V. Susan Dahinten

Neighborhood Disadvantage: Pathways of Effects for Young Children

The present study used Canadian National Longitudinal data to examine a model of the mechanisms through which the effects of neighborhood socioeconomic conditions impact young childrens verbal and behavioral outcomes (N= 3,528; M age = 5.05 years, SD= 0.86). Integrating elements of social disorganization theory and family stress models, and results from structural equation models suggest that both neighborhood and family mechanisms played an important role in the transmission of neighborhood socioeconomic effects. Neighborhood disadvantage manifested its effect via lower neighborhood cohesion, which was associated with maternal depression and family dysfunction. These processes were, in turn, related to less consistent, less stimulating, and more punitive parenting behaviors, and ultimately, poorer child outcomes.

An Examination of the Reciprocal Relationships Between Adolescents’ Aggressive Behaviors and Their Perceptions of Parental Nurturance

This study examined reciprocal relationships between adolescents’ perceptions of parental nurturance and two types of adolescent aggressive behaviors (indirect and direct aggression) using a transactional model. Three waves of longitudinal data were drawn from the Canadian National Longitudinal Survey of Children and Youth. The sample included 1,416 (735 female) adolescents who were 10- and 11-year-olds at Time 1 and became 14-and 15-year-olds at Time 3. The findings failed to support reciprocal effects, but confirmed parental effects at different ages for girls and boys. For girls, perceptions of parental nurturance at age 10 were negatively associated with both indirect and direct aggression at age 12. For boys, perceptions of parental nurturance at age 12 were negatively associated with both aggressive behaviors at age 14. Future research should continue to investigate reciprocal effects in parent-adolescent relationships to identify developmental periods where the effect of adolescents’ or their parents’ behavior may be stronger.

Almutairi's Critical Cultural Competence model for a multicultural healthcare environment.

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairis critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross-cultural interactions. CCC has addressed the limitations of many other cultural competence approaches that have been discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC.

RNs and LPNs: emotional exhaustion and intention to leave

AIMS To describe and compare registered nurse (RN) and licensed practical nurse (LPN) emotional exhaustion, intention to leave and reasons for leaving. BACKGROUND Different skill mix/care delivery models are being used to address nurse shortages and rising health-care costs. Skill mix may include RNs and LPNs. More LPNs are being employed in areas, such as acute care, that have been previously staffed by all RNs. Little is known about nurse outcomes since the introduction of LPNs to acute care settings. METHODS This study was a cross-sectional correlational design. A stratified, random sample of acute care nurses completed surveys via Fluidsurveys. The survey was modelled after the RN4CAST nursing workforce survey. RESULTS For both groups of nurses higher levels of emotional exhaustion were associated with intention to leave and workload was the most frequent reason cited for intention to leave. More RNs than LPNs cited career advancement as a reason to leave, and more LPNs than RNs identified poor salary as a reason to leave. CONCLUSIONS Emotional exhaustion is linked to intention to leave health care. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers should address work environment factors associated with turnover intentions, such as professional development opportunities and shared decision-making.

Developmental Trajectories of Weight Status in Childhood and Adolescence

Abstract Understanding patterns of weight status development or change across childhood and adolescence requires repeated measurements of the same individuals over time. Several statistical approaches are available to conceptualize, model, and study the developmental patterns or trajectories of weight status. This chapter summarizes three different approaches used in obesity research to investigate developmental patterns or trajectories of weight status: tracking methods, normative growth curve methods, and nonnormative growth curve methods. Tracking methods, used most often in epidemiological studies, estimate stability or change across at least two time points, focusing on time point-to-time point comparisons. Normative growth curve methods, concerned with developmental change, simultaneously analyze multiple assessments of weight status to provide average trends and individual variations around the trends. Nonnormative growth curve methods also use multiple assessments of weight status, but these approaches do not assume homogeneity in the distribution of trajectories. Rather, these techniques identify meaningful subgroups of individuals who follow distinct trajectories of development. The differences in the developmental patterns and information provided by these three approaches are described, along with identified predictors of these trajectories.

The emerging use of social media for health-related purposes in low and middle-income countries: A scoping review

Abstract Background Social media allows for instant access to, and dissemination of, information around the globe. Access to social media in low- and middle-income countries has increased exponentially in recent years due to technological advances. Despite this growth, the use of social media in low- and middle-income countries is less well-researched than in high-income countries. Objective To identify, explore and summarize the current state of the literature on the use of social media for health in low- and middle-income countries. Methods A scoping review was conducted on literature available to December 2017. Six databases were searched, and grey literature was identified through the Google and Google Scholar search engines. Literature was considered for inclusion if it (1) was published in English, (2) was conducted in or in relation to a low or middle-income country, (3) reported on as least one type of social media or social media use generally for health purposes, and (4) reported on at least one aspect of human health. Content analysis was performed to identify themes. Results Forty articles met the inclusion criteria. Thirty-one were research articles, and nine were review/discussion/descriptive and evaluative reports. Since 2010, when the first article was published, most of the literature has focused on Asian (n = 15) and African (n = 12) countries. Twitter (n = 11) and Facebook (n = 10) were the most frequently discussed individual social media platforms. Four themes were identified: (1) use for health education and influence (sub-themes were health behaviour and health education); (2) use within infectious disease and outbreak situations; (3) use within natural disaster, terrorism, crisis and emergency response situations; and (4) producers and consumers of social media for health (sub-themes were misinformation, organizational challenges, users’ expectations, and challenges of unique sub-populations). Most studies addressed more than one theme. Conclusion Social media has the ability to facilitate disease surveillance, mass communication, health education, knowledge translation, and collaboration amongst health providers in low- and middle-income countries. Misinformation or poorly communicated information can contribute to negative health behaviours and adverse health outcomes amongst consumers, as well as hysteria and chaos. Organizations using social media should provide accurate and readable information. Promotion of credible social media sites by governments, health care professionals and researchers, as well as education on the appropriate use of social media, could help to lessen the effect of misinformation. This is a nascent body of literature and future research should investigate the relative effectiveness of various platforms for different users, other potential uses, and pursue a broader geographical focus.

Safety Culture, Patient Safety, and Quality of Care Outcomes: A Literature Review:

This integrative literature review was conducted to examine the relationships between safety culture and patient safety and quality of care outcomes in hospital settings and to identify directions for future research. Using a search of six electronic databases, 17 studies that met the study criteria were selected for review. This review revealed semantic inconsistencies, infrequent use of a theory or theoretical framework, limited discussions of validity of instruments used, and significant methodological variations. Most notably, this review identified a large array of nonsignificant and inconsistent relationships between safety culture and patient safety and quality of care outcomes. To improve understanding of the relationships, investigators should consider using a theoretical framework and valid measures of the key concepts. Researchers should also give more attention to selecting appropriate sampling and data collection methods, units of analysis, levels of data measurement and aggregation, and statistical analyses.

Construct Validity of Almutairi’s Critical Cultural Competence Scale

Cultural diversity in health care settings can threaten the well-being of patients, their families, and health care providers. This psychometric study evaluated the construct validity of the recently developed four-factor, 43-item Critical Cultural Competence Scale (CCCS) which was designed to overcome the conceptual limitations of previously developed scales. The study was conducted in Canada with a random sample of 170 registered nurses. Comparisons with the Cultural Competence Assessment instrument, Scale of Ethnocultural Empathy, and Cultural Intelligence Scale provided mixed evidence of convergent validity. Modest correlations were found between the total scale scores suggesting that the CCCS is measuring a more comprehensive and conceptually distinct construct. Stronger correlations were found between the more conceptually similar subscales. Evidence for discriminant validity was also mixed. Results support use of the CCCS to measure health care providers’ perceptions of their critical cultural competence though ongoing evaluation is warranted.

Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis

PURPOSE This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. DESIGN This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. METHODS Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. FINDINGS Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. CONCLUSIONS This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. CLINICAL RELEVANCE Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality.