Jasmine Travers Altizer

Abstract

Objectives: Despite increased risk for chronic disease, there is limited research that has examined disparities in multimorbidity among sexual minority adults and whether these disparities differ by age. Methods: Data were from the 2014–2018 Behavioral Risk Factor Surveillance System. We used sex-stratified multinomial logistic regression to examine differences in multimorbidity between sexual minority and heterosexual cisgender adults and whether hypothesized differences varied across age-groups. Results: The sample included 687,151 adults. Gay, lesbian, and bisexual adults had higher odds of meeting criteria for multimorbidity than same-sex heterosexual adults. These disparities were greater among sexual minority adults under the age of 50 years. Only other non-heterosexual men over the age of 50 years and lesbian women over the age of 80 years were less likely to have multimorbidity than their same-sex heterosexual counterparts. Discussion: Health promotion interventions to reduce adverse health outcomes among sexual minorities across the life span are needed.

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OBJECTIVE: To determine if Black nurses are more likely to report job dissatisfaction and whether factors related to dissatisfaction influence differences in intent to leave. BACKGROUND: Minority nurses report higher job dissatisfaction and intent to leave, yet little is known about factors associated with these differences in community settings. METHOD: Cross-sectional analysis of 11 778 nurses working in community-based settings was conducted. Logistic regression was used to estimate the association among race, job satisfaction, and intent to leave. RESULTS: Black nurses were more likely to report job dissatisfaction and intent to leave. Black nurses' intent to leave decreased in adjusted models that accounted for dissatisfaction with aspects of their jobs including salary, advancement opportunities, autonomy, and tuition benefits. CONCLUSION: Nurse administrators may find opportunities to decrease intent to leave among Black nurses through focused efforts to target areas of dissatisfaction.

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Approximately 25% of US older adults live with a mental health disorder. The mental health needs of this population are chiefly met by primary care providers. Primary care practices may have inadequate strategies to provide satisfactory care to mentally ill older adults. This study used Centers for Medicare and Medicaid Services data to identify factors, including racial/ethnic differences, associated with dissatisfaction with medical care quality among older adults diagnosed with a mental health disorder. Our findings suggest factors that can be addressed to improve satisfaction with medical care quality and potentially promote adherence and follow-up for mentally ill older adults.

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Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.

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BACKGROUND: Persons with Parkinson disease (PD) have complex care needs that may benefit from enhanced nursing care provided in Magnet-designated hospitals. Our primary objective was to determine whether an association exists between hospital Magnet status and patient safety events for PD inpatients in the United States. METHODS: We conducted a retrospective cohort study using the Nationwide Inpatient Sample and Agency for Healthcare Research and Quality databases from 2000 to 2010. Parkinson disease diagnosis and demographic variables were retrieved, along with Magnet designation and other hospital characteristics. Inpatient mortality and preventable adverse events in hospitals with and without Magnet status were then compared using relevant Agency for Healthcare Research and Quality patient safety indicators. RESULTS: Between 2000 and 2010, 493 760 hospitalizations among PD patients were identified. Of those, 40 121 (8.1%) occurred at one of 389 Magnet hospitals. When comparing PD patients in Magnet versus non-Magnet hospitals, demographic characteristics were similar. Multivariate regression models adjusting for patient and hospital characteristics identified a 21% reduction in mortality among PD inpatients in Magnet hospitals (adjusted odds ratio [AOR], 0.79; 95% confidence interval [CI], 0.74-0.85). PD inpatients in Magnet hospitals also had a lower odds of experiencing any patient safety indicator (AOR, 0.74; 95% CI, 0.68-0.79), pressure ulcers (AOR, 0.60; 95% CI, 0.55-0.67), death from a low mortality condition (AOR, 0.74; 95% CI, 0.68-0.79), and a higher odds of postoperative bleeding (AOR, 1.45; 95% CI, 1.04-2.04). CONCLUSIONS: PD patients had a reduced risk of inpatient mortality and several nursing-sensitive patient safety events, highlighting the possible benefits of Magnet status on inpatient safety in PD.

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Diagnosis and hospitalization for COVID-19 are disproportionately higher among black persons. The purpose of this study was to explore the lived experience of being diagnosed with COVID-19 among black patients. Semistructured one-on-one interviews with black patients diagnosed with COVID-19 were conducted. Data were analyzed using conventional content analysis and a directed content approach. Fifteen patients participated and 3 themes were identified: Panic amidst a COVID-19 diagnosis, Feeling the repercussion of the diagnosis, and Personal assessment of risks within one’s individual environment. Fear of dying, inadequate health benefits, financial issues, and worries about spreading the virus to loved ones were acknowledged by the patients as critical areas of concerns. Majority of the patients looked to God as the ultimate way of surviving COVID-19. However, none of the patients reported receiving support for spiritual needs from health care providers. This is the first study to investigate the lived experience of being diagnosed with COVID-19 among black patients. Our results highlight several factors that put this group at increased risk for COVID-19 and where additional strategies are needed to address these inadequacies. Integrating public health interventions to reduce socioeconomic barriers and integrating spirituality into clinical care could improve patient care delivery.

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Background: Little is known about clinical staff's perspectives on preparedness for a pandemic. The purpose of this study was to obtain various clinical staff perspectives about preparedness to meet the demands for care during the early phase of the SARS-CoV-2 (COVID-19) pandemic. Methods: We conducted a qualitative study using semistructured in-person interviews from March 2020 to April 2020 at a large tertiary academic urban hospital center. Interview guides were informed by the Resilience Framework for Public Health Emergency Preparedness and analyzed using a directed content analysis approach. Results: Fifty-five clinical staff participated in the study. Three themes emerged from the data (1) Risk assessment and planning: “The powder keg,” (2) Innovative evolution of roles and responsibilities, and (3) Pandemic response and capacity. In the early phases of the pandemic, participants reported varying levels of risks for dying. However, most participants adapted to practice changes and became innovative in their roles over time. Hierarchies were less relevant during care delivery, whereas team collaboration became crucial in managing workforce capacity. Discussion: As the pandemic progressed, staff preparedness evolved through a trial-and-error approach. Conclusions: The pandemic is evolving as is clinical staff preparedness to meet the demands of a pandemic. In order to get a grasp on the crisis, clinical staff relied on each other and resorted to new workarounds.

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Objective: The purpose of this study was to understand the physical and psychological impact of high stress clinical environments and contributory factors of burnout in multidisciplinary healthcare workforce during the initial outbreak of COVID-19. Method: In-person qualitative interviews informed by an adaptation of Karasek's Job Demand-control model were conducted with a convenience sample of healthcare workforce from March to April 2020. Results: Themes emerging from interviews coalesced around three main areas: fear of uncertainty, physical and psychological manifestations of stress, and resilience building. Shifting information, a lack of PPE, and fear of infecting others prompted worry for those working with Covid-infected patients. Participants reported that stress manifested more psychologically than physically. Individualized stress mitigation efforts, social media and organizational transparency were reported by healthcare workers to be effective against rising stressors. Conclusion: COVID-19 has presented healthcare workforce with unprecedented challenges in their work environment. With attention to understanding stressors and supporting clinicians during healthcare emergencies, more research is necessary in order to effectively promote healthcare workforce well-being.