Flourishing: An Evolutionary Concept Analysis

Flourishing among undergraduate nursing students: Insights from a cross-sectional study in Saudi Arabia

AIM

This study aimed to examine the factors that influence the level of flourishing among nursing students.

DESIGN

Cross-sectional study.

METHODS

A multistage sampling technique was used to recruit 328 undergraduate nursing students from a nursing college. Data were collected from February to June 2023 using the Global Flourishing Study (GFS) questionnaire, which assesses six domains of flourishing and their determinants. To ensure reliability and validity, a pilot study was conducted and a thorough validation process was employed.

RESULTS

The Flourishing Index ranged from 24.0 to 100.0, with an average score of 74.2 (SD = 14.8). Well-being, disposition and behaviour, as well as external factors, correlated strongly positively with the Flourishing Index (r = 0.741, r = 0.565, r = 0.596, all p < 0.001). The Flourishing level was significantly negatively correlated with religion (r = -0.381, p < 0.001). Married participants had a significantly negative association with flourishing (p = 0.009). Disposition and behaviour were significantly and positively associated with flourishing (p = 0.017). The regression model had goodness of fit (R2  = 0.628) and was significant overall (F = 108.703, p = 0.001). The Flourishing model was established based on well-being, external factors, religion, disposition and behaviour, and marital status.

CONCLUSION

Positive correlations between flourishing and well-being, disposition and external factors suggest areas of improvement. Conversely, the negative association with religion emphasizes the necessity of culturally sensitive approaches. Future studies with larger and more diverse samples, as well as additional variables, are crucial to obtain a deeper understanding of the factors that influence flourishing among nursing students in Saudi Arabia.

Association of positive childhood experiences with flourishing among children with ADHD: A population-based study in the United States

BACKGROUND

Child flourishing includes healthy social and emotional development and an open, engaged approach to learning. However, there remains a significant knowledge gap concerning a minority of children with ADHD who may demonstrate flourishing in one or more areas of functioning. This study investigated the association between positive childhood experiences (PCEs) and flourishing among children with ADHD.

METHOD

Data were derived from the 2021 National Survey of Children's Health in the United States. The analysis included a final sample of 3727 children with ADHD. Logistic regression, restricted cubic splines, and random forest were used to examine the associations between seven PCEs and flourishing.

RESULTS

The adjusted odds of flourishing were 72% lower (odds ratio [OR] = 0.28,95% confidence interval [CI] = 0.21, 0.38) among children with PCE scores of 0-2 compared to those with scores of 3-5. In addition, the adjusted odds of flourishing were 2.45 times (95%CI = 2.00, 2.99) greater for children with PCE scores of 6-7 compared to those with scores of 3-5. These associations were consistent regardless of the level of adverse childhood experiences. Having a "connected caregiver" was the PCE most closely related to flourishing (unweighted OR = 3.24, 95%CI = 2.72, 3.89).

CONCLUSIONS

Our findings revealed a positive association between higher levels of PCEs and greater flourishing among children with ADHD, regardless of the level of childhood adversity they experienced. These results highlight the importance of positive experiences in the lives of children with ADHD, with a specific focus on nurturing supportive relationships within families.

Measurement of flourishing: a scoping review

Introduction

Flourishing is an evolving wellbeing construct and outcome of interest across the social and biological sciences. Despite some conceptual advancements, there remains limited consensus on how to measure flourishing, as well as how to distinguish it from closely related wellbeing constructs, such as thriving and life satisfaction. This paper aims to provide an overview and comparison of the diverse scales that have been developed to measure flourishing among adolescent and adult populations to provide recommendations for future studies seeking to use flourishing as an outcome in social and biological research.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a scoping review across PubMed and EMBASE of studies introducing original flourishing scales (defined as a previously unpublished measure of mental health or wellbeing that used "flourishing" in its definition). Studies focusing on adult populations that were published before April 28, 2023 were considered eligible for inclusion.

Results

Out of 781 studies retrieved, we identified seven eligible studies covering seven unique flourishing scales. We find that all seven scales are multidimensional and assess features over monthly or yearly intervals. While most of the scales (six out of seven) include indicators of both hedonic and eudaimonic wellbeing, the operationalization of these dimensions of wellbeing varies considerably between scales. Several of the scales have been translated and validated across multiple geographical contexts, including higher- and lower-income countries.

Discussion

Complementing self-report measures with other social, economic, regional, and biological indicators of flourishing may be useful to provide holistic and widely applicable measures of wellbeing. This review contributes to concept validation efforts that can guide strategies to sustain flourishing societies.

Wellbeing in high-performance swimming: A grounded theory study

The demands of elite sport have the potential to negatively impact on athletes' wellbeing (e.g., Arnold & Fletcher, 2012; Rice et al., 2016). Despite this, not all elite athletes experience detrimental effects, rather some individuals thrive in an elite sports environment. The reasons why some athletes experience positive wellbeing while others struggle remains unclear although, in part, due to methodological limitations of previous research. To overcome these limitations, the purpose of the current study was to examine how change in high-performance swimmers' wellbeing occurs. Grounded theory methodology was used to enable examination of processes of change. Semi-structured interviews with 22 current and five retired swimmers, eight coaches, and seven support staff were used to generate data alongside observations and field notes. The resultant theory illustrated how a dominant performance narrative influenced the development and maintenance of an exclusive swimmer identity that was tied to performance. Specifically, transitions were highlighted as critical points where wellbeing was likely to be affected, due to the increased potential for change and uncertainty to impact on performance and subsequently identity. However, the use of proactive coping strategies, such as anticipating and planning, as well as accessing and utilising appropriate support were shown to help minimise the impact on wellbeing.

Exploring college students' flourishing: The interplay of demographic characteristics, time allocation in daily activities and responsibilities, and sense of belonging

The purpose of this study is to investigate how college students' flourishing relates to their demographic characteristics, students allocating time in daily activities and responsibilities, and sense of belonging to the university. The total sample for this study includes 553 undergraduate students, of which 69% identified as female, 24% as male, 7% as non-binary, 29% as underrepresented minority (URM) students, and 38% as first-generation students. Method. The study utilized the ACHA-NCHA III survey data from a large public 4-year university. The researchers conducted an exploratory factor analysis to identify prominent components, resulting in seven constructed variables to measure students' level of involvement in managing roles related to their academic, extracurricular, and personal life. The researchers then used multiple regression models to examine the relationship between student flourishing outcomes and students' time allocation in fixed roles (as a student, caretaker, and employee) and other activities, and their sense of belonging to the university. The results showed that college students who assume additional roles besides being a student, who spend more time engaging in prosocial activities while balancing socializing, and have a strong sense of belonging, also have a higher level of flourishing. Conversely, media consumption was negatively associated with students' flourishing.

Positive childhood experiences on flourishing mediated by meaning in life in Chinese undergraduate nursing students: A cross-sectional study

AIM

To examine the associations of positive childhood experiences (PCEs) with positive mental well-being (i.e. meaning in life and flourishing) in Chinese undergraduate nursing students. The mediation effect of meaning in life on the association between PCEs and flourishing was investigated.

BACKGROUND

Mental health problems, such as high stress, have been prevalent in nursing students. Less is known about positive well-being that could be independent of mental health problems.

DESIGN

This was a cross-sectional study in Chinese nursing students of age ≥ 18 years enrolled in either three-year associate degree or four-year bachelor's degree program at 25 different universities across mainland China.

METHODS

PCEs were measured using the 10-item Benevolent Childhood Experiences scale on perceived relational and internal safety and security, positive and predictable quality of life, and interpersonal support by age 18. Measures of positive mental well-being included the Secure Flourish Index on flourishing and the Meaning in Life Questionnaire on presence of meaning and searching for meaning. Associations were analyzed using multivariable linear regression adjusting for perceived stress.

RESULTS

Of 2105 participants, 87.7% were female, the mean [SD] age was 19.8 [1.6] years. More PCEs were associated with higher flourishing (adjusted b=6.82, 95% CI 6.23, 7.41, β = 0.44), presence of meaning (adjusted b=0.91, 95% CI 0.75, 1.06, β = 0.24), and searching for meaning (adjusted b=0.67, 95% CI 0.49, 0.84, β = 0.17). Presence of meaning (indirect effect: adjusted b=1.57, 95% CI 1.27, 1.89) and searching for meaning (indirect effect: adjusted b=0.84, 95% CI 0.60, 1.08) partially mediated 23% and 12% of the association between PCEs and flourishing, respectively.

CONCLUSIONS

PCEs showed dose-response associations with meaning in life and flourishing in Chinese undergraduate nursing students, and the associations remained independent of perceived stress. The association between PCEs and flourishing was mediated through meaning in life. Higher meaning of life and flourishing associated with more PCEs highlighted the importance of increasing awareness and early screening of PCEs in nursing schools. The mediation effects of meaning in life warranted targeted interventions for helping students with fewer PCEs to flourish.

Association Between Positive Childhood Experiences and Childhood Flourishing Among US Children

OBJECTIVE

There has been limited research examining the fostering of positive childhood experiences (PCEs) that could promote flourishing among children. The purpose of this study is to examine the relationship between 7 selected PCEs and the outcome of flourishing, among a nationally based population-level survey sample of children aged 6 to 17 years.

METHODS

Data were drawn from the 2018 to 2019 National Survey of Children's Health, with children aged 6 years and older included (n = 40,561). Children were designated as flourishing if they had responses of always or usually to all 3 flourishing items measured by the National Survey of Children's Health, which were (1) showing an interest and curiosity in learning new things, (2) working to finish the task they started, and (3) staying calm and in control when faced with a challenge. To examine the association between PCEs and flourishing, multivariable logistic regression models were used.

RESULTS

Children who experienced each type of PCE had higher odds of flourishing: after-school activities (adjusted odds ratio [aOR], 1.81; 95% confidence interval [CI], 1.58-2.07), community volunteer (aOR, 1.63; 95% CI, 1.47-1.80), guiding mentor (aOR, 1.66; 95% CI, 1.39-2.00), resilient family (aOR, 2.35; 95% CI, 2.08-2.67), safe neighborhood (aOR, 1.43; 95% CI, 1.29-1.60), supportive neighborhood (aOR, 1.57; 95% CI, 1.42-1.74), and connected caregiver (aOR, 3.26; 95% CI, 2.93-3.64).

CONCLUSION

Findings demonstrating a significant association between PCEs and flourishing have implications for population-wide approaches to improving the prevalence of flourishing among children and youth.

Career readiness and well-being: The mediation role of strategies for coping with career indecision

In the uncertain and flexible labour market, some people experience indecision in dealing with career choices, despite having career readiness. The present research explored the relationship between career readiness, strategies for coping with career indecision, and well-being. Participants were 529 people aged between 18 and 60 ( M = 26.57; SD = 6.83). The survey included: Readiness scale of the Career Transition Inventory, Productive scale and Support Seeking scale of Strategies for coping with career indecision, Flourishing Scale and Satisfaction with life scale. Results show that both productive and support-seeking strategies mediate the association between career readiness and flourishing and between career readiness and life satisfaction. As implications for career guidance, in addition to favouring career readiness, counsellors could promote productive strategies for coping with career indecision– and in some cases, support-seeking strategies–, to help people transform the experience of career indecision from insurmountable obstacles into an opportunity to act towards well-being.

A systematic review of adolescent flourishing

Traditionally, the study of well-being has been approached from the hedonic and eudaimonic perspectives. However, the last findings suggest that both aspects are complementary, giving place to an integrated conceptualization of well-being called flourishing. In spite of the constant increase of research around this construct, there is still little information regarding flourishing in adolescents. The objective of this study is to review the available literature on flourishing in adolescence in relation to its tie with other constructs, its study in different contexts and the way it has been operationalized. The selection of the studies was conducted in two phases. First, it was verified that the exclusion and selection criteria were met. Then, an evaluation of the quality of the pre-selected studies was carried out. The data were synthesized through the thematic synthesis method. For the results, 28 empirical studies were selected. Four thematic axes were identified: (a) Flourishing in different contexts, (b) Flourishing in regards to other results and positive psychological characteristics and/or their negative counterpart, (c) Flourishing and psychosocial vulnerability, and (d) indicators for the evaluation of flourishing. Suggestions are provided with the goal of consolidating the science of human flourishing.

Psychometric Properties of PERMA Profiler Scale in Argentinian Adolescents

Aim

To adapt and validate the PERMA Profiler Scale (Butler & Kern, 2016) for Argentinian adolescents.

Method

The items were reviewed by 6 expert judges and 21 adolescents. The sample consisted of 421 adolescents (M = 14.9; SD = 1.75). The content validity and the discrimination capacity of the items were assessed. Afterwards, the structure of the scale was analyzed, as well as the internal consistency and the concurrent validity.

Results

All the items obtained an Aiken's V between .8 and 1 and were discriminatory. The factor analysis confirmed the five-dimension structure (CFI = .94, T LI = .92; RMSEA = .08, SRMR = .04). An Alpha of .92 was obtained for the full scale and satisfactory levels were obtained for the subscales. The correlations for concurrent validity were significant and in line with what was theoretically expected.

Conclusion

This adaptation enables the assessment of flourishing in a practical way.

Higher exposure to childhood adversity associates with lower adult flourishing

Background

Adverse childhood experiences (ACEs) are prevalent and associated with negative health and social outcomes. However, our understanding of how patterns of ACEs exposure relate to positive outcomes in adulthood remains limited. This study aims to identify patterns of ACEs and examine associations with flourishing in a sample of Chinese young adults.

Methods

This cross-sectional study was conducted from August to November 2020. Young adults, ages 18–35, enrolled in undergraduate or graduate programs at universities in Mainland China were recruited through convenience and snowball sampling to participate in a survey. The exposure to ACEs was measured by the twelve-item Chinese version of the ACE-International Questionnaire. Additional measures included six domains of flourishing assessed using the Chinese version of the Flourishing Measure, and demographic covariates (i.e., gender, age, year in university, marital status). Descriptive statistical analysis and latent class analysis (LCA) were performed using SPSS 27 and Mplus 8.5.

Results

Participants included 9468 young adults (mean age = 20.1 years). Majority of participants were female (75.3%), undergraduate students (96.4%), and single (79.8%). Approximately 56% of participants reported at least one ACE; 7.0% reported four or more ACEs. Emotional neglect (33.2%), household violence (20.6%), and parental separation/divorce (13.9%) were the most frequently reported ACEs. LCA identified three ACEs classes: multiple maltreatment and household violence (4.7%), emotional neglect and household violence (16.2%), and low ACEs (79.1%). Individuals in the low ACEs class had the highest level of flourishing whereas individuals in multiple maltreatment and household violence had the lowest level of flourishing in all six domains. There were no significant differences in flourishing between the multiple maltreatment and household violence and the emotional neglect and household violence classes except in the physical and mental health (means = 6.17 vs 6.51, p = 0.02) and the financial and material stability domains (means = 5.25 vs 5.66, p = 0.04).

Conclusions

Patterns of multiple ACEs exposures were associated with lower levels of flourishing. Our findings have implications for efforts to prevent ACEs exposure through monitoring and promoting family well-being and routine screening to identify those with ACEs exposure to prevent negative social and health sequelae.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13063-6.

Health-related behaviors, self-rated health, and predictors of stress and well-being in nursing students

BACKGROUND

Nursing students are at increased risk for the consequences of stress on wellbeing. Little is known about nursing students' health promoting behaviors and how these relate to health, stress, and well-being.

PURPOSE

The purpose was to describe perceived stress and measures of well-being (self-compassion, happiness, and life satisfaction) along with self-reported health promoting behaviors and health status in order to identify factors that could affect stress and well-being in nursing students.

METHODS

A multi-site team employed cross-sectional research methods to explore well-being, stress, and potential physical and emotional health-relevant factors in undergraduate nursing students. Baccalaureate Nursing students from three nursing programs in North Texas participated in a web-based survey. Undergraduate students (n = 417) reported being junior or senior level in a traditional (74.1%) or an alternative nursing training program (on-line, fast-track, or weekend nursing program; 24.9%) in the fall of 2019. Recruitment fliers went to a total of 2264 potential participants via university e-mail. Consenting students completed online surveys collecting demographic and health related factors as well as measures of well-being and stress.

RESULTS

More than half (56.6%) of students reported worsening health since starting nursing school. Exercise and meditation were related to higher measures of well-being and lower stress, but this relationship diminished in the multivariate model when considering individual demographic and health related factors. Our multivariate model suggests that self-rated health status remains a main potential predictor of reduced stress and improved well-being.

CONCLUSIONS

Self-reported health factors are related to wellbeing in nursing students. Targeted interventions to improve well-being among nursing students may be necessary and would fit with national recommendations for nursing education programs. Resiliency skills training with mindfulness practices may help nursing students reduce stress, improve overall well-being, and equip students to avoid burnout and stress-related illness once in the workforce.

Learned Helplessness in Renal Dialysis Patients: Concept Analysis with an Evolutionary Approach

BACKGROUND

Learned helplessness is an early psychological concept, but in the field of nursing, the concept of learned helplessness in renal dialysis patients and its unique challenges are not well understood.

OBJECTIVE

This article provides a conceptual analysis of learned helplessness in renal dialysis patients to increase knowledge of this psychological phenomenon in the setting of renal nursing.

DESIGN

Rodgers' evolutionary concept analysis.

METHODS

The literature published in five databases (PubMed, CINAHL, Embase, PsycINFO, CNKI) was searched using specific terms. In the first stage, search terms and strategies were used to narrow the relevant articles. In the second stage, the data were extracted from the included articles. In the third stage, the data were analyzed using thematic analysis, and the results were presented in the form of attributes, antecedents, consequences, surrogate terms, and related terms. We found additional instruments and interventions and presented a model case to emphasize the practicality of the concept. In the fourth phase, experts contributed to the discussion and interpretation of the findings.

RESULTS

A total of 22 articles were included. Four attributes of learned helplessness in renal dialysis patients were identified: low self-concept, perceived loss, negative cognitive set, and abandonment of action. The antecedents were sociodemographic characteristics, disease and treatment, and psychological factors. Consequences were separated into four themes: psychological problems, physiological problems, quality of life, and health-related behavior. Surrogate terms are hopelessness and powerlessness, and the related term is depression.

CONCLUSION

The process of conceptual analysis in this study provides a means of identifying awareness gaps and practice challenges of learned helplessness in renal dialysis patients and other concepts. The findings can be used to guide the design of tools and interventions to expand the use of learned helplessness theory in nursing.

The Psychological Impact of Coronavirus Pandemic Restrictions in Italy. The Mediating Role of the Fear of COVID-19 in the Relationship between Positive and Negative Affect with Positive and Negative Outcomes

Italy was quickly hit hard by the coronavirus. 'Lockdown' has significantly impacted the psychological health, personal wellbeing and quality of life of the people. The study aims to explore the relationship between positive and negative affect, as well as positive (spiritual well-being and flourishing) and negative outcomes (psychological distress caused by a traumatic life event in terms of perception of PTSD symptoms) on Italian adults during the lockdown period. Data was collected between April and May 2020. The participants were 281 Italian adults aged between 18 and 73 years. The survey was composed of the following measures: Flourishing Scale, Jarel Spiritual Well-Being scale, Positive and Negative Affect Schedule, Impact of Event Scale-Revised, Fear of COVID-19. The mediational analysis shows that fear of COVID-19 fully mediates the relationship between negative affect and spiritual well-being and flourishing; fear of COVID-19 partially mediates the relationship between negative affect and PTSD symptoms; the positive affect shows only direct effects on positive outcomes. Therefore, fear of COVID-19 does not play any mediation role. Implications for psychological interventions and future research will be discussed.

Flourishing: migration and health in social context

Health and the capacity to flourish are deeply intertwined. For members of vulnerable migrant groups, systemic inequalities and structural forms of marginalisation and exclusion create health risks, impede access to needed care and interfere with the ability to achieve one's full potential. Migrants often have limited access to healthcare, and they frequently are portrayed as less deserving than others of the resources needed to lead a healthy and flourishing life. Under these circumstances, clinicians, healthcare institutions and global health organisations have a moral and ethical obligation to consider the role they can-and do-play in either advancing or impeding migrants' health and their capacity to flourish. Drawing on case studies from three world regions, we propose concrete steps clinicians and health institutions can take in order to better serve migrant patients. These include recommendations that can help improve understanding of the complex circumstances of migrants' lives, strengthen collaboration between care providers and non-medical partners and transform the social, economic and structural circumstances that impede flourishing and harm health. Developing new strategies to promote the flourishing of precarious migrants can strengthen our collective ability to re-envision and redesign health systems and structures to value the health, dignity and bodily integrity of all patients-especially the most vulnerable-and to promote flourishing for all.

Right by your side? - the relational scope of health and wellbeing as congruence, complement and coincidence

Purpose: Although the relation between health and well-being is deemed conceptually important, it is diverse and intractable. The aim of this small-scale study is to reveal different possible relations of the concepts of health and well-being, interrelation of these relations and consequences of implied normative expectations in the relations.

Method: Primary data originate from course literature in Swedish health education. Additional data included scientific articles and website content (collected from WHO and via Google) and were analysed with objective hermeneutics.

Results: Congruent, complementary and coincident relations were found. In congruence, health and well-being are synonyms. Complement relations contain: “quality” with well-being as overall aim, “plurality” with health as umbrella term, “well-being as positive health”, “enhancement” with health and well-being potentially boosting each other and “subjectivity/objectivity” with objective health complemented by subjective well-being. In coincidence, health and well-being are counter-intuitively regarded unlinked, which may challenge expectations concerning health promotive activities. Independent and affiliated relations were identified.

Conclusion: In congruence and complement, health and well-being are mostly aligned whereas in coincidence, their quality may be decoupled. In the discursive climate of second modernity, the relation of health and well-being tends to conflict and ambiguous coincidence, demanding ambiguity tolerance as key skill.

Public Engagement and Neurology: An Update

BACKGROUND

Public engagement (PE) is defined as the involvement of "specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters". The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases.

METHOD

This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson's disease, migraine, neurogenetics, and amyotrophic lateral sclerosis.

RESULTS AND CONCLUSIONS

PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.

A Community Partnered Approach for Defining Child and Youth Thriving

OBJECTIVE

To develop a community-informed definition of child and youth thriving and identify community priorities for child/youth thriving.

METHODS

Through concept mapping, a mixed-methods community-based participatory research method, this study examined community and health professionals' conceptualizations of child and youth thriving. We conducted brainstorming, sorting and rating, and interpretation sessions in 3 geographically distinct neighborhoods with concentrated disadvantage; simultaneously, researchers and health professionals participated in online sessions.

RESULTS

Participants included 91 community members, health care and social service professionals, and researchers who identified 104 items related to child and youth thriving and grouped these items into 7 distinct clusters. Two clusters focused on child-level factors (Strong Minds and Bodies; Positive Identity and Self-Worth), 2 focused on place-based factors (Healthy Environments; Vibrant Communities), and 3 focused on relationships and interactions between children and their environments (Caring Families and Relationships; Safety; and Fun and Happiness). The community-informed conceptualization of child thriving builds on previous models, adding dimensions of physical health and safety. Participants ranked having "someone to talk to," being "comfortable in their own skin," having "pride in themselves," and having a "strong sense of self and self-worth" as most important to child and youth thriving.

CONCLUSIONS

By integrating perspectives of community members from diverse neighborhoods with those of researchers and health professionals, this study captures novel domains to inform a conceptual model of thriving that focuses on stakeholder priorities. Findings will guide development, implementation, and evaluation of community-based interventions and their impact on child and adolescent health and thriving.

Ethical Leadership, Flourishing, and Extra-Role Behavior Among Nurses

Introduction

The nursing literature is silent about the relationship between ethical leadership, nurses’ flourishing, and extra-role behavior. This study was carried out to contribute to the relevant field research.

Objective

The aim of the present study was to investigate the relationship between nurses’ perceptions of their nursing managers’ ethical leadership behavior, nurses’ flourishing, and their extra-role behavior.

Methods

This was a cross-sectional study involving 302 nurses from six hospitals in Damietta City, Egypt. Data were collected using the following three self-report scales: Ethical Leadership at Work questionnaire, Flourishing Scale, and extra-role behavior scale. The data were analyzed using descriptive statistical, Pearson correlation, regression analysis and the structure equation model.

Results

There was a significant positive relationship between nursing managers’ ethical leadership, nurses’ flourishing, and extra-role behavior. The regression analysis showed that the ethical leadership of nursing managers and nurses’ flourishing predict extra-role behavior.

Conclusion

Nurses with a high level of flourishing and who work with a manager exhibiting ethical leadership behavior are more likely to activate extra-role behavior. Hence, it is recommended that nursing managers embrace an ethical approach in their leadership practices and promote flourishing among nurses to encourage them to go the extra the mile in their jobs.

"You have to be okay with okay": experiences of flourishing among university students transitioning directly from high school

Mental health is central to overall wellbeing and, for students attending university, mental health is critical for learning and academic success. A wealth of research has focused on young people who experience psychosocial declines during academic and developmental transitions, but little is known about how young people flourish in this transition. The first to explore the experiences of flourishing among first-year Canadian university students making the transition directly from high school, this study sought to develop an understanding of: 1) the factors that promote flourishing amidst this academic and developmental transition, and 2) how first-year students define and experience flourishing. An interpretive phenomenological approach underpinned by Gadamerian hermeneutic philosophy was used to explore experiences of flourishing, using semi-structured interviews, in a sample of nine full-time, first-year university students, ages 18-20 years. What it meant to flourish amidst this developmental and academic transition and how participants defined flourishing offer new understandings of the concept associated with: 1) personal/individual aspects of flourishing, 2) contextual nature of flourishing, 3) temporality of flourishing, 4) dialectic aspects of flourishing. Implications for practice, policy, and research in light of these new understandings are discussed.

The Interaction of Adverse Childhood Experiences and Resiliency on the Outcome of Depression Among Children and Youth, 8-17 year olds

BACKGROUND

Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression.

OBJECTIVE

Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression.

PARTICIPANTS AND SETTING

Data were drawn from the nationally representative 2016-2017 National Survey of Children's Health (NSCH) and included a total sample of 40,302 children and adolescents.

METHODS

Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used.

RESULTS

Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience.

CONCLUSIONS

These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.

Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels

IMPORTANCE

Associations between adverse childhood experiences (ACEs) and risks for adult depression, poor mental health, and insufficient social and emotional support have been documented. Less is known about how positive childhood experiences (PCEs) co-occur with and may modulate the effect of ACEs on adult mental and relational health.

OBJECTIVE

To evaluate associations between adult-reported PCEs and (1) adult depression and/or poor mental health (D/PMH) and (2) adult-reported social and emotional support (ARSES) across ACEs exposure levels.

DESIGN, SETTING, AND PARTICIPANTS

Data were from the cross-sectional 2015 Wisconsin Behavioral Risk Factor Survey, a random digit-dial telephone survey of noninstitutionalized Wisconsin adults 18 years and older (n = 6188). Data were weighted to be representative of the entire population of Wisconsin adults in 2015. Data were analyzed between September 2016 and January 2019.

MAIN OUTCOMES AND MEASURES

The definition of D/PMH includes adults with a depression diagnosis (ever) and/or 14 or more poor mental health days in the past month. The definition of PCEs includes 7 positive interpersonal experiences with family, friends, and in school/the community. Standard Behavioral Risk Factor Survey ACEs and ARSES variables were used.

RESULTS

In the 2015 Wisconsin Behavioral Risk Factor Survey sample of adults (50.7% women; 84.9% white), the adjusted odds of D/PMH were 72% lower (OR, 0.28; 95% CI, 0.21-0.39) for adults reporting 6 to 7 vs 0 to 2 PCEs (12.6% vs 48.2%). Odds were 50% lower (OR, 0.50; 95% CI, 0.36-0.69) for those reporting 3 to 5 vs 0 to 2 PCEs (25.1% vs 48.2%). Associations were similar in magnitude for adults reporting 1, 2 to 3, or 4 to 8 ACEs. The adjusted odds that adults reported "always" on the ARSES variable were 3.53 times (95% CI, 2.60-4.80) greater for adults with 6 to 7 vs 0 to 2 PCEs. Associations for 3 to 5 PCEs were not significant. The PCE associations with D/PMH remained stable across each ACEs exposure level when controlling for ARSES.

CONCLUSIONS AND RELEVANCE

Positive childhood experiences show dose-response associations with D/PMH and ARSES after accounting for exposure to ACEs. The proactive promotion of PCEs for children may reduce risk for adult D/PMH and promote adult relational health. Joint assessment of PCEs and ACEs may better target needs and interventions and enable a focus on building strengths to promote well-being. Findings support prioritizing possibilities to foster safe, stable nurturing relationships for children that consider the health outcomes of positive experiences.