nurses have had a delayed response to climate change and may not have viewed it as a professional concern. A planetary health perspective is suggested as a theoretical basis for nursing education, research and practice. Taking on a planetary health perspective could help nurses progress the profession and move healthcare systems towards supporting a climate-resilient future.

Background: Family caregivers experience spiritual and existential concerns while caring for their terminally ill family members. Aim: To evaluate and synthesise studies on spirituality among family caregivers in palliative care. Design: An integrative literature review of peer-reviewed articles published between 2000 and 2016. Sample: Participants were family caregivers (parents, spouses, relatives or friends) caring for an adult (age>18 years) family member with a terminal illness in a palliative care setting. Results: Data from 26 published research papers were systematically analysed. Five themes were identified regarding spirituality and family caregiving: a close and meaningful connection, spirituality as a way of coping, spiritual needs and expressions among family caregivers, spirituality to transcend fears, and spirituality in family caregivers' decision-making. Implications for Practice: Nurses are encouraged to explore the spirituality and spiritual experiences of family caregivers to support their spiritual wellbeing while caring for their terminally ill family members.

Background: Limited skill in health literacy is a global issue. Variation in health literacy skills within societies is a source of health inequality unless health care providers apply health literacy practices to effectively communicate with all clients. Objective: This study examined Iranian registered nurses' knowledge of and experience with health literacy practices. Methods: This cross-sectional study provides a quantitative description of knowledge of and experience with health literacy practices. Using a rigorous process, we adapted the Health Literacy Knowledge and Experience Survey to collect data from the participants, who were 190 registered nurses working in Tehran, Iran. Key Results: Findings identify gaps in participants' knowledge and experience with health literacy practices. Knowledge deficits are most noticeable in standards to create written materials, screening tools to identify limited health literacy, and the Teach-Back strategies to determine people's understanding. Limited experience is prominent in using health literacy screening tools, evaluating written health information, and applying technologies to provide health information. Our multivariate analysis suggests participants who reported more interaction with health care professionals for personal reasons scored higher in knowledge of health literacy practices. Conclusions: This study indicated that registered nurses in Iran do not have adequate knowledge and experience regarding health literacy practices. Addressing this issue is fundamental to promoting health equity. Future investigations should identify both barriers and facilitators for nurses to apply health literacy practices. [ HLRP: Health Literacy Research and Practice . 2019;3(4):e268–e279.] Plain Language Summary: Health literacy practices enable health care professionals to offer understandable health information to all people and contribute to health equity. We surveyed 190 registered nurses in Iran to assess their knowledge of and experience with health literacy practices. The findings will be a guide to create interventions to improve registered nurses' knowledge of these practices and to use them to communicate clearly with clients.

Background Nurses are increasingly expected to provide care for older persons; however, there are too few nurse educators with expertise in older person care to ensure students graduate with the requisite competencies. Methods An integrative review, using Whittemore and Knafl's framework, was undertaken to identify and synthesise evidence about factors affecting nurse educators' knowledge, skills or attitudes about older persons and their care. Results Forty-four articles met the inclusion criteria. All but three papers originated in the USA. Content analysis yielded three central themes: external-level factors, employer-level factors and individual-level factors. Findings demonstrated that external funding from philanthropic organisations and government agencies supported many of the national, regional and site-specific initiatives, which were, in many cases, underpinned by professional regulatory frameworks. Negative attitudes of administrators and reduced budgets of educational institutions impeded the availability of such initiatives. Negative attitudes of individual educators towards older person care and the specialty of gerontology constrained their pursuit of such learning, as did their lack of awareness of current gerontology resources. Conclusions The lack of educators with gerontology knowledge, skills and requisite attitudes requires a focused effort from external and professional bodies, and from educational institutions to ensure the resources are available to enhance educator expertise in gerontology. Rigorous study addressing the factors influencing educators' knowledge, skills or attitudes towards older persons and their care is required. Implications for practice Addressing the lack of nurse educator expertise in gerontology could help to ensure new nurses have the required competencies to provide quality older person care.

Aims and objectives To identify the current state of knowledge about the use of the sit-to-stand intervention with older people and to identify implications for further research. Background Many older people experience mobility challenges which can negatively affect their well-being. Physical activities are vital to improving or maintaining mobility. Although there is evidence that mobility challenged older people benefit from the sit-to-stand intervention, there is a need to systematically examine the state of knowledge about this intervention. Design Scoping review using Arksey and O'Malley's methodological framework. Methods A systematic search of three databases was completed. Abstracts were evaluated for relevance using predetermined inclusion criteria. Studies that met the inclusion criteria had data extracted and were appraised for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Results Of 3,041 papers, six studies met the inclusion criteria. Publications provided a range of sit-to-stand interventions with durations varying from four weeks to six months. The frequency of each intervention fluctuated from three to seven times/week with a duration of 15-45 min. Different professionals prompted the activity. Three themes were identified the following: (a) sit-to-stand activity as an intervention; (b) generalisability of findings; and (c) sustainability. Conclusions Most of the studies reviewed indicated improvements in performance of the sit-to-stand activity and in motor function. However, issues with studies rigour do not allow us to make generalisations. Further research is needed to confirm the effectiveness of the intervention. Implications for practice Healthcare providers are expected to offer evidence-based patient care. This review details current knowledge about the sit-to-stand intervention with older people.

In rural communities, religious places can significantly shape health for individuals, families, and communities. Rural churches are prominent community centers in rural communities and are deeply woven into rural culture. Thus, health influences arising from the rural church likely have health implications for the greater community. This article explores health influences emerging from rural churches using social determinants of health, social capital, and health expertise. Although nurses are important health resources for all populations, their value in rural areas may be exceedingly significant. The contribution of nurses to church-based health capital in rural communities may be quite significant and underestimated, although it remains poorly understood.

Breastfeeding provides ideal nutrition for young children. To reduce childhood mortality and morbidity rates, the World Health Organization (WHO) recommends exclusive breastfeeding during the initial 6 months of a child's life and emphasizes continued breastfeeding along with complementary feeding until the child is 2 years old (World Health Organization, 2015). Although nurses act as key mediators in the promotion, protection, and support of breastfeeding practices of lactating mothers, the success of breastfeeding greatly relies on autonomous decisions made by the mothers (Brunson, Shell-Duncan, & Steele, 2009; Shroffet al., 2011; Vaz, Pratley, & Alkire, 2015). Nurses often encounter situations where maternal autonomy regarding breastfeeding is in conflict with healthcare advice and welfare of young children (Murphy, 1999; Sundean & McGrath, 2013). Nurses are obliged to respect patient autonomy and assure the utmost welfare of their patients at all times (International Council for Nurses, 2012). Infants cannot make autonomous feeding decisions, and therefore nurses need to consider the autonomy of lactating mothers when safeguarding the welfare of young children.While substantial literature in nursing concerns the concept of autonomy (Ballou, 1998; Keenan, 1999; Wilkinson, 1997), the concept of maternal autonomy has yet to be fully explored. Although several social science researchers have studied maternal autonomy (Brunson et al., 2009; Cox & Turnbull, 1998, 2000; Schmied & Lupton, 2001; Ziaei et al., 2014), these studies lack a clear understanding of the concept and reveal little consensus in its definition. Moreover, the concept of maternal autonomy has yet to be analyzed in the context of breastfeeding. Therefore, this article uses Walker and Avant's (2011) eight-stage approach to concept analysis to analyze the concept of maternal autonomy in the context of breastfeeding and offer a clearer definition. Such insight is vital for nurses to improve delivery of care to lactating mothers and safeguard the welfare of young children.SignificanceIt can be argued that the current understanding of autonomy is sufficient to guide knowledge development regarding maternal autonomy and offer direction for maternal-child nursing practice. So why is it essential to analyze the concept of maternal autonomy in the context of breastfeeding? Autonomy, as currently understood, works well in the context of adults whose autonomy is concerned only with their own welfare. However, it does not completely apply in the context of maternal-child health, where maternal autonomy holds direct implications for the welfare of young children.Concept analysis is a rigorous process by which an abstract concept can be defined, explored, clarified, compared, refined, validated, or differentiated from similar concepts (Morse, Hupcey, Mitcham, & Lenz, 1996; Walker & Avant, 2011). This concept analysis will be useful in guiding research regarding maternal autonomy in the context of breastfeeding and in delivering quality care to lactating mothers. Moreover, it will assist stakeholders and policymakers in protecting, promoting, and supporting breastfeeding globally toward achieving the United Nations Sustainable Development Goals, 2015- 2030 (United Nations, 2015).MethodsWalker and Avant's eight-stage approach (Walker & Avant, 2011) was utilized to undertake the conceptual analysis. Although this method is heavily criticized for its simplistic approach and positivist nature, it is a well-tried and tested approach for concept development (Cutcliffe & McKenna, 2005). Moreover, the approach is useful for concepts that are unclear and underdeveloped (Hupcey & Penrod, 2005), as is the case here. The eight stages include selecting a concept, determining the purpose of analysis, reviewing relevant literature, clarifying the attributes, presenting a model case, clarifying the antecedents, identifying consequences, and defining empirical referents (Hupcey & Penrod, 2005; Walker & Avant, 2011). …

Introduction: The purpose of this scoping review is to identify measures of spiritual fitness that can be used in a military context. Methods: Two independent reviewers applied post-hoc inclusion and exclusion criteria for the identification of relevant articles, reviews, and assessments. Each reviewer independently recorded criteria met using a jointly developed form, considering relevant spiritual fitness screening and assessment tools based on clinical experience. When two reviewers were in disagreement, a third blinded reviewer was used to create consensus. Results: 35 assessments with psychometric properties were identified that could be administered by military chaplains, health care professionals, or military personnel (through self-reporting) to evaluate spiritual fitness over time among those in the military service. The assessments were compiled into a table to isolate differing properties of each assessment, including target population, length/time to complete, measurement of affective, behavioural, and cognitive aspects of spiritual fitness, psychometric properties, and example questions. Discussion: There is now an opportunity to further identify and evaluate spiritual fitness screening and assessment tools that will appropriately and effectively determine the spiritual fitness and resilience of individuals serving in the military as well as their families.

The worst disaster of natural origin in recent Canadian history occurred in May 2016 in the northern Alberta community of Fort McMurray Wood Buffalo (FMWB). Among the 88,000 people abruptly evacuated amidst a raging wildfire were approximately 1850 pregnant or pre-conception women. Based on the Allostatic Load and Preterm Birth Conceptual Framework (Olson et al., 2015) [1], a simple, cost-effective expressive writing intervention following Pennebaker's work (Pennebaker and Beall, 1986; Pennebaker et al., 2007) [2,3] was implemented in a primary study to help mitigate the negative effects of stress on a sample of these women and their unborn children. Journal writing served as an intervention in the primary study while the contents of the journal entries became the data analyzed in this qualitative study. This study utilized both inductive and deductive thematic analysis of journal entries completed by 54 women over four consecutive days (15 min/day). Deductive analysis followed a coding structure that was generated from two resilience scales. Themes that emerged during inductive analysis were also coded. The main themes that emerged described the women's challenging experiences: fears for themselves and their offspring, fire-related and past trauma, and relationship changes. Resilience characteristics and practices also emerged from the writings and mirrored those found in the literature: (a) post-traumatic growth, (b) adaptability, (c) emotional/social connectedness, (d) composure, and (e) reasoning. This paper highlights the challenging experiences of pregnant women exposed to a disaster and the resilience they demonstrated in the face of the tragedy.

Facilitating student achievement of nationally recognized entry-level-competencies in nursing leadership is a critical step in building capacity to promote patient safety, quality of care, and healthy work environments. Data for this substudy were drawn from a larger multi-phased, multi-method, cross-sectional, descriptive study conducted to inform comprehensive undergraduate curricular revision. The research question for this substudy was: what are the perceptions about undergraduate program preparation for nursing leadership? Frequencies and percentages summarized relevant quantitative data from the surveys and deductive content analysis was used to further explore the category of leadership which emerged from content analysis of qualitative data in the larger study. Key findings illustrate need for additional attention to learning experiences in conflict management, delegation and supervision of clinical teams, and advocacy. Greater collaboration between educational and clinical agencies is needed to find mutually beneficial strategies to support nursing leadership development for nursing students and new graduates.

Death is a common occurrence in intensive care units (IC Us) and the complexity of care makes it difficult for nurses to find a balance between the patient's physical needs and the family's emotional needs, especially in circumstances of unexpected death. Cumulative or unresolved grief for families can have lasting negative repercussions. Nurses, therefore, need access to bereavement education in order to provide optimal- bereavement support.The purpose of this review is to identify challenges and facilitators that nurses experience in delivering bereavement support during and after sudden or unexpected death in ICUs.A narrative overview was conducted based on a literature search using GINA HL, Medline, Psyclnfo, Scopus, and Pro quest databases, as well as grey literature, revealing 241 articles, 15 of which met inclusion criteria.Four themes surrounding bereavement support in the ICUs emerged: influence of hospital policies and organizational constraints; sign ~tl cance of time and trust; level of knowledge and support of staff and nurses' inner conflict, moral distress, and personal ways of coping.The availability of up-to-date literature in this area is limited. Further research could inform organizational poli- cies, nursing education, and nursing staff development to address existing barriers. With adequate resources, practical strate- gies could be implemented to provide bereavement support that ensures optimal bereavement outcomes for families experiencing sudden or unexpected death in ICUs.

This project is a mixed-methods systematic review on the use of simulation in pre-licensure nursing. This research question guided this review: What is the best evidence available upon which to base decisions regarding the use of simulation experiences with pre-licensure nursing students? Searches of CINAHL Plus with Full Text, MEDLINE, and ERIC were performed to identify relevant literature. These searches yielded 1220 articles. After duplicates were removed and titles and abstracts were reviewed for relevance to the inclusion criteria, the remaining 852 articles were independently assessed for quality by pairs of researchers. Forty-seven articles were retained. Findings were grouped into research using high-, medium-, and low-fidelity simulations and a group where researchers included several or all types of simulation. The conclusion is that insufficient quality research exists to guide educators in making evidence-based decisions regarding simulation. More rigorous and multi-site research is needed.