Publications

Abstract

The American Association of Colleges of Nursing identifies palliative and hospice care as one of 4 core spheres of nursing in its new Essentials outcomes. However, research shows inpatient medical-surgical nurses are not adequately trained to deliver end-of-life (EOL) care. This lack of foundational learning leads to gaps when communicating with patients and families and negatively impacts quality of care. When a large urban hospital opened a specialty unit for comfort-focused EOL care, nurses felt unprepared to communicate effectively with patients and families. A literature review and staff interviews identified barriers to communication, such as lack of formal education and experience; personal, cultural, and emotional challenges; and high workload. A multimodal intervention focusing on improving staff nurse communication skills was designed. It included environmental cues, engaging pocket cards, and an education module on communication techniques. Data were collected on nurses' confidence and competence in EOL communication, and qualitative feedback on the usefulness of the interventions was obtained. Nurses demonstrated increased confidence and competence immediately following the education session, enduring at 4 weeks. Nurses reported pocket cards and posters were helpful clinical reminders. Innovative, clinically relevant interventions can positively impact communication skills without requiring increased time commitments or high cost.

Abstract

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals’ perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

Abstract

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other’s persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Abstract

Background: Chronic kidney disease (CKD) impacts more than 800 million people. It causes significant suffering and disproportionately impacts marginalized populations in the United States. Kidney palliative care has the potential to alleviate this distress, but has not been tested. This pilot study evaluates the feasibility of a randomized clinical trial (RCT) testing the efficacy of integrated kidney palliative and CKD care in an urban safety-net hospital. Methods: This is a single-site pilot RCT designed to enroll 85 participants, with a goal of at least 60 completing the study. The inclusion criteria are adults 18 or older, who are either Spanish or English speakers, have an estimated Glomerular Filtration Rate (eGFR) of ≤30 mL/min/1.73 m2, and are receiving care at our safety net hospital. Participants will be randomized in permuted blocks of two or four to either the intervention group, who will receive monthly ambulatory care visits for six months with a palliative care provider trained in kidney palliative care, or to usual nephrology care. Primary outcomes are feasibility of recruitment, retention, fidelity to the study visit protocol, and the ability to collect outcome data. These outcomes include symptom burden, quality of life, and engagement in advance care planning. Discussion: This pilot RCT will provide essential data on the feasibility of testing integrated palliative care in CKD care in an underserved setting. These outcomes will inform a larger, fully powered trial that tests the efficacy of our kidney palliative care approach. Clinical trial registration: NCT04998110.

Abstract

Hypermutated proviruses, which arise in a single Human Immunodeficiency Virus (HIV) replication cycle when host antiviral APOBEC3 proteins introduce extensive guanine to adenine mutations throughout the viral genome, persist in all people living with HIV receiving antiretroviral therapy (ART). However, hypermutated sequences are routinely excluded from phylogenetic trees because their extensive mutations complicate phylogenetic inference, and as a result, we know relatively little about their within-host evolutionary origins and dynamics. Using >1400 longitudinal single-genome-amplified HIV env-gp120 sequences isolated from six women over a median of 18 years of follow-up—including plasma HIV RNA sequences collected over a median of 9 years between seroconversion and ART initiation, and >500 proviruses isolated over a median of 9 years on ART—we evaluated three approaches for masking hypermutation in nucleotide alignments. Our goals were to (i) reconstruct phylogenies that can be used for molecular dating and (ii) phylogenetically infer the integration dates of hypermutated proviruses persisting during ART. Two of the approaches (stripping all positions containing putative APOBEC3 mutations from the alignment or replacing individual putative APOBEC3 mutations in hypermutated sequences with the ambiguous base R) consistently normalized tree topologies, eliminated erroneous clustering of hypermutated proviruses, and brought env-intact and hypermutated proviruses into comparable ranges with respect to multiple tree-based metrics. Importantly, these corrected trees produced integration date estimates for env-intact proviruses that were highly concordant with those from benchmark trees that excluded hypermutated sequences, supporting the use of these corrected trees for molecular dating. Subsequent molecular dating of hypermutated proviruses revealed that these sequences spanned a wide within-host age range, with the oldest ones dating to shortly after infection. This indicates that hypermutated proviruses, like other provirus types, begin to be seeded into the proviral pool immediately following infection and can persist for decades. In two of the six participants, hypermutated proviruses differed from env-intact ones in terms of their age distributions, suggesting that different provirus types decay at heterogeneous rates in some hosts. These simple approaches to reconstruct hypermutated provirus’ evolutionary histories reveal insights into their in vivo origins and longevity toward a more comprehensive understanding of HIV persistence during ART.

Abstract

Background: Adverse events in nursing homes, which are unintended incidents causing unnecessary harm to older residents. Previous studies in Chinese populations often focused on adverse events in hospitals, rather than residents in nursing homes. Additionally, they tended to focus on single incident rather than multiple types of adverse events. This study aims to assess the occurrence and contributing factors of multiple adverse events perceived by staff in Chinese nursing homes. Methods: A cross-sectional survey was conducted among 691 frontline staff from 11 nursing homes in Southern China (August 2021–January 2022). Data were collected using a General Information Questionnaire, the Adverse Event Reporting Awareness Scale, and the Adverse Event Reporting Habit Scale. Logistic regression models were employed to analyze the contributing factors of adverse events. Results: A total of 13 types of adverse events were screened out in nursing homes, and 477 (69.0%) participants reported that the adverse events “had happened” in the past year. The most common events were falls, unplanned extubation, and pressure sores. Clinical staff were 2.06 times more likely than frontline workers to report adverse events (95% CI = 1.13–3.76). Increased awareness (OR = 1.24, 95% CI = 1.15–1.34) and habitual reporting of adverse events (OR = 1.04, 95% CI = 1.01–1.08) were positively associated with higher reporting rates. Conclusion: A significant proportion of staff reported adverse events, with clinical staff and those with better reporting habits noting higher occurrences. To enhance resident safety, nursing homes must prioritize preventing high-risk adverse events. Targeting frontline workers with lower reporting awareness and habits is crucial for effective interventions.

Abstract

Background: Oral hygiene care is instrumental to maintaining optimal oral health. As dementia progresses, individuals face challenges performing adequate oral hygiene care and become dependent on their caregivers. The role of family caregivers in assisting with oral hygiene care becomes increasingly critical. This study explored the association between caregiving circumstances, care recipient characteristics, and assistance in oral hygiene care among dementia caregivers in Chinese American communities. Methods: Data came from a pilot study on Chinese dementia caregivers in New York City collected between November 2021 and June 2022. Purposive sampling was used to recruit family caregivers to participate in a survey (online or via telephone). Current caregivers (n = 76) were included. Caregiver assistance with oral hygiene care was measured by assistance with toothbrushing (yes or no) and assistance with flossing (yes or no). Descriptive analyses, group comparisons, and logistic regressions were conducted. Results: Female caregivers tended to assist with toothbrushing. Caregivers with an average of 2.4 years in providing care tended to assist with flossing. Care recipients with tooth pain were 5.12 times more likely to receive assistance with toothbrushing. Care recipients with more natural teeth were 1.07 times more likely to receive assistance with toothbrushing. Care recipients with severe dementia were 94 % less likely to receive assistance with flossing. Conclusions: The findings underscore the importance of understanding the factors that influence caregivers’ assistance with oral hygiene care. This study is a crucial first step toward developing effective, caregiver-led interventions to improve the oral hygiene of individuals with dementia.

Abstract

South Asians are among the fastest-growing immigrant population group in the United States (U.S.) with a unique disease risk profile. Due in part to immigration and acculturation factors, South Asians engage differently with behavioural risk factors (e.g. smoking, alcohol intake, physical activity, sedentary behaviour, and diet) for hypertension, which may be modified for the primary prevention of cardiovascular disease. Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, we conducted a cross-sectional analysis to evaluate the association between behavioural risk factors for cardiovascular disease and diet. We created a behavioural risk factor score based on smoking status, alcohol consumption, physical activity, and TV watching. We also calculated a Dietary Approaches to Stop Hypertension (DASH) dietary score based on inclusion of relevant dietary components. We used both scores to examine the association between engaging with risk factors for hypertension and the DASH diet among a cohort of South Asian adults. We found that participants with 3–4 behavioural risk factors had a DASH diet score that was 3 units lower than those with no behavioural risk factors (aβ: –3.25; 95% CI: –4.28, –2.21) and were 86% less likely to have a DASH diet score in the highest category compared to the lowest DASH diet score category (aOR: 0.14; 95% CI: 0.05, 0.37) in the fully adjusted models. These findings highlight the relationship between behavioural risk factors for hypertension among South Asians in the U.S.

Abstract

Background: Experiential learning activities on care for people with disabilities (PWD) would help nursing students develop the knowledge, skills, and attitudes (KSAs) needed to provide quality care for PWD. Purpose: The purpose of this study was to evaluate the perceived changes in nursing students' KSAs related to the care for PWD following participation in health assessment and prevention (HAP) experiential learning activities. Methods: This was a quasi-experimental, pre- and posttest educational intervention study. Nursing students (n = 160) attended multiple experiential learning activities as a required part of their HAP coursework and completed a pre and posttest survey to assess changes in their KSAs. Results: Participation in experiential learning activities on care for PWD was associated with significant increases in perceived knowledge, skills and positive attitudes toward PWD. Conclusions: Experiential learning activities aligned with core competencies for health care providers caring for PWDs have the potential to change nursing care and address health inequities for this population.

Abstract

Introduction: Timely diagnosis is critical for persons with Alzheimer’s disease and related dementias (ADRD) to ensure they receive adequate services; however, timely diagnosis may be prevented by a person’s English language skills. The purpose of this integrative review was to understand how limited English proficiency (LEP) impacts older Latino’s ability to access a timely ADRD diagnosis. Methods: Whittemore and Knafl’s methodological approach guided the review. Searches in five databases yielded 12 articles for inclusion. Results: Lack of culturally congruent health care systems, health care providers, and knowledge of ADRD resulted in delays in obtaining a timely ADRD diagnosis among older Latinos with LEP. Discussion: Latinos with LEP and risk for ADRD benefit from language assistance and support in navigating the health care system. Nurses must be advocates, even when a language barrier is present, and recognize that interpreters are not a single source solution.

Abstract

Background: Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men. Objectives: This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI. Methods: Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups. Results: The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (−0.52 [95% CI: −0.77 to −0.28]) but not the heart disease education arm (−0.19 [95% CI: −0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036). Conclusions: MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.

Abstract

The rising prevalence of Alzheimer's disease and Alzheimer's disease-related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare & Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [Research in Gerontological Nursing, 18(1), 7-16.].

Abstract

Introduction: South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease. Methods: Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up. Results: The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score >100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score >100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models. Conclusions: The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men.

Abstract

Background The recent wave of clinical trials of psychedelic substances among patients with life-limiting illness has largely focused on individual healing. This most often translates to a single patient receiving an intervention with researchers guiding them. As social isolation and lack of connection are major drivers of current mental health crises and group work is expected to be an important aspect of psychedelic assisted psychotherapy, it is essential that we understand the role of community in psychedelic healing. Objectives To explore how psychedelic guides in the United States discuss the role of community in naturalistic psychedelic groups. Methods This is a secondary qualitative data study of data from a larger modified ethnographic study of psychedelic plant medicine use in the US. Fifteen facilitators of naturalistic psychedelic groups were recruited via snowball sampling. Content analysis was used to identify themes. Results Participants viewed the concept of community as essential to every aspect of psychedelic work, from the motivation to use psychedelics, to the psychedelic dosing experience and the integration of lessons learned during psychedelic experiences into everyday life. Themes and subthemes were identified. Theme 1: The arc of healing through community (Subthemes: Community as intention, the group psychedelic journey experience, community and integration); Theme 2: Naturally occurring psychedelic communities as group therapy (Subthemes [as described in Table 2]: Belonging, authenticity, corrective experience, trust, touch). Significance Results suggest that existing knowledge about therapeutic group processes may be helpful in structuring and optimizing group psychedelic work. More research is needed on how to leverage the benefit of community connection in the therapeutic psychedelic context, including size and composition of groups, selection and dosing of psychedelic substances in group settings, facilitator training, and role of community integration. Psychedelic groups may provide benefits that individual work does not support.

Abstract

Background: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Objectives: Develop and validate criteria that identify appropriate HBPC target populations. Research Design: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. Subjects: Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age above 70) enrolled in NHATS. Measures: Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. Results: Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. Conclusions: We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.

Abstract

Palliative care improves the quality of life for seriously ill patients, but misconceptions and knowledge gaps hinder its implementation in home healthcare (HHC). This study developed and pilot-tested HHC-specific questionnaires to measure palliative care knowledge, attitudes, and confidence (PC-KAC) among clinicians, patients, and caregivers. Using literature reviews, expert input, and cognitive interviews, the questionnaires were refined to ensure clarity, practical relevance, and content validity. Pilot testing revealed widespread confusion about palliative care, with patients and caregivers often conflating it with hospice care and holding misconceptions about opioid use for pain and symptom management. While clinicians demonstrated adequate knowledge, gaps in pain management and confidence in handling emergencies were evident. These findings highlight the need for targeted education and training to integrate palliative care effectively into HHC, improving patient outcomes and supporting interdisciplinary collaboration.</jats:p>

Abstract

Loneliness is a global health concern that negatively impacts physical/mental health. Social capital, encompassing resources from social networks, may protect against loneliness. We investigated the association between different sources of social capital and feelings of loneliness and examined whether these associations differ by sex. An online survey of 3220 Shanghai residents (mean age 34.5 years, 48.5% females) was conducted in 2022, Shanghai, China. We assessed bonding and bridging social capital using the revised 8-item Personal Social Capital Scale (PSCS) and used the revised three-item UCLA Loneliness Scale to measure loneliness. Multivariable linear regression analysis results suggest that both bonding (β coefficient: −0.152; SE: 0.035) and bridging social capital (β coefficient: −0.131; SE: 0.036) were significantly associated with lower loneliness, adjusting for sociodemographic characteristics, health conditions, and COVID-19-related factors. Notably, the mitigating effect of bonding social capital on loneliness was more pronounced in females, as indicated by significant interactions between sex and bonding social capital. Our study findings indicated that social capital serves as a protective factor against loneliness for Chinese adults, with bonding social capital having a stronger effect among females. Policies and interventions strengthening bonding social capital may facilitate reduced feelings of loneliness among Chinese, especially females.

Abstract

Objective: Past correlational research has shown that minority stress has direct and indirect effects on the biology of sexual minority people. This pilot randomized controlled trial (RCT) examined the potential of AWARENESS, a nine-session cognitive behavioral intervention to reduce intersectional minority stress, to alter gene expression related to immune function, inflammation, and HIV disease progression. Method: Between 2016 and 2019, 25 sexual minority men living with HIV with recent substance use (n=12 in AWARENESS and n= 13 in control) were enrolled, a subset with complete gene expression data among the 41 individuals within the parent RCT. Blood samples were taken prior to the intervention, at the 9-week conclusion of the intervention, and at 4 months postrandomization, and leukocyte RNA was sequenced for all samples. The authors examined differential expression analyses of single genes and overrepresentation analysis of gene sets. Results: Neither AWARENESS nor the control condition was related to the differential expression of single genes. Overrepresentation analysis suggested that AWARENESS was related to changes over time in gene expression in leukocyte RNA in 52 gene sets (q,.05), many of which are related to immune function, while the active control condition was related to changes in gene expression among genes in only one gene set. When AWARENESS was compared to the control condition, four gene sets evidenced an overrepresentation of genes reflecting change over time. Conclusions: This RCT suggests that AWARENESS is associated with changes in gene expression, primarily focused on changes in genes associated with immune processes.

Abstract

Sexual and gender minority (lesbian, gay, bisexual, and transgnder: LGBT) adults experience heightened social discrimination and minority stress throughout their lives because of their minority identities. LGBT older adults are particularly vulnerable to the impact of minority stress as they are more likely to live alone and to be estranged from their families of origin. To cope, many LGBT older adults have developed social networks that include chosen families and non-biological relatives who care for one another as if they are family. The chosen family resilience strategy renegotiates what it means to do family and is worthy of theoretical examination. We apply the convoy model of social relations as an interdisciplinary framework for examining LGBT older adults' social networks and chosen families. We discuss points of convergence between the model and what is known about LGBT social networks, and we extend the model to account for chosen families and online social connections.

Abstract

Inner strength, one's internal process of moving through challenging circumstances, has not been described in persons living with mild cognitive impairment (MCI). This qualitative study used the Listening Guide methodology to explore experiences of inner strength in persons newly diagnosed with MCI. We analyzed 36 joint and individual semi-structured interviews with nine participants with MCI and nine care partners. Analytic poems represented three themes explaining inner strength experiences. In the foundational theme, Me with MCI, participants reconfigured their sense of self. The theme Vacillating between Seeking Relief and Dwelling in Challenge illustrated adjusting to life with MCI. The theme You Get through It characterized inner strengths including perseverance, optimism, accepting MCI, and seeking help. Each participant's inner strength profile was unique and impacted by cognitive impairment, and therefore benefitted from support. Though limited by homogeneity, this study highlights Listening Guide utility and has implications for strengths-based interventions and nursing practice.

Abstract

Introduction: Nursing faces numerous challenges amidst broader socio-political transitions in many countries. Despite efforts to establish formal nursing education and legislative frameworks, the profession’s status remains relatively low within some healthcare systems. This study aims to examine the factors influencing nursing professionalism and provide insights into strategies for its enhancement. Aim: The study seeks to summarize the existing literature on nursing professionalism, assess methodological quality, and derive recommendations for future research. Through a systematic review, the study explores various factors shaping nursing professionalism, including communication skills, resilience, education, and cultural perceptions. Methods: A systematic search was conducted across multiple electronic databases from 2014 to 2024 to identify relevant studies on nursing professionalism. The search strategy encompassed elements of professionalism, nursing, and exclusion criteria. Selected studies underwent methodological quality assessment using the Critical Appraisal Skills Programme Qualitative Checklist. Results: The review identified 421 records, yielding 72 eligible studies after screening and eliminating duplicates. Fourteen studies met the inclusion criteria, revealing a complex framework of factors influencing nursing professionalism. The key determinants include communication skills, resilience, education, and cultural perceptions. Studies emphasized the importance of effective communication, resilience in crisis management, quality education, and understanding psychological and cultural influences on professionalism. Conclusions: Nursing professionalism is influenced by multifaceted factors, including communication skills, resilience, education, and cultural perceptions. Recognizing these factors is vital for promoting high-quality nursing practice and ensuring patient safety. Addressing these elements can inform targeted interventions to enhance nursing professionalism and support nurses in delivering optimal healthcare. This study underscores the importance of investing in nursing education, fostering resilience, and considering cultural nuances to cultivate a culture of excellence and professionalism within healthcare systems.

Abstract

Introduction: Racial and ethnic minorities experience a disproportionate burden of the type 2 diabetes (T2D) and are at a 2 to 5 times higher risk of developing macrovascular disease. The purpose of the study was to describe the perspectives of Haitian American immigrants’ challenges to effective T2D self-management. Methods: Utilizing a descriptive qualitative approach, purposive sampling was employed to recruit a subgroup of adult Haitian American immigrants from a parent cross-sectional study. Content analysis was used to identify themes describing participant perspectives. Lincoln and Guba’s four criteria to assess the trustworthiness and ensure the rigor of the study were applied. Results: A total of 36 participants were enrolled, with 54% being male, and age ranged from 34 to 63 years. The majority were married, and 77% reported using metformin. Three facilitators and two barriers to their T2D self-management were found. Facilitators included (1) family and social support, (2) optimism and hope, and (3) novel devices. Barriers included (1) psychosocial and (2) environmental factors. Discussion: The facilitators underscore the pivotal role of close familial relationships, communal influence, and the potential utility of innovative devices like continuous glucose monitoring in enhancing T2D management, whereas the barriers delineate the unique challenges posed by discrimination, lack of provider/client decision-making and communication, the compounding effects of COVID-19, concerns about safety, mistrust in healthcare systems, and financial constraints, which collectively exacerbate the complexities of ineffective T2D management. Collaboration between clinicians, clients, and policymakers is imperative to emphasize the urgent necessity for a multifaceted approach in addressing the complex healthcare landscape of Haitian American immigrants managing T2D in the United States.

Abstract

In Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female (n = 143; 67.1%); the mean age was 60.1 years (SD ± 17.02) and 42.6% (n = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 (SD ± 21.9) mmHg and a diastolic BP of 85.9 (SD ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance (n = 148; 69.4%) and management (n = 47; 71.2%) support, while a slight majority (n = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members (n = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical (n = 189; 88.7%) and mental QOL (n = 196; 92%) and low levels of caregiver burden (n = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.