Publications

Abstract

Objectives: Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety. Methods: In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: (1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; (2) thematic analysis to identify domains. Results: Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only 1 (0.8%) corresponded to a staff-reported IR. Twenty-five percent of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: (1) patients and families as safety actors; (2) emotional safety; (3) system-centered care; and (4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1–3), while others fit within standard healthcare safety domains (#4). Conclusions: Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations—collected with an option for anonymity and eliciting both positive and constructive comments.

Abstract

Objective: Infants of mothers with adult congenital heart disease (ACHD) are at increased risk for adverse pregnancy and neonatal outcomes. We aim to identify mediators in the relationship between ACHD and pregnancy and infant outcomes. Study design: Case-control study using linked maternal and infant hospital records. Structural equation modeling was performed to assess for potential mediators of pregnancy and infant outcomes. Result: We showed an increased risk of multiple adverse infant and pregnancy outcomes among infants born to mothers with ACHD. Maternal placental syndrome and congestive heart failure were mediators of prematurity. Prematurity and critical congenital heart disease in the infant were mediators of infant outcomes. However, the direct effect of ACHD on outcomes beyond that explained by these mediators remained significant. Conclusion: While significant mediators of infant and pregnancy outcomes were identified, there was a large direct effect of maternal ACHD. Further studies should aim to identify more factors that explain these infants’ vulnerability.

Abstract

Background: Chinese and Korean Americans are among the fastest-growing minority groups in the US but face disparities in income and limited English proficiency, leading to health inequities in Alzheimer's disease and related dementias (ADRD) care. Objective: This study aims to understand cultural influences in ADRD care from the perspectives of Chinese and Korean American caregivers to inform culturally sensitive support for caregivers in Asian immigrant populations. Methods: We conducted a study that was part of a broader project aimed at informing the cultural adaptation of the NYU Caregiver Intervention-Enhanced Support (NYUCI-ES) program specifically for Chinese and Korean American caregivers managing multiple chronic conditions. In our interviews with 14 Chinese American and 11 Korean American caregivers, we focused on how their roles as primary caregivers were influenced by cultural and family expectations, the impact of caregiving on their personal and emotional well-being, and the specific barriers they face in accessing healthcare for themselves and their relatives with dementia. Results: Cultural beliefs and values significantly influenced the perceptions and utilization of support systems among Chinese and Korean American caregivers. Family stigma and adherence to cultural norms impacted their caregiving experiences. The study also highlighted the added burden during the pandemic and the potential benefits of telehealth and information technology in ADRD care. Conclusions: Developing culturally tailored, person-centered programs is crucial to meeting the unique needs of Chinese and Korean American caregivers. This research contributes to understanding and supporting this vulnerable population, promoting healthcare equity for ADRD patients and caregivers.

Abstract

An increasing body of evidence highlights the importance of an individual’s place of residence on their health and functional outcomes. This study is based on Outcome and Assessment Information Set data to assess the differences in emergency department visits among Medicare home health care patients by patients' residence location (rural/urban status and neighborhood socioeconomic status). Compared to urban patients, a disproportionately higher proportion of rural patients lived in more or most disadvantaged neighborhoods (83.9% vs. 41.3%). Using linear probability regression models, patients in rural areas (coefficient =.02, p <.001) and disadvantaged neighborhoods (less disadvantaged: coefficient =.02, p <.001; more disadvantaged: coefficient =.034, p <.001; most disadvantaged: coefficient =.042, p <.001) were more likely to experience emergency department visits. Policymakers should consider utilizing area-based target interventions to mitigate gaps in home health care. Also, given that the majority of rural patients reside in disadvantaged neighborhoods, neighborhood characteristics should be considered in addressing rural–urban disparities and improving home health care.

Abstract

The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.

Abstract

Objective: To investigate mental health needs and barriers to seeking mental health support in Medicaid-funded Assisted Living Facility (M-ALF). Design: A multimethod, qualitative-dominant descriptive design using questionnaires and semistructured interviews. Setting and Participants: The study occurred at a M-ALF in the Bronx, New York. A researcher in residence recruited 13 residents (11 Black or African American, 2 Asian) using purposive sampling. Methods: Demographic data and mental health indicators (depression, anxiety, stress, hopelessness) were measured with questionnaires (Center for Epidemiological Studies Depression Scale, Edmonton Symptom Assessment System, Perceived Stress Scale, Beck Hopelessness Survey) and analyzed with descriptive statistics. Interviews were conducted between June and November 2021, transcribed, and analyzed using conventional content analysis. Results: Thirteen residents (mean age: 73.4 years, mean length of stay: 3.5 years; range: 1.0-7.5) completed data collection. Quantitatively indicators of unmet mental health were common. Qualitatively, residents reported barriers to mental health access to address depression, anxiety, and substance use. This was accompanied by concerns surrounding loss of autonomy, mistrust for M-ALF organizational support, isolation and uncertainty about how to receive mental health support. Perspectives were shaped by past experiences with institutional living, serious illness, and being unhoused. Themes and subthemes were (1) mental health need (unmet mental health need, depression, and anxiety and seeking support through non–mental health resources) and (2) barriers to mental health support (dissatisfaction with M-ALF care, perceived threats to autonomy, desire for autonomy that leads to diminished care seeking). Conclusion and Implications: Residents of M-ALF have mental health needs for which care is stymied by loss of autonomy, lack of resources, and the M-ALF environment. Residents use unconventional resources to address needs that may be neither efficient nor effective. Novel mental health interventions and processes are needed to improve mental health access and should prioritize residents’ desire for autonomy and the unique circumstances of living in M-ALF.

Abstract

In order to reduce care partner strain and support aging in place for people living with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood’s conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood’s framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood’s principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.

Abstract

Encounters with discrimination are a normative experience for many Black and Latino adolescents and young adults (AYAs); these experiences may be even more common for expecting AYAs. While the harmful effects of discriminatory experiences on mental and physical health have been well explored, relatively little is known regarding the impact of discrimination on relationship quality and sexual health—specifically HIV/STI risk. Using the Actor Partner Interdependence Model, we examined both actor and partner effects of discrimination on relationship quality and willingness to be non-monogamous in a sample of 259 pregnant adolescent and young adult couples. There was a significant indirect actor effect, such that one’s own discrimination was associated with a decrease in their own relationship quality which, in turn, was associated with their own greater willingness to be non-monogamous. The partner effect for the association of one’s partner’s discrimination on one’s own relationship quality was not significant. Findings highlight the need for more attention to the implications of discrimination on relational and sexual health.

Abstract

Objectives: This study aimed to discern the longitudinal association between tooth loss and subsequent functional status, specifically investigating the moderated mediation effects of social relationships and psychological resilience. Methods: Data from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed, we included 2834 older adults aged 65 and over in the study. The longitudinal relationship between tooth loss and functional status was analyzed using the generalized estimating equation. Hayes’ PROCESS macro for SPSS was utilized to study the mediating and moderating effects. Results: In the fully adjusted model, the number of natural teeth at T1 was positively associated with instrumental activities of daily living (IADL) score at T3, but not activities of daily living (ADL) score. Compared with 20+ teeth, participants with complete tooth loss at T1 had a higher risk of developing ADL and IADL disability. Participants with 1–9 teeth at T1 had a 38 % risk of developing IADL disability at T3 (OR = 1.38, 95 % CI = 1.07–1.76, p = 0.012). Social relationships mediated the association between tooth loss and IADL only among participants whose psychological resilience was average (B = 0.0006, 95 % CI = 0.0001–0.0014) or high (B = 0.0013, 95 % CI = 0.0003–0.0026). Conclusion: Psychological resilience moderated the mediating effects of social relationships on the association between tooth loss and functional ability. Clinical significance: This longitudinal study contributes to elucidating parts of social-psychological mechanisms underlying tooth loss and functional disability. It suggests that by cultivating positive social relationships and enhancing psychological resilience, the adverse impacts of tooth loss on functional disability may be mitigated.

Abstract

Background: The Self- and Family Management Framework was created in 2006 to help structure self- and family management science. Based on a series of reviews and syntheses of emerging research and critical evaluation, we developed the Framework into a robust nursing theory. Purpose: In this article, we reintroduce the Self- and Family Management Framework as the Middle Range Theory of Self- and Family Management of Chronic Illness. Methods: We review steps in the development and updating of the Framework, share rationale for advancement to a middle range theory, explicate components of the newly designed model, and propose future directions. Discussion and Conclusion: It is our hope that this middle range theory will guide researchers and clinicians more comprehensively in supporting patients and families managing chronic illness, which will in turn inform continued theory development.

Abstract

Objective: The purpose of this study was to understand the limited English proficiency patient experience with health care services in an urban setting in the United States. Methods: Through a narrative analysis approach, 71 individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews between 2016 and 2018. Analyses used monolingual and multilingual open coding approaches to generate themes. Results: Six themes illustrated patient experiences and identified sources of structural inequities perpetuating language barriers at the point of care. An important thread throughout all interviews was the sense that the language barrier with clinicians posed a threat to their safety when receiving healthcare, citing an acute awareness of additional risk for harm they might experience. Participants also consistently identified factors they felt would improve their sense of security that were specific to clinician interactions. Differences in experiences were specific to culture and heritage. Conclusions: The findings highlight the ongoing challenges spoken language barriers pose across multiple points of care in the United States' health care system. Innovation: The multi-language nature of this study and its methodological insights are innovative as most studies have focused on clinicians or patient experiences in a single language.

Abstract

Hyponatremia is a common, potentially serious problem encountered in primary, acute, and critical care settings. Proper treatment requires an understanding of the multiple possible causes of hyponatremia. This case report presents an unusual cause of hyponatremia—3,4 methylenedioxymethamphetamine (MDMA; “Ecstasy” or “Molly”) use. With encouraging research emerging on the use of psychedelic drugs to treat depression, anxiety, posttraumatic stress disorder, and addiction, nurse practitioners should increase their knowledge about the evolution of MDMA from a recreational drug to a potential medicine for the care of people with serious and persistent mental health concerns.

Abstract

Background: Health equity is essential for improving the well-being of all individuals and groups, and research remains a critical element for understanding barriers to health equity. While considering how to best support research that acknowledges current health challenges, it is crucial to understand the role of social justice frameworks within health equity research and the contributions of minoritized researchers. Additionally, there should be an increased understanding of the influence of social determinants of health on biological mechanisms. Purpose: Biological health equity research seeks to understand and address health disparities among historically excluded populations. Discussion: While there are examples of studies in this area led by minoritized researchers, some individuals and groups remain understudied due to underfunding. Research within minoritized populations must be prioritized to authentically achieve health equity. Furthermore, there should be increased funding from National Institutes of Health to support minoritized researchers working in this area.

Abstract

It is often said that modern-day nursing and midwifery was founded on the spirit of activism. Yet, historically, the link between nursing and activism has been inconsistent. Nursing Now USA was created in response to a global campaign launched in 2020 by the World Health Organization to mark the Year of the Nurse and Midwife. A goal of this initiative is education about how contemporary nurses serve as leaders in healthcare in the United States. This article describes the methods and results of a scoping review that sought to explore the current state of the science, key concepts, and operationalization of activism in nursing. The general consensus in the literature is that the profession of nursing has deep roots in activism, but a lack of a clear definition of activism and operationalization in policy, practice, research, and academic settings likely limits active engagement by many nurses. The current state of nurse activism is more subtle, often unseen, and non-confrontational compared to the participation and contribution of nurses from the 1900s to the 1980s. We identified barriers and facilitators to activism in nursing and our discussion includes implications for nursing practice, education, and leadership.

Abstract

Background: In the US, sexual and gender minority (SGM) individuals continue to experience health inequities, and nursing curricula content and nursing faculty with SGM health expertise in the US remain limited. Addressing health disparities begins with the preparation of future nurses—US nursing faculty must be supported to meet these growing needs. Purpose: To describe, appraise, and synthesize research from 2000-2020 on US nursing faculty knowledge, awareness, inclusion, and perceived importance of SGM health content. Methods: Following PRISMA 2020 guidelines, we registered a systematic review and appraisal protocol in PROSPERO, and then executed the protocol and synthesized the literature. Discussion: We found an empirical evidence base surrounding US nursing faculty and SGM health much more limited than expected. Only four cross-sectional, descriptive empirical articles fit the a priori inclusion criteria. The studies were of moderate quality at best and often relied on unvalidated or older measures. In general, the studies focused on examining characteristics of nursing programs, faculty comfort with content, faculty perceptions of content importance, and hours dedicated to content. Conclusion: Since the close of the review, new commentaries and editorials expanding the call for change in the US were published—the time for commentary has passed. It remains unclear whether US nursing faculty are adequately prepared to educate future nurses about SGM health issues—and an unprepared healthcare workforce is yet another barrier to SGM health equity. The evidence base supporting US nursing faculty development desperately needs more studies using rigorous methodologies.

Abstract

Background: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation’s worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool’s initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals.

Abstract

This study aims to examine whether adverse childhood experiences (ACEs) are associated with oral health conditions (denture use, difficulty in chewing, and edentulism) among middle-aged and older adults in China and if gender and adulthood education moderate the associations. Data were obtained from the 2014 and 2018 surveys from the China Health and Retirement Longitudinal Study (N = 17,091) and logistic regressions were carried out. Results show that childhood hunger (OR = 1.12), loneliness (OR = 1.10) and family relations (OR = 1.07) were significantly associated with higher odds of denture use and there were significant associations between hunger (OR = 1.16) and difficulty in chewing. For the female subsample, education significantly moderated the adverse effect of childhood hunger on denture use and difficulty in chewing. Findings suggest that ACEs have long-lasting impacts on oral health conditions in later life and adulthood education might offer critical resources for females, helping them buffer the detrimental health impacts of ACEs.

Abstract

Objective: To evaluate whether sleep apnea or insomnia among pregnant people is associated with increased risk for adverse infant outcomes. Design: Retrospective cohort study Setting: California Participants: The sample included singleton live births. Sleep apnea and insomnia were defined based on ICD-9 and -10 codes. A referent group was selected using exact propensity score matching on maternal characteristics, obstetric factors, and infant factors among individuals without a sleep disorder. Measurements: Adverse infant outcomes were obtained from birth certificate, hospital discharge, and death records (eg, Apgar scores, neonatal intensive care unit (NICU) stay, infant death, long birth stay, etc.). Logistic regression was used to calculate odds of an adverse infant outcome by sleep disorder type. Results: Propensity-score matched controls were identified for 69.9% of the 3371 sleep apnea cases and 68.8% of the 3213 insomnia cases. Compared to the propensity-matched referent group, individuals with a diagnosis of sleep apnea (n = 2357) had infants who were more likely to have any adverse outcome, low 1-min Apgar scores, NICU stay, and an emergency room visit in the first year of life. Infants born to mothers with a diagnosis of insomnia (n = 2212) were at increased risk of few negative outcomes relative to the propensity matched referent group, with the exception of an emergency room visit. Conclusions: In unadjusted analyses, infants born to individuals with a diagnosis of sleep apnea or insomnia were at increased risk of several adverse outcomes. These were attenuated when using propensity score matching, suggesting these associations were driven by other comorbidities.

Abstract

Background: The objectives of this study were to describe trends in the prevalence of postpartum suicidal behaviors in California, 2013-2018, and to estimate associations between adverse perinatal outcomes and suicidal behaviors. Materials and Methods: We used data from a population-based cohort derived from all birth and fetal death certificates. Records were individually linked to maternal hospital discharge records for the years before and after delivery. We estimated the prevalence of postpartum suicidal ideation and attempt by year. Then, we estimated crude and adjusted associations between adverse perinatal outcomes and these suicidal behaviors. The sample included 2,563,288 records. Results: The prevalence of postpartum suicidal ideation and attempt increased from 2013 to 2018. People with postpartum suicidal behavior were younger, had less education, and were more likely to live in rural areas. A greater proportion of those with postpartum suicidal behavior were Black and publicly insured. Severe maternal morbidity, neonatal intensive care unit admission, and fetal death were associated with greater risk of ideation and attempt. Major structural malformation was not associated with either outcome. Conclusions: The burden of postpartum suicidal behavior has increased over time and is unequally distributed across population subgroups. Adverse perinatal outcomes may help identify individuals that could benefit from additional care during the postpartum period.

Abstract

The association between age and mental health symptoms among persons with HIV (PWH) is inconsistent, and little is known about the mediators and moderators of this association. This study aimed to examine the association between age and mental health symptoms, as well as the mediators and moderators of perceived discrimination. Data were from 1,304 PWH who completed a cross-sectional survey in five areas of China. Multiple linear regressions showed that younger age was significantly associated with more severe mental health symptoms and that perceived discrimination moderated this relationship. The Sobel test showed that perceived discrimination also mediated the association between age and mental health symptoms. Our study indicates that perceived discrimination shapes the association between age and mental health symptoms among PWH and highlights the importance of designing age-Tailored mental health intervention strategies for perceived discrimination among young PWH. Interventions addressing discrimination are necessary to help improve mental health, especially for young PWH.