Patricia Butterfield

Thinking upstream: nurturing a conceptual understanding of the societal context of health behavior.

This article addresses the issue of overreliance on theories that define nursing in terms of a one-to-one relationship at the expense of theoretical perspectives that emphasize the societal context of health. When individuals are perceived as the focus of nursing action, the nurse is likely to propose intervention strategies aimed at either changing the behaviors of the individual or modifying the individuals perceptions of the world. When nurses understand the social, political, and economic influences that shape the health of a society, they are more likely to recognize social action as a nursing role and work on behalf of populations.

Unreconciled inconsistencies: a critical review of the concept of social justice in 3 national nursing documents.

A critical review of the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, Nursings Social Policy Statement, and Nursing: Scope and Standards of Practice provides evidence that these documents present an inconsistent, ambiguous, and superficial conceptualization of social justice, and do not offer an adequate framework for nurses to address underlying issues that affect health outcomes. Despite expansive references to the historic role of nursing in social reform, the documents implicitly reinforce nursing practice directed toward the individual nurse-patient relationship and give short shrift to nursing models that endorse broad systems change intended to improve health.

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

OBJECTIVES To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. DESIGN AND SAMPLE A cross-sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). MEASURES A 39-item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. RESULTS Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. CONCLUSION PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.

Rural Community Leaders' Perceptions of Environmental Health Risks Improving Community Health

Qualitative description was used to explore how rural community leaders frame, interpret, and give meaning to environmental health issues affecting their constituents and communities. Six rural community leaders discussed growth, vulnerable families, and the action avoidance strategies they use or see used in lieu of adopting health-promoting behaviors. Findings suggest intervention strategies should be economical, use common sense, be sensitive to regional identity, and use local case studies and “inside leadership.” Occupational health nurses addressing the disparate environmental health risks in rural communities are encouraged to use agenda-neutral, scientifically based risk communication efforts and foster collaborative relationships among nurses, planners, industry, and other community leaders.

I PREPARE: development and clinical utility of an environmental exposure history mnemonic.

The I PREPARE environmental exposure history mnemonic is a quick reference tool created for primary care providers. Health care providers (N = 159) were asked to evaluate a prototype mnemonic, to suggest new health history questions, and to propose the deletion of less relevant questions. The goal of this evaluation was to create a practical and clinically relevant mnemonic, rather than to obtain quantitative estimates of validity. The final I PREPARE mnemonic cues the provider to “Investigate potential exposures;” ask questions related to “Present work,” “Residence,” “Environmental concerns,” “Past work,” and “Activities;” provide “Referrals and resources;” and “Educate” the patient by reviewing a checklist of strategies to prevent or minimize exposures. The sequence of I PREPARE makes intuitive sense by cueing the provider to ask specific questions and provide educational materials to the patient. National improvements in the quality of environmental exposure history data are predicated in part on the creation of simple and convenient tools for use in clinical practice.

Implementing AACN's recommendations for environmental sustainability in colleges of nursing: from concept to impact.

In 2011, the American Association of Colleges of Nursing (AACN) released a guidance report titled Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education. The report was developed in response to a vivid slide presentation at an AACN meeting depicting the deleterious public and environmental health effects of global industrialization. Following the presentation, AACN members capitalized on the opportunity to provide national leadership to U.S. colleges of nursing in regard to environmental sustainability and stewardship. This article summarizes key features of the AACN plan and outlines one colleges multifaceted implementation plan. The goal of the implementation plan was to translate the AACN recommendations from concept into college-specific actions. Specific steps taken by the college included the following: (a) increasing student and faculty awareness, (b) greening business operations, (c) increased participation in media events, (d) leveraging the impact of national sustainability initiatives, and (e) enhancing curricula at the undergraduate and graduate levels. Through this work, the college achieved not only a higher standard of sustainability within its own walls but also a richer appreciation of the importance of educating nurses as future stewards in an environmentally sustainable health care system.

Retest of a Principal Components Analysis of Two Household Environmental Risk Instruments.

Household Risk Perception (HRP) and Self-Efficacy in Environmental Risk Reduction (SEERR) instruments were developed for a public health nurse-delivered intervention designed to reduce home-based, environmental health risks among rural, low-income families. The purpose of this study was to test both instruments in a second low-income population that differed geographically and economically from the original sample. Participants (N = 199) were recruited from the Women, Infants, and Children (WIC) program. Paper and pencil surveys were collected at WIC sites by research-trained student nurses. Exploratory principal components analysis (PCA) was conducted, and comparisons were made to the original PCA for the purpose of data reduction. Instruments showed satisfactory Cronbach alpha values for all components. HRP components were reduced from five to four, which explained 70% of variance. The components were labeled sensed risks, unseen risks, severity of risks, and knowledge. In contrast to the original testing, environmental tobacco smoke (ETS) items was not a separate component of the HRP. The SEERR analysis demonstrated four components explaining 71% of variance, with similar patterns of items as in the first study, including a component on ETS, but some differences in item location. Although low-income populations constituted both samples, differences in demographics and risk exposures may have played a role in component and item locations. Findings provided justification for changing or reducing items, and for tailoring the instruments to population-level risks and behaviors. Although analytic refinement will continue, both instruments advance the measurement of environmental health risk perception and self-efficacy.

Workers With Irregular Hours During Seasonal Work Surges Promoting Healthy Sleep

A significant proportion of the labor force works irregular hours during harvest, summer, or holiday work surges. Unfortunately such workers are often uninformed about the importance of sleep and fatigue management. Seasonally timed worker training can improve health and safety outcomes during work surges.

Rural Families' Process of Re-Forming Environmental Health Risk Messages

PURPOSE This study was undertaken to explore how rural low-income families with children process health information following a nurse-delivered intervention designed to reduce environmental risks in their homes. DESIGN AND METHOD Grounded theory methodology with a constructivist approach was used to conduct the study. Semistructured interviews of 10 primary child caregivers in rural low-income families who had participated in an environmental risk reduction intervention were completed from 2009 to 2011. Data were categorized using comparative analysis, theoretical sampling, and coding techniques. FINDINGS The three phases-(a) visiting my perception, (b) weighing the evidence, and (c) making a new meaning-explained the core process of the grounded theory of Re-Forming the Risk Message. CONCLUSIONS Rural low-income families at risk for environmental hazards in their homes determined what health information and needed subsequent actions regarding their risks were important by changing the meanings of nurse-delivered messages. CLINICAL RELEVANCE Nursing interventions designed to improve health behaviors and reduce risks are often based on stage theories that explain how change occurs through steps leading to positive actions through delivery of risk messages. However, the risk message delivered in an intervention designed to engage action is not always the risk message people decide to use. To understand whether people are ready to engage in positive behaviors through interventions, or if needed changes to the information must be made, nurses need to discover and explore reasons for the re-formed risk messages.

Nursing Students’ Perceptions of the Transition to Shift Work: A Total Worker Health Perspective

Nursing students make an abrupt transition from traditional classes to clinical rotations and shift work. Little is known about students’ sleep, sleep disturbances, and safe practice behaviors during this critical phase of professional development. The purpose of this study was to identify nursing students’ perceptions of problems and potential solutions related to shift work and long work hours. This qualitative, descriptive study used two nursing student focus groups which engaged in a two-round participatory process aimed at framing future interventions. Participants identified problems and solutions related to personal and workplace well-being. Findings will inform undergraduate curricular revisions, and hospital hiring and managerial practices.