Background: Engaging with nature can profoundly impact psychological and physiological health of persons across the lifespan. Greenspace interventions (GSI) encompass a broad range of strategic, nature-based activities for overall health and wellbeing. Within the past 20 years there has been a growing interest in the access to and management of greenspace to mediate the deleterious impact of acute and chronic stress, particularly, physiologic biomarkers of stress such as cortisol. Objective: This review aims to describe the impact of greenspace interventions on cortisol, to present the current state of the science on GSIs as they impact cortisol, and to uncover any limitations of current research strategies to best inform future research. Methods: A scoping methodology was conducted to systematically study this emerging field and inform future research by mapping the literature based on the GSI category, interventional design, cortisol metrics, and subsequent analysis of cortisol. Conclusion: Considerable heterogeneity in research design, aim(s), interventional strategy, and cortisol metrics were identified from a total of 18 studies on GSIs and cortisol outcomes. While studies demonstrated a potential for the positive association between GSIs and stress relief, more rigorous research is needed to represent GSIs as an intervention to mitigate risks of stress.

The aims of this study were to determine if the infection rate differs between the first and recurrent ischemic stroke/transient ischemic attack (TIA), if the pattern of the peripheral immune response (PIR) differs between the first and recurrent ischemic stroke/TIA and if infection further influenced the pattern of the PIR. Retrospective review of 500 stroke cases with strict exclusion criteria (e.g., hemorrhagic stroke, subarachnoid hemorrhage, or spontaneous intracerebral hemorrhage; history of cancer; on steroids or immune suppressive drugs; recent invasive procedure) resulted in inclusion of 198 cases. Independent variables were first stroke or recurrent stroke and not infected or infected cases. Main-effect dependent variables were the white blood cell (WBC) and differential leukocyte counts (percentages of 100 cell counts for neutrophils, lymphocytes, and monocytes and absolute counts of neutrophils, lymphocytes, and monocytes). Infection rate was not different between the first versus recurrent stroke (p = .279). The pattern of WBC and differential counts were not different between groups, but addition of the covariate of infection showed group differences (p = .05). A four-group comparison of the dependent variables with the laboratory normal ranges showed lymphocyte percentages below the lower range limit in all four groups. Generalized linear modeling showed a modest rise (15%) in WBC counts in both groups with concomitant infection, a modestly low (-18%) lymphocyte percentage in recurrent stroke with infection, and a more substantial rise (22%-26%) in absolute neutrophil count in both groups with concomitant infection. Infection influences the pattern of the PIR in the first and recurrent stroke/TIA, and this difference can be quantified.

Preparing undergraduate nursing students to practice nursing in the 21st century requires a focus on the development of evidence-based practice and outcomes management knowledge and skills throughout the nursing curriculum. To this end, seven learning activities were created that spiral and increase in complexity while building on previously acquired skills. Working in teams and practicing team-building techniques, students learned how to develop a clinical question, search the literature, synthesize the current knowledge, identify the significance of the issue in an ecological model, decipher existing quality data and compare that data to national benchmarks, investigate a health care quality issue using quality improvement methods, and draft a proposal for implementation of a continuous quality improvement initiative. Work was presented in both written and oral presentation formats, with emphasis on engaging various audiences in a compelling health care issue.

Shinrin-yoku, forest bathing, may provide relief from chronic and breakthrough pain in patients with axial spondyloarthritis and improve immune function through increasing NK cell numbers and activity and their downstream effectors, perforin and granulysin, after chemo- or radiation therapy in breast and prostate cancer patients. The aim of this paper is to describe the study protocol for a simulated forest immersion therapy using virtual reality and atomized phytoncides, volatile organic compounds found in forested areas designed to effect positive change for these two patient populations. The setting, including the room set up and samples with inclusion/exclusion specific to this type of intervention, is outlined. Measures and calibration procedures pertinent to determining the feasibility of simulated forest immersion therapy are presented and include: ambient and surface room temperatures and relative humidity in real time, ambient ultrafine particulate matter, ambient droplet measurement that coincides with volatile organic compounds, specific phytoncides, and virtual reality and atomization of phytoncide set up. Particular lessons learned while training and setting up the equipment are presented. Simulated forest immersion therapy is possible with attention to detail during this early phase when development of methods, equipment testing, and feasibility in deploying the intervention become operational. The expected outcome of the development of the methods for this study is the creation of a standardized approach to simulating forest therapy in a controlled laboratory space.

Background. With projected nursing shortages, an aging workforce, and the imminent retirement of nurse leaders, nursing leadership shortages are a concern. While several studies have indicated the interest of nurses in pursuing leadership positions, limited research has focused on examining the influence of the leadership practice environment on nurses’ motivation to lead. Aim. The aims of the study were to (1) assess the relationship between the leadership environment and the motivation of nurses to lead and (2) determine whether there are particular aspects of the leadership environment that influence motivation to lead. Methods. A cross‐sectional research design was used to collect data from 435 nurses working in 16 public and private hospitals in Oman. Leadership Environment Scale and Motivation to Lead Scale were used to assess participants’ perceived leadership environment and their motivation to engage in formal leadership roles, respectively. Multivariate linear regression was used to assess the relationship between the perceived leadership environment and the motivation of nurses to undertake leadership roles. Findings. Nurses reported a mean scale value of 3.208 out of 5 (SD = 0.467) for their motivation to lead, which exceeds the midpoint, indicating a strong motivation to engage in formal leadership roles. Nurses reported a mean score of 3.194 out of 4 (SD = 0.661), which exceeds the midpoint, suggesting a favorable perception of leadership environment. The findings showed a significant relationship between the leadership environment and nurses’ motivation to lead. Specifically, self‐organization (β = 0.185, p = 0.001, CI = 0.086–0.378), agents (β = 0.221, p = 0.002, CI = 0.124–0.474), and transformative exchange (β = 0.100, p = 0.037, CI = 0.101–0.142) were characteristics of the leadership environment that were associated with greater motivation to engage in leadership. Conclusion. This study emphasizes the importance of cultivating a supportive leadership environment as a potential strategy to attract nurses to assume formal nursing leadership roles. Implications for Nursing Management. Strategies to improve nurses’ motivation to lead in a complex healthcare environment include improving nurses’ active involvement in their organization, creating a collegial supportive and mentoring leadership culture, and improving transformative exchange by supporting career and educational advancement.