The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

A number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n=81) and those who work in states without CHW certification programs (n=115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system

The Use of Aromatherapy to Reduce Test Anxiety Among Nursing Students

1. Purpose/Aims: The purpose of this study is to examine the effects of aromatherapy on test anxiety in undergraduate nursing students and to compare the efficacy of lavender and orange-peppermint aromas on this population. 2. Rationale/Conceptual Basis/Background: While approximately 17% of the general population suffers from test anxiety, research demonstrates that a greater proportion of nursing students typically fall in this category (Driscoll, Evans, Ramsey, & Wheeler, 2009). Test anxiety can lead to higher cortisol levels in the bloodstream, inducing a full physiological response and negatively affecting performance (Toda & Morimoto, 2011). However, lavender and orange-peppermint are both aromas that have demonstrated an ability to decrease cortisol levels and perception of stress. Lavender has previously been used to reduce anxiety in students at various levels (Kutlu, Yilmaz, & Çeçen, 2008; McCaffrey, Thomas, & Kinzelman, 2009), and other aromas have successfully reduced anxiety in undergraduate nursing students (Johnson, 2014). No research has been done to assess the effects of lavender and orange-peppermint on test anxiety in undergraduate nursing students. 3. Methods: A quantitative experimental design was utilized to evaluate the effects of lavender and orange-peppermint aromas. Undergraduate nursing students are required to pass a high-stakes exam at the beginning of the semester, and participants were randomly assigned to the control group or one of the two intervention groups: lavender or orange-peppermint aromatherapy. The intervention took place directly before the exam. The Visual Analog Scale (VAS) was used before and after the intervention to determine the state anxiety of the student, and the Westside Test Anxiety Scale (WTAS) was used before the intervention and after the test to evaluate general levels of test anxiety. A repeated measures analysis of variance was used to analyze data. 4. Results: Results demonstrated a statistically significant (p=0.045) decrease in VAS scores when comparing the combined treatment against the control group by 1.3 versus 0.7 respectively. However, there was no significant difference between the combined treatment and control groups for change in WTAS scores. Furthermore, when evaluating each treatment group individually, there was also no significant difference against the control group in VAS or WTAS. One factor in the data was the orange-peppermint intervention group had significantly lower WTAS scores initially than the control group and significantly lower VAS scores initially than either the control group or the lavender group. 5. Implications: Aromatherapy has the potential to significantly decrease state anxiety in nursing students immediately before an exam. Additionally, this study demonstrates that reduction in anxiety can occur when students spend time to stop what they are doing and focus on something other than studying before taking a test. Further research should investigate other aromas, as well as utilize a larger sample size. References Driscoll, R., Evans, G., Ramsey, G., & Wheeler, S. (2009). High test anxiety among nursing students. Retrieved from ERIC database. (ED506526) Johnson, C. E. (2014). Effect of aromatherapy on cognitive test anxiety among nursing students. Alternative and Complementary Therapies, 20(2) 84-87. http://dx.doi.org/10.1089/act.2014.20207. Kutlu, A. K., Yilmaz, E., & Çeçen. D. (2008). Effects of aroma inhalation on examination anxiety. Teaching and Learning in Nursing, 3(4) 125-130. http://dx.doi.org/doi:10.1016/j.teln.2008.04.005. McCaffrey, R., Thomas, D. J., & Kinzelman, A. O. (2009). The effects of lavender and rosemary essential oils on test-taking anxiety among graduate nursing students. Holistic Nursing Practice, 23(2) 88-93. http://dx.doi.org/10.1097/HNP.0b013e3181a110aa. Toda, M. & Morimoto, K. (2011). Evaluation of effects of lavender and peppermint aromatherapy using sensitive salivary endocrinological stress markers. Stress and Health, 27(5) 430-435. http://dx.doi.org/10.1002/smi.1402

Development of a candidate reference material for adventitious virus detection in vaccine and biologicals manufacturing by deep sequencing.

Unbiased deep sequencing offers the potential for improved adventitious virus screening in vaccines and biotherapeutics. Successful implementation of such assays will require appropriate control materials to confirm assay performance and sensitivity. A common reference material containing 25 target viruses was produced and 16 laboratories were invited to process it using their preferred adventitious virus detection assay. Fifteen laboratories returned results, obtained using a wide range of wet-lab and informatics methods. Six of 25 target viruses were detected by all laboratories, with the remaining viruses detected by 4-14 laboratories. Six non-target viruses were detected by three or more laboratories. The study demonstrated that a wide range of methods are currently used for adventitious virus detection screening in biological products by deep sequencing and that they can yield significantly different results. This underscores the need for common reference materials to ensure satisfactory assay performance and enable comparisons between laboratories

The impact of state certification of community health workers on team climate among registered nurses in the United States

A number of states have adopted certification programs for community health workers (CHWs) to increase oversight, allow for direct funding, and improve recognition of CHWs as members of the health care team. More states are considering CHW certification programs to increase the use of CHWs by health care organizations with the hopes of improving health outcomes and decreasing health disparities. There has been little research into the impact of state CHW certification on the adoption and dissemination of CHWs into the existing health care system. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. Team climate is defined as the perceptions of team members on how they work together, share a single vision, are open to new ideas, and if they feel safe and supported by other team members. This study recruited RNs using an online purposeful sampling method to compare the perceptions of team climate using the Team Climate Inventory (TCI) short-form. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a significant difference in one survey question on the RNs views of whether state certification of CHW improved the ability of their health care team to deliver quality care. Further analysis of the results using multiple regression found few significant predictors of overall TCI and TCI subscale scores among the independent variables used in the regression models. Registered nurses are the largest part of the professional health care workforce, and their ability to collaborate and work with CHWs is critical to the integration of CHWs into existing health care organizations. More research on the impact of state certification of CHW and the factors that influence the adoption of innovative health care delivery methods is needed to meet the national goal of eliminating health disparities and improving health in minority and underserved populations

Impact of CHW Certification on Team Climate in Texas - Grandfathering versus State Certified Training

Purpose: This study compared the perceptions of team climate among Texas Community Health Workers (CHWs) who were certified based on experience or grandfathering to those who had completed a CHW certification program from a post-secondary institution such as a community college, technical school, or other state-certified training programs in Texas. Methods: Study participants were recruited though emails and snowball sampling. CHW\u27s perception of team climate was assessed using the Team Climate Inventory Short Form (TCI-SF) which consists of 19 questions related to four factors: Participation, Support for Innovation, Team Objectives, and Task Orientation (Kivimäki and Elovainio, 1999). Results: No significant differences were found for independent demographic variables between the two study groups. Results of non-parametric tests for the survey data found no significant differences in mean TCI-SF scores between the two groups. Clinical Relevance: This research found that there were no significant differences in the perceptions of team climate between CHWs who are certified through a grandfathering process (i.e., prior work experience) and those who have completed a state CHW certification training program in Texas. The study suggests that both methods of certification resulted in similar perceptions of team climate among CHWs working in health care settings

4.b Young Christians in Germany - Fading Embers?

Dr. Ruff presents a look at German youth and their declining faith in God

4.c Session Four Q & A

Prof. Rutz and Dr. Ruff answer questions from the audience

Developing an Integrated Caregiver Patient-Portal System

We have developed an integrated caregiver patient-portal system (i.e., patient–caregiver portal) that (1) allows a patient to identify their primary caregiver and their communication preferences with that caregiver in the healthcare setting; (2) connects the caregiver to a unique portal page to indicate their needs; and (3) informs the healthcare team of patient and caregiver responses to aid in integrating the caregiver. The purpose of this manuscript is to report on the formative phases (Phases I and II) of system development. Phase I involved a pre-assessment to anticipate complexity or barriers in the system design and future implementation. We used the non-adaption, abandonment, scale-up, spread, and sustainability (NASSS) framework and rubric to conduct this pre-assessment. Phase II involved exploring reactions (i.e., concerns or benefits) to the system among a small sample of stakeholders (i.e., 5 palliative oncology patients and their caregivers, N = 10). The purpose of these two phases was to identify system changes prior to conducting usability testing among patient/caregiver dyads in palliative oncology (phase III). Completion of the NASSS rubric highlighted potential implementation barriers, such as the non-uniformity of caregiving, disparities in portal use, and a lack of cost–benefit (value) findings in the literature. The dyads’ feedback reinforced several NASSS ratings, including the benefits of connecting caregivers and allowing for caregiver voice as well as the concerns of limited use of patient-portals by the patients (but not the caregivers) and the need for user assistance during stressful health events. One change that resulted from this analysis was ensuring that we provided research participants (users) with detailed guidance and support on how to log in and use a patient–caregiver portal. In future iterations, we will also consider allowing more than one caregiver to be included and incorporating additional strategies to enable caregivers to interact in the system as part of the care team (e.g., via email)