As the nation’s healthcare system moves through the 21st century, unprecedented changes are occurring on both a local and global stage. Healthcare organizations are faced with creating and implementing leadership strategies to enhance the overall patient experience. When coupled with the need to ensure increased nurse job satisfaction, improved cost-effectiveness and healthy organizational cultures with fiscally sound budgets, improvement work has led efforts to ensure effective leadership techniques are used across an agency. This task may be viewed as commonplace for some organizations, while others may perceive this process as a complete paradigm shift from historical practices related to leadership style, behaviors and performance. A successful transition during this time of unprecedented change may depend on an organization’s ability to accept and implement the tenets of transformational leadership. Empirical research illustrates that transformational leadership empowers staff, increases job satisfaction and facilitates cost-effectiveness while constructing an environment conducive to the development of a supportive organizational culture. In an effort to ascertain the current state of leadership at a southeastern Veterans Affair Medical Center, this research study explored the self-reporting leadership practices of all supervisory staff employed at the facility. As a means of measurement, the Leadership Practices Inventory (LPI) was coupled by demographic questionnaire developed by the researcher. Both measurement tools were used to collect the data.

Incivility is rude or discourteous behavior that demonstrates a lack of respect for others. Some nurses ignore the dictates of professionalism and exhibit a total disregard for colleagues and peers by purposefully targeting each other with uncivil behaviors. Incivility has invaded the nursing educational environment with deleterious results. Uncivil behaviors perpetrated by nursing students against other nursing students cause psychological and physiological distress for victims and witnesses. The purposes of this quantitative descriptive study were to identify the behaviors that constituted lateral student-to-student incivility, determine the frequency of experienced student-to-student incivility, and describe the coping strategies employed by prelicensure registered nursing students experiencing lateral student-to-student incivility. Prelicensure registered nursing students in associate degree, baccalaureate degree, and diploma programs were recruited online using nonprobability convenience sampling through the email member list of a national student nursing organization. Participants completed the Ways of Coping (Revised)* survey and the Incivility in Nursing Education Revised (INE-R) Survey anonymously online via email accounts. The response rate was 38%. Four behaviors are identified as highly uncivil by 83.1% to 86.1% of the 373 participants: (1) making threatening statements about weapons; (2) threats of physical harm against others; (3) property damage; and (4) making discriminating comments directed toward others. The most frequently occurring incivility behavior (n = 202; 54.2%) is the use of media devices for purposes unrelated to the current educational task. Planful problem-solving (PP) is the coping strategy employed by most participants (n = 88, 23.6%). Data was analyzed comparing participants’ nursing program levels, ages, genders, and ethnicities using descriptive statistics and Kruskal-Wallis analyses. There were no statistically significant differences across these variables.

This qualitative narrative descriptive study focused on nine successful Latino nursing school graduates. Five participants were interviewed twice and four participants were interviewed once for a total of fourteen interviews. Participants and their families immigrated from Brazil, Costa Rica, Cuba, and Mexico. Participants attended school in North Carolina, South Carolina, and Tennessee. Interviews revealed themes of Familism, Empowerment, and Perseverance. Familism was an overriding theme throughout each of the interviews. Participants described family as being their greatest support. They discussed sacrifices made by their families which assisted them in being successful. In addition, they also shared their willingness to make personal sacrifices in order to honor their family by being successful. Empowerment was also a theme which surfaced. Participants were empowered to attain their goal of attending college and then succeeding in nursing school. The theme of Empowerment was supported by descriptions of parental sacrifice, parental and family support, and support of faculty. The theme of perseverance was demonstrated through continued goal-attainment. Participants struggled through time-management issues such as balancing family, work, and school commitments. They also worked through the guilt of not providing 100% of their time and attention to any one area of their life, especially family. Perseverance was displayed in multiple ways by participants. One of the most compelling was their need to honor their family. Another area which fueled their perseverance was faith. Lastly, participants stated that their need to be self-sufficient added to their perseverance. Self-efficacy surfaced as an attribute they all attained. Familism, perseverance, and empowerment were themes which were consistent with other studies. However, this study is the first study to address the successfulness of Latino nursing school graduates in the Appalachian area of the United States. This study is also unique in that each of the participants attributed their success to family. In addition, seven of the nine families immigrated to the United States for sole purpose of educating their children. This act of sacrifice by families further strengthened the theme of familism.

Diabetes has reached epidemic levels, to the currently estimated 29 million individuals who are living with diabetes. Those with diabetes must manage their disease through a combination of medication, physical activity recommendations, and nutritional guidelines. The consequences of non-adherence to recommendations include cardiovascular disease, kidney failure, vision loss, or ultimately, death. Despite the risks of non-adherence, individuals often do not adhere to recommended treatment. Researchers have attempted to identify strategies to promote diabetes self-management adherence, thereby decreasing complications related to the disease. Specific Aims: describe the factors that prohibit individuals from adhering from diabetes self-management behaviors as well as the factors that promote self-management adherence, compare adherence rates of individuals participating in an enhanced diabetes education program with the adherence rates of individuals that participated in enhanced diabetes education and also attended group social support sessions, evaluate the adherence to self-management behaviors of individuals participating in a diabetes care coordination program. Results: A review of research articles from 2009 through 2013 identified barriers to diabetes self-management adherence as complexity of self-management, low health literacy, the financial burden of adherence, availability of resources, and lack of knowledge. Factors that promote diabetes self-management adherence include diabetes self-management education, self-efficacy, social support, and goal setting. A retrospective chart review of participants in an employer-sponsored health program was performed to examine the effectiveness of a social support intervention administered through the health program to promote adherence to recommended diabetes treatment. Results of the study revealed that individuals who participated in the social support intervention, in addition to the employer-sponsored health program, demonstrated increased adherence to recommended diabetes treatment from baseline to 12 months, in comparison to those who participated in only the health program (p = .048). Additional chart review compared participants’ self-management behaviors at baseline with their self-management behaviors at 12 months after entry into the program. There was a significant improvement in adherence to self-management behaviors of receiving an influenza vaccination (p = .036), decreased reported use of alcohol (p = .002) and tobacco (p = .043), and fewer reports of skipped meals (p = .009).

This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors’ degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish (n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson’s correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students’ cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.

People living with a mental health issue is elevated both nationally and internationally, and the likelihood of a person interacting with someone who has a mental health issue is high. It is even higher for those who work in the health care profession, so understanding their attitudes on this matter is important. As a review of current literature reveals, there is not only stigma in the health care system, but there is also stigma among health care professionals and students. One of the groups of students that has not been researched to a great extent is nursing students and the degree of stigma they have for caring for those with mental health issues. A cross-sectional survey was conducted to assess the degree of stigma among these individuals. A voluntary online survey was done was administered to undergraduate nursing students at a university in the southeastern part of the United States using the twenty item Opening Minds Scale for Health Care Providers (OMS-HC). The results indicated that mental illness stigma did exist within the student nurse community with no association between gender, classification, and mental health nursing course completion and total score on the OMS-HC scale.

Purpose: The purpose of this Qualitative Descriptive study was to describe the experience of hospitalized adults during the pandemic who did not have COVID-19. Specific Aims: The specific aims of the study were to: Describe the hospital experience, including but not limited to, interactions with hospital staff, visitation, isolation, physical and emotional stressors, and the environment. Identify perceived comfort needs during hospitalization and perceptions of the nurse’s role in providing comforting interventions. Examine the ability to achieve physical, psychospiritual, sociocultural, and environmental comfort during hospitalization despite the required infection control measures. Framework: This study was guided by Kolcaba’s Theory of Comfort (1994). Design: This was a qualitative descriptive study. Semi-structured interviews were conducted. Interview questions focused on the overall hospital experience, the nurse’s role in their experience, comfort needs, and the experience of having comfort needs met during the hospitalization. Results: Twenty participants took part in this study. Conventional content analysis revealed five main themes. The themes are: I don’t expect the hospital to be comfortable, I was always tense, Wanting human connection, Communication is important, and Nurses are busy. Conclusion: The findings identified a need for targeting education, research, and policy development to improve patient comfort (physical, psycho-spiritual, sociocultural, and environmental). This is important as we look toward improving the overall patient experience during hospitalization.

PURPOSE: The purpose of this research was to identify the value of undergraduate nursing student clinical preparation within a dedicated education unit on transition to practice. SPECIFIC AIMS: Describe perceived competence, practice readiness, self-efficacy, job satisfaction, intent-to-stay and orientation length of students who participated in a clinical experience in a dedicated education unit upon graduation, 3- and 6-months employment. Explore new graduate nurses’ perception of the impact of a dedicated education unit clinical experience on transition to practice. Examine relationships between outcome variables. Explore associations between outcome variables and demographic and employment characteristics. FRAMEWORK: This research was guided by Albert Bandura’s Social Learning Theory. DESIGN: This study used a descriptive, longitudinal design with quantitative measures and qualitative interviews. RESULTS: 18 participants provided quantitative data, and five participated in an interview. Competence, practice readiness and job satisfaction were relatively high. Self-efficacy remained essentially unchanged at all three time points. Average orientation length was 13 weeks, with 41.7% reporting their orientation was shorter than planned. At 6-months employment, 91.7% planned to stay in their current position for one year. Competence and Self-efficacy were associated at 3- and 6-months. Prior healthcare work experience was associated with higher competence at 3- and 6-months. Participants valued the experience of working with a preceptor and the supportive learning environment that allowed them to develop technical and professional nursing skills. CONCLUSION: These findings support dedicated education units as having a positive impact on new graduate nurse’s transition to practice.

North Carolina has, in recent decades, experienced significant growth in its Latinx, and more particularly Mexican immigrant population. As a traditionally non-Latinx state, or a state without a long-standing, large Latinx population, many communities and healthcare and service providers within North Carolina still lack knowledge, resources, and skills needed to serve and support Latinx immigrant populations well. Guided by interpretive description, this qualitative study on Mexican immigrant women in Western North Carolina sought to gain knowledge and understanding of what it is like for them to live in a traditionally non-Latinx region and how immigration has affected their well-being. Asking about experiences in the context of immigration as a way of learning about well-being was inspired by scholars who have asserted immigration to be an important determinant of health and well-being and significant life experience. Individual interviews with 12 Mexican immigrant women generated five themes: 1) Difference and Disruption, 2) Losing to Gain, 3) Living with Risks and Limitations, 4) From Lost to Found, and 5) Resilience and Adaptation. Together these themes highlight sacrifices and struggles, strengths and resources, and gains and hope that have affected these women’s well-being and paint an overall picture of resilience and adaptation in spite of losses, difficulties, risks, and limitations incurred by immigrating. These findings argue for use of a strengths-based approach when interacting with Mexican immigrant women to improve healthcare and other services and promote their well-being and integration in their NC communities.

Background: Many health care facilities enforce strict dress code policies prohibiting visible body modifications, including tattoos, piercings, and vibrant hair colors. As popularity of body modifications among young adults surges, facilities may be forced to adapt policies as these workers enter the workforce. While some evidence exists related to patient perceptions of health care workers with body modifications, there is little about how nursing students perceive them. This study aimed to describe undergraduate, pre-licensure nursing students’ perceptions of health care worker appearance on compassion, skill, knowledge, and trustworthiness. Methods: Using cross-sectional design, an on-line Likert-type survey was used to collect data from 137 undergraduate, pre-licensure nursing students in Northeast Tennessee. Participants viewed photos of male and female workers with various body modifications. Data were analyzed using descriptive and inferential statistics. Results: There were statistically significant differences between groups across all four variables. Male and female health care workers without body modifications were rated highest on all four variables. Male and female with tattoos were rated the second highest. Male and female with facial piercings were rated lowest. The female health care worker color, irrespective of body modification type, was rated higher than the male counterpart across all variables. Conclusion: Results suggest that nursing students may perceive health care workers without body modifications to be the most compassionate, skilled, knowledgeable, and trustworthy. Students may perceive tattoos as more acceptable in the workplace than facial piercings or vibrant hair colors. Students may perceive body modifications as more acceptable for females than males.