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As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. The need for integrated disability and PC services with extensive collaboration is great. The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.

The COVID-19 pandemic overwhelmed the US healthcare system and healthcare providers. Nurses, who comprise one of the most affected groups because they are the largest group of healthcare providers, were in a unique position to speak about their perspectives. As a result of the COVID-19 pandemic, nurses have experienced ongoing physical and psychological challenges while displaying strength and perseverance during uncertain times. In this study, we explored the perceptions and experiences of nurses in clinical practice caring for patients diagnosed with COVID-19 during the pandemic. Researchers conducted a qualitative descriptive study with 20 clinical nurses most of whom were enrolled in a graduate program while working in healthcare settings. Semi-structured interviews conducted through Zoom occurred between August 2020 and December 2020. Thematic analysis was used to analyze the transcripts. Five themes emerged: navigating uncertainty, managing death and loss, acknowledging emotional responses, learning opportunities, and facing community undercurrents. Lack of clinical practice guidelines, and inconsistent access to personal protective equipment when providing care to patients with COVID-19 caused emotional strain for nurses and highlighted future learning opportunities. Providing support to dying patients was devastating to nurses. Concern about community misunderstandings of the pandemic created challenges. Evolving teamwork provided invaluable support to study participants. Nurses shared essential information for revising and creating clinical practice guidelines. Nursing interventions and strategies were used to produce humane and positive patient outcomes and provide a foundation for nurse-driven care in possible future pandemics.

Background and Purpose:Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD.Methods:The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument.Results:Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach’s alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD.Conclusions:The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.

To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability.Qualitative descriptive design.Telephone interviews.Seventeen childbirth educators.We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis.We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability.Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.

Approximately 100,000 Americans have sickle cell disease (SCD). In the USA, the majority of patients with SCD are of African descent. Due to persistent racial and ethnic disparities in healthcare in the USA, patients with SCD experience disproportionately more health inequities because of providers’ implicit biases regarding patient race. Lack of access to health insurance, lack of transportation to healthcare providers, and inadequate provider knowledge contribute to the morbidity and mortality of patients with SCD. The purpose of this integrative review was to analyze and synthesize the literature on providers’ knowledge, perceptions, beliefs, and attitudes toward patients with SCD. A modified (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) method was used to conduct a comprehensive review of the literature yielding 31 publications included in this review. Three connected, yet distinct areas of focus were identified: (1) providers’ knowledge, attitudes, and perceptions of patients with SCD; (2) providers’ perceived or true barriers to caring for patients with SCD; and (3) interventions to improve providers’ attitudes, perceptions, and care of patients with SCD. In each area of focus, research has evolved over time. Also included in this integrative review is a synthesis of measurement instruments used to assess provider knowledge, attitudes, perceptions, and perceived and true barriers to caring for patients with SCD. Adolescents with SCD who are transitioning from pediatric to adult care are at a particularly high risk for morbidity and mortality, so this review focused on the many opportunities that exist to advance the healthcare for young adults with SCD to improve patient outcomes later in life. This includes improving providers’ knowledge, perceptions, beliefs, and attitudes, and lessening the real or perceived barriers to care for patients with SCD.

Background Both clinical and nonclinical transition-to-practice courses have been offered to facilitate the transition from student to novice nurse. Problem Nonclinical transition-to-practice courses are less widely discussed in the literature; thus, their content and effectiveness have not been examined. Approach Academic institutions with baccalaureate nursing programs were surveyed to determine if they offered a nonclinical transition-to-practice course and to identify the associated content. Outcome Of 19 responding institutions, 15 reported having a nonclinical transition-to-practice course. Eighty-seven percent of the courses address ethical dilemmas, and 80% include delegation, interview preparation, stress management, and work/life balance. Conclusion Although schools of nursing are urged to address students' transition to practice, there is considerable variation in the nonclinical topics addressed. Research is needed to provide guidance to maximize the impact of these nonclinical transition-to-practice courses on new nurses' transition experience.

The transition period from student nurse to novice nurse is a stressful time. Patient outcomes, healthcare organizations, the new nurse, and the nursing profession can be negatively affected if the transition from nursing student to novice nurse is not a positive and successful experience. Currently, there are numerous interventions aimed at easing the transition for the new nurse with just as many instruments used to evaluate the success of the interventions in doing so. This integrative review examined quantitative studies that evaluated the outcomes of interventions implemented to ease the transition from student to professional nurse. The seven articles that met the criteria for this review discussed four types of programs and one curriculum revision and collectively used 14 instruments to measure a total of 18 concepts related to new nurse transition. Despite the significance of the studies' results that indicate interventions to ease the transition-to-practice experience are beneficial and can have a positive impact on areas such as job satisfaction and retention, overall findings from this integrative review suggest the need for greater standardization of concepts that should be evaluated and the instruments used to determine if new nurses are successfully transitioning into professional nursing.

Background The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy. Objectives The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error. Data sources The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies. Conclusions The 33 studies included in this review represent four categories of debiasing strategies: increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklists to expand diagnosis considerations (seven studies). The studies were inclusive of medical students and residents; no studies included nurse practitioner (NP) students. Guided reflection, the most clearly defined and implemented strategy, showed the most promise for improvement of diagnostic accuracy. Educational interventions were wide ranging in content and delivery but did yield a path for future research. Implications for practice There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.

Background: A Curriculum Embedded Weight Sensitivity Training program (CeWebs) was integrated into an undergraduate nursing course to improve attitudes and beliefs toward individuals with obesity. Method: A one-group repeated measures study was conducted to compare students' pretest and posttest attitudes and beliefs using the Attitudes Toward Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) at the beginning and end of the semester. Results: Comparison of pretraining and posttraining scores of 125 junior nursing students on ATOP (73.96 ± 15.02 and 84.59 ± 15.39, respectively) indicated a significant increase in scores ( p < .01), which reflects more positive attitudes. Comparison of pretraining and posttraining BAOP scores (18.20 ± 6.84 and 22.22 ± 7.87, respectively) indicated a significant ( p < .01) increase in scores, indicating beliefs that obesity is not controllable. Conclusion: These findings suggest that embedding weight sensitivity training into undergraduate nursing curricula may improve attitudes and beliefs toward patients with obesity. [ J Nurs Educ . 2020;59(8):453–456.]

PURPOSE: Throughout the world, illicit drug use continues to pose a significant risk to public health. The opioid crisis in North America, the diversion of the prescription drug tramadol throughout Africa, and the increasing supply of methamphetamines in East and South Asia all contribute to increasing risks to individual and societal health. Furthermore, the violation of human rights in efforts to enforce prohibitionist values poses significant threats to many individuals worldwide. With these evolving situations, it is imperative that researchers direct their attention to the various populations of illicit drug users. However, the inclusion of illicit drug users, often considered a vulnerable population, as participants in research studies presents several increased risks that must be addressed in study protocols. Researchers are required to provide “additional safeguards” to all study protocols involving illicit drug users, but there is often substantial variability and inconsistency in how these safeguards are applied. Additional safeguards can be timely, costly, and unduly burdensome for researchers, ethical review boards, and research participants. APPROACH: Through synthesis of the current literature, this article addresses the barriers to studying illicit drug users and the methods researchers can utilize to minimize risk. A case study is provided to illustrate the high level of scrutiny of study protocols involving the participation of illicit drug users and the effect of such scrutiny on recruitment of participants. The article concludes with a discussion of the effects of the current political climate on the recruitment of illicit drug users in research. CONCLUSIONS: Individuals who participate in criminal or illegal behaviors such as illicit drug use, prostitution, illegal entry into a country, and human trafficking are susceptible to multiple physical, mental, and social health risks, as well as criminal prosecution. The importance of research on the health of marginalized populations cannot be overstated. This work must continue, and at the same time, we must continue to protect these individuals to the best of our ability through diligent attention to sound research methods. CLINICAL RELEVANCE: The use of illicit drugs continues to pose a substantial threat to global health. Individuals who use illicit drugs are susceptible to multiple physical, mental, and social health risks, as well as criminal prosecution. It is imperative that researchers study these vulnerable populations in order to develop interventions to minimize individual and societal harm. There are several barriers to the study of illicit drug users that must be addressed through rigorous methodology and the addition of safeguards.

Background Palliative care education and experience are needed for student competence in delivering high-quality palliative nursing care. Simulation has been linked to acquired clinical competency among pre-licensure students. A known literature gap is measurement of students' performance during end-of-life simulations. Objectives The aim of this study was to determine relationships among previous palliative care nursing experience, knowledge, self-awareness, and performance in nursing students during an end-of-life simulation. Design/Setting/Participants A quasi-experimental pretest/posttest design was used to assess these variables with a convenience sample of 75 senior nursing students during an end-of-life simulation at a Midwest Jesuit university. Methods Self-awareness was measured with the Frommelt Attitudes Toward Care of the Dying, Form B. The Palliative Care Quiz for Nursing measured participants' knowledge. Participants' performance during the simulation was measured using a modified version of the Creighton Competency Evaluation Instrument®. Palliative care nursing self-awareness and knowledge were assessed before and after the simulation. Previous end-of-life care experience was assessed with a single demographic question at pretest only. Results The sample was highly experienced in end-of-life care (93.3% reporting experience pre-simulation). Although pretest self-awareness (M = 124.5; ±1.3) and knowledge (M = 57.1%; ±2.2) were higher in students with two or more types of end-of-life experience (n = 42), there were no significant differences (p > .10) in these outcomes by groups pre- or post-simulation. Self-awareness (M = 130.1; ±1.2), knowledge (M = 80.5%; ±2.6), and performance (M = 94.1%; IQR 87.5 to 100) scores were high for student participants (n = 36) post-simulation, with moderate correlations found between some scores (rpb Conclusions Findings support self-awareness and knowledge as antecedents of high quality palliative nursing care. Students demonstrated increased post-simulation knowledge, self-awareness, and quality performance of palliative nursing care regardless of previous end-of-life experience. End-of-life simulation is supported as an education method for increasing palliative care nursing competence and assessing student performance of palliative care nursing interventions.

Studies show decreased well-being during the COVID-19 pandemic, especially for healthcare providers from Asia. Less is known about the psychological responses of working during the pandemic on hospital-based registered nurses (RNs) in the United States (US). Therefore, the purpose of this paper is to report the well-being of U.S.-based hospital RNs working during the initial acute phase of COVID-19 and compare it with well-being among healthcare workers described in two global meta-analyses. We conducted a cross-sectional survey in May-June 2020 (N = 467). Well-being was measured using the following tools: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depressive symptoms, Impact of Events Scale-Revised for traumatic stress, and the Insomnia Severity Index. Compared with global rates from two meta-analyses, US-based RNs reported significantly more traumatic stress (54.6% vs. 11.4% and 21.5%; p .001) and depressive symptoms (54.6% vs. 31.8% and 21.7%; p .001). Rates of insomnia were also higher in U.S.-based RNs than in the meta-analysis that reported insomnia (32.4% vs 27.8%; p .033). Rates of anxiety symptoms among US-based RNs did not differ from that reported in one meta-analysis (37.3% vs. 34.4%), while it was significantly higher in the other (37.3% vs. 22.1%; p .001). Hospital-based RNs from the US exhibited over twice the rates of trauma and nearly double the rates of depressive symptoms than shown in reports from hospital workers globally during the acute phase of the COVID-19 pandemic. The lasting effects of this distress are unknown and warrant ongoing evaluation and solutions to better support emotional well-being and prevent burnout in the workplace.

Aim This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. Background Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. Method Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. Results Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. Conclusion Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.

Aim: The purpose of this quasi-experimental one-group repeated measure (pre-test/post-test) study was to determine the effect of an end-of-life (EoL) simulation-based experience (SBE) on active and observer nursing students' palliative care knowledge and self-awareness. Background: Baccalaureate nursing (BSN) graduates must demonstrate competence in EoL care; however, gaining EoL experience is challenging given constraints on nursing faculty and clinical sites. Research also is needed to determine whether similar outcomes are achieved by active and observer participants after EoL SBE. Method: Senior-level BSN students' palliative care knowledge and self-awareness of active and observer participants were measured before and after an EoL SBE. Results: Knowledge and self-awareness increased (Pattitude=130.1; Mknowledge=80.5) and observer (Mattitude=128.3; Mknowledge=77.9) participants. Conclusion: EoL SBE is an effective method for increasing student palliative care competence. Student observers benefit as much as active participants on knowledge and self-awareness outcomes.

The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy.The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error.The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies.The 33 studies included in this review represent four categories of debiasing strategies: increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklists to expand diagnosis considerations (seven studies). The studies were inclusive of medical students and residents; no studies included nurse practitioner (NP) students. Guided reflection, the most clearly defined and implemented strategy, showed the most promise for improvement of diagnostic accuracy. Educational interventions were wide ranging in content and delivery but did yield a path for future research.There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.

The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group ( n = 35); an inpatient DSME only group ( n = 100); and a group who received usual care ( n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge. Rates of rehospitalization and A1C improved for older adults who received nurse-led inpatient DSME and homecare during transitions of care from hospital to home. Rehospitalization rates up to 90 days were decreased for the DSME plus homecare group (10%) compared to DSME only (20%) and usual care groups (26.7%) ( p < 0.05). A decrease of −0.4 and −2.3 A1C units was observed for the DSME group and DSME plus homecare group, respectively, at 90 days. These results support a transitional care educational intervention for older adults with type 2 diabetes mellitus and obesity. Targets: Older adults with type 2 diabetes mellitus and obesity. Intervention Description: Transitional care intervention including diabetes self-management education and homecare. Mechanisms of Action: Inpatient diabetes education and homecare helps improve rates of rehospitalization and hemoglobin A1C during care transitions from hospital to home. Outcomes: Rehospitalization rates, glycemic control (i.e., A1C level). [Res Gerontol Nurs. 2018; 11(2):71–81.]

Background Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. Objective The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. Methods The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. Results The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. Conclusions The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 International Registered Report Identifier (IRRID) DERR1-10.2196/30757

Background: The benefits of breastfeeding are well established, and breastfeeding is now widely practiced in the United States. Although increasing numbers of women with physical disabilities are having children, little information is available about breastfeeding practices among these women. Nonetheless, the children of women with physical disabilities should benefit from breastfeeding just as children of nondisabled mothers do. Research aim: This study aimed to explore the facilitators and barriers to breastfeeding among women with physical disabilities. Methods: This study involved semistructured telephone interviews with a convenience sample of women ( N = 25) with diverse physical disabilities from across the United States. All participants had given birth within the past 10 years. Interviews were audio-recorded, professionally transcribed, and analyzed using content analysis. Results: Analyses found four broad themes indicating facilitators to breastfeeding: (a) adaptations and equipment, (b) use of breast pump, (c) physical assistance from others, and (d) peer support. We also found five broad themes suggesting barriers to breastfeeding: (a) lack of supports, (b) disability-related health considerations, (c) limited information, (d) difficulties with milk production, and (e) difficulties latching. Conclusion: The need for greater supports for women with physical disabilities who desire to breastfeed as well as information for women and their clinicians about facilitating breastfeeding.

This integrative review summarized the findings from 19 studies about the known effects of simulation on nursing students' preparation for delivery of palliative care (PC), identified gaps in the literature, and provided directions for future research. Three mixed method studies, 10 quantitative studies, and 6 qualitative studies were reviewed. The outcomes support PC simulation in developing nursing student competence by providing meaning and context to the care they deliver to seriously ill patients. Future investigations examining the relationships between PC simulation, students' role in simulation, and effects on student knowledge, self-awareness, and clinical performance in providing PC are warranted.

Women with physical disabilities increasingly aspire to become pregnant and bear children. Limited information about the potential interaction of their disabling conditions with pregnancy and childbirth exists to guide these women and their clinicians.The interview guide was created with questions on topics such as pregnancy complications and secondary conditions, the impact of prior surgeries, experiences with pain relief during labor, and the impact on women's independence and participation in life activities. Interviews were conducted by telephone with 25 women with physical disabilities. They were subsequently transcribed verbatim and analyzed by using Atlas TI.Women generally reported a relatively modest impact of disabling conditions on their pregnancies. Most women were satisfied with the mode of delivery, but they experienced challenges during the labor and delivery process. The women found that careful advanced planning was helpful in managing the impact of their disabling conditions. The involvement of clinicians with disability-related expertise was, in some cases, another factor that contributed to a positive outcome.The importance of advanced planning and the utility of involving clinicians with disability-related expertise suggest that the use of integrated, interdisciplinary team approaches could promote quality care by facilitating improved planning and management. Additional clinical research is needed to provide women and their clinicians with more information on potential complications and options for labor and delivery.

Background Childbirth is widely acknowledged as one of the most painful experiences most women will undergo in their lifetimes. Alleviating labor and delivery pain for women with physical disabilities can involve an additional level of complexity beyond that experienced by most women, but little research has explored their experiences. Objective The purpose of this study was to explore the experiences of women with physical disabilities with respect to pain relief during labor and delivery with the goal of informing their care. Methods Data were collected using semi-structured interviews with twenty-five women with physical disabilities from across the United States. Results Women expressed specific preferences for the method of pain relief. Some confronted systemic barriers in exploring their options for pain relief, while others were given a choice. At times, anesthesiologists lacked knowledge and experience in caring for women with disabilities. Conversely, some women described how the administration of anesthesia was meticulously planned and attributed their positive labor and delivery experiences to this careful planning. Conclusions Advanced, individualized planning and evaluation of their options for pain relief was most satisfying to women and enabled them to make an informed choice. This approach is consistent with the recommendations of clinicians who have successfully provided pain relief during labor to women with complex physical disabilities. Clinicians who have successfully delivered babies of women with these and similar disabilities emphasize the importance of a team approach where the anesthesiologist and other specialists are involved early on in a woman's care.

Purpose This integrative review presents a synthesis of the current qualitative research addressing the motivating factors, usability, and experiences of mobile health tracking applications (apps) across various chronic disease populations. Design Integrative review of the literature. Methods Databases used to conduct this integrative review included: PubMed Plus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Google Scholar, Science Direct, and EBSCO megafile. The following search terms were used in all five databases: smartphone apps, apps, mHealth, eHealth, mobile health apps, health tracking apps, user-centered apps, wireless technology, engagement, qualitative, and usability. Findings The initial literature review yielded 689 results. Once inclusion and exclusion criteria were employed, 11 studies met the criteria set forth for this review. The reviewed studies provided insight into users’ perceptions, experiences, and motivations to incorporate smartphone mobile health apps into their daily lives when living with chronic illnesses. Conclusions This review indicates the growing interest in user-centered mobile health tracking apps, but with little understanding of motivating factors that foster sustained app use. Mobile health tracking apps targeted to users with chronic conditions need to have a high level of usability in order to motivate users to sustain engagement with their mobile health tracking app. Clinical Relevance User-centered mobile health tracking app technology is being used with increasing frequency to potentially provide individualized support to chronic illness populations.

Background Although many women with physical disabilities report poor quality reproductive health care, little research has addressed labor, delivery, and anesthesia experiences of these women. This study was conducted to explore these experiences in women with significant mobility disabilities. Methods A qualitative descriptive study was conducted with 22 women from the United States who had delivered newborns within the prior 10 years. All had significant mobility disabilities. Two-hour, in-depth telephone interviews were conducted using a semistructured, open-ended interview protocol, which addressed many topics, including labor, delivery, and anesthesia experiences. We recruited most participants through social networks, interviewing women from 17 states. Conventional content analysis, facilitated by NVivo software, was used to identify major themes. Results The mean age of women was 34.8 ± 5.3 years. Most women were white, college educated, and used wheeled mobility aids. Four key themes emerged from participants’ narratives of laboring and giving birth with a disability. These included women's preferences for type of delivery, clinicians and some women expected no labor pain, fears prompting active advocacy, and positive experiences. As participants discussed their experiences with anesthesia, four additional themes were identified: importance of consultation with the anesthesia team, decisions about epidural/spinal vs general anesthesia, failed epidural with repeated efforts, and fear of injury related to anesthesia. Conclusions The responses of women in this study suggest that there is need to make intrapartum care better for women with physical disabilities and to improve their experiences with labor, birth, and obstetric anesthesia care.

Background Self-reflection, combined with clinical experience, has been shown to enhance clinical and didactic knowledge among undergraduate nursing students. Reflective journaling is a valuable educational tool that builds critical thinking skills and raises self-awareness through the purposeful inspection of beliefs and attitudes. However, there are little data available on reflective journaling during clinical education exploring weight bias as part of a weight sensitivity training program. Objectives The study aimed to explore the use of reflective journals as a tool to raise self-awareness and self-reflection of weight bias as part of a weight sensitivity training program. Settings The project was conducted at a four-year pre-licensure baccalaureate nursing program with third-year clinical students in a private Catholic university in southeastern Pennsylvania, USA. Participants All third-year students enrolled in a medical-surgical clinical practicum were eligible to participate from August to December 2017. Design & methods For this qualitative study, data were collected during the 15-week medical-surgical clinical practicum, in which students completed five journal entries. De-identified data were analyzed using thematic analysis. Results A total of 98 students, 18 years of age and older consented, and 280 journal entries were analyzed. Four themes emerged from a majority of the journal entries: 1) increased self-awareness of personal weight bias; 2) acknowledgment of obesity as a chronic disease and not a choice; 3) insufficient resources or training may perpetuate weight bias; and 4) opportunity for weight sensitivity training to improve patient care. Conclusions Through reflective journaling, nursing students were able to periodically self-reflect on their personal weight bias as it pertained to caring for patients with obesity. This introspective self-reflection as part of a weight sensitivity training may lead to not only improving clinical competencies in patient care but also in reducing weight bias in clinical practicum.

The National Academy of Medicine recognizes medical errors as a leading cause of death in the United States. Hospitals nationwide have acted to improve patient safety, quality of care, and system processes; however, no standards mandate assessment of the emotional impact of perioperative catastrophes on healthcare professionals. A cross-sectional descriptive study using a sample of 196 Certified Registered Nurse Anesthetists (CRNAs) tested the psychometric properties of an adapted version of the Perioperative Catastrophes Survey and administered this survey along with the Ways of Coping Questionnaire to measure CRNAs' perceptions, experiences, and responses associated with perioperative catastrophes. The adapted survey demonstrated acceptable internal consistency reliability (α = .893) and construct validity (factor analysis), with 4 subscales explaining 68.1% of the variance in the measure. The CRNAs scored similarly to anesthesiologists in a prior study conducted by Gazoni and colleagues, showing that memorable perioperative catastrophes have a negative emotional, cognitive, and functional impact. On the 8 Ways of Coping Questionnaire subscales, CRNAs with less than 10 years of experience reported significantly higher Escape-Avoidance behaviors compared with more experienced CRNAs (P = .016). Future research must examine perceptions of perioperative catastrophic events and coping mechanisms to identify providers at risk of negative consequences.

Background People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care. Purpose The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs. Methods A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data. Results Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral. Conclusions The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.

Background Parents across the United States use medical cannabis for their children, often without professional guidance. These parents have become more expert on medical cannabis than most health professionals. Purpose Using a case-study design, this study was conducted to describe the experience of parents using medical cannabis for relief of seizures in their child or dependent. Methods Data were subjected to qualitative content analysis for the identification of patterns and themes. Findings Analysis of all data revealed seven themes including “Discovery of Cannabis as a Medication,” “Guidance on Dosing,” “Costs and Benefits of Cannabis,” “Distrust of the Pharmaceutical Industry,” “Federal Interference,” “God and Cannabis,” and “Changing Societal Perceptions about Medical Cannabis.” Discussion Themes revealed a complex, multifaceted experience. Many parents report benefit from medical cannabis, and are not hindered by the financial costs or uncertainties. Political and social influences have significant impact on the stigmatization and normalization of cannabis.

Self-efficacy is a well-researched concept and a key component of Bandura's Social Cognitive Theory. Teacher self-efficacy is widely researched within education; it affects student achievement and motivation as well as teacher performance and commitment. Minimal information exists on teacher self-efficacy within clinical settings of practice professions which likely affects patient outcomes. This paper provides background on self-efficacy and teacher self-efficacy; it then addresses clinical teacher self-efficacy using the Walker and Avant (2005) method for concept analysis. Assumptions, definitions, characteristics, antecedents and consequences of the concept of clinical teacher self-efficacy are discussed and represented visually, and exemplified as cases within nursing education. Implications and recommendations are suggested for the applicability of clinical teacher self-efficacy within clinician education and practice.

The transition from student to novice is a difficult time. Although the novice nurse is excited to start working, the nurse struggles with acclimating to a new role with new responsibilities and the need to reconcile disparities between what was taught in school and what is practiced in the real world. To lessen the impact of the transition experience, health care organizations have implemented transition-to-practice programs including orientations, preceptorships, and residencies. Despite these efforts, if the novice nurse does not find these programs helpful, there is still a risk that the transition experience will not conclude with successful results. This integrative review examined qualitative studies that explored the transition-to-practice experience of novice nurses who participated in a transition-to-practice program provided by their place of employment. Thirteen articles met the criteria for this integrative review; seven themes emerged from the commonalities in the studies: socialization, professional growth, feeling supported, transition challenges, reflections, transition shock, and feelings. Though the transition period includes unique experiences for each novice nurse, the common feelings and needs identified in these studies require nurse educators and the healthcare organizations to ensure that novice nurses are prepared and given the tools to successfully transition to professional nursing practice.

Background Although growing numbers of women with mobility disability are becoming pregnant and desiring motherhood, relatively little is known about their pregnancy experiences or what they might recommend to other women with mobility disability contemplating pregnancy. Methods Using a semistructured, open-ended interview protocol, we conducted 2-hour telephone interviews with 22 women who had a significant mobility disability before becoming pregnant and had delivered babies within the prior 10 years. We recruited most interviewees through online social networks. We used NVivo software to sort interview transcript texts and performed conventional content analyses to identify major themes. Results Participants’ mean ± standard deviation age was 34.8 ± 5.3 years; most were White, well-educated, and middle income and 18 used wheeled mobility aids. Recommendations for other women with mobility disability coalesced around five themes: recognizing the possibility of giving birth, advocacy and support, being informed, approaches toward obstetrical practitioners, and managing fears about losing custody of their child. Lacking information about what to expect during their pregnancy was a significant problem. Women got information about pregnancy from diverse sources, but questions arose about accuracy and relevance of this information to individual circumstances. Women urged their peers to advocate for their preferences and needs with obstetrical practitioners. Conclusions Women with mobility disability who had delivered babies offered constructive advice for their peers who desire pregnancy. Increasing availability of accurate and relevant information about pregnancy among women with mobility disability is critically important, as is training obstetrical practitioners to provide patient-centered care to these women during pregnancy.

Background Despite concerns raised in the literature on the adverse pregnancy outcomes of women with physical disabilities, there is little information about unmet needs of women with physical disabilities during pregnancy and childbirth. Objective This article provides an in-depth examination of unmet health care needs during and around the time of pregnancy among a sample of women with physical disabilities. It also offers recommendations to other women with physical disabilities who are considering pregnancy. Methods Twenty-five phone interviews were conducted with women with physical disabilities from across the United States who had a baby in the past ten years. Individual semi-structured qualitative interviews lasting about 2 h were conducted. Interviews were audio-recorded, transcribed, and analyzed using an iterative, interpretive process. Results Women reported a wide range of disabling conditions. Analysis revealed three broad themes related to unmet needs during pregnancy among women with physical disabilities. They included (1) clinician knowledge and attitudes, (2) physical accessibility of health care facilities and equipment, (3) need for information related to pregnancy and postpartum supports. The women also provided recommendations to other women with disabilities who are currently pregnant or thinking of becoming pregnant. Recommendations related to finding a clinician one trusts, seeking peer support, self-advocating, and preparing oneself for the baby. Conclusions This study sheds light on the unmet needs and barriers to care of women with mobility disabilities during pregnancy and childbirth. The study findings highlight the need for policy and practice recommendations for perinatal care of women with mobility disabilities.

This article reports the findings of a study that examined the research and scholarship productivity of doctorally prepared nursing faculty teaching and mentoring doctoral students and the conflicting demands on them to maintain programs of research and scholarship. The specific aims were to (a) examine the research productivity and scholarship of faculty members teaching in doctoral programs and mentoring doctoral students to examine the perceived effectiveness of existing institutional mechanisms to support scholarship, (b) explore institutional features and personal practices used by doctoral program faculty to develop and maintain research and scholarship productivity, and (c) analyze predictors of scholarship productivity. Data were collected via an on-line researcher-developed survey that examined doctoral faculty roles/responsibilities and their relationship to their scholarly productivity, overall research productivity, and institutional features and personal practices to support research/scholarship activities. Survey respondents reported spending a large amount of time engaged in research-related activities with 58.9% (n = 326) spending anywhere from 6 to 20 hours per week conducting research, writing research-based papers, giving presentations, grant writing, or conducting evidence-based improvement projects. Scholar productivity among the respondents was robust. Personal practices that most strongly supported faculty members' scholarship productivity were the belief that engaging in scholarship made them better teachers and the personal gratification in experiencing doctoral students' successes. A multiple regression analysis conducted to determine predictors of productivity indicated that the strongest predictor was the average number of hours spent on research/scholarship-related activities, followed by time bought out from teaching and other responsibilities of the faculty role for research.

End stage renal disease (ESRD) is a global health problem, and the gold standard treatment is kidney transplantation. However, due to the global shortage of organs, many patients with ESRD rely on dialysis for survival while waiting several years for a kidney transplant. An integrative review of qualitative studies was conducted on the experience of patients with ESRD who require either peritoneal dialysis or hemodialysis while waiting for a deceased donor kidney transplant. Eight international studies were selected for review. Six themes were identified: 1) living in hope, 2) uncertainty, 3) mixed emotions, 4) coping with waiting, 5) restrictions on freedom, and 6) support network. Patients on dialysis and waiting for a kidney transplant have emotional, educational, and informational needs that need to be better understood and addressed by nurses and physicians.

Objectives To explore the relationship between 16 symptom clusters (SCs), clinical and demographic influencing factors, and clinical outcomes over time in patients with pancreatic cancer (PC) undergoing surgical resection. Sample & setting 143 patients with stage II PC undergoing surgical resection were recruited to participate in this longitudinal, exploratory study conducted at Thomas Jefferson University Hospital, a National Cancer Institute-designated cancer center. Methods & variables Quality of life was measured preoperatively and at three, six, and nine months postoperatively. Statistical methods included simple linear and Cox proportional hazard regression. Results Preoperative pain was significantly associated with the pain-gastrointestinal SC, and preoperative worry was significantly associated with the mood SC. The strongest negative association with emotional well-being across all study time points was found with the preoperative mood SC. The insomnia-digestive problems SC and the nutritional problems SC demonstrated a trend toward poor survival. Implications for nursing Findings provide evidence that preoperative worry and pain are associated with SC severity and that SCs may have a detrimental effect on quality of life and survival in patients with PC undergoing surgical resection.

There is a paucity of information concerning adaptive parenting strategies utilised by mothers with physical disabilities, particularly during early motherhood. The purpose of this study is to describe the adaptive strategies used by mothers with physical disabilities during early motherhood. This qualitative study included semi-structured telephone interviews between January and March 2014 with US mothers with a range of physical disabilities who had a baby within the past 10 years (N = 25). Interviews were audio-recorded, professionally transcribed, and coded using content analysis. Analysis revealed five broad themes indicating important adaptive parenting strategies for mothers with physical disabilities caring for infants and toddlers: They are as follows: (a) acquiring or modifying baby-care equipment, (b) adapting the home environment, (c) accessing information and supports, (d) developing communication strategies to facilitate safety, and (e) receiving assistance from others. This study indicates that mothers with physical disabilities employ a variety of adaptive strategies during early motherhood. The findings from the study suggest the need for more availability of supports and equipment for mothers with physical disabilities as well as information for prospective mothers with disabilities. In addition, healthcare and social work professionals must receive training about adaptive parenting strategies.

Objectives The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth. Methods Data from the 2002-2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed. Results Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6-15.6 compared with 8.9%; 95% CI, 8.5-9.3 for women without disabilities) and low-birth-weight babies (10.3%; 95% CI, 9.4-11.2 compared with 6.8%; 95% CI, 6.8-6.9). There was no difference in the rates of cesarean section between women with and without disabilities. Conclusions These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.

Little is known about current societal attitudes toward women with significant mobility disability who are visibly pregnant.To use qualitative descriptive analysis methods to examine perceptions of women with significant mobility disability about how strangers reacted to their visible pregnancies.In late 2013, we conducted 2-h telephone interviews with 22 women with significant mobility difficulties who had delivered babies within the prior 10 years. The semi-structured, open-ended interview protocol addressed wide-ranging pregnancy-related topics, including statements from strangers. Most participants were recruited through social networks, coming from 17 states nationwide. We used NVivo to sort the texts for content analysis.The women's mean (standard deviation) age was 34.8 (5.3) years; most were white, well-educated, and higher income, although half had Medicaid during their pregnancies; and 18 used wheeled mobility aids. Eighteen women described memorable interactions with strangers relating to their pregnancies or newborn babies. Strangers' statements fell into six categories: (1) curious; (2) intrusively and persistently curious; (3) hostile, including concerns that taxpayers would end up supporting the mother and child; (4) questioning woman's competence as a potential parent; (5) oblivious, not recognizing visible pregnancy or motherhood; and (6) positive. Many women reported strangers asking how their pregnancy had happened. The women doubted that visibly pregnant women without disabilities evoke the same reactions from strangers.Women with mobility disability who are visibly pregnant may perceive reactions from strangers that appear intrusive. Planning ahead for handling such encounters could reduce the stresses of these interactions.

Key wordsDoctoral faculty, research doctorate, clinical doctorate, practice doctorateAbstractPurpose: This study, which is part of a larger project, was conducted to profile the nursing faculty in the United States teaching in PhD and DNP programs.Design: This is a descriptive study. A sample of 554 nursing faculty who teach in PhD and DNP programs was recruited by email solicitation to represent all geographic regions of the United States. Data were collected from November 2013 through January 2014 using an online survey instrument.Methods: The instrument was developed based on results of review of the literature and of focus groups of doctoral faculty (faculty teaching in doctoral programs) to ascertain characteristics of faculty teaching in doctoral programs and of the schools in which they teach. Frequencies and descriptive statistics are reported.Findings: Growth in DNP programs has outpaced growth in PhD programs, and DNP graduates have moved into doctoral education in greater numbers than PhD graduates. DNP faculty report less prior experience and current productivity scholarship than faculty in PhD programs only or both types of programs.Conclusions: Strategies are needed to ensure that doctoral programs are staffed by faculty who are prepared for doctoral education and the development of nursing science.Clinical Relevance: The Institute of Medicine has recommended doubling the number of doctorally prepared nurses in the United States by 2020 to ensure that sufficient numbers of faculty are available to prepare the nursing labor force that is needed for delivery of healthcare services. Nurse scientists are needed to contribute to improvement in patient care quality and safety, and practice leaders are needed to facilitate the translation of research into safe, high-quality, and cost-effective care. The landscape of doctoral education in nursing is rapidly changing.The Institute of Medicine (IOM, 2010), in its report, The Future of Nursing: Leading Change, Advancing Health, recommended doubling the number of doctorally prepared nurses in the United States by 2020 in order to have enough faculty to educate a labor force sufficient to address public health needs, and to conduct research. Research is required to test interventions that prevent illness and disability and promote health, improve safety and quality, and enable people to manage complex health conditions (IOM, 2010; National Research Council, 2005).The nursing faculty shortage is well documented (Brady, 2010). The U.S. Bureau of Labor Statistics (2013a, 2013b) indicated that from now until 2022 the registered nurse (RN) labor force will need to be 22% larger, and the advanced practice labor force will need to increase by 31%. In 2012, nearly 80,000 qualified prospective baccalaureate and graduate nursing students were turned away because there were insufficient faculty to teach them (American Association of Colleges of Nursing [AACN], 2014a).The global demand for more doctorally prepared nurses is resulting in an increase in the number of doctoral programs. In the United States, growth in the number of practice-focused doctoral programs, hereafter referred to as doctor of nursing practice (DNP) programs, has increased more dramatically than that of research-focused programs, hereafter referred to as doctor of philosophy (PhD) programs (AACN, 2014b). Some evidence suggests that this trend is resulting in increased demands on the aging and shrinking senior faculty, taxing their ability to mentor doctoral students and conduct their own research (Smeltzer et al., 2014b). Participants in a national study of doctoral nursing faculty expressed concern that there would be insufficient faculty qualified to teach in PhD programs in the next 5 years (Dreher, Smith Glasgow, & Cornelius, 2012). Controversy exists about the adequacy of research preparation in most PhD programs, though Beckett (2014) believes that most prepare graduates well for faculty positions. …

Background: Despite a growing population of people with disabilities (PWD), health care professionals, including nurses, receive little educational preparation to provide health care to them. To address this issue in nursing education, the faculty of a school of nursing designed and implemented an innovative teaching strategy that can be adopted by other nursing programs and faculty. Method: A systematic plan was developed and implemented to integrate standardized patients with disabilities (SPWD) into an existing undergraduate nursing program. Steps included careful planning, review, and modification of existing simulation-based scenarios, obtaining buy-in of faculty across the curriculum, recruitment and training of PWD to be SPWD, and implementation of the project. Results: The program in which all undergraduate nursing students have repeated contact with SPWD has been successfully implemented throughout the curriculum. Conclusion: The project addressed the multiple calls to improve the preparation of health care professionals to provide quality care to PWD. [ J Nurs Educ . 2018;57(12):760–764.]

The American Association of Colleges of Nursing specifies that all nurses must be prepared to deliver high-quality palliative care upon entry into practice. To achieve this aim, a clear understanding of palliative care nursing is needed. The Walker and Avant model for concept analysis was used to review and analyze relevant literature from 2000 to 2016. The authors utilized findings of this extensive review to develop a concept model and other practical resources for guiding nurses, educators, and researchers in applying and evaluating competence in the delivery of high-quality palliative nursing care.

Nursing faculty teaching in research and clinical doctoral programs participated in a national survey study to examine the impact of expanded doctoral enrollments on the doctoral faculty's scholarly productivity. They were invited to respond to an open-ended question soliciting information not already addressed in the survey. Results of the analysis are reported here. Findings corroborated the review of literature and results of the survey and focus groups that provided the basis for the survey's development. Current workloads may be unsustainable, jeopardizing the profession's response to Institute of Medicine recommendations.

Background Women with physical disabilities (WPD) experience major barriers to care during pregnancy. Lack of education about disability in health professionals' education is a pervasive barrier to quality care. In an effort to explore this issue, this study examined the issue from the perspective of obstetric clinicians who provide care to WPD. Objective This qualitative descriptive study explored perspectives of obstetric clinicians who provide perinatal care for WPD to inform the educational preparation of clinicians to care for women with disabilities. Method We contacted 33 obstetric clinicians who care for pregnant WPD. Thirteen obstetricians and one nurse midwife participated in semi-structured telephone interviews. Interview transcriptions were content analyzed to identify initial themes. Investigators discussed and revised the themes as additional transcripts were reviewed and new themes were identified. Results Themes identified from transcript analyses included: lack of education at any level including during postgraduate residency and fellowship on care of pregnant WPD, unplanned career pathway, educating other clinicians, and positive and negative experiences providing obstetrical care to women with physical disability. Several clinicians provided this care because of requests from other clinicians and did not begin their careers with the goal of providing obstetric care to women with physical disabilities. None had received formal education or training including during their residencies or fellowships. The clinicians described very rewarding experiences caring for WPD. Conclusions The experiences reported by this study's participants suggest the need to include disability in undergraduate and postgraduate education and training to improve obstetric care to WPD.

This integrative review presents a synthesis of the current qualitative research addressing the motivating factors, usability, and experiences of mobile health tracking applications (apps) across various chronic disease populations.Integrative review of the literature.Databases used to conduct this integrative review included: PubMed Plus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Google Scholar, Science Direct, and EBSCO megafile. The following search terms were used in all five databases: smartphone apps, apps, mHealth, eHealth, mobile health apps, health tracking apps, user-centered apps, wireless technology, engagement, qualitative, and usability.The initial literature review yielded 689 results. Once inclusion and exclusion criteria were employed, 11 studies met the criteria set forth for this review. The reviewed studies provided insight into users' perceptions, experiences, and motivations to incorporate smartphone mobile health apps into their daily lives when living with chronic illnesses.This review indicates the growing interest in user-centered mobile health tracking apps, but with little understanding of motivating factors that foster sustained app use. Mobile health tracking apps targeted to users with chronic conditions need to have a high level of usability in order to motivate users to sustain engagement with their mobile health tracking app.User-centered mobile health tracking app technology is being used with increasing frequency to potentially provide individualized support to chronic illness populations.