Publications

Abstract

Background: The period surrounding childbirth is a uniquely vulnerable time for women and their mental health. We sought to describe the association between maternal mental health diagnoses in the year prior and after birth and infant Emergency Department (ED) utilization, hospitalization, and death. Methods: We studied mothers who gave singleton live birth in California (2011–2017) and their infants using linked infant birth and death certificates and maternal and infant discharge records. Maternal mental health diagnoses in the year before and after birth were identified using International Classification of Diseases (ICD) codes. We abstracted infant ED visits, hospitalizations, discharge diagnoses, deaths, and causes of death. Log-linear regression was used to compare relative risks of infant outcomes between mothers with and without mental health diagnoses, adjusting for maternal variables. Results: Of the 3,067,069 mother-infant pairs, 85,047 (2.8%) mothers had at least one mental health diagnosis in the year before and after birth. Infants of mothers with mental health diagnoses were more likely to visit the ED (aRR 1.2, CI:1.1–1.2), have three or more ED visits (aRR 1.4, CI:1.3–1.4), be hospitalized (aRR 1.1, CI:1.04–1.1), and die (aRR 1.7, CI:1.6–1.8) in the first year of life. These infants were also more likely to be diagnosed with accidental injuries, nonaccidental trauma, and non-specific descriptive diagnosis (fussiness/fatigue/brief resolved unexplained event). Conclusion: This large administrative cohort study showed associations between maternal mental health diagnoses and infant acute ED visits, hospitalization, and death. This study underscores the urgent need to understand what is driving these findings and how to mitigate this risk.

Abstract

Objectives: Home health care serves millions of Americans who are "Aging in Place," including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees. Methods: A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist. Results: Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits. Conclusions: Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.

Abstract

Schools’ health screenings can identify students’ missed health concerns. Data from the 2016 School Health Policies and Practices Study were used to determine the proportion of U.S. school districts with physical and mental health screening policies and the proportion that arrange off-campus mental health services. We also examined differences between districts with and without mental health screening policies regarding having physical health screening policies, patterns of these policies, and off-campus mental health service arrangements. Eleven percent of districts had no policies on any of the four physical health screenings assessed, and 87% lacked policies on mental health screenings, the latter especially concerning considering the impact of COVID-19. Districts with policies on mental health screenings were significantly more likely to have body mass index (p <.01) and oral health (p <.001) screening policies, and to arrange for off-campus case management (p <.001), family counseling (p <.05), group counseling (p <.01), self-help (p <.05) and intake evaluation (p <.05).

Abstract

The Centers for Disease Control and Prevention affirm that health equity is only achieved when everyone has opportunities to attain full health potential without disadvantages related to social position or socially determined circumstances. To reduce health inequities in nursing research, researchers must increase diversity in study samples and ensure that study participants are representative of all populations in the United States. Identifying effective methods for recruiting underrepresented populations must be a thoughtful and reflective component of every research methodology. To achieve health equity in research studies, nurse researchers and clinicians must carefully plan ways to recruit study participants who represent all populations.

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Background: Transgender populations experience disproportionately higher rates of mental and physical health issues such as suicidality and heart disease than their cisgender counterparts. Education of health professions students and providers is recognized as an effective method in mitigating transgender health disparities. Purpose: This narrative review investigated the methods in which transgender health is taught in undergraduate nursing programs. Suggestions for optimizing transgender health education are presented. Method: This review critically appraised and synthesized 28 articles that met these inclusion criteria: articles in English describing teaching strategies used in transgender health education with samples that include undergraduate nursing students. Results: Didactic lecture is the most widely used method, followed by role-play simulation, use of film and video, guest presentation, and high-fidelity and standardized patient simulation. Conclusion: Lectures remain the dominant method of delivering transgender health content. Improvements in students' knowledge and attitude related to transgender care were noted posteducation.

Abstract

Editor’s note: This is the 22nd article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation.

Abstract

The Diabetes Prevention Program (DPP) randomized controlled trial demonstrated that metformin treatment reduced progression to type 2 diabetes (T2D) by 31% compared to placebo in adults with prediabetes. Circulating micro-ribonucleic acids (miRs) are promising biomarkers of T2D risk, but little is known about their associations with metformin regimens for T2D risk reduction. We compared the change in 24 circulating miRs from baseline to 2 years in a subset from DPP metformin intervention (n = 50) and placebo (n = 50) groups using Wilcoxon signed rank tests. Spearman correlations were used to evaluate associations between miR change and baseline clinical characteristics. Multiple linear regression was used to adjust for covariates. The sample was 73% female, 17% Black, 13% Hispanic, and 50 ± 11 years. Participants were obese, normotensive, prediabetic, and dyslipidemic. Change in 12 miR levels from baseline to 2 years was significantly different in the metformin group compared with placebo after adjusting for multiple comparisons: six (let-7c-5p, miR-151a-3p, miR-17-5p, miR-20b-5p, miR-29b-3p, and miR-93-5p) were significantly upregulated and six (miR-130b-3p, miR-22-3p, miR-222-3p, miR-320a-3p, miR-320c, miR-92a-3p) were significantly downregulated in the metformin group. These miRs help to explain how metformin is linked to T2D risk reduction, which may lead to novel biomarkers, therapeutics, and precision health strategies.

Abstract

Background: Suicide, especially by firearm, remains a leading cause of death in military populations in the USA. Reducing access to firearms, especially during high risk times, may help prevent suicide and other forms of violence. The purpose of this study was to adapt a promising existing lethal means safety intervention (Project Safe Guard, PSG) for cross-cutting violence prevention and peer support in active-duty service communities using community engagement methods. Methods: A two-pronged community-engaged research approach was employed, including the Community Translation (CT) process that engaged 15 Service Members from one installation to help adapt PSG successfully. In addition, qualitative data was collected from 40 active-duty service members and military violence prevention specialists through in-depth interviews and focus group discussions. Results: Qualitative data and CT feedback led to site-specific PSG adaptations. Participants emphasized the importance of peer-to-peer discussions and highlighted resource allocation, leadership support, and stigma on firearm ownership as potential implementation challenges. Conclusions: Findings demonstrate the feasibility of community-engaged research to adapt lethal means safety interventions within military populations. PSG implementation should consider resource allocation, leadership support, and addressing stigma. This study has implications for future policies and standards for performing research on sensitive topics, particularly among military populations.

Abstract

Background: Secure firearm storage is a proposed method for reducing intentional and unintentional firearm injury and death among US military service members. However, little is known about suggested key messengers and optimal message content to promote secure firearm storage practices among at-risk US service members. This qualitative study focused on military spouse and stakeholder perspectives concerning key messengers and message content for the delivery of effective messaging around promoting secure firearm storage practices among US service members. Methods: Military spouses and stakeholders of military support organisations were recruited at various military installations in the USA and completed either individual or group qualitative interviews via Zoom consisting of open-ended questions on perspectives of effective messaging for secure firearm storage for at-risk service members. Qualitative analysis included comprehensive memoing, regularly scheduled team meetings and triangulation of data with established literature. Results: 56 participants were interviewed between August 2022 and March 2023. Participants identified key messengers for promoting secure firearm storage as peers, chaplains, clinicians or a combination. Perspectives on preferred message content for the promotion of secure firearm storage consisted of focusing on lived experience, personal anecdotes and relatable stories. Discussion and conclusions: Extant research has focused exclusively on firearm owners' perspectives of effective messaging for the promotion of secure firearm storage practices. This study highlights the important contributions of military spouses and stakeholder perspectives on who are credible messengers and what is the most effective message content to promote a perspective shift on how firearms are stored among military firearm owners.

Abstract

Objective: This study aimed to develop and evaluate a mobile health (mHealth)-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with human immunodeficiency virus (HIV). Methods: This study involved two phases: Phase 1: development of a theory-guided and culturally adapted STN intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three arms: Arm 1: tablet-based video (mHealth) with STN (n = 60); Arm 2: mHealth with a video of nonnarrative educational materials (n = 59); and Arm 3: control group with only reading nonnarrative educational materials in person (n = 60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention. Results: Both arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50.0%, respectively, vs. 35.0%, P = 0.01) at 2 months follow-up, but there were no differences among groups from 2- to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention, and VIA uptakes. Conclusions: The findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-min session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi.

Abstract

The COVID-19 pandemic has exacerbated the difficulties nurses face, resulting in higher turnover rates and workforce shortages. This study investigated the relationships between nurses' moral distress, burnout, and turnover intention during the last stage of the COVID-19 pandemic. It also explored the coping strategies nurses use to mitigate moral distress. Utilizing a mixed-method approach, this study analyzed data from 307 nurses caring for patients with COVID-19 in acute care hospitals through an online survey conducted in November 2022. Our data analysis encompassed quantitative methods, including descriptive statistics and path analysis, using a generalized structural equation model. For the qualitative aspect, we examined open-ended responses from 246 nurses using inductive content analysis. The quantitative findings revealed that nurses' moral distress had a significant direct effect on turnover intention. In addition, burnout significantly mediated the relationship between moral distress and turnover intention. Qualitative analyses contextualized the relationships uncovered in the quantitative analyses. The qualitative analysis identified various positive and negative coping strategies. Positive strategies included a commitment to minimize COVID-19 transmission risks, adopting a holistic approach amidst the challenges posed by the pandemic, voicing concerns for patient safety, engaging in continuous learning, and prioritizing self-care. Conversely, negative strategies involved adopting avoidance behaviors stemming from feelings of powerlessness and adopting a passive approach to one's role. Notably, some participants shifted from positive to negative coping strategies because of institutional barriers and challenges. The findings underscore the importance for hospital administrators and nurse managers to acknowledge the impact of the pandemic-related challenges encountered by nurses and recognize the link among moral distress, burnout, and turnover intention. It highlights the essential role of organizational and managerial support in fostering effective coping strategies among nurses to address moral distress.

Abstract

Introduction: Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Increasing evidence links MCR to several adverse health outcomes, but the specific relationship between MCR and the risk of frailty, Alzheimer's disease (AD), and vascular dementia (VaD) remains unclear. Additionally, literature lacks analysis of MCR's components and associated health outcomes, complicating risk identification. This systematic review and meta-analysis aimed to provide a comprehensive overview of MCR's predictive value for adverse health outcomes. Methods: Relevant crosssectional, cohort, and longitudinal studies examining the association between MCR and adverse health outcomes were extracted from ten electronic databases. The Newcastle-Ottawa Scale (NOS) and modified NOS were used to assess the risk of bias in studies included in the analysis. Relative ratios (RRs) and 95% confidence intervals (CIs) were pooled for outcomes associated with MCR. Results: Twenty-eight longitudinal or cohort studies and four cross-sectional studies with 1,224,569 participants were included in the final analysis. The risk of bias in all included studies was rated as low or moderate. Pooled analysis of RR indicated that MCR had a greater probability of increased the risk of dementia (adjusted RR = 2.02; 95% CI = 1.94-2.11), cognitive impairment (adjusted RR = 1.72; 95% CI = 1.49-1.99), falls (adjusted RR = 1.32; 95% CI = 1.17-1.50), mortality (adjusted RR = 1.66; 95% CI = 1.32-2.10), and hospitalization (adjusted RR = 1.46; 95% CI = 1.16-1.84); MCR had more prominent predictive efficacy for AD (adjusted RR = 2.23; 95% CI = 1.81-2.76) compared to VaD (adjusted RR = 3.78; 95% CI = 0.49-28.95), while excluding analyses from the study that utilized the timed-up-and-go test and one-leg-standing to evaluate gait speed. One study examined the association between MCR and disability (hazard ratios [HR] = 1.69; 95% CI = 1.08-2.02) and frailty (OR = 5.53; 95% CI = 1.46-20.89). SG was a stronger predictor of the risk for dementia and falls than SCC (adjusted RR = 1.22; 95% CI = 1.11-1.34 vs. adjusted RR = 1.19; 95% CI = 1.03-1.38). Conclusion: MCR increases the risk of developing any discussed adverse health outcomes, and the predictive value for AD is superior to VaD. Additionally, SG is a stronger predictor of dementia and falls than SCC. Therefore, MCR should be routinely assessed among adults to prevent poor prognosis and provide evidence to support future targeted interventions.

Abstract

Physical inactivity is a major public health concern, but for hospitalized adults, the results of immobility are even more alarming. The “trauma of hospitalization” is a syndrome that refers to the collective impact of immobility, sleep deficits, and malnutrition associated with hospitalization and contributes to functional deficits. Functional decline is a modifiable and preventable risk factor. Nursing, at the center of patient care, is poised to coordinate the patient's mobility activities. Multiple steps to stave off functional decline to improve health outcomes for older adults are in the control of nurses and nursing practice and reflect the goals of the NICHE practice model.

Abstract

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic severely disrupted hospice care, yet there is little research regarding how widespread disruptions affected clinician and family decision-making. We aimed to understand how the pandemic affected structures, processes, and outcomes of end-of-life care. Research Design and Methods: Retrospective narrative chart review of electronic health records of 61 patients referred and admitted to hospice from 3 New York City geriatrics practices who died between March 1, 2020, and March 31, 2021. We linked longitudinal, unstructured medical, and hospice electronic health record notes to create a real-time, multiperspective trajectory of patients' interactions with providers using directed content analysis. Results: Most patients had dementia and were enrolled in hospice for 11 days. Care processes were shaped by structural factors (staffing, supplies, and governmental/institutional policies), and outcomes were prioritized by care teams and families (protecting safety, maintaining high-touch care, honoring patient values, and supporting patients emotionally and spiritually). Processes used to achieve these outcomes were decision-making, care delivery, supporting a "good death,"and emotional and spiritual support. Discussion and Implications: Care processes were negotiated throughout the end of life, with clinicians and families making in-the-moment decisions. Some adaptations were effective but also placed extraordinary pressure on paid and family caregivers. Healthcare teams' and families' goals to meet patients' end-of-life priorities can be supported by ongoing assessment of patient goals and process changes needed to support them, stronger structural supports for paid and family caregivers, incentivizing relationships across primary care and hospice teams, and extending social work and spiritual care.

Abstract

Young adults thrust into the role of caregiving for parents with young-onset dementia (YOD) face unique challenges during their formative years. While existing research acknowledges the crucial role of young adult caregivers, a gap persists in understanding how this group experiences and redefines their identity amidst these circumstances, along with the psychological and societal challenges encountered. This knowledge deficit hinders the identification of suitable social support, adversely affecting the personal growth and well-being of these young adult caregivers. In this single-case study, we used a combination of a semi-structured interview and photovoice to explore the journey of a 19-year-old caregiver, Alice, whose mother had been diagnosed with dementia in the preceding 3 years. Through this unique perspective, we aimed to illuminate how caregiving for a mother with YOD may profoundly redefine familial roles and relationships. Over 3 months, Alice captured significant life moments through photography, selecting meaningful images for bi-weekly meetings. These images served as pivotal themes, triggering in-depth conversations during subsequent interviews to provide nuanced insights into her life experiences. Findings reveal four major themes faced by a young caregiver: (1) challenges adapting to an unexpected role, (2) navigating the complex emotional terrain of losing a loved one to YOD, (3) prioritizing the well-being of the healthy parent, and (4) expressing a profound desire for both informal and formal support. These results underscore the intricate identity and emotional challenges faced by young adult caregivers, emphasizing the urgency of addressing their unique needs through family-centered systemic support services.

Abstract

Background: Young-onset dementia (YOD) refers to dementia occurring before the age of 65, with Alzheimer’s disease being the most common form, posing distinct challenges for spousal caregivers. Objective: This study aims to investigate the unique experiences of spousal caregivers of persons with YOD in China, where dementia-specific community care services and primary healthcare professionals are relatively lacking, in order to inform the tailored support services development. Methods: This qualitative-design study utilized semi-structured interviews with 11 spousal caregivers of persons with YOD dwelling in the community. Traditional content analysis was employed to analyze the interview data. Results: Limited dementia-specific healthcare professionals and low public awareness made diagnosing and accepting YOD a prolonged and challenging journey. Spousal caregivers faced skepticism when seeking diagnosis, exacerbating their burden and emotional stress. Disparities in healthcare professionals and insufficient collaboration between institutions worsened the situation. YOD significantly impacted family dynamics and led to changes in emotional communication within the family. The stigma surrounding YOD raised concerns among spousal caregivers about their children’s future in marriage and career, emphasizing genetic risks. Conclusions: In settings where dementia-specific community care services and primary healthcare professionals are limited and unevenly distributed, integrating support services at both the primary and community levels is crucial for families dealing with YOD in the community. Additionally, raising public awareness about YOD can foster a more understanding and supportive environment, addressing challenges related to stigma faced by affected families, contributing to increased investment in supporting resources, and encouraging individuals to seek help early on.

Abstract

This chapter presents a case of a six-year-old Daniel who is presented to the primary care office with his mother, Donna, with complaints of frequent nightmares. Donna states that Daniel will be asleep and will suddenly sit upright with his eyes open and start to scream loudly. She says that Daniel looks terrified and that he sweats and breathes fast during these episodes. Donna says that while Daniel is screaming, she is unable to wake, console, or comfort him. The screaming episodes typically last about 5 minutes each and happen 3–4 times weekly. The chapter also provides essential guidance and information for understanding how to diagnose and manage this case. This includes differential diagnosis and a series of critical thinking questions ideal for the family nurse practitioner.

Abstract

The major healthcare challenge addressed by Nurses Improving Care for Healthsystem Elders (NICHE), a program of NYU Rory Meyers College of Nursing, has been the need for evidence-based knowledge in the nursing care of older adults. NICHE has successfully developed this knowledge by pioneering the development of geriatric nursing clinical protocols and most importantly has developed a sustainable model for knowledge transfer across multiple healthcare delivery systems with nursing staff at all levels of practice encompassing nursing assistants, licensed practical nurses, registered nurses, and advanced practice nurses.

Abstract

This chapter explores the case of Neil, a 12-month-old male, who is presented to the primary care office for a well-baby visit. Neil's mother states that Neil has been healthy since his last well-baby visit at 9 months of age. His nutrition history reveals that he has successfully transitioned to a diet with whole milk. Neil's birth weight was 3000 g, and his Apgar scores were 8 at 1 minute and 9 at 5 minutes. Past medical history reveals that Neil has had 3 episodes of acute otitis media since birth. The chapter provides essential guidance and information for understanding how to diagnose and manage this case. This includes differential diagnosis and a series of critical thinking questions ideal for family nurse practitioner.

Abstract

This chapter explores the case of Anita, a 2-week-old Hispanic female, who is presented in the primary care office for well-child check, including nutrition and weight. Anita's mother is concerned that Anita spits up a lot after eating. The mother is worried that, since the baby is vomiting so much, she is not getting enough food. Therefore, the mother has been feeding Anita even more formula. Also, Anita's mother is worried that she will run out of formula since the baby takes so much. The chapter provides essential guidance and information for understanding how to diagnose and manage this case. This includes differential diagnosis and a series of critical thinking questions ideal for the family nurse practitioner.

Abstract

This chapter presents a case of a 12-year-old girl, came to the community health clinic with her mother, who had requested an urgent appointment to discuss a note from her physical education teacher with her nurse practitioner (NP). The note stated that Tamika was having difficulty keeping up with her classmates because she became short of breath when participating in activities. She has no persistent cough, wheeze, or seasonal allergies. The chapter also provides essential guidance and information for understanding how to diagnose and manage this case. This includes differential diagnosis and a series of critical thinking questions ideal for the family nurse practitioner.

Abstract

Obstructive sleep apnea (OSA) and hypertension are two important modifiable risk factors for cardiovascular disease and mortality. Numerous studies have highlighted the interplay between these two conditions. We provide a critical review of the current literature on the role of the OSA as a risk factor for hypertension and its effect on blood pressure (BP). We discuss several key topics: the effect of OSA on nocturnal BP, BP response to continuous positive airway pressure (CPAP) treatment, CPAP effect on BP in refractory hypertension, the role of OSA in BP variability (BPV), and maladaptive cardiac remodeling mediated by OSA’s effect on BP. Finally, we discuss the unique aspects of ethnicity and social determinants of health on OSA with a focus on Asian populations and the disparity in BP control and cardiovascular outcomes.

Abstract

Background: Home-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people’s experience and related factors while receiving home-based long-term care services. Methods: A qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis. Results: Analysis of interview data resulted in the identification of three major themes that captured participants’ personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people’s social well-being; and (3) Older people’s contradictory emotions regarding care delivery. Conclusions: Findings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future.