BACKGROUND:Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PURPOSE:The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing's Health Behavior Expert Panel Tobacco Control subcommittee. METHODS:Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FINDINGS:The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DISCUSSION:Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.

AIM:This study aimed to develop and psychometrically test a competence-based human resource management scale to improve managerial competence of first-line nurse managers in public hospitals.BACKGROUND:To ensure the high competence of the first-line nurse managers, the competence-based human resource management should be evaluated using the best-fit instrument. However, no instrument has been identified in the hospital setting.METHODS:This methodological study consists of three main steps: (1) generating scale items based on literature review and expert interviews, (2) pilot testing of face and content validity and (3) evaluating psychometric properties with 300 first-line nurse managers from 16 public hospitals in Indonesia selected using a multistage sampling. Data were collected from May to December 2017. Principal component analysis and Cronbach's α were used for construct validity and internal consistency reliability.RESULTS:The final scale consists of 30 items in five dimensions, which explained 65.48% of the total variance. The dimensions include 'training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system'. Cronbach's α for the scale was .89, with a range of .85 to .88.CONCLUSION:The competence-based human resource management scale is reliable and valid to use in public hospital settings.

Introduction: Changes in nursing, health care, and education warrant continued pedagogical innovations. Faculty are challenged to develop many innovative strategies in the clinical and simulation laboratory setting. Intentional simulation-based learning experiences are one method to prepare new graduates for nursing practice. Methods: One college integrated intentional simulation-based learning experiences as an improvement strategy in a newly transformed undergraduate nursing curriculum, from mapping through evaluation and revision. Simulation-based learning experiences that were intentionally mapped, organized, and interactive enhanced the teaching and learning needs of students and faculty. Conclusion: The positive outcomes from this curricular transformation serve as a platform for continuous improvement for future approaches to nursing education. This affirmed that the key to transforming a nursing curriculum encompasses intentional mapping, evaluation, and revision.

Objective: First-line nurse managers are more likely to work according to gender beliefs and stereotypes, which may affect their managerial competence. This study is aimed at comparing managerial competence of male and female first-line nurse managers in public hospitals in Indonesia.Methods: This study employed a descriptive comparative approach with a cross-sectional survey with a total of 256 participants selected from 18 public hospitals. To measure managerial competence, the managerial competence scale for Indonesian first-line nurse managers was used. Data were analyzed using descriptive analyses using mean, standard deviation, and Independent t-test.Results: Managerial competence of male and female first-line nurse managers was not significantly different（P = 0.555）. Female nurse managers descriptively reported/received higher ranking in facilitating spiritual nursing care, managing self, staffing and professional development, utilizing informatics, and applying quality care improvement. Male nurse managers repor ted higher in leadership and financial management.Conclusions: Female and male first-line nurse managers should be treated equally for leadership and managerial development.

Knowing the perceptions of first-line nurse managers (FLNMs) regarding their managerial competence is an important step to resolve disparities between their perceived competence and the competencies required for them to effectively function in their roles. Yet, evidence examining managerial competence of FLNMs among public hospitals in Indonesia is sparse. To fill this gap, we conducted a cross-sectional study aimed to identify managerial competence of FLNMs according to hospital type and ownership. This study was conducted from January to May 2018 and included a convenience sample of 233 FLNMs selected from 13 public hospitals. We used the Indonesian-First-Line Nurse Managers Managerial Competence Scale (I-FLNMMCS) to measure managerial competence. Descriptive statistics, Kruskal-Wallis, and Dunn's Pairwise were used for data analysis. Findings showed a significant difference in managerial competence according to the hospital type (p < .05). The FLNMs with a Diploma III, those relatively older, in their position for 7 or more years, and with managerial training in Type A hospitals (larger hospitals) had the highest managerial competence. The FLNMs with a bachelor's degree, those relatively younger, with less training, and those in their position for 3 to 4 years in Type B and C hospitals (smaller hospitals) had less managerial competence. A significant difference was also found in managerial competence according to hospital ownership (p <.05). Public hospitals owned by the Ministry of Health of Indonesia had the highest competence among the others. This study is useful for guiding future policy work for human resource development in public hospitals.

Purpose: Working as a first-line nurse manager requires high managerial competence as an essential component in the delivery of health care. Therefore, factors that influence managerial competence warrant examination. The aim of this study was to identify factors associated with managerial competence of the first-line nurse managers using the best-fit model of human resource management framework. Methods: A cross-sectional study was conducted. A total of 247 first-line nurse managers from 18 public hospitals in Indonesia participated. Data on managerial competence and its related factors were collected via validated questionnaires. Results: The five factors of managerial competence were identified - performance appraisal (beta = 0.476, p < 0.001), career advancement (beta = 0.425, p < 0.001), recruitment and selection (beta = 0.354, p < 0.001), larger hospitals (beta = 0.165, p = 0.001), and management training attendance (beta = 0.109, p = 0.029), which collectively explained 44.9% of the variance in managerial competence. Conclusion: Human resource management factors, hospital types, and training attendance have significant roles to improve managerial competence of the first-line nurse managers. Nurse managers should provide routine performance appraisal, career advancement, and transparent recruitment and selection as well as to improve the attendance of management training and learn from larger hospitals for leadership and development of the first-line nurse managers.

OBJECTIVE The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making. BACKGROUND The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment. METHODS Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked. RESULTS Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention. CONCLUSIONS Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.

This study aimed to develop and psychometrically test the managerial competence scale for first-line nurse managers (FLNMs) in Indonesia. The scale was based on items derived from an integrative review and interviews with experts. A total of 300 FLNMs from 16 public hospitals were randomly selected for this test of psychometric properties. A principal component analysis generated seven dimensions with 43 items as a final scale, with overall Cronbach's α of .95 while the dimensions' Cronbach's α ranged from .71 to .90. The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of managerial competence of FLNMs.

Background: The ecological fallacy is broadly understood, though its complimentary problem, the individualistic or atomistic fallacy, isless often considered. Multilevel models offer the statistical tools needed to avoid both errors by allowing simultaneous considerationof individual, contextual, and policy factors. This study applies such methods to smoking cessation data. Tobacco control is of particularconcern in Ohio where the adult smoking prevalence remains around 22%.Methods: Data from the 1,785 participants in the Technology Enhanced Quitline Study were used to test the theory that contextualfactors impact relapse rates and program effectiveness, employing a mixed-effects model to account for the nested nature of the datawhile testing for the relationship between contextual factors and relapse, controlling for individual characteristics.Results: No contextual factors or policy variables were significant predictors of smoking relapse in the sample, nor were any associated with the success of the intervention.Conclusions: While this work could not identify specific influences of contextual and policy factors on smoking outcomes in our sample, it demonstrates the feasibility of adding such predictors to future clinical trials. This project clearly does not rule out the possibility that contextual and policy factors may influence smoking even after controlling for individual characteristics, but does not provide strong evidence of such a link. It is possible that these negative findings may be due to geocoded mailing addresses being a poor proxy for relevant contextual factors, use of the wrong geographic unit of analysis (modifiable areal unit problem), or a lack of temporal resolution in contextual variables.

Dual users of e-cigarettes and cigarettes may represent a unique and receptive population for evidence-based tobacco dependence treatment. We measured the frequency of quit attempts during the past year, and the use of evidence-based tobacco dependence treatments (i.e., behavioral and/or pharmacological treatments), among adult smokers who are current e-cigarette users (dual users) compared with those who do not use e-cigarettes (exclusive smokers). Data were analyzed from the 2015 National Health Interview Survey. Multivariate-adjusted regression models were used to examine the correlates of tobacco treatment use among adult smokers, comparing current e-cigarette users with those who did not use e-cigarettes, stratifying by age group, and adjusting for sociodemographic characteristics. Analyses were based on 5415 adult current cigarette smokers. Compared to exclusive smokers, dual users were more likely to report a quit attempt in the past year among adults <65 years: 18-24 years (odds ratio [OR] = 2.25), 25-44 years (OR = 1.60), and 45-64 years (OR = 1.96). With the exception of adults ≥65 years, dual users reported low rates of using combination (behavioral and pharmacological) treatments that were not statistically different from exclusive smokers: 18-24 years (0.1% vs. 2.1%, respectively), 25-44 years (4.3% vs. 4.7%), and 45-64 years (3.0% vs. 8.3%). Despite higher likelihood for dual users to make a quit attempt, their use of evidence-based tobacco treatment is low, similar to exclusive smokers. Dual users of cigarettes and e-cigarettes represent a prime target for interventions to expand access and utilization of evidence-based tobacco use treatments.

Objectives: The overall purpose of this study was to evaluate the validity and reliability of the Caring Assessment Tool-Administration survey. Three specific aims were to (1) evaluate construct validity of the Caring Assessment Tool-Administration survey by testing the hypothesized eight-factor structure of staff nurses’ perceptions of nurse manager caring behaviors, (2) estimate the internal consistency, and (3) conduct item reduction analysis. Methods: A 94-item Caring Assessment Tool-Administration designed to assess nurse manager caring behaviors appeared in the literature but lacked robust psychometric testing. Using a foundational theory and a cross-sectional descriptive design, the Caring Assessment Tool-Administration was evaluated for reliability and construct validity. Using convenience sampling, 1143 registered nurses were recruited from acute care hospitals in three states located in the Midwestern, Mid-Atlantic, and Southern Regions of the United States. Results: Psychometric testing of the Caring Assessment Tool-Administration was conducted using confirmatory analysis to determine the dimensionality of the construct, nurse manager caring behavior. The null hypothesis was an eight-factor solution fitting the theoretical model being tested. The null hypothesis was rejected because none of the measures examined for goodness of fit indicated the model fit the data. Confirmatory factor analysis did not support the hypothesized structure; however, exploratory factor analysis supported a one-factor solution that was conceptually labeled caring behaviors . To decrease subject burden, the 94-item survey was reduced to 25 items using item reduction analysis including assessing minimum factor loadings of ≥0.60 and evaluating survey item-total correlation and alpha. The Cronbach’s alpha of the new 25-item survey was 0.98. Conclusion: The new 25-item Caring Assessment Tool-Administration survey provides hospital administrators, nurse managers, and researchers with a sound, less burdensome instrument to collect valuable information about nurse manager caring behaviors.

In order to meet the needs of an increasingly diverse patient population, nursing schools around the United States have been trying to recruit future nurses from a variety of racial/ethnic backgrounds, with limited success. To date, the literature does not describe how to develop culturally appropriate engagement models that can successfully transform minority nursing students into nurse researchers and leaders. Thus, the purpose of this article is to describe a promising research and leadership program for underrepresented undergraduate students entitled, “EMBRACE - Engaging Multiple-communities of BSN students in Research and Academic Curricular Experiences”. More specifically, this article will: 1) describe the steps one College of Nursing has taken toward developing the EMBRACE program; 2) describe the theoretical framework developed for the program; and 3) present the initial challenges and positive outcomes of the program. The theoretical framework of the program is based on principles of excellence for diversity and inclusion as well as student and faculty engagement. The EMBRACE framework includes components of education, faculty contributions, social connections and emotional intelligence. The EMBRACE program consists of group mentoring with peers, one-on-one mentoring with faculty and graduate students, and working on a hands-on project relating to research or leadership.

PURPOSE To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES Healthcare literature. DATA SYNTHESIS AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine - Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.

AbstractBackground and ObjectivesIn October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls. This study aimed to examine whether the CMS no-pay policy influenced four fall prevention practices: bed alarms, sitters, room changes, and physical restraints.Research Design and MethodsUsing electronic medical record data collected from four hospitals between 2005 and 2010, this secondary observational analysis examined the associations between the CMS no-pay policy and nursing interventions and medical orders related to fall prevention. Multivariable generalized linear mixed models with logit link function and accommodation for matching was used to assess the associations between the CMS no-pay policy and nursing interventions and medical orders.ResultsAfter the CMS policy change, nurses were more likely to perform one or more fall-related interventions (adjusted odds ratio (aOR): 1.667; 95% confidence interval (CI): 1.097–2.534). Of the four prevention practices, the use of bed alarms (aOR: 2.343; 95% CI: 1.409–3.897) increased significantly after the CMS policy change.Discussion and ImplicationsThe CMS no-pay policy increased utilization of fall prevention strategies despite little evidence that these measures prevent falls.

Objective We aimed to determine if abnormal laboratory values which may indicate volume depletion are associated with increased odds of experiencing a hospital-acquired fall.Design Matched case-control study.Setting Four hospitals located in the Southeast USA.Participants Data from 699 adult fallers and 1189 matched controls (non-fallers) were collected via chart review from 2005 to 2010. Controls were matched to cases by nursing unit, time of fall and length of stay.Outcome measures The primary exposures included serum sodium, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio and haematocrit. Conditional logistic regression with m:n matching was used to determine adjusted and unadjusted ORs.Results Serum sodium levels were strongly associated with falls. In models controlling for demographic and other fall risk factors, patients with serum sodium levels of 125 mEq/L or less were associated with increased odds of experiencing a fall as compared with those with serum sodium levels of greater than 134 mEq/L (adjusted OR (aOR)=5.08, 95% CI 1.43 to 18.08). Conversely, elevated BUN, creatinine and elevated BUN/creatinine ratios were not associated with increased odds of experiencing a fall (aOR=0.64, 95% CI 0.49 to 0.84; aOR=0.70, 95% CI 0.54 to 0.92 and aOR=0.77, 95% CI 0.58 to 1.04, respectively.)Conclusions Laboratory indices that may indicate volume depletion appear to be unrelated to falls. However, hyponatraemia does appear to be a risk factor for falls, and those with serum sodium levels below 126 mEq/L are at especially high risk. It may be that other deficits associated with hyponatraemia, like altered mental status, are associated with risk of experiencing a hospital-acquired fall. These results indicate that abnormal laboratory values, like low sodium, can be useful for identifying hospitalised patients at risk of falling. Therefore, further investigation into abnormal laboratory values as predictors of hospital-acquired falls is warranted.

Background: Adolescents living with incurable cancer require ongoing support to process grief, emotions, and information as disease progresses including treatment options (phase 1 clinical trials and/or hospice/palliative care). Little is known about how adolescents become ready for such discussions. Objective: The purpose of this study was to explore the process of adolescent readiness for end-of-life preparedness discussions, generating a theoretical understanding for guiding clinical conversations when curative options are limited. Methods: We explored 2 in-depth cases across time using case-study methodology. An à priori conceptual model based on current end-of-life research guided data collection and analysis. Multiple sources including in-depth adolescent interviews generated data collection on model constructs. Analysis followed a logical sequence establishing a chain of evidence linking raw data to study conclusions. Synthesis and data triangulation across cases and time led to theoretical generalizations. Initially, we proposed a linear process of readiness with 3 domains: a cognitive domain (awareness), an emotional domain (acceptance), and a behavioral domain (willingness), which preceded preparedness. Results: Findings led to conceptual model refinement showing readiness is a dynamic internal process that interacts with preparedness. Current awareness context facilitates the type of preparedness discussions (cognitive or emotional). Furthermore, social constraint inhibits discussions. Conclusions: Data support theoretical understanding of the dynamism of readiness. Future research that validates adolescent conceptualization will ensure age-appropriate readiness representation. Implications for Practice: Understanding the dynamic process of readiness for engaging in end-of-life preparedness provides clinician insight for guiding discussions that facilitate shared decision making and promote quality of life for adolescents and their families.