Kerry A. Milner

Health Action Process Approach: Application to Medication Adherence in Cardiac Rehabilitation Patients

The purpose of this study was to examine the relationship between Health Action Process Approach (HAPA) postintentional constructs (maintenance self-efficacy, recovery self-efficacy, action planning, coping planning) and medication adherence among phase II cardiac rehabilitation (CR) patients. Purposive sampling was used to recruit 91 phase II CR patients age 50 years and over. All respondents completed paper and pencil questionnaire examining HAPA postintentional constructs (action planning, coping planning, maintenance self-efficacy, recovery self-efficacy), medication adherence, and demographic characteristics. Validity and reliability were confirmed for all scales included in the questionnaire. Descriptive statistics were used to describe respondents’ characteristics. Bivariate statistics (correlation, Mann-Whitney U-test, Kruskal Wallis test) were used to examine associations between medication adherence and each HAPA postintention construct as well as medication adherence and respondent demographic characteristics. Better medication adherence was associated with greater maintenance self-efficacy (r = −.290, p = .006) and better action planning skills (r = −.233, p = .027) and coping planning skills (r = −.277, p = .008) as indicated by higher scores on the maintenance self-efficacy, action planning, and coping planning scales. There was no significant linear relationship between medication adherence and recovery self-efficacy (r = −.103, p = .335) or medication adherence and any of the respondents’ demographic characteristics (p > .05). Only maintenance self-efficacy remained significant in a multivariate model predicting medication adherence. Greater maintenance self-efficacy was associated with increased medication adherence; health professionals working in CR settings might consider opportunities to enhance maintenance self-efficacy for medication adherence. Additional research is needed to identify strategies for promoting maintenance self-efficacy for medication adherence.

Benchmarking of Prelicensure Nursing Students' Evidence-Based Practice Knowledge

Evidence-based practice (EBP) knowledge among prelicensure nursing students was measured before, immediately following, and 1 year after completion of an EBP course using a relatively new instrument. There was a significant increase in EBP knowledge immediately following the course, and knowledge was sustained 1 year later. Results enabled faculty to gauge the effectiveness of the EBP course within the curriculum to prepare students with the knowledge needed to enact EBP in practice.

Health Professions Faculty Beliefs, Confidence, Use, and Perceptions of Organizational Culture and Readiness for EBP: A Cross-sectional, Descriptive Survey

BACKGROUND Evidence-based practice (EBP) is an essential skill and ethical obligation for all practicing health professions clinicians because of its strong association with improved health outcomes. Emerging evidence suggests that faculty who prepare these clinicians lack proficiency to teach EBP. OBJECTIVES The purpose of this study was to describe; 1) health profession faculty beliefs about and confidence in their ability to teach and implement EBP, 2) use of EBP for education, 3) organizational culture and readiness for EBP; and to determine whether relationships exist among these variables. DESIGN This study used a cross-sectional, descriptive survey design. SETTING AND PARTICIPANTS College of Nursing (CON) and College of Health Professions (CHP) faculty from a university located in the Northeast, United States. Faculty were defined as anyone teaching a course for the CON or CHP during the fall of 2016. METHODS Faculty were invited to complete an electronic survey measuring EBP beliefs, EBP use, and EBP organizational culture and readiness. The survey was comprised of three tools developed specifically for health professions educators in 2010 by Fineout-Overholt & Melnyk. RESULTS Sixty-nine faculty returned usable surveys (25.5% response rate). Mean EBP beliefs score was 89.49 (SD = 10.94) indicating respondents had a firm belief in and confidence in their ability to implement and teach EBP. Mean EBP use was 32.02 (SD = 20.59) indicating that respondents taught and implemented EBP between 1 and 3 times in the last 8-weeks. Mean EBP culture and readiness score was 90.20 (SD = 15.23) indicating essential movement toward a sustainable culture of college-wide integration of EBP. Mean scores for beliefs/confidence were higher for full-time clinical faculty compared to other groups [F(2, 55) = 0.075, p = 0.928; ηp2 = 0.003)]. Adjunct faculty reported higher EBP behaviors expected by health profession educators in the last 8-weeks compared to other groups [F(2, 55) = 0.251, p = 0.779; ηp2. =0.009)]. Adjunct faculty had the highest mean scores on OCRSIEP-E followed by full-time clinical faculty. These group differences in OCRSIEP-E were statistically significant [F(2, 49) = 7.92, p = 0.001; ηp2 = 0.244)]. OCRSIEP-E was significantly different between full-time tenure/tenure track faculty (M = 78.0, SD = 12.58) and full-time clinical faculty (M = 91.37, SD = 14.79, p = 0.027) and between full-time tenure/tenure track faculty and adjunct faculty (M = 97.19, SD = 12.39, p = 0.001). CONCLUSIONS Faculty adoption of EBP as a foundational pillar of teaching is essential. Research is needed to define the scope of the problem internationally. Organizations need to set standards for faculty teaching in the health professions to be EBP proficient. Programs preparing faculty to teach in nursing and other health professions must include educator EBP competencies.

Implementation and Evaluation of a Physical Activity and Dietary Program in Federal Incarcerated Females

The purpose of this 3-month quasi-experimental pilot study was to examine the effect of a physical activity and dietary education program on body mass index (BMI) and resilience. Participants were given data-storing pedometers to record their physical activity, attended classes on healthy eating, and used portion control tools from http://ChooseMyPlate.gov. MyPlate usage and commissary purchases were collected weekly. BMI and resilience scores were measured at baseline, 6 weeks, and 12 weeks. Twenty-nine female prisoners completed the study. There was a statistically significant reduction in BMI after 12 weeks (χ2 = 7.56, p = .023) and resilience levels increased but did not reach statistical significance (χ2 = 1.66, p = .437). A physical activity and dietary intervention delivered by a correctional health nurse practitioner was an efficacious approach to reducing BMI and improving resilience among female prisoners.

Using Simulated Family Presence to Decrease Agitation in Older Hospitalized Delirious Patients: A Randomized Controlled Trial

BACKGROUND Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed. OBJECTIVES To examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients. DESIGN Single site randomized control trial, 3 groups×4 time points mixed factorial design conducted from July 2015 to March 2016. SETTING Acute care level one trauma center in an inner city of the state of Connecticut, USA. PARTICIPANTS Hospitalized patients experiencing hyperactive or mixed delirium and receiving continuous observation were consecutively enrolled (n=126), with 111 participants completing the study. Most were older, male, Caucasian, spouseless, with a pre-existing dementia. METHODS Participants were randomized to one of the following study arms: view a one minute family video message, view a one minute nature video, or usual care. Participants in experimental groups also received usual care. The Agitated Behavior Scale was used to measure the level of agitation prior to, during, immediately following, and 30min following the intervention. RESULTS Both the family video and nature video groups displayed a significant change in median agitation scores over the four time periods (p<0.001), whereas the control group did not. The family video group had significantly lower median agitation scores during the intervention period (p<0.001) and a significantly greater proportion (94%) of participants experiencing a reduction in agitation from the pre-intervention to during intervention (p<0.001) than those viewing the nature video (70%) or those in usual care only (30%). The median agitation scores for the three groups were not significantly different at either of the post intervention time measurements. When comparing the proportion of participants experiencing a reduction in agitation from baseline to post intervention, there remained a statistically significant difference (p=0.001) between family video(60%) and usual care (35.1%) immediately following the intervention CONCLUSION: This work provides preliminary support for the use of family video messaging as a nonpharmacological intervention that may decrease agitation in selected hospitalized delirious patients. Further studies are necessary to determine the efficacy of the intervention as part of a multi-component intervention as well as among younger delirious patients without baseline dementia.

The PICO Game: An Innovative Strategy for Teaching Step 1 in Evidence‐Based Practice

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Shared Decision Making and Decision Aids: An Important Part of Evidence-Based Practice

Student and Faculty Evaluation Student feedback was positive (Table 2), with themes of feeling safe in the learning environment and learning to consider patient care from a variety of perspectives, including that of the nurse, the patient, and the family. The faculty had the opportunity to evaluate each student’s level of clinical reasoning without the chaos of the hospital setting. Thoughtful feedback provided students with an opportunity to determine strengths and weaknesses while enhancing learning. Incorporating unfolding case studies throughout the nursing curriculum can identify students struggling with certain concepts or the process of clinical decision making. These case studies can be used across the curriculum or to supplement the clinical experience. The case study can be individualized for each student depending on his or her progress. Incorporating a discussion board and a video conferencing debriefing session would allow to students to examine and evaluate their performance in making a clinical decision. The use of online case studies as clinical makeup would need to be researched with each state board of nursing to determine the allowed hours. Using these case studies can enhance and improve a student’s clinical decision making.

Strategies for Providing Spiritual Care & Support to Nursing Students

ABSTRACT: Nurse educators need to equip nursing students with suitable resources and education so they can develop their own spiritual care, as well as recognize spiritual care needs in patients. There is a paucity of literature on teaching strategies for spiritual care and prayer in undergraduate nursing programs. This article describes how one faith-based school implemented strategies to facilitate spiritual development in students, which are integrated throughout the curriculum and utilized in the U.S. and a study-abroad program in Ireland.