Western Journal of Nursing Research

Illness uncertainty is prevalent in patients awaiting liver transplant. We described high levels of illness uncertainty in these patients and examined relationships between uncertainty and person factors and the antecedents of uncertainty. Mishel uncertainty in illness scale was used to measure illness uncertainty. We used modes and interquartile range (IQR) to describe illness uncertainty levels in 115 patients. Multiple logistic and linear regression models estimated the associations of uncertainty with hypothesized antecedents. High total illness uncertainty score was reported by 15.6% of the patients. After adjusting for all variables, illness uncertainty was associated with two antecedents of uncertainty, low social well-being (OR = 0.816; p = .025) and low self-efficacy (OR = 0.931; p = .013). Complexity was negatively associated with social well-being; ambiguity and inconsistency were negatively associated with self-efficacy. One in seven patients experienced high illness uncertainty. Social well-being and self-efficacy were negatively related to illness uncertainty.

The Patient Activation Measure (PAM) assesses a person’s level of knowledge, skills, and confidence to self-manage their day-to-day health. We conducted a mediation analysis to examine potential direct effects of race on significantly lower baseline PAM scores in Black than in White participants (p<0.001) who were a subset of 184 adults who participated in a randomized controlled trial. In the mediation analysis, using natural indirect effects, the continuous outcome was the PAM score. The mediators were income, education, ability to pay bills, and health literacy; race (Black or White) was the “exposure.” The results indicate that income (p=0.025) and difficulty paying monthly bills (p=0.04) mediated the relationship between race and baseline PAM score, whereas health literacy (p=0.301) and education (p=0.436) did not. Researchers must further investigate the role of economic diversity as an underlying mechanism of patient activation and differences in outcomes.

Clinical Trial Registration: Avoiding Health Disparities When Collecting Patient Contextual Data for Clinical Care and Pragmatic Research: NCT03766841

https://clinicaltrials.gov/ct2/show/NCT03766841?term=crotty&draw=2&rank=1

Retention of registered nurses (RNs) and health care assistants continue to be a challenge in acute care settings. This descriptive, comparative study examined differences of job embeddedness (JE) scores between RNs and health care assistants (HCAs) in acute care facilities. Generational differences for JE scores were also compared. A convenience sample of RNs and HCAs from medical and surgical units at two Texas hospitals completed the surveys. RNs valued community sacrifices significantly higher than HCAs. Total JE scores between baby boomers and millennials were significantly different, while organizational links scores among all three generations showed statistical significantly differences. Organizational fit, organizational sacrifice, and level of education added statistical significance to the prediction of job satisfaction.

Lack of access to healthy foods disproportionately impacts adolescents. This mixed-methods study used photovoice to explore everyday lived experiences of food access among teens from low-income families, empowering them to share their stories. Sixty-three diverse teens (12–17 years) from across one Midwest state took images and created narratives to support community presentations. Independent content analysis identified themes. Researchers used t tests to compare pre-post differences (p < 0.05) for two scales related to empowerment and positive youth development. Themes suggest teens take on adult responsibilities relative to food access, generally selecting unhealthy foods. Families and after-school programs were critical to food-related experiences, with cultural differences noted. A statistically significant increase, t(58) = -2.225, p = .032, was noted for “most community leaders in my city would listen to me.” Findings support the need to address factors contributing to difficulties accessing healthy foods in home and community settings.

Interventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.

The purpose of this pilot study was to test a church-based, culturally sensitive, six-week intervention called GET FIT DON’T QUIT. The intervention aimed to increase knowledge and change beliefs about physical activity, and to improve social facilitation to increase self-regulation, in order to promote physical activity in African-American women. A two-group pretest/posttest, quasi-experimental design was conducted in a convenience sample (N = 37) of African-American women. Participants were randomly assigned to the intervention or control group by church affiliation. The six-week intervention consisted of teaching and roundtable discussions, and email reminders to be physically active. There were significant differences (p < .05) in the level of self-efficacy, self-regulation, and friend social support. There were no significant differences in knowledge of physical activity guidelines, beliefs, and family social support. These pilot study results suggested that multiple factors are associated with physical activity engagement in African-American women.

Low self-efficacy is a barrier to effective nurse prescribing. Therefore, nurses’ self-efficacy should be assessed using validated tools. We aimed to develop and psychometrically test the Nurse Prescribing Self-Efficacy Scale (NP-SES). We conducted an observational cross-sectional study with 290 nurses between January and June 2019. We studied the NP-SES’ reliability (i.e., internal consistency and temporal stability), validity (i.e., content, criterion, and construct) and legibility. The NP-SES showed good internal consistency (Cronbach’s alpha=0.958) and temporal stability (intraclass correlation coefficient=0.783). The NP-SES also showed good content validity (scale’s content validity index=0.98) and criterion validity (r=0.75; p<0.001). Construct validity analysis revealed the NP-SES’ three-dimensional structure and showed its ability to detect significant differences between nurses with different levels of experience. Our psychometric analysis suggests that the NP-SES is a reliable and valid instrument that could be used to assess nurses’ self-efficacy in nurse prescribing.

In the United States, breastfeeding duration and exclusivity rates are not at ideal levels. The purpose of this systematic review was to examine the effects of education and support interventions during the third trimester, immediate postpartum, and the first six months of life on breastfeeding duration and exclusivity from six weeks to six months. Inclusion criteria were (a) randomized controlled trials or controlled clinical trials, (b) pregnant and/or postpartum women, (c) lactation education and support interventions, (d) measurement of breastfeeding outcomes during the first six months, and (e) published between 2008 and 2020. Twenty articles (21 studies) were reviewed. Fourteen studies employed interventions that resulted in significant differences in breastfeeding outcomes between groups. Common study weaknesses included limited use of a theoretical model, incomplete description of the intervention, and inconsistent outcome definitions and measurements. Based on these results recommendations for future breastfeeding interventions were derived.

This study was to evaluate the effect of pelvic floor muscle training (PFMT) on urinary incontinence (UI) in prenatal and postnatal women. The relevant literatures were searched from Pubmed, Embase, Cochrane Library, and Web of Science until January 20, 2020. Meta-analysis was performed with STATA 15.1 and the Begg’s test was used for the publication bias. Results of the meta-analysis demonstrated that the rate of UI in the intervention group was lower than that in the control group [relative risk (RR): 0.712, 95%confidence intervals (CI): 0.622–0.816, P<0.001); the strength of pelvic floor muscle in the intervention group was higher than that in the control group [weighted mean difference (WMD): 8.448, 95%CI: 2.300–14.595, P=0.007); and the urine leakage measured by the urinal pad in the intervention group was less than that in the control group (WMD: -1.699, 95%CI:-2.428–-0.970, P<0.001). PFMT showed a better effect for UI than the routine nursing.