Extensive literature suggests that adverse experiences in early childhood may deleteriously impact later health. These effects are thought to be related to the impact of persistent or chronic stress on various biological processes, mediated by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and ultimately irregularities in cortisol levels. Ameliorating persistent stress in young children requires accurately measuring the chronicity of physiologic stress, which is difficult in young children because of unreliable self-report and the burden and inaccuracy associated with using invasive acute-stress biomeasures. A better way to approximate persistent stress in young children is measuring hair cortisol concentration (HCC), as it only requires one noninvasive collection to measure months of HPA-axis activity or experienced stress. However, few studies measure HCC in young children despite wide use in adult stress research. This article reviews and synthesizes research that uses HCC to approximate persistent stress in healthy children, 12-60 months of age. Reviewed studies indicate that HCC is elevated in young children who are experiencing forms of persistent stress such as low socioeconomic status and maternal distress. Hair cortisol is thus a promising measure of early childhood persistent stress, but due to the limited use of HCC in this population, much research is still needed. Specifically, nurse researchers may need to measure several factors associated with early childhood persistent stress and HCC to identify which children are at risk for stress-related disease.

OBJECTIVE This study examined the relationships among nurse fatigue, individual nurse factors, and the practice environment in the inpatient setting. BACKGROUND Nurse fatigue affects the quality of care provision on inpatient units. Scant literature exists regarding how aspects of the practice environment relate to nurse fatigue. METHODS A cross-sectional, correlational design was used in this survey study of 175 neonatal intensive care unit nurses from multiple hospitals. Data were collected using the Checklist Individual Strength questionnaire and the Practice Environment Scale of the Nursing Work Index. Hierarchical regression analysis was performed to examine the relationships. RESULTS Higher fatigue was significantly associated with more hours worked, fewer hours of sleep, a physical or mental contributor to fatigue, and a recent distressing patient event. Lower fatigue was significantly associated with better nurse manager ability, leadership, and support. CONCLUSIONS Nurse fatigue may be diminished with organizational and individual strategies. Developing tactics for nurse managers to better support staff members after a recent distressing patient event is indicated.