The concept of unintended consequences is widely discussed in the realms of politics or economics, but not as frequently as related to health care. Nursing professionals act with the intent to improve health outcomes for patients; however, with every action, there are risks and consequences that may or may not be anticipated. This article utilizes a modified version of Walker and Avant’s framework for concept analysis (2011) to identify the characteristics, defining attributes, and antecedents of the concept of unintended consequences, present a model case and empirical referents, and provide a practical and theoretical application to nursing. Opportunities for future research related to the concept of unintended consequences include a closer study of nurses’ choices that may affect their well-being or productivity, as well as educational opportunities to better inform nurses of the impact unintended consequences may have on them and the care they provide.

This article explores the applicability of the Doctor of Nursing Practice degree from the Australian nurse practitioner (NP) perspective. NPs have been endorsed to practice in Australia for more than 13 years in many diverse roles requiring education beyond that of the current master’s level. However, there is little formal university training beyond this level. Current regulatory requirements, clinical practice settings, and the small number of NPs practicing do not provide the impetus to expand NP education requirements at this time.

In the worrisome context of increasing rates of intimate partner violence and a number of recent deaths reportedly occurring in domestic situations, the establishment and maintenance of effective intervention strategies is a critical public health concern. The present study aimed to evaluate the functioning of a regional intersectoral rapid intervention collaboration agreement (called A-GIR) initiated to respond preventatively to situations identified as high risk of domestic homicide, in Quebec, Canada. In order to better understand how such a collaboration may be successfully implemented, a qualitative analysis was conducted of the perceived functioning of A-GIR and the factors that favor its success as well as issues that should be addressed in this and other such initiatives to ensure efficient and effective practices that prevent the loss of life. Participants (N = 15) were active A-GIR members, who responded to semi-structured interviews which were thematically analyzed. Results are discussed in relation to established partnership action evaluation criteria. The study highlights the necessary conditions for the success of a collaborative agreement such as A-GIR.

A myriad of factors influence the sub-optimal breastfeeding rates in the U.S. Among these factors is maternal obesity (BMI > 30 kg/m²), which has been found to negatively impact breastfeeding initiation and duration for some women. Obesity increases women’s risk for various complications throughout the perinatal period, which may impact breastfeeding and the long-term health and well-being of women and their children. However, adequate lactation support that upholds a respectful consciousness regarding the potential breastfeeding challenges of women with obesity can assist these women to successfully meet their breastfeeding goals. This review summarizes the literature on the impact of maternal BMI on breastfeeding duration, and maternal and infant risk factors that may complicate lactation for women with obesity. Recommendations for assessing and supporting the needs of mothers with obesity to best achieve their breastfeeding goals are provided.

The purpose of this study was to evaluate the psychometric properties of two scales—one to measure the self-efficacy of parents to discuss sexual health issues with their adolescents and the other to measure parents’ outcome expectancy associated with such discussions. Understanding how parents feel about their confidence in talking with their children about important sexual health issues and the outcomes they expect as a result of such discussions can be useful in guiding both the development and refinement of educational programs to promote parent-child discussions. The responses of 491 mothers who participated in an HIV prevention intervention with their adolescents were used for the present analysis. Mothers ranged in age from 25 to 68 years with a mean of 37.9 years (SD = 6.9). Of mother participants, 33% were married, 96.7% were African American, and 89.2% had completed high school. Their adolescents ranged in age from 11 to 14 years, and 61.5% were male. Assessment of reliability for both scales showed that internal consistency reliability was acceptable for the total scales as well as three of the five subscales. With the exception of one item on the outcome expectancy scale, the inter-item correlations, the mean inter-item correlations, and the item-to-total correlations meet the standard criteria for scale development for both scales. Factor analysis was used to identify the underlying structure of the scales, and hypothesis testing was used to assess construct validity. The results of these analyses provide support for the construct validity of the scales.

Background and Purpose: The ethical challenges of the COVID-19 pandemic have contributed to an increase in moral distress (MD) in nurses—a long-standing, ubiquitous issue in nursing—highlighting its detrimental impact on nurses, patients, and healthcare organizations. MD is the negative outcome of a moral situation or dilemma in which a nurse is prevented from taking action on ethical decisions usually related to organizational constraints. On the opposite end of the spectrum, moral comfort (MC), an emerging concept in nursing, is an individual’s feelings of ease with decisions and actions related to a moral dilemma or the positive outcome of a moral situation or dilemma. However, nursing literature on MC is sparse. While several instruments to measure MD exist, an instrument to measure MC was not found. The MC Questionnaire (MCQ) was theoretically developed. The purpose of this study was to conduct a psychometric evaluation of the new 35-item MCQ. Methods: Psychometric evaluation design was used. Reliability testing consisted of the examination of internal consistency (Cronbach’s alpha values) and stability (test–retest reliability: Spearman’s correlation coefficient, weighted Kappa, and Bland–Altman [B&A] analysis). Validity was examined using content validity (content expert evaluation) and discriminant validity (r < .30). Model fit of a proposed five-factor model was tested using confirmatory factor analysis (CFA). Results: Hospital-based direct-care (HB-DC) RNs (n = 466) participated from February 2019 to September 2019 in this Institutional Review Board–approved study. Participants completed demographic information, the MCQ, and the Moral Distress Scale—Revised (MDSR). The psychometric evaluation included a priori content validation and multiple statistical analyses: Cronbach’s alpha, Spearman’s correlation coefficient, weighted Kappa, B&A, discriminant validity, and CFA. Cronbach’s alpha was .951, suggesting internal consistency. Spearman’s correlation coefficient was 0.605 (p < .001), suggesting a strong correlation between Time 1 and Time 2. Weighted Kappa values for each item (range = .139–.559) suggested slight to moderate agreement between responses over time. The B&A plot suggested agreement of responses over time. Discriminant validity results suggested no correlation between the MCQ and MDSR (r = −.219), which was expected. CFA results suggest a poor model fit of the proposed five-factor model. A post hoc hierarchical cluster analysis showed the presence of two clusters. A subsequent two-factor exploratory factor analysis showed items loading onto one of the two factors (internal and external). Conclusions: MC in nurses is essential to promoting positive outcomes for nurses. An instrument to measure MC in nurses is needed to gain a further understanding of the concept. The MCQ was theoretically developed and psychometrically evaluated. Results suggest the validity and reliability of the MCQ with further testing of a two-factor model. Knowledge acquired from studies using the MCQ could potentially be used to develop strategies to promote MC in nurses, thereby promoting positive outcomes for nurses, patients, and healthcare organizations.

Background and Purpose: Cultural competence is significant in addressing the health needs of vulnerable populations. This study conducted psychometric testing of a cultural competency instrument in the Philippines. Methods: Brislin’s translation and a cross-sectional online design were used. Exploratory factor analysis (EFA) with varimax rotation examined construct validity of the 23-item scale among 157 adult LGBTQ+ residents. The scale revealed overall reliability (α = .85) including two subscales (α = .87, α = .81, and α = .61). The EFA yielded three theoretical factorial solutions. Conclusion: The Filipino version of the instrument demonstrated reliability and validity. Measuring clients’ perceptions of provider and organizational cultural competency can improve the utilization of healthcare in Filipino LGBTQ+ communities. Future research will examine the dimensional structures of the instrument among expanded LGBTQ+ communities.