Andrea E. Berndt

An empirical analysis of stressors for gay men and lesbians.

Abstract This research describes the empirical classification of stressors for gay men and lesbians. Volunteer respondents were recruited through a free local gay and lesbian newspaper, through gay and lesbian student organizations nationwide, through gay and lesbian bookstores nationwide, and at a gay festival in St. Louis. Nine hundred seventy-nine (979) participants completed a 70-item measure with stressors that had been identified in previous qualitative research. Participants were asked to indicate the degree to which they had experienced stress associated with a variety of experiences. Participants also completed a measure of dysphoria (CES-D), responded about their degree of openness regarding sexual orientation, and provided information about their relationship status and involvement with gay groups and activities. Using confirmatory factor analysis, a six-factor model was predicted to account for the data. One-factor, six-factor, and ten-factor models were tested. The ten-factor model yielded the best fit with the data and accounted for 63.5% of the variance. The factor structure remained stable when gay men were compared to lesbians, when those endorsing a predominantly gay versus exclusively gay orientation were compared, and when those in a relationship were compared to those who were not in a relationship. Increased gay stress was associated with more dysphoria. Implications of these findings are discussed and directions for future research are considered.

Assessing and addressing moral distress and ethical climate, part 1

Background: There is minimal research exploring moral distress and its relationship to ethical climate among nurses working in acute care settings. Objectives: Objectives of the study were to explore moral distress, moral residue, and perception of ethical climate among registered nurses working in an academic medical center and develop interventions to address study findings. Method: A mixed-methods design was used. Two versions of Corley and colleagues’ Moral Distress Scale, adult and pediatric/neonatal, were used in addition to Olson’s Hospital Ethical Climate Survey. Participants were invited to respond to 2 open-ended questions. This article reports the results for those nurses working in adult acute and critical care units. Results: The sample (N = 225) was predominantly female (80%); half held a bachelor of science in nursing or higher, were aged 30 to 49 years, and staff nurses (77.3%). The mean item score for moral distress intensity ranged from 3.79 (SD, 2.21) to 2.14 (SD, 2.42) with mean item score frequency ranging from 2.86 (SD, 1.88) to 0.23 (SD, 0.93). The mean score for total Hospital Ethical Climate Survey was 94.39 (SD, 18.3) ranging from 23 to 130. Qualitative comments described bullying, lateral violence, and retribution. Discussion: Inadequate staffing and perceived incompetent coworkers were the most distressing items. Almost 22% left a previous position because of moral distress and perceived the current climate to be less ethical compared with other participants. Findings may potentially impact nurse retention and recruitment and negatively affect the quality and safety of patient care. Interventions developed focus on the individual nurse, including ethics education and coping skills, intraprofessional/interprofessional approaches, and administrative/policy strategies.

Complementary Therapy Used by Hispanic Women During Treatment for Breast Cancer

The purposes of this study are to assess Hispanic women’s use of complementary interventions during breast cancer treatment and delineate the association between the most burdensome side effects and the most frequently used complementary and alternative medicine (CAM). The researchers examined both descriptive statistics and correlational relationships between side effects and CAM. Data were collected from a convenience sample (N = 125). The mean age was 54, the educational average was less than 10 years, and the median income level was less than

Assessing and addressing moral distress and ethical climate part II: Neonatal and pediatric perspectives

20,000 per year. CAM was positively correlated with family income. Prayer was used by 93% of the women, humor was used by 83%, and 65% used exercise. The most frequent side effect of hair loss (70%) was the most bothersome side effect. The most burdensome and unmanageable side effects were bowel problems and nausea. Nurses play a key role in offering affordable, culturally appropriate symptom management interventions.

Development and psychometric testing of the nursing research self-efficacy scale (NURSES)

Moral distress remains a pervasive and, at times, contested concept in nursing and other health care disciplines. Ethical climate, the conditions and practices in which ethical situations are identified, discussed, and decided, has been shown to exacerbate or ameliorate perceptions of moral distress. The purpose of this mixed-methods study was to explore perceptions of moral distress, moral residue, and ethical climate among registered nurses working in an academic medical center. Two versions of the Moral Distress Scale in addition to the Hospital Ethical Climate Survey were used, and participants were invited to respond to 2 open-ended questions. Part I reported the findings among nurses working in adult acute and critical care units. Part II presents the results from nurses working in pediatric/neonatal units. Significant differences in findings between the 2 groups are discussed. Subsequent interventions developed are also presented.

Nurse Competence on Physiologic Monitors Use: Toward Eliminating Alarm Fatigue in Intensive Care Units

Background and Purpose: The Nursing Research Self-Efficacy Scale (NURSES) was designed to measure individual nurses’ degree of research self-efficacy and their perceptions regarding their unit’s collective support of research use. Development for the NURSES instrument spanned a 4-year period, which included initial development, revisions, and psychometric evaluations. Method: The NURSES is a 38-item Likert-scale instrument developed through ongoing instrument validation that included content validation and exploratory and confirmatory analysis. The 5 subscales include obtaining science-based knowledge resources, critically reading and evaluating quantitative research literature, critically reading and evaluating qualitative research literature, understanding and applying theory, and collective research efficacy. Results: Over a 4-year period, approximately 1000 practicing nurses from multiple hospitals responded to the instrument. Exploratory and confirmatory factor analyses supported the existence of four subscales for research self-efficacy and one subscale for collective research efficacy. Reliability for the subscales was excellent, ranging from .94 to .97. Conclusions: Hospitals may wish to use the NURSES instrument as an orientation tool, or to examine relationships between research efficacy and nurses’ professional development. Health care facilities on a Magnet journey might also use the NURSES instrument to assess their nursing staff as they pursue evidence-based practice and conduct research.

Hierarchical regression and structural equation modeling: Two useful analyses for life course research

Background: Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses’ perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose. Methods: This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors’ features. Thirty nurses from 4 adult ICUs were invited to respond to the survey. Results: Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales’ scores and demographic characteristics (p > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users’ needs. Conclusion: This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all necessary skills and should not assume proficiency on basic skills. Special attention should be focused on managing technical alarms. Increasing the number of super users is a recommended strategy for individualized and unit-specific training. There is a need for a usability testing of complex IT-equipped medical devices, such as physiologic monitors, for effective, efficient and safe navigation of the monitors.

Improving glycemic control with the adjunct use of a data management software program.

This article reviews the life course perspective and considers various life course hypotheses such as trajectories, transitions, critical periods, sequencing, duration, and cumulative effects. Hierarchical regression and structural equation modeling are suggested as analyses to use in life course research. Secondary analysis was performed on the Early Head Start Research and Evaluation Study, 1996-2010, to illustrate their strengths and challenges. Models investigated the influence of mother and infant characteristics and of parent-child dysfunction at 14 and 24 months to childrens cognitive outcomes at 36 months. Findings were interpreted and discussed in the context of life course hypotheses.

Developing Collaborative Research Agreements

BACKGROUND Published studies have supported the implementation of tight glucose control (TGC) programs to improve patient outcomes and reduce mortality rates. However, measuring a programs efficiency is challenging, because of a lack of systems that capture data, allow access to data, and support analysis and interpretation in a near prospective time frame. We hypothesized that providing clinicians access to real-time blood glucose (BG) results reports could improve the efficacy of our TGC program. METHODS We performed a retrospective review of BG data during a 12-month period in a surgical trauma intensive care unit at a level I trauma center. A unit-specific insulin algorithm was used throughout the study. We compared BG values before and after the implementation of a data management software program that allowed clinicians access to real-time BG results reports. Reports were run daily and weekly to monitor the units TGC program. RESULTS A total of 70 616 BG values from 1044 patients were analyzed. An overall decrease was observed in the BG level mean, from 121 mg/dL to 112 mg/dL (P < .001), as well as a decrease in the aggregated mean across patients, from 132 mg/dL to 119 mg/dL (P < .001), after implementation of the software. The percentage of values within the target range of 80 to 110 mg/dL increased from 38.9% to 50.4% (P < .001). The percentage of BG values less than 70 increased from 2.7% to 3.4% (P < .001). However, the percentage of severe hypoglyce-mic episodes (≤ 40 mg/dL) remained unchanged. CONCLUSIONS Access to real-time aggregated BG data reports through the use of a data management software program improved the efficacy of our TGC program.

Community-Based Partnership to Improve Parenting Skills and Academic Achievement and Reduce Subsequent Births

Academic nurse researchers will tell you that collaborative evidence-based research is a labor-intensive undertaking that demands high levels of commitment, time, and effort. Bedside nurse researchers will agree, but they also may tell you that conducting collaborative evidence-based research demands such high levels of commitment, time, and effort that they were unable to successfully complete their research project. Conducting evidencebased research at the bedside almost always has to be collaborative. Successfully completed research requires the participationofindividualswithvariedskillsetswhoarelikely to be balancing multiple demands. 1 Collaborative research efforts offer several benefits over individual research. 2 Examples of these benefits include the