Transition of Experienced and New Graduate Nurses to a Pediatric Hospital

This study reports on the 3-, 6-, 12-, and 18-month outcomes of 118 newly hired registered nurses (RNs) who completed a 12-month transition-to-practice program at a pediatric hospital. Experienced RNs (n = 42) and new graduate RNs (n = 76) showed improved organization, prioritization, communication, and leadership skills over time. The experienced RNs reported better communication and leadership skills than the new graduate nurses. Results inform transition program development for both new and experienced nurses. The American Association of Colleges of Nursing (2012) predicts that, without a multifaceted approach, a national nursing shortage will occur by 2020. Many nurses leave their first position and sometimes the profession within the first year of employment (Baxter, 2010; Welding, 2011). Retaining nurses is a vital component of any approach to averting a nursing shortage. In an attempt to retain nurses, healthcare institutions often provide a transition-to-practice (TTP) or nurse residency program for new graduate nurses (NGN) entering the profession. The Institute of Medicine (2011) in its Future of Nursing report also recommends a transition program for nurses moving to a new specialty or to advanced practice roles. Completing a NGN transition program is associated with a decrease in nurse attrition by as much as 80% (Halfer, Graf, & Sullivan, 2008; Rush, Adamack, Gordon, Lilly, & Janke, 2013; Spector et al., 2015). This reported decrease has led to organizational interest in transition programs to improve retention. The goals of residency programs for the NGN have ranged from increasing new nurse confidence and competence, to increasing satisfaction and retention (Fink, Krugman, Casey, & Goode, 2008; Goode, Lynn, McElroy, Bednash, & Murray, 2013; Institute of Medicine, 2011; Spector et al., 2015). Although literature supports the effectiveness of transition programs for the NGN (Fink et al., 2008; Goode et al., 2013; Spector et al., 2015), there is little evidence on the experienced nurse’s transition to a new specialty practice. Furthermore, most transition programs do not report outcomes beyond the first 12 months of employment. Thus, the purpose of this study is to evaluate nurse stressors and supports during and after a 12-month transition-to-employment program for both new and experienced nurses transitioning to a pediatric practice

Examining Long‐Term Effects Of An Infant Mental Health Home‐Based Early Head Start Program On Family Strengths And Resilience

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home‐based Early Head Start (IMH‐HB EHS) program on family functioning. The sample includes 152 low‐income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH‐HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH‐HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH‐HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH‐HB EHS services are maintained after services cease.RESUMENLa meta de las intervenciones con base en la salud mental infantil es promover el desarrollo sano de infantes y bebés por medio de promover un funcionamiento familiar sano para adoptar relaciones de apoyo entre el pequeño niño y sus importantes cuidadores. Este estudio examinó el impacto que sobre el funcionamiento familiar tiene un programa “Early Head Start” de salud mental infantil con base en casa (IMH‐HB EHS). El grupo muestra lo componen 152 familias de bajos recursos del Medio Oeste de Estados Unidos, en espera de o ya criando a un niño menor de un año de edad, que fueron asignadas al azar para recibir los servicios de IMH‐HB EHS (n=75) o a una condición comparativa (n=77). Las madres que recibieron los servicios de IMH‐HB EHS reportaron un funcionamiento sicológico y familiar más saludable, resultados que son consistentes con el enfoque de IMH, cuando sus niños tenían entre 3 y 7 años de edad. Específicamente, las madres en el grupo IMH‐HB EHS reportaron un funcionamiento y relaciones familiares más saludables, mejores habilidades para arreglárselas que eran necesarias para abogar por sus familias, así como menos estrés en el papel de crianza al ser comparadas con aquellas madres en la condición comparativa. El estudio también examinó la manera de arreglárselas buscando apoyo, algunas de las cuales cambiaron diferentemente a través del tiempo con base en las asignaciones de grupo del programa. En general, los resultados sugieren que los aspectos positivos que las familias alcanzan como resultado de participar en los servicios de IMH‐HB EHS se mantienen después que los servicios terminan.RÉSUMÉLes interventions fondées sur la santé mentale ont pour but de promouvoir le développement sain des nourrissons et des jeunes enfants en promouvant le fonctionnement saind'une famille afin de favoriser des relations de soutien entre le jeune enfant et ceux qui s'occupent d'elle ou de lui. Cette étude a examiné les impacts d'un programme américain de Early Head Start focalisé sur la santé mentale du nourrisson (abrégé IMH‐HB EHS) sur le fonctionnement de la famille. L’échantillon a compris 152 familles de milieu défavorisé de la région centre des Etats‐Unis, attendant un enfant ou s'occupant d'un enfant de moins d'un an, a qui on a assigné au hasard les services IMH‐HB EHS (n=75) ou une condition de comparaison (n=77). Les mères ayant reçu les services IMH‐HB EHS ont fait état d'un meilleur fonctionnement psychologique et familial, des résultats qui correspondent à l'objectif de santé mentale du nourrisson, lorsque leurs enfants avaient entre 3 et 7 ans. Plus spécifiquement, les mères du groupe IMH‐HB EHS ont fait état d'un meilleur fonctionnement familial et de meilleurs relations familiales, de meilleures capacités à s'adapter nécessaires afin de se porter les avocates de leurs familles, et de moins de stress de parentage comparé à celles du groupe de comparaison. L’étude a aussi examiné l'adaptation liée à la quête de soutien, qui a en partie changé différemment au fil du temps, en fonction du groupe de placement. Au bout du compte les résultats suggèrent que les gains obtenus par les familles comme résultat de la participation aux services du IMH‐HB EHS se maintiennent après que les services cessent.ZUSAMMENFASSUNGInterventionen, die auf der mentalen Gesundheit von Säuglingen basieren, zielen darauf ab, die gesunde Entwicklung von Säuglingen und Kleinkindern zu verbessern, indem ein gesundes familiäres Funktionieren gefördert wird, um unterstützende Beziehungen zwischen dem Kleinkind und ihren/seinen wichtigsten Bezugspersonen zu begünstigen. Diese Studie untersuchte die Effekte eines Early Head Start‐Hausbesuchs‐Programms (IMH‐HB EHS) auf das familiäre Funktionieren. Die Stichprobe umfasst 152 Familien mit niedrigem Einkommen aus dem Mittleren Westen der USA. Es handelt sich bei der Stichprobe um werdende Eltern oder Eltern mit einem Kind unter einem Jahr, die randomisiert einer Dienstleistung zugewiesen wurden: zum IMH‐HB EHS‐Programm (n = 75) oder zu einer Vergleichsbedingung (n = 77). Mütter, die das IMH‐HB EHS‐Programm erhielten, berichteten von gesünderem psychologischem und familiärem Funktionieren, wenn ihre Kinder im Alter zwischen 3 und 7 Jahren waren. Dies sind Ergebnisse, die mit dem IMH Fokus übereinstimmen. Im Speziellen berichteten Mütter, die in der IMH‐HB EHS‐Gruppe waren, von gesünderem familiären Funktionieren und familiären Beziehungen, besseren Bewältigungsstrategien, um für ihre Familien einzustehen und von weniger Stress in der Elternrolle verglichen mit den Müttern der Vergleichsbedingung. Die Studie untersuchte auch unterstützungssuchende Bewältigungsstrategien, von denen sich einige basierend auf der Gruppenzugehörigkeit im Laufe der Zeit in unterschiedlicher Weise veränderten. Insgesamt deuten die Ergebnisse darauf hin, dass die Gewinne, die die Familien infolge der Teilnahme am IMH‐HB EHS‐Programm erzielten, nach Ende des Programms aufrechterhalten werden.抄録乳幼児精神保健に基づく介入は、幼い子どもとその重要な養育者との間の支持的な関係性を育てるという健康な家族機能の促進を通して、乳幼児の健康な発達を促進することを目的としている。この研究は、乳幼児精神保健在宅早期ヘッドスタートInfant Mental Health home‐based Early Head Start (IMH‐HB EHS)プログラムが、家族機能に与える影響を調査した。対象はアメリカ合衆国中西部の妊娠中か1歳以下の子どもを育てている152の低所得家族で、IMH‐HB EHSサービスを受ける(n=75)か、比較の条件か(n=77)に、ランダムに割り当てられた。IMH‐HB EHSサービスを受けた母親は、子どもが3歳から7歳の間に、より健康的な心理機能および家族機能を報告した。これはIMHの焦点と一致している結果だった。特に、IMH‐HB EHS群の母親は、比較条件の母親と比べ、より健康な家族機能と関係性、家族を擁護するのに必要なよりよい対処機能、そして親役割にストレスが少ないことを報告した。研究はまた、支援を求める対処についても調査した。その一部はプログラム群への割り当てに基づいて時間経過により異なって変化していた。全体として、IMH‐HB EHSサービスに参加した結果として家族が達成し獲得したものは、サービスが終了した後も、維持されている。摘要以幼兒心理健康為基礎的介入旨在通過健康的家庭運作去培養小童與其重要看護者間的支持性關係, 以此促進幼兒和學步兒的健康發展。本文探討一個幼兒心理健康家訪早期搶步計畫 (IMH‐HB‐EHS) 對家庭運作的影響。樣本包括一百五十二個在美國中西部低入息的家庭。這些家庭正待產或在養育一個少於一歲的小孩。參與家庭被隨機分派到接受IMH‐HB‐EHS服務 (n=75) 或一個比較環境 (n=77)。有接受IMH‐HB‐EHS服務的母親報告在孩兒三至七歲間有較健康的心理和家庭運作, 這結果與IMH的焦點相附合。具體來說, 在IMH‐HB‐EHS組的母親較在比較環境組的母親報告有健康些的家庭運作和關係, 有好些的因應技巧為家庭作鼓吹, 及在親職角色中有少些壓力。本文亦探討尋求支持的因應, 發現這會根據組別分派而有不同的隨時間改變。總體而言, 探討結果顯示家庭從參與IMH‐HB‐EHS服務所得的收益在服務停止後仍會維持。Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112230/1/imhj21518.pd

The Use of Technology to Support Precision Health in Nursing Science

PurposeThis article outlines how current nursing research can utilize technology to advance symptom and self‐management science for precision health and provides a roadmap for the development and use of technologies designed for this purpose.ApproachAt the 2018 annual conference of the National Institute of Nursing Research (NINR) Research Centers, nursing and interdisciplinary scientists discussed the use of technology to support precision health in nursing research projects and programs of study. Key themes derived from the presentations and discussion were summarized to create a proposed roadmap for advancement of technologies to support health and well‐being.ConclusionsTechnology to support precision health must be centered on the user and designed to be desirable, feasible, and viable. The proposed roadmap is composed of five iterative steps for the development, testing, and implementation of technology‐based/enhanced self‐management interventions. These steps are (a) contextual inquiry, focused on the relationships among humans, and the tools and equipment used in day‐to‐day life; (b) value specification, translating end‐user values into end‐user requirements; (c) design, verifying that the technology/device can be created and developing the prototype(s); (d) operationalization, testing the intervention in a real‐world setting; and (e) summative evaluation, collecting and analyzing viability metrics, including process data, to evaluate whether the technology and the intervention have the desired effect.Clinical RelevanceInterventions using technology are increasingly popular in precision health. Use of a standard multistep process for the development and testing of technology is essential.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151985/1/jnu12518.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151985/2/jnu12518_am.pd

Biomarkers as Common Data Elements for Symptom and Selfâ Management Science

PurposeBiomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a â minimum setâ of biomarkers for consideration as CDEs in symptom and selfâ management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance.Design and MethodsFrom May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and selfâ management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and selfâ management science are proposed along with implications for future research and use of CDEs in these areas.FindingsThe recommended minimum set of biomarker CDEs include proâ and antiâ inflammatory cytokines, a hypothalamicâ pituitaryâ adrenal axis marker, cortisol, the neuropeptide brainâ derived neurotrophic factor, and DNA polymorphisms.ConclusionsIt is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and selfâ management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and selfâ management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and selfâ management science.Clinical RelevanceThe use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and selfâ management science.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143764/1/jnu12378.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143764/2/jnu12378_am.pd

The IARC perspective on cervical cancer screening

In May 2018, the World Health Organization (WHO) called for a global initiative to eliminate cervical cancer as a public health problem. To achieve this goal, global scale-up of effective vaccination against the human papillomavirus (HPV) as well as screening for and treatment of cervical cancer are required. Cervical cancer screening was evaluated in 2005 by the International Agency for Research on Cancer (IARC) Handbooks program,1 and a reevaluation was deemed to be timely given the major advances in the field since then. The new handbook provides updated evaluations of the effectiveness of screening methods, which were used as a basis for the update of the WHO Guideline for Screening and Treatment of Cervical Pre-cancer Lesions for Cervical Cancer Prevention.2 We convened an IARC Working Group of 27 scientists from 20 countries to assess the evidence on the current approaches to and technologies used in cervical cancer screening with the use of the newly updated Handbooks Preamble3 (Fig. 1) and Table 1).Fil: Bouvard, Véronique. International Agency For Research On Cancer; FranciaFil: Wentzensen, Nicolas. National Cancer Institute; Estados UnidosFil: Mackie, Anne. Public Health England; Reino UnidoFil: Berkhof, Johannes. University of Amsterdam; Países BajosFil: Brotherton, Julia. VCS Foundation; Australia. University of Melbourne; AustraliaFil: Giorgi Rossi, Paolo. Azienda Unità Sanitaria Locale Di Reggio Emilia; ItaliaFil: Kupets, Rachel. University of Toronto; CanadáFil: Smith, Robert. American Cancer Society; Estados UnidosFil: Arrossi, Silvina. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bendahhou, Karima. Casablanca Cancer Registry; MarruecosFil: Canfell, Karen. The University Of Sydney; AustraliaFil: Chirenje, Z. Mike. University Of Zimbabwe; ZimbabueFil: Chung, Michael H.. University of Emory; Estados UnidosFil: del Pino, Marta. Hospital Clinico de Barcelona; EspañaFil: de Sanjosé, Silvia. Program for Appropriate Technology in Health; Estados UnidosFil: Elfström, Miriam. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Franco, Eduardo L.. McGill University; CanadáFil: Hamashima, Chisato. Teikyo University; JapónFil: Hamers, Françoise F.. French National Public Health Agency; FranciaFil: Herrington, C. Simon. University of Edinburgh; Reino UnidoFil: Murillo, Raúl. Hospital Universitario San Ignacio; ColombiaFil: Sangrajrang, Suleeporn. National Cancer Institute; TailandiaFil: Sankaranarayanan, Rengaswamy. Research Triangle Institute; Estados UnidosFil: Saraiya, Mona. Centers for Disease Control and Prevention; Estados UnidosFil: Schiffman, Mark. National Cancer Institute; Estados UnidosFil: Zhao, Fanghui. Chinese Academy of Medical Sciences & Peking Union Medical College; ChinaFil: Arbyn, Marc. Sciensano; BélgicaFil: Prendiville, Walter. International Agency For Research On Cancer; FranciaFil: Indave Ruiz, Blanca I.. International Agency For Research On Cancer; FranciaFil: Mosquera Metcalfe, Isabel. International Agency For Research On Cancer; FranciaFil: Lauby Secretan, Béatrice. International Agency For Research On Cancer; Franci

Neuroanatomical heterogeneity and homogeneity in individuals at clinical high risk for psychosis

Individuals at Clinical High Risk for Psychosis (CHR-P) demonstrate heterogeneity in clinical profiles and outcome features. However, the extent of neuroanatomical heterogeneity in the CHR-P state is largely undetermined. We aimed to quantify the neuroanatomical heterogeneity in structural magnetic resonance imaging measures of cortical surface area (SA), cortical thickness (CT), subcortical volume (SV), and intracranial volume (ICV) in CHR-P individuals compared with healthy controls (HC), and in relation to subsequent transition to a first episode of psychosis. The ENIGMA CHR-P consortium applied a harmonised analysis to neuroimaging data across 29 international sites, including 1579 CHR-P individuals and 1243 HC, offering the largest pooled CHR-P neuroimaging dataset to date. Regional heterogeneity was indexed with the Variability Ratio (VR) and Coefficient of Variation (CV) ratio applied at the group level. Personalised estimates of heterogeneity of SA, CT and SV brain profiles were indexed with the novel Person-Based Similarity Index (PBSI), with two complementary applications. First, to assess the extent of within-diagnosis similarity or divergence of neuroanatomical profiles between individuals. Second, using a normative modelling approach, to assess the ‘normativeness’ of neuroanatomical profiles in individuals at CHR-P. CHR-P individuals demonstrated no greater regional heterogeneity after applying FDR corrections. However, PBSI scores indicated significantly greater neuroanatomical divergence in global SA, CT and SV profiles in CHR-P individuals compared with HC. Normative PBSI analysis identified 11 CHR-P individuals (0.70%) with marked deviation (>1.5 SD) in SA, 118 (7.47%) in CT and 161 (10.20%) in SV. Psychosis transition was not significantly associated with any measure of heterogeneity. Overall, our examination of neuroanatomical heterogeneity within the CHR-P state indicated greater divergence in neuroanatomical profiles at an individual level, irrespective of psychosis conversion. Further large-scale investigations are required of those who demonstrate marked deviation.publishedVersio

Normative modeling of brain morphometry in clinical high risk for psychosis

Importance The lack of robust neuroanatomical markers of psychosis risk has been traditionally attributed to heterogeneity. A complementary hypothesis is that variation in neuroanatomical measures in individuals at psychosis risk may be nested within the range observed in healthy individuals. Objective To quantify deviations from the normative range of neuroanatomical variation in individuals at clinical high risk for psychosis (CHR-P) and evaluate their overlap with healthy variation and their association with positive symptoms, cognition, and conversion to a psychotic disorder. Design, Setting, and Participants This case-control study used clinical-, IQ-, and neuroimaging software (FreeSurfer)–derived regional measures of cortical thickness (CT), cortical surface area (SA), and subcortical volume (SV) from 1340 individuals with CHR-P and 1237 healthy individuals pooled from 29 international sites participating in the Enhancing Neuroimaging Genetics Through Meta-analysis (ENIGMA) Clinical High Risk for Psychosis Working Group. Healthy individuals and individuals with CHR-P were matched on age and sex within each recruitment site. Data were analyzed between September 1, 2021, and November 30, 2022. Main Outcomes and Measures For each regional morphometric measure, deviation scores were computed as z scores indexing the degree of deviation from their normative means from a healthy reference population. Average deviation scores (ADS) were also calculated for regional CT, SA, and SV measures and globally across all measures. Regression analyses quantified the association of deviation scores with clinical severity and cognition, and 2-proportion z tests identified case-control differences in the proportion of individuals with infranormal (z < −1.96) or supranormal (z > 1.96) scores. Results Among 1340 individuals with CHR-P, 709 (52.91%) were male, and the mean (SD) age was 20.75 (4.74) years. Among 1237 healthy individuals, 684 (55.30%) were male, and the mean (SD) age was 22.32 (4.95) years. Individuals with CHR-P and healthy individuals overlapped in the distributions of the observed values, regional z scores, and all ADS values. For any given region, the proportion of individuals with CHR-P who had infranormal or supranormal values was low (up to 153 individuals [<11.42%]) and similar to that of healthy individuals (<115 individuals [<9.30%]). Individuals with CHR-P who converted to a psychotic disorder had a higher percentage of infranormal values in temporal regions compared with those who did not convert (7.01% vs 1.38%) and healthy individuals (5.10% vs 0.89%). In the CHR-P group, only the ADS SA was associated with positive symptoms (β = −0.08; 95% CI, −0.13 to −0.02; P = .02 for false discovery rate) and IQ (β = 0.09; 95% CI, 0.02-0.15; P = .02 for false discovery rate). Conclusions and Relevance In this case-control study, findings suggest that macroscale neuromorphometric measures may not provide an adequate explanation of psychosis risk

A Center Experience with Common Data Elements in Chronic Illness Self-Management Research

In recent decades, the use of common data elements has expanded across the health disciplines. This has included growth within programs of research focused on self-management and family nursing. Family nursing and self-management science may be expanded with the increased use of common concepts, measures, and theoretical frameworks. This article describes the experience of exploring the use of common data elements and identifying shared concepts from the perspective of one National Institute of Nursing Research funded Exploratory Center in Self-Management. Guidance offered by the Individual and Family Self-Management Theory is discussed, and implications for family research are presented

Factors Influencing Self-Management of Chronic Obstructive Pulmonary Disease by Community-Dwelling Adults

Individuals with chronic obstructive pulmonary disease (COPD) struggle with effective self-management, contributing to poor health outcomes and costly health care. More research is needed to understand the factors influencing COPD self-management better in order to improve outcomes and reduce health care costs for those living with this prevalent chronic illness. The purpose of this article is to describe factors influencing community-dwelling adults’ COPD self-management. In-depth interviews were conducted with 28 people living with COPD. Braun and Clarke’s thematic analysis approach was used to analyze interview data, and it resulted in the identification of themes providing insight into COPD self-management as described by those living with the disease. Specifically, factors impacting engagement in treatment recommendations are described. These findings have implications for informing evidence-based recommendations for self-management support and improving the quality of care provided to those with COPD

An Integrative Review of the Use of the Individual and Family Self-Management Theory in Research

The extent of the application of the Individual and Family Self-Management Theory (IFSMT) in research has yet to be determined. The purpose of this analysis was to review the use of the IFSMT in published research and evaluate posited constructs and relationships. Dimensions and categories of the IFSMT and the interrelationships were generally supported in the 77 articles reviewed. A majority focused on self-management of chronic conditions in the adult population. More research on the strength, direction, and interaction of relationships is needed. Defining and exploring social constructs, including race, ethnicity, and gender, should be prioritized in future IFSMT research