Mary E. Cramer

Factors Influencing Organized Political Participation in Nursing

This study addresses the issue of organized political participation in nursing. The conceptual framework is the civic voluntarism model (CVM) of Verba, Schlozman, and Brady, which posits that three factors influence organized participation: (a) having the engagement (motivation), (b) having the resources (wherewithal), and (c) having networks of recruitment (cues to action and requests). Multiple discriminant analysis showed that the CVM and its influencing factors and dimensions were useful in predicting nurses’ organized participation. Resources and engagement were found to be the most important influencing factors, whereas networks of recruitment were less important. Rank ordering of each influencing factor’s dimension was used to develop a parsimonious list of predictors specific to nurses. Free time and personal efficacy were found to be the two most significant dimension predictors of nurses’ organized participation. Suggestions and strategies for building organized participation are made based on results of this study.

Comparative analysis of urban and rural nursing workforce shortages in Nebraska hospitals.

Current workforce models that rely on economic indicators have seriously underestimated the rural RN shortage and its impact on rural hospitals. This cross-sectional study developed an algorithm using the concept of need and applied it to health service demand data in 66 counties of a midwestern state (1993-2002) to determine trends in RN shortages between urban and rural areas. Results showed that rural areas consistently had the largest gap between predicted need for RNs and numbers employed and that the rural RN shortages were significantly greater than in urban areas. This study suggests that adequate and geographically specific targets of RN need are essential, especially for rural areas, because of policy implications for rural hospital staffing and workforce planning. Inadequate workforce targets perpetuate the shortage, especially in rural areas, and exacerbate the very reasons that RNs leave over concerns for patient safety, inadequate staffing, and job dissatisfaction.

Landlord Attitudes and Behaviors Regarding Smoke‐Free Policies: Implications for Voluntary Policy Change

OBJECTIVE The study purpose was to describe multiunit landlord attitudes and behaviors toward smoke-free policies. DESIGN AND SAMPLE This was a descriptive, cross-sectional survey of multiunit landlords in Douglas County (N=392). MEASURES A 25-item survey was developed and pilot tested. It was administered by telephone (n=143) and mail (n=249) to multiunit landlords. RESULTS Combined response rate was 30.1% (81/143 telephone, 37/249 mail) representing 24,080 units on 974 properties with 34,399 tenants. Most respondents (73.7%) allowed smoking. Reasons for not implementing smoke-free policies were potential enforcement problems (57.0%), tenant objections (43.0%), loss of market share (39.5%). Respondents without smoke-free policies expected vacancy (53.6%) and turnover (50.0%) rates to increase, which was significantly different (p <.0001) than respondents with smoke-free policies where only 10.7% reported increased vacancy and only 3.7% reported increased turnover. CONCLUSIONS Expected adverse impacts of smoke-free policies do not reflect real experiences of smoke-free policy implementation. Public health advocates can use these study findings to develop community-based education and social marketing messages directed at voluntary smoke-free policy changes. Respondents without smoke-free policies expressed interest at the end of the survey in learning how to implement smoke-free policies indicating a readiness for change.

Partnering with rural communities to meet the demand for a qualified nursing workforce

The registered nurse (RN) shortage threatens rural health care quality and economic vitality. Educational institutions have the opportunity to collaborate with rural communities in building pipelines for a more highly educated, sustainable nursing workforce. Leaders from 19 Midwestern rural counties approached a university about their regional nurse workforce issues and a desire to locate a nursing campus in their community. This article describes the partnership between a university and a rural community and the process for addressing their concerns and determining program feasibility. A Task Force of faculty and community leaders used the Determining Program Feasibility model to frame data collection and analysis. The Task Force met regularly with a Community Advisory Board for problem-solving and formative feedback. The sound methodology and transparent process facilitated a successful collaboration and resulted in a final report outlining the significant opportunities and challenges to overcome. Plans are underway for a new rural nursing campus and the community has raised monies for the new facility. The state legislature will address needed start-up funds.

Predictive Model to Determine Need for Nursing Workforce

This article describes a statistical modeling study designed to improve targets of need for registered nurse (RN) workforce. The model is place-based and incorporates the concepts of clinical need and regional service utilization. A cross-sectional study was conducted in Nebraska (1993-1999), and the unit of study was the county (N = 66). A mixed-model approach was used, and five predictor variables (% age 20-44,% age 45-64,% age 65+,% White non-Hispanic, and area) were significantly (p < .001) associated with service demand. Coefficient estimates were applied to various population projection scenarios, and the model’s algorithm converted service demand into number of RNs needed to compare numbers of RNs employed with projected need. The implications for RN workforce policy and funding decisions—at both federal and state levels—are significant. Further research with a larger, multistate database will be conducted to refine the model and demonstrate generalizability.

Telehealth: A policy analysis for quality, impact on patient outcomes, and political feasibility

Telehealth is seen as a venue for improving healthcare access in vulnerable populations through use of electronic devices in the patients home that monitor and assess for early complications. Major technological advances have improved telehealth services, prompting introduction of federal legislation for reimbursement of telehealth care. Yet, policymakers have stalled passage based on several concerns. This article conducted a policy analysis of HR1601, one of the most recent Congressional proposals for telehealth. The policy analysis was based on 3 criteria: quality of telehealth services, impact of telehealth on patient outcomes, and political feasibility. Overall, the concerns regarding quality, impact on patient outcomes, and feasibility are outweighed by the benefits of using telehealth to extend care. Federal funding of telehealth through passage of legislation, such as HR1601, is a good first step to establishing further evidence for its capabilities, and it could lead to a more comprehensive approach to quality care.

A policy analysis of federal registered nurses safe staffing legislation

Public and professional concerns over the registered nurse shortage and its effect on quality of care have led to 18 state and 2 federal initiatives to ensure safe hospital nurse staffing. Policy analysis of registered nurses safe staffing legislation introduced by the Congress suggests that its implementation is not likely to achieve all of its stated goals. An alternative policy approach is introduced.

Evaluation informs coalition programming for environmental tobacco smoke reduction.

The objective for this formative evaluation was to establish baseline data for informing a community coalitions strategic planning in environmental tobacco smoke (ETS) risk reduction. The coalition had chosen 3 targeted settings for ETS risk reduction: restaurants, childcare facilities, and government buildings. The evaluation methodology involved telephone interviews (restaurants, n = 805; governmental buildings, n = 258) and mailed surveys (childcare facilities, n = 1,142). Data on county residents and businesses were used for comparison purposes and were analyzed from the Nebraska Social Climate Survey (2001; n = 558). Evaluation baseline findings showed that licensed childcare facilities were more ETS knowledgeable, less ETS tolerant, and more smoke-free than restaurants. Residents were more bothered by ETS than what restaurant proprietors perceived. The majority of governmental buildings were not smoke-free. Conclusions were that community health nurse evaluators can provide coalitions with formative evaluative data to inform strategic planning and increase the likelihood of effective program interventions for community impact on ETS.¹

Social Marketing Campaign Promoting the Use of Respiratory Protection Devices Among Farmers

ABSTRACT This article describes the formal use of marketing concepts in a systematic approach to influence farmers to voluntarily increase respiratory protective device (RPD) use. The planning process for the project incorporated six key decision or action points, each informed by formative research or health behavior theory. The planning process included developing behavior change strategies based on a 4P model (product, price, place, and promotion). The resulting campaign elements included print and e-mail messages that leveraged motivators related to family and health in order to increase farmers’ knowledge about the risks of exposure to dusty environments, four instructional videos related to the primary barriers identified in using RPDs, and a brightly colored storage bag to address barriers to using RPDs related to mask storage. Campaign implementation included a series of e-mails using a bulk e-mail subscription service, use of social media in the form of posting instructional videos on a YouTube channel, and in-person interactions with members of the target audience at farm shows throughout the Central States Center for Agricultural Safety and Health seven-state region. Evaluation of the e-mail campaigns indicated increased knowledge about RPD use and intent to use RPDs in dusty conditions. YouTube analytic data indicated continuing exposure of the instructional videos beyond the life of the campaign. The project demonstrates the efficacy of a planning process that incorporates formative research and clear decision points throughout. This process could be used to plan health behavior change interventions to address other agriculture-related health and safety issues.

Evaluating community-based programs for eliminating secondhand smoke using evidence-based research for best practices.

Extensive research has been conducted on the hazardous effects of tobacco use, and more recently attention has focused on the harmful effects of secondhand smoke (SHS). A growing body of evidence-based research supports best practices for eliminating SHS. This article describes the evaluation and outcomes of a community-based coalition in the midwest that used best practices to educate and change public attitudes on SHS, and thereby promote social policy change for tobacco-free environments. The evaluation model incorporated evidence-based indicators as measures for coalition goal achievement and found the best practices program to be effective for eliminating SHS exposure.