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As childhood obesity has increased, schools have struggled with their role in this epidemic. Parents with a school-age child in a suburban latchkey program were surveyed regarding their perceptions of childhood obesity, body mass index, and the school's role in prevention and treatment of obesity. More than 80% of participants identified inactivity, poor eating behavior, lack of parental control in what children eat, and eating too much as the main causes of childhood obesity. Parents preferred receiving information about their child's body mass index from the school via a letter from the school nurse. Participants agreed that physical education classes, as well as units on nutrition and weight control, should be present in schools. Parents also supported eliminating junk food machines and offering special low-calorie meals. By supporting these strategies, parents indicated that schools should have a role in childhood obesity. School nurses can advocate for parental preferences in their school district. [ABSTRACT FROM AUTHOR]

Aims and objectives. To discuss the Health Promotion Model for Violence Prevention and Exposure and intervention strategies for implementation. Background. Violence causes physical and psychosocial harm to children. Because little collaboration exists between specialties in the USA, a model that incorporates both a public health and psychosocial approach is needed to assess the risk for exposure to violence and the effects of violence as well as developing prevention strategies. Prevention and intervention includes primary, secondary and tertiary levels that focus on either the community or individual. However, primary and secondary prevention, such as anticipatory guidance and screening, can be implemented by both community and primary care nurses. Methods. A review of the literature and on-line resources focusing on children's exposure to violence provided the basis for discussion of the commonalities and differences between the public health and psychosocial approach to assessing, preventing and intervening with children exposed to violence. This discussion led to the development of the proposed model. Conclusions. This model can identify more children at risk for social, physical and psychological harm because of exposure to violence. Implementing prevention or treatment interventions can decrease the impact of violence on children. Relevance to clinical practice. This model can be implemented by public health, psychiatric and primary care nurses by incorporating the model into the well-child exam, school screenings and after-school programs. Collaboration between specialties will increase referrals for participation in anti-violence programs or treatment interventions. [ABSTRACT FROM AUTHOR]

Nuclear spin relaxation experiments with 8Li adsorbed on various surfaces provide new information in surface science which is not obtainable othervise. Both dipolar (Korringa) and quadrupolar relaxation due to diffusion are observed. However, in addition, a fast and presently not understood spin relaxation mechanism is present while dosing during the first 0.5 s the surface with polarized 8Li. Most strange in this respect is the fact that those 8Li atoms which survive depolarization through this mechanism depolarize afterwards with modest spin lattice relaxation rates. The origin of the fast spin lattice relaxation mechanism is presently unknown. [ABSTRACT FROM AUTHOR]

Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored., Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days., Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma., Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high., Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies., (©Barbara Polivka, Kathryn Krueger, Olivia Bimbi, Luz Huntington-Moskos, Sharmilee Nyenhuis, Emily Cramer, Kamal Eldeirawi. Originally published in JMIR Formative Research (https://formative.jmir.org), 10.10.2024.)

The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Food insecurity has been associated with poorer asthma control in children, but research lacks in adults., Objective: To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic., Methods: An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed., Results: Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic., Conclusions: Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Place-based international electives that build global health competencies have existed for decades. However, these electives require travel and are infeasible for many trainees around the world, particularly those with insufficient financial resources, logistical complexities, or visa limitations. The emergence of virtual approaches to global health electives, catalyzed by the travel pause related to the COVID-19 pandemic, necessitates the exploration of learner impacts, participant diversity, and curricular frameworks. Child Family Health International (CFHI), a non-profit global health education organization that partners with universities to expand immersive educational offerings, launched a virtual global health elective in 2021. The elective drew on faculty from Bolivia, Ecuador, Ghana, Mexico, the Philippines, Uganda, and the United States., Objective: This study aimed to describe a newly developed virtual global health elective curriculum and evaluate the demographics of and impacts on trainee participants., Methods: Eighty-two trainees who were enrolled in the virtual global health elective from January to May 2021 completed both 1) pre- and post-elective self-assessments of domains of competency mapped to the elective curriculum and 2) free text responses to standardized questions. Data were analyzed through descriptive statistical analysis, paired t-testing, and qualitative thematic analysis., Findings: The virtual global health elective had 40% of its participants hail from countries other than the United States. Self-reported competency in global health broadly, planetary health, low resource clinical reasoning, and overall composite competency significantly increased. Qualitative analysis revealed learner development in health systems, social determinants of health, critical thinking, planetary health, cultural humility, and professional practice., Conclusion: Virtual global health electives effectively develop key competencies in global health. This virtual elective had a 40-fold increase in the proportion of trainees from outside the United States, compared to pre-pandemic place-based electives. The virtual platform facilitates accessibility for learners from a variety of health professions and a wide range of geographic and socioeconomic environments. Further research is needed to confirm and expand on self-reported data, and to pursue approaches to greater diversity, equity, and inclusion in virtual frameworks., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Objectives: Evaluate the relationship between nurses' perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses' fatigue during the COVID-19 pandemic., Background: LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses' fatigue., Methods: The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses' perception of having visible and accessible HHS and fatigue among LTC nurses., Results: The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [ OR ] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC., Conclusions: This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses' fatigue during the pandemic. A conceptual framework has been proposed for future studies.

Objectives: There is a paucity of evidence on the provision of trauma-informed care among nurses and midwives during the pandemic.Therefore, this online survey of Turkish nurses and midwives aimed to: describe reported maternal concerns and anxieties during the COVID-19 pandemic; and explore aspects of trauma-informed care for perinatal women during the COVID-19 pandemic (i.e., nurses' and midwives' knowledge, opinions, perceived competence, current practices, and implementation barriers)., Design: A cross-sectional descriptive survey design., Setting and Participants: A web-based survey conducted between June 2021 to December 2021. A total of 102 nurses and midwives comprised the final sample of this study., Findings: The safety of COVID-19 vaccine was both the most common maternal concern (73%) and the most frequently noted maternal source of anxiety (79%) reported to nurses and midwives by perinatal women. Most nurses and midwives were knowledgeable of, held favorable opinion about, and perceived moderate competence in trauma-informed care. The most frequently provided practice was encouraging mothers to make use of their own social support system (82%). Time constrains and lack of resources were perceived as somewhat to significant barriers to providing trauma-informed care during the pandemic., Conclusions: Access to correct information related to COVID-19 vaccination is necessary to reduce maternal anxiety. Since perinatal nurses and midwives had favorable opinions concerning implementing trauma-informed care, successful strategies for mitigating the implementation barriers are essential to facilitate the provision of trauma-informed care during the pandemic., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report, (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic created stressful working conditions for nurses and challenges for leaders. A survey was conducted among 399 acute and ambulatory care nurses measuring availability of calming and safety resources, perceptions of support from work, and intent to stay. Most nurses reported intent to stay with their employer, despite inadequate safety and calming resources. High levels of support from work were significantly influenced nurses' intent to stay. Leadership actions at the study site to provide support are described, providing context for results. Nurse leaders can positively influence intent to stay through consistent implementation of supportive measures., (2022 by Elsevier Inc. All rights reserved.)

Introduction: No safe detectable level of lead (Pb) exists in the blood of children. Until recently, U.S. Centers for Disease Control and Prevention (CDC) guidelines designated a blood lead level (BLL) ≥ 5 μg/dL as an elevated BLL (EBLL). For the State of Kansas, early childhood blood lead burdens lack reporting in the literature., Methods: Secondary analysis was conducted of passively reported EBLL rates ≥ 5 μg/dL among children ages 0 - 5 years at the zip code-level in Kansas during 2005 to 2012. Data weights using corresponding population estimates were applied to produce statewide outcomes., Results: Statewide estimates of annual testing coverage in Kansas among children ages 0 - 5 years were low (9.7%). Approximately 17,000 children ages 0 - 5 years developed an EBLL ≥ 5 μg/dL each year in Kansas with a 6.9% statewide EBLL rate compared to the national rate of 3.2% for the corresponding years. Significant variations in EBLL rates were found between suburban zip codes compared to urban, urban cluster, or rural at 3.1%, 7.2%, 8.8%, and 10.0%, respectively. Among the worst outcomes in EBLL rates was observed for zip codes in southeast Kansas (13.5%) and rural areas with < 500 persons (15.1%)., Conclusions: Young children in Kansas had twice the risk of developing an EBLL ≥ 5 μg/dL compared to the national rate, while higher rates consistently were seen outside of the suburbs and particularly in more rural and less populated areas. At-risk children and troubled areas of toxic lead exposure in the State of Kansas require increased recognition with improved targeting and interventions., (© 2022 The University of Kansas Medical Center.)

Background: It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM 2.5 ) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms., Objective: The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM 2.5 ), and lung function in terms of forced expiratory volume in 1 second (FEV 1 %); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control., Methods: We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM 2.5 , and FEV 1 %, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility., Results: This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023., Conclusions: Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines., Trial Registration: ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076., International Registered Report Identifier (irrid): DERR1-10.2196/39887., (©Sharmilee Nyenhuis, Emily Cramer, Matthew Grande, Luz Huntington-Moskos, Kathryn Krueger, Olivia Bimbi, Barbara Polivka, Kamal Eldeirawi. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 02.08.2022.)

Normalization of deviance is a phenomenon in which individuals and teams deviate from what is known to be an acceptable performance standard until the adopted way of practice becomes normalized. In health care, this phenomenon erodes the safety culture, and it can be particularly concerning in high-risk work environments, such as the operating room (OR). The purposes of this study were to: (a) Explore the concept of normalization of deviance in the OR; (b) Identify reasons for normalization of deviance; and (c) Identify factors that protect against normalization of deviance.This focused ethnographic study included a sample of 10 perioperative nurses who were interviewed. Our findings demonstrated that normalization exists in the OR. Reasons for normalization of deviance included productivity pressures, generalized complacency, complacency related to length of experience, social pressures, and negative acculturation. Factors that protect against normalization of deviance included nurse engagement and having supportive managerial relationships.

Purpose: To gain an understanding of the cancer diagnosis, treatment, and survivorship experiences of adult Muslim cancer survivors residing in the United States., Participants & Setting: A purposive sample of 17 male and 15 female Muslim cancer survivors was recruited from across the United States. Data on Muslim cancer survivors' experience were collected through individual, in-depth, semistructured interviews., Methodologic Approach: An interpretive, descriptive, qualitative approach was used to gain an understanding of the experience of Muslim cancer survivors., Findings: Six broad themes were identified to gain an understanding of the cancer experiences of adult Muslim cancer survivors residing in the United States., Implications for Nursing: This study provided key information concerning the unique experience of Muslim cancer survivors residing in the United States. Identifying, understanding, and meeting survivors' religious needs, as well as understanding their cancer experience, may reduce cancer health disparities and enhance health outcomes.

Objective: The aim of the study was to assess the relationship of culture of safety dimensions and the rate of unanticipated care outcomes in long-term care facilities (LTCFs) using the Agency for Healthcare Research and Quality framework of resident safety culture., Methods: Cross-sectional survey data were collected on 13 dimensions of culture of safety in five LTCFs from registered nurses, licensed practical nurses (LPNs), nursing assistants, administrators/managers, administrative support, and rehabilitation staff. Secondary data on falls in the five LTCFs from quarters 1 to 3 of 2014 were obtained from the Centers for Medicare and Medicaid Services in February 2015. Spearman's ρ and the Generalized Estimating Equations using a log link (Poisson distribution) were used., Results: Communication and feedback about incidences reported the highest mean scores (M = 4.35, SD =0.71). Higher rate of falls was associated with a lower level of team work, lower degree of handoffs, and lower levels of organizational learning. The risk for falls increased as the number of residents per facility increased (rate ratio [RR] = 1.02; 95% confidence interval [CI] = 1.01-1.02) and as the number of LPN hours per resident increased (RR = 37.7, 95% CI = 18.5-76.50). Risk for long stay urinary tract infections increased as number of residents increased (RR =1.01, 95% CI =1.01-1.01). Increase in culture of safety score was associated with decrease in risk of falls, long stay urinary tract infections, and short stay ulcers., Conclusions: With the shortage of registered nurses in LTCFs and new reimbursement regulations, many LTCFs are hiring LPNs to have full staffing and save money. Licensed practical nurses may lack essential knowledge to decrease the rate of falls., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

The perioperative setting is an intricate, complicated work environment in which patients are vulnerable to adverse events. Using a convenience sample, we examined relationships between the length of perioperative nurse experience, perioperative nurse engagement, and an OR culture of safety. We explored differences in safety culture scores based on CNOR certification status. There was no significant relationship between the length of perioperative nurse experience and the level of OR culture of safety. However, perioperative nurse engagement had a significant relationship with an OR culture of safety (P < .001), and this factor was a significant predictor of an OR culture of safety (P < .001). Perioperative nurses who held CNOR certification had significantly higher culture of safety scores compared with those who did not (P = .004). Additional research on perioperative nurse engagement and factors relating to patient safety may help perioperative leaders develop and implement engagement strategies., (© AORN, Inc, 2021.)

Normalization of deviance is a phenomenon demonstrated by the gradual reduction of safety standards to a new normal after a period of absence from negative outcomes, which suggests that the absence of negative outcomes tends to reinforce the behaviors associated with cutting corners, bypassing safety checklists, and ignoring alarms. While the concept was first identified within the National Aeronautics and Space Administration, it has a strong, dangerous presence within health care, holding specific peril within high-risk environments such as the operating room. The aims of this article are to (1) analyze the concept of normalization of deviance and (2) identify the role of normalization of deviance with respect to the behavior of nurses in high-risk health care environments to prevent adverse patient outcomes. The steps outlined by Walker and Avant are applied to guide the concept analysis., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Home environmental exposures are a primary source of asthma exacerbation. There is a gap in decision support models that efficiently aggregate the home exposure assessment scores for focused and tailored interventions. Three development methods of a home environment allergen exposure scale for persons with asthma (weighted by dimension reduction, unweighted, precision biomarker-based) were compared, and racial disparity tested., Methods: Baseline measures from a longitudinal cohort of 187 older adults with asthma were analyzed using humidity and particulate matter sensors, allergy testing, and a home environment checklist. Weights for the dimension reduction scale were obtained from factor analysis, applied for loadings > 0.35. Scales were tested in linear regression models with asthma control and asthma quality of life outcomes. Racial disparities were tested using t tests. Scale performance was tested using unadjusted regression analyses with asthma control and asthma quality of life outcomes, separately., Results: The 7-item empirically weighted scale demonstrated best performance with asthma control associations (F = 4.65, p = 0.03, R 2  = .02) and quality of life (F = 6.45, p = 0.01, R 2  = .03) as follows: evidence of roach/mice, dust, mold, tobacco smoke exposure, properly venting bathroom fan, self-report of roach/mice/rats, and access to a HEPA filter vacuum. Pets indoors loaded on a separate scale. Racial differences were observed (t = - 3.09, p = 0.004)., Conclusion: The Home Environment Allergen Exposure Scale scores were associated with racial disparities. Replicating these methods in populations residing in high-risk/low-income housing may generate a clinically meaningful, tailored assessment of asthma triggers. Further consideration for variables that address allergic reactivity and biomarker results is indicated to enhance the potential for a precision prevention score.

Objective: To explore how knowledge of and perceived competence in trauma-informed care inform the attitudes of NICU nurses toward mothers of newborns with neonatal abstinence syndrome (NAS)., Design: A cross-sectional survey study., Setting: A southern U.S. metropolitan children's hospital with 145 NICU beds., Participants: Convenience sample of 150 NICU nurses., Methods: Participants completed an online survey questionnaire adapted from the Attitudes About Drug Abuse in Pregnancy questionnaire and the Trauma-Informed Pediatric Care survey. Participants also responded to one open-ended question about their experiences in working with mothers of newborns with NAS. We used descriptive and inferential statistics and content analysis to analyze the survey data., Results: Participants demonstrated low to moderate knowledge about and perceived competence in trauma-informed care and showed more judgmental attitudes toward mothers of newborns with NAS. Level of knowledge about mothers with substance use disorder and perceived competence in trauma-informed care were associated with participants' attitudes toward mothers of newborns with NAS. Emergent themes from qualitative data included the following: Mother-Newborn Dyads Shape Nurses' Judgmental Attitudes, Caring for Mothers of Newborns With NAS Is a Challenging Experience, and Need to Refine Care for Mothers Through Intra- and Interdisciplinary Collaboration., Conclusion: NICU nurses need further education about mothers of newborns with NAS. Improved knowledge about these women and adaptation of the principles of trauma-informed care may influence NICU nurses' judgmental attitudes toward mothers of newborns with NAS., (Copyright © 2020 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: Perioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors' aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population., Methods: A prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group-WG). The remaining 82 patients received no extra warming care during their perioperative period (control group-CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively., Results: WG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group., Conclusions: Preoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.

Objective: Globally, indoor and outdoor pollutants are leading risk factors for death and reduced quality of life. Few theories explicitly address environmental health within the nursing discipline with a focus on harmful environmental exposures. The objective here is to expand the National Institutes of Health Symptom Science Model to include the environmental health concepts of environmental endotype (causative pathway) and environmental exposure., Design: Meleis' research to theory strategy for theory refinement was used. Research workshop proceedings, environmental health nursing research expert consensus, panelist research trajectories, and review of the literature were utilized as data sources., Results: Ongoing emphasis on the physical environment as a key determinant of health and theoretical perspectives for including environmental exposures and endotypes in symptom science are presented. Definitions of these concepts, further developed, are provided. Recommendations to strengthen environmental health nursing research and practice through capacity building/infrastructure, methods/outcomes, translational/clinical research, and basic/mechanistic research are included., Conclusion: The revised model deepens theoretical support for clinical actions that include environmental modification, environmental health education, and exposure reduction. This modification will enable a middle-range theory and shared mental model to inspire the prioritization of environmental health in nursing leadership, research, practice, and education., (© 2019 Wiley Periodicals, Inc.)

Introduction: There are significant and negative psychological effects that can occur in nursing staff caring for pediatric patients experiencing critical incidents. Debriefings can provide relief from the stressors caused by critical incidents. Adapting a pre-existing critical incident stress debriefing (CISD) process to ED staff is 1 way to provide staff debriefing., Methods: This qualitative study used an emerging, descriptive design. Focus groups, (n = 3, total participant n = 19), consisting of pediatric emergency nurses and a nursing assistant, met for a minimum of 63 to a maximum of 83 minutes. Participants provided feedback on current debriefing strategies and suggestions for adapting a currently existing critical incident stress- debriefing process. Focus group questions included "Have you participated in a structured debriefing process? If so, tell us about it" and "What would you like to see in a structured debriefing process?", Results: A theoretical orientation content analysis revealed 1 main theme-Clearing the Air and Finding Answers-and 6 subthemes: Current Debriefing Strategies; Positive Reinforcement; Constructive Critique; Clinical, Not Emotional; I've already moved on; and CISD Structure., Discussion: Pediatric ED staff de-stress in a variety of ways, and a nonmandatory, formalized CISD process-open to staff involved and facilitated by an emergency nurse-could provide additional relief from stress. This debriefing process should include positive feedback and critiques to help improve care processes, information about mechanism of injury, and should occur before the end of shift or within 12 to 24 hours of the incident. Staff may deal with personal feelings outside of debriefing., (Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: The purpose of this study was to identify whether or not sleep behaviors mediated bioecological predictors of weight-related behaviors among college students., Methods: This descriptive, quantitative, cross-sectional study, guided by Bronfenbrenner's bioecological model, examined bioecological characteristics and path analysis to assess model fit., Conclusions: The fit indices indicated excellent fit of the final model to the data (χ (24) = 30.33, p = .17, root-mean-square error approximation = 0.04, comparative fit index = 0.96, standardized root-mean-square residual = 0.03). Sleep duration mediated significant bioecological predictors of weight-related behaviors, but sleep quality did not. Having children significantly predicted increased sugar-sweetened beverage (SSB) consumption and decreased physical activity (PA) among college students. Conversely, eating the majority of meals at home significantly predicted decreased consumption of SSBs and increased PA., Implications for Practice: Findings support inclusion of sleep duration and use of the bioecological model, when providing patient-centered healthcare focused on weight-related behaviors and weight management in college students.

The use of smartphones in acute care settings remains controversial due to security concerns and personal use. The purposes of this study were to determine (1) the current rates of personal smartphone use by nurses in acute care settings, (2) nurses' preferences regarding the use of smartphone functionality at work, and (3) nurse perceptions of the benefits and drawbacks of smartphone use at work. An online survey of nurses from six acute care facilities within one healthcare system assessed the use of personal smartphones in acute care settings and perceptions of the benefits and drawbacks of smartphone use at work. Participants (N = 735) were primarily point-of-care nurses older than 31 years. Most participants (98%) used a smartphone in the acute care setting. Respondents perceived the most common useful and beneficial smartphone functions in acute care settings as allowing them to access information on medications, procedures, and diseases. Participants older than 50 years were less likely to use a smartphone in acute care settings and to agree with the benefits of smartphones. There is a critical need for recognition that smartphones are used by point-of-care nurses for a variety of functions and that realistic policies for smartphone use are needed to enhance patient care and minimize distractions.

Background and Purpose: The purpose of this systematic review was to examine influences affecting sleep behavior in traditional-age college students and to advocate for improved sleep behavior assessments., Data Sources: A literature search of CINAHL, MEDLINE, and PubMed databases was performed using the search terms "college students" and "sleep" in the title that were published in English from 1978 to 2016., Conclusions: The circadian clock is reset in traditional-age college students leading to delayed sleep times. Newly realized autonomy and increased use of technology also prevent traditional-age college students from obtaining sufficient sleep. Insufficient sleep experienced by these students has been linked to insulin resistance, hypertension, diabetes, weight gain, and stress. Sleep insufficiency increases the risk for pedestrian, motor vehicle, and domestic and occupational injuries. Insufficient sleep may result in poor academic performance influencing subsequent health outcomes., Implications for Practice: Evidence supports the need for nurse practitioners and other healthcare providers to incorporate systematic sleep behavior assessments to improve health outcomes among traditional-age college students., (©2017 American Association of Nurse Practitioners.)

Background: Low-income, unemployed women with low levels of education are more likely to smoke during pregnancy compared to their higher-income, employed, and well-educated counterparts. The reserve capacity model (RCM) offers a theoretical framework to explain how psychosocial factors may serve as pathways connecting socioeconomic status (SES) to health behaviors. Research supports the link between prenatal smoking and several psychosocial variables such as chronic stressors, depressive symptoms, and social support. How these variables interrelate to explain the predominance of prenatal smoking in lower socioeconomic groups of pregnant women has not been fully elucidated., Objective: The aim of this study was to test the RCM to evaluate the roles of early pregnancy levels of chronic stress, quality of the primary intimate relationship, and depressive symptoms in explaining the relationship between SES and persistent prenatal smoking., Methods: A secondary analysis of data from 370 pregnant nonsmokers, spontaneous quitters, and persistent prenatal smokers was conducted. On the basis of the RCM, chronic stressors, depressive symptoms, and the quality of the primary intimate relationship were evaluated as potential mediating variables linking SES with persistent prenatal smoking using path analysis., Results: Path analyses indicated that a simple model with all three psychosocial variables as mediators of the relationship between SES and persistent prenatal smoking provided the best fit., Discussion: Findings indicated that chronic stressors, depressive symptoms, and the quality of the primary intimate relationship play important roles in the pathway from SES to prenatal smoking status. This knowledge can assist in the development of prevention and intervention strategies to target these variables and ultimately reduce prenatal smoking., Competing Interests: The authors have no conflicts of interest to report.

Purpose: The purpose of this study was to determine if increased frequency of telephone contact immediately following diabetes self-management education (DSME) impacts improvements in A1C levels versus routine telephone follow-up. Methods: This study used a quasi-experimental design consisting of a control group ( n = 30) who received routine follow-up (1 telephone call 4-6 weeks after DSME class completion) and an intervention group ( n = 26) who received an average of 5 telephone calls over a 3-month period following DSME. Participants were obtained from an outpatient diabetes education program assoctiated with a large urban health care system. Results: Most participants were female, White, with the average age of 57.2 years ( SD = 14.1). Preintervention A1C levels ranged from 6.5% to 14.3%, whereas postintervention A1C levels ranged from 5.2% to 13.6%. There was significant improvement in A1C levels for both the intervention and the control groups. However, no statistically significant difference in A1C change scores was found between the groups. Sixty percent of the control group participants had post-A1C levels below 7% compared to 54% of the intervention group. Increased telephone contact was associated with A1C reductions, although this relationship was not statistically significant. Conclusions: This study demonstrated that A1C reductions can occur with either frequency of telephone follow-up. The diabetes educator should evaluate the telephone follow-up needs of each DSME participant to support his or her diabetes self-management success.

Objective: To examine the experiences of, meaning for, and personal consequences for obstetric, emergency, and surgical nurses caring for women after fetal death and to determine how these nurses use Swanson's caring processes in providing such care., Design: Four focus groups., Setting: Two hospitals within the same health care system., Participants: Registered nurses (N = 24) working in the obstetric, surgery, or emergency departments., Methods: Swanson's Theory of Caring guided focus group questions that were audiotaped and transcribed verbatim. Data were analyzed using a continuously emergent process of data collection, data reduction, data display, and interpretation., Results: All participants demonstrated all of Swanson's caring processes but used them preferentially according to situational exigencies and level of rapport with each woman. Nurses had positive and negative feelings associated with caring for women after fetal loss., Conclusions: Obstetric nurses provided relatively equal focus on all processes in the Theory of Caring except Maintaining Belief. Surgical and emergency department nurses focused primarily on the caring processes of Knowing and Doing For. The negative feelings reported by nurses mirror some emotions commonly associated with compassion fatigue. More research is needed to determine whether nurses caring for mothers experiencing fetal loss are at risk for compassion fatigue. Research is also needed to identify strategies and interventions to help nurses so they may continue to give the best care possible to these very vulnerable families without detriment to themselves., (Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Meeting the Magnet Recognition Program® requirements for integrating research into practice can be daunting, particularly for nonacademic hospitals. The authors describe 1 healthcare system's approach to advancing nursing research in 5 hospitals through collaboration with a local university school of nursing and development of an infrastructure to support, empower, and mentor clinical nurses in the conduct of research. Outcomes include completed research, presentations, publications, practice change, and professional development.