Nancy L. Fahrenwald

Teaching social justice.

Social justice is a core nursing value and the foundation of public health nursing. Social justice ideology requires nursing students to uphold moral, legal, and humanistic principles related to health. As such, teaching social justice requires a basis in moral developmental theory. In addition, teaching social justice demands action beyond classroom pedagogy. The author describes how social justice is taught within a baccalaureate program. A social justice project is described and examples are provided.

Developing cultural competence in the baccalaureate nursing student: a population-based project with the Hutterites.

The purpose of this article is to articulate the process of educating baccalaureate students to apply culturally competent, population-based nursing care to the Hutterites. The Hutterites are a German dialect-speaking, ethnoreligious population. Campinha-Bacote’s culturally competent model guided the student learning process. Groups of students developed culture-specific, population-based assessment models to identify the health-related needs of the Hutterites. One example of a Hutterite health assessment model that was derived from Dever’s epidemiologic model and Purnell and Paulanka’s model for cultural competence is presented. Priority health needs of Hutterite colonies are described, and examples of health programs are given. Recommendations for working with the Hutterite population as part of an undergraduate public health nursing course are put forth. The culturally congruent process of teaching and learning for nursing students can be applied to other health-related professions and adapted to other cultural contexts.

High bone mass in a female Hutterite population.

We examined a Hutterite population (n = 243) to determine if their agriculturally diverse, self‐sufficient communal lifestyle promotes optimal bone mass attainment because of adequate calcium intake and high physical activity levels during growth and young adulthood. We measured total body (TB) and lumbar bone mineral content (BMC) and bone mineral density (BMD) in 39 school‐age (younger) females and 204 working (older) females. Forty‐five percent of older females and 79% of younger females currently consumed ≥3 servings (svg) of dairy per day. Older females had lumbar (0.6 ± 1.3) and TB (1.1 ± 1.1) BMD Z scores greater than 0 (both, p < 0.001). The lumbar BMD Z score of younger females was not different from 0 (−0.1 ± 1.0; p = 0.5). Both lumbar (r = 0.46; p < 0.001) and TB (r = 0.20; p = 0.02) BMD Z scores increased with increasing age. In multiple regression analyses for older females, lumbar bone area (p < 0.001), weight (p < 0.001), current hours on feet per day (p = 0.01), colony workload (p < 0.01), and estrogen status (p = 0.06) predicted lumbar BMC. TB bone area (p < 0.001), current hours on feet per day (p < 0.01), and colony workload (p < 0.01) predicted TB BMC. For younger females, lumbar bone area (p < 0.001), weight (p < 0.01), years in present colony (p = 0.02), and menses (p < 0.001) predicted lumbar BMC. TB bone area (p < 0.001), height (p < 0.01), years in present colony (p = 0.03), and menses (p < 0.01) predicted TB BMC. The effect of colony workload could not be separated from other factors different by colony. A heritability estimate of 0.66 was calculated for lumbar BMD using mother and daughter Z scores. Adequate calcium intake during growth, high physical activity early in life, and genetic factors may be contributing to above normal BMD levels in adult female Hutterites.

Mediator analysis of Moms on the move.

This study examined whether improvements in physical activity discovered in a test of Moms on the Move were mediated by the behavioral constructs from which the intervention was derived. Identifying mediator variables is vital for intervention planning. The intervention was derived from the Transtheoretical Model (TTM) of behavior change and promoted moderately intense activities like walking. Sedentary mothers with children enrolled in the Women, Infants, and Children program (N = 44) were randomly assigned to the experimental intervention or attention control. Large effect sizes were reported for improvements in physical activity and changes in TTM constructs. This study examined whether the physical activity improvements were mediated by the behavioral constructs. Statistical analyses used bivariate correlation coefficients and two-stage multiple linear regression. These exploratory findings did not support the hypothesis that increased physical activity, which was associated with the experimental intervention, was mediated by the TTM constructs.

Time Management Strategies for Research Productivity

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

Outcome evaluation of 'sharing the gift of life': an organ and tissue donation educational program for American Indians.

Culturally focused education about deceased donation is needed for American Indians (AIs). This study tested a program designed to impact intention to serve as a deceased donor for reservation dwelling AIs. A pre/posttest design and a community‐based participatory research approach were used. The study was based upon the Transtheoretical Model. Adult participants (N = 1580, 58% women) were from four Northern Plains reservations. An outreach coordinator delivered the program using print and video materials. The outcome was stage of motivational readiness (SMR) to serve as a deceased donor. McNemars test was used to compare pre‐ to postintervention changes in SMR. At baseline, 55% of participants were not thinking about being a donor (precontemplation stage) and 45% were thinking about it (contemplation stage). Postintervention, 43.1% of participants were unchanged in SMR and 56.9% progressed in SMR. Of those who progressed, 26.5% (n = 418) changed to the contemplation stage, 19.4% (n= 306) changed to the preparation stage (signed a donor card or joined a registry), and 11.1% (n = 175) confirmed a discussion of the decision with family (action stage). Progression in SMR from pre/post was significant, χ2(1) = 18.32, p < 0.05. The intervention resulted in important changes in deceased donor intentions for reservation dwelling AIs.

Cessation Among State Quitline Participants with a Mental Health Condition

INTRODUCTION Telephone quitlines are an effective treatment option for tobacco cessation in the general population. Many participants who use quitline services have mental health conditions (MHC), yet few published studies have examined the use of quitline services in this population. This study examined the prevalence of MHC among state quitline participants and compared cessation outcomes among those with and without MHC. METHODS Demographic and tobacco use data were collected at enrollment and 7 months post-enrollment using standardized assessments for 10,720 eligible participants who enrolled in a state quitline between September, 2010 and August, 2012. RESULTS The prevalence of self-reported MHC was 19.8% (2,086/10,720 callers). The intent to treat quit rate for participants with a MHC was 16.4% compared to 21.5% for those without a MHC (p < .001), and the responder quit rate was 36.9% for those with a MHC compared to 44.4% for those without (p < .001). The adjusted odds ratio describing the association of MHC status and tobacco cessation was identical for both the intent-to-treat and responder populations, and indicated that participants with MHC were 23% less likely to quit (p < .05). CONCLUSIONS This study identified that participants with MHC accessed a state quitline, but were less likely to quit. The finding was independent of other factors influencing tobacco cessation, such as gender, race, and education. These findings indicate that although quitline services are an option for tobacco cessation among persons with MHC, further research is needed to determine why cessation rates are lower.

Knowledge, Beliefs, and Behaviors Regarding Organ and Tissue Donation in Selected Tribal College Communities

American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes and kidney failure. For those with chronic kidney disease, transplantation may be the most effective treatment option. However, low rates of organ donation and transplantation are reported for AI/ANs, who face significant barriers in accessing the transplant waiting list. They are also less likely than Whites to consent to become organ donors. We partnered with five tribal colleges and universities to conduct focus groups to assess knowledge, cultural beliefs, and behaviors related to organ donation and transplantation among AI/AN college students. Focus group data were used to develop a culturally targeted media campaign and outreach strategy aimed at increasing rates of consent to donate organs. Community knowledge typically drew from direct family experience with chronic illness. Study findings confirmed that attitudes about organ donation were influenced by cultural beliefs. Nevertheless, many participants supported organ donation even when it conflicted with cultural and spiritual beliefs about keeping the body intact for burial. Participants also expressed mistrust of the local health care system, suggesting that trust issues might interfere with health messaging on this topic. This is the first study to examine sociocultural beliefs about organ donation among AI/AN college students. Through focus group findings, study staff were better positioned to develop culturally relevant outreach materials. Rising rates of chronic illness among AI/ANs ensure that organ donation and transplantation will be a long-term feature of the health landscape in AI/AN communities. Targeted health messaging must be part of the strategy to reduce donor shortages.

Evaluation of an Intervention to Increase Self-Efficacy for Independent Exercise in Cardiac Rehabilitation

Adherence to independent exercise is an essential outcome of cardiac rehabilitation (CR), yet limited theory-based interventions to improve adherence exist. This study tested the effects of an intervention based on Banduras conceptualization of self-efficacy. The self-efficacy coaching intervention (SCI), a supplement to standard care, was designed to increase self-efficacy for independent exercise and independent exercise behavior in CR. We examined whether the SCI vs. attention control (AC) resulted in improved exercise self-efficacy (ESE), barriers self-efficacy (BARSE), and minutes of independent exercise for CR participants (n = 65). While between-group differences did not reach significance (p > .10) for any of the outcome measures, significant within-group changes were noted in BARSE scores and independent exercise (p < .001) for the SCI group. Change in independent exercise for the AC group was also significant (p =. 006). Further study is needed to explore whether short-term changes translate into maintenance of independent exercise participation after program completion.

Scientific Impact: Opportunity and Necessity

Recent National Institutes of Health changes have focused attention on the potential scientific impact of research projects. Research with the excellent potential to change subsequent science or health care practice may have high scientific impact. Only rigorous studies that address highly significant problems can generate change. Studies with high impact may stimulate new research approaches by changing understanding of a phenomenon, informing theory development, or creating new research methods that allow a field of science to move forward. Research with high impact can transition health care to more effective and efficient approaches. Studies with high impact may propel new policy developments. Research with high scientific impact typically has both immediate and sustained influence on the field of study. The article includes ideas to articulate potential scientific impact in grant applications as well as possible dissemination strategies to enlarge the impact of completed projects.