Patricia Newcomb

Objective: This study investigated links between incivility and intention to leave (ITL) employment among new graduate nurses (NGNs) during residency. Background: As an undesirable characteristic of workplace environments, incivility may predispose inexperienced nurses to leave employment. Methods: Surveys of NGN residents conducted 6 months after hire from 2022 through 2024 were analyzed. Results: Incivility from physicians and unit leaders significantly increased ITL scores but did not predict termination within 2 years. Long-term retention was related to having positive role models and satisfaction with work schedules Conclusions: Fostering supportive leadership and cultivating strong role models could improve retention and reduce early career distress among NGNs.

Objective: The purpose of this study was to measure healthcare worker awareness of climate change and concern about its impact on health. Design: Cross‐sectional population study. Sample: Researchers administered the CHANT Tool to a convenience sample of 691 employees of a large health system in North Texas ranging from 20 to 75 years of age. About 71% were nurses. Measure: The 52‐item CHANT 2024: Climate and Health Tool measured engagement with climate change. Subscales measure familiarity with climate concepts, awareness of extreme weather events in respondents’ region, concern about impact of climate change, conservation behaviors, and optimism regarding climate change. Respondents rated scaled items on a 5‐point Likert‐type scale from 0 (most negative or least) to 4 (most positive or greatest). In this sample subscales had acceptable internal reliability with Cronbach's alphas ranging from 0.69 to 0.96. Results: Respondents (79%) were familiar with the existence of climate change, but not that US Healthcare delivery is responsible for a significant proportion of the greenhouse gas emissions associated with it (36%). Most respondents were not optimistic about preparation for the impacts of climate change or preventing further climate change (56% and 59%, respectively). Degree of concern about the health impacts of climate change was significantly associated with six variables, including race, awareness that warming is associated with human activity, awareness that vulnerable populations are more at risk, personal exposure to extreme heat, observations of heat illness in patients, and observations of mental health in patients related to climate events. Most respondents (>50%) wanted to change practice to prepare for health impacts of climate change. Conclusions: North Texas healthcare workers are familiar with climate change and believe it has potential to harm patients but are generally not optimistic about preparation for its effects or changing its course. However, they wish to change practice to make a positive difference.

OBJECTIVE: The study purpose was to generate theory to explain why some hospital staff chose to stay on the job during a prolonged public health crisis. BACKGROUND: The “great resignation” of 2021 created shortages across the healthcare industry. Why some healthcare staff chose to stay at work when coworkers were leaving in large numbers through retirement, transition to different careers, or perceived suddenly better clinical opportunities was not clear. METHODS: Qualitative Grounded Theory methods guided this research study. Sixteen healthcare workers participated in open-ended interviews that provided data to identify major concepts in an emerging model of commitment during crisis. RESULTS: A “Commit to Stay” model emerged showing 4 major influences including sense of personal agency, supportive organization, social connections at work, and external connections and influence. CONCLUSIONS: The Commit to Stay conceptual model can help guide nurse leaders as they grapple with supporting those who choose to stay at work in healthcare during intense, sustained healthcare crises.

OBJECTIVE: The purpose of this project was to report patient impressions of discharge teaching delivered by nurses among a population of heart failure (HF) inpatients. BACKGROUND: Heart failure readmissions are frequently attributed to the quality of discharge teaching delivered by nurses. METHODS: Thematic analysis, an atheoretical approach to the identification, organization, and analysis of themes in texts, was used to explore the data collected from patient interviews. RESULTS: Sixteen interviews were conducted with patients readmitted for HF on dedicated cardiac units. Six major themes were identified including: 1) recall of instructions; 2) comprehension; 3) teaching media; 4) follow-up; 5) role of caregivers; 6) mismatch between nurse and patient concerns; and 7) readmission stories. CONCLUSION: Discharge teaching could be improved by diminishing the volume of print materials distributed to HF patients, providing simple summaries of the most relevant advice, focusing on patient concerns more than the hospital agenda, and directly including home caregivers in teaching.

Objectives The aims of this study were to evaluate geographic differences in obstructive sleep apnea (OSA) prevalence, to determine if readmissions were more likely among rural patients with OSA than others, and to model predictors, including diagnosed OSA, of 30, 60, and 90-day acute-care readmissions. Design This cohort study employed a secondary analysis of data extracted from the electronic health record shared by all hospitals in a north Texas healthcare system. Sample The sample consisted of records associated with 472,503 adult patients admitted to any of the study system's acute-care facilities from 2016 through 2019. Measurements Measurements consisted of case-level health information, including admissions, demographic variables, payors, diagnoses, screens, and physician orders. Results OSA was significantly related to hospital readmission when considered in isolation but did not significantly predict readmission when modeled with plausible covariates. Screening rates for OSA did not vary by geography. Differences in rural/urban-suburban OSA prevalence were not statistically significant. Conclusions Findings contrast with previous suggestions that OSA plays an independent role in hospital readmissions or that rural resident may be disadvantaged regarding services that support the OSA diagnosis. Prevalence and screening rates were almost identical in urban and rural populations.

This cross-sectional study investigated the influences on feeding decisions made by mothers of infants admitted to neonatal intensive care units. The primary aims were to describe discrete influences on maternal behavior and to test Fishbein and Azjen's Theory of Planned Behavior in the neonatal intensive care unit (NICU) setting. The study included a convenience sample of 445 mothers in North Texas and Wisconsin. An investigator-designed tool was administered to subjects by research team members in the study units. Significant differences between minority and dominant racial groups emerged, which highlight known disparities in perinatal outcomes. Results supported the Theory of Planned Behavior and demonstrated predictors of exclusive breastfeeding at discharge including intention, race/ethnicity, length of stay in the NICU, and beliefs that the following factors influenced feeding decisions: having help with chores or childcare at home, talking with mothers in the NICU, having the NICU nurse help with feeding, and space for breastfeeding in the NICU. Incidental findings included the observation that mothers in the only NICU with private rooms were significantly more likely to report fatigue and to perceive that unit busyness, space, and privacy affected their feeding decisions, although there was no difference in breastfeeding at discharge between this NICU and others.