Health care environments are complex and chaotic, therein challenging patients and professionals to attain satisfaction, well-being, and exceptional outcomes. These chaotic environments increase the stress and burnout of professionals and reduce the likelihood of optimizing success in many dimensions. Coaching is evolving as a professional skill that may influence the optimization of the health care environment. This article reflects on three coaching programs: Gallup Strengths-Based Coaching, Dartmouth Microsystem Coaching, and Health and Wellness Nurse Coaching. Each approach is presented, processes and outcomes are considered, and implications for educators are offered. Continuing education departments may recognize various coaching approaches as opportunities to support staff professionals achieve not only the triple aim, but also the quadruple aim. J Contin Educ Nurs. 2017;48(8):373-378.

Heart disease, including hypertension, is a leading cause of morbidity and mortality among persons experiencing homelessness (PEH). PEH exhibit a greater number of modifiable risk factors for hypertension than the general population and are challenged to reach optimal blood pressure control despite receiving medical treatment. This descriptive qualitative study used data collected from three focus groups to explore the barriers and facilitators of self‐management of hypertension while experiencing homelessness. Participants discussed co‐morbidity, limited food choices, medication issues, stress, and negative health care provider experiences as the biggest barriers toward self‐management of hypertension. To address the barriers described above, participants discussed strategies to manage their medications, healthy eating, exercise, social support, and reducing stress. Strategies for health care practitioners and shelter providers to reduce barriers to self‐management of hypertension among PEH are discussed.

Nurses are poised in community situations to actively effect social changes to improve health outcomes of our nation's most vulnerable people, but nurses must get involved.

Objective: To evaluate the effects of nutrition education, diet coaching, and a protein prescription (PP) on protein intake, and associations with muscle strength and function. Design: Prospective pretest posttest single-arm study. Setting: Urban area, East coast of South Florida. Participants: 20 white, non-Hispanic adults, aged 73.3 + 10.4 years. Intervention: 10-week telephone-based diet coaching, nutrition education and a per-meal PP. Measurements: Protein and energy intakes, weight, grip strength (GS), and 5-chair-rise (5CR), timed up and go (TUG), 3-meter walk (3mW) tests at baseline and 10 weeks. Results: Pre to 10-week post values significantly improved (p<0.05) for protein intake/kg body weight (0.8 + 0.3 to 1.2 + 0.3g), protein intake/meal (17.2 ± 4.8g to 26.4 ± 6.g), protein intake/100 kcal (3.74 + 1.16 to 5.97 + 0.98g), GS (22.4 to 23.4kg), and times for TUG (10 to 8sec), 3mW (4 to 3sec), and 5CR (13 to 11sec). Conclusions: Given the positive findings of this unique pilot investigation, additional studies, which include a larger more diverse group of participants and provide for control group(s), are needed to better investigate the effectiveness of this approach and its effects on muscle strength and function.

Childhood obesity is a multifaceted phenomenon that has risen strikingly over the last 30 years. Some of the contributing factors include more fast food availability, an increase in sedentary lifestyles (including television, video games, and computers), less physical education in school environments, more specific advertising to children by food companies, and fewer safe areas for children to play outside within neighborhoods. Epidemiological studies of the prevalence of childhood obesity have determined that approximately 11% of youth in the U.S. are classified as obese (BMI > 95%) and another 14% have a BMI between the 85 th and 95 th percentiles for age placing them in the obese category. These estimates suggest that almost 25% of the pediatric population is overweight or obese. [1][2][3] As with many chronic illnesses, children living in poverty and ethnic populations seem to be disproportionately affected by childhood obesity, specifically Hispanic and Black children. 2,4 The significance of childhood obesity has both societal and individual effects. Large amounts of personal and national resources are used to address this chronic condition. The Surgeon General's call for action on obesity determined that $117 billion annually could be attributed to heath care cost associated with obesity and obesity related disorders. 5 In addition to economic costs, childhood overweight has an effect on both the child's physical as well as emotional health. Physical conditions related to childhood obesity include cardiovascular disease, type 2 diabetes, and orthopedic problems. [6][7] Psychological and emotional consequences include but are not limited to poor self-esteem, ridicule, and discrimination. 8 Some ethnic groups seem to be affected to a greater extent than other groups by health issues. Haitians and Hispanics are two at risk populations that suffer disproportionate amounts of adverse health outcomes, including obesity. 2,4 Although research statistics specific to the Haitian population and health are sparse, Haitians fall within the broader Black racial/ethnic group and suffer from the same health issues. In light of this, current research has shown that both Black (including Haitian) and Hispanic children have the highest prevalence of childhood overweight compared to all other ethnic groups. 4,9 The increasing prevalence of childhood overweight in these populations suggests each culture may have unique contributing factors to the chronic condition. Therefore, it is necessary to investigate cultural influences contributing to this chronic condition within each culture before effective, culturally appropriate primary care interventions can be developed. As nurse practitioners understand what parents perceive as contributing factors of childhood obesity in each culture, care providers are able to cater interventions, education, and advocacy that are culture specific.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are p...