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Accelerated resolution therapy (ART) is a psychotherapy for the treatment of prolonged grief disorder (PGD) defined as severe, enduring longing for the lost person. Currently, ART lacks examination of intrapersonal processes, like expectancy, as behavioural mechanisms for action. Therefore, the purpose of this paper was to present the findings on participants' treatment expectations of ART for PGD and then discuss potential hypotheses for future testing. This study was a primary qualitative descriptive analysis of prospectively collected interview data (collected 2017–2019) accrued as part of a randomised, wait‐list controlled clinical trial in bereaved hospice family caregivers in the United States. The sample included 29 former informal caregivers who were at least 1‐year post death of their care recipient. They were primarily female, older (67.4 ± 7.1 years), and a little over half (n = 18) had been married to their care recipient. Thematic analysis resulted in three distinct themes with six sub‐themes: The role of knowledge in expectations (sub‐themes uncertainty, prior knowledge); The role of personality in expectations (sub‐themes openness, positive affect); and Expecting a process (sub‐themes cognitive processes, affective processes) which described the interaction of person and process in shaping expectations of our intervention. An across theme analysis of the specificity of the participants' expectations uncovered that knowledge and personality inform expectations of ART and that individuals who verbalise a process for recovery tend to be very specific in their expectations. Three hypotheses for testing are put forward and implications for practice, research and policy discussed. [ABSTRACT FROM AUTHOR]

Reciprocal partnerships are growing alongside the rise of international learning and 'doing' experiences for students and clinicians. This paper questions how global citizenship, the acquisition of awareness and skills to sensitively navigate through a rapidly globalized social world, is cultivated amidst international partnerships focused on short-term immersion opportunities. Using an ethnographic methodology to examine the experiences of occupational therapy students abroad, this paper addresses the potential for competing agendas when the motivation to participate within these partnerships is driven in part by a desire to 'do good.' The empirical lens was directed towards the students' verbal, written and enacted narratives rather than the sociocultural realm of the sending institution, the host organization or the occupational realities of the local communities, therefore is limited in discursive scope. Nevertheless, the need is great for further critical appraisal of objectives and expectations by all parties to foster a partnership culture of reciprocity and equality and to diminish the neocolonial legacy of Western expertise dissemination. By examining how the stated and implied desire to do good exists alongside the risk to do harm to individuals and international networks, the conclusions can be extended locally to highlight the challenges to 'partnering up' between clinicians and patients. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores racial disparities and risk factors of adverse pregnancy outcomes in Black and White pregnant women in the US. The study uses a cross‐sectional approach to explore Black and White disparities using data from the 2012 National Survey on Drug Use and Health (NSDUH), which collects interview data from approximately 70,000 randomly selected participants. We included several self‐reported conditions that we categorised as individual and social stressors (e.g. measures of institutionalised racism, individual health behaviours, access to quality care and social context factors). We used descriptive statistics, univariate and multivariate analyses in risk factors of adverse pregnancy outcomes between Black and White women. Black women who were pregnant had a lower socioeconomic status and experienced more measures of institutionalised racism compared to White women who were pregnant. More white women who were pregnant were married, had higher levels of educational attainment, higher income levels, and greater employment opportunities. White pregnant women also had higher levels of private health insurance and less dependency on government programmes for access to healthcare. Results from the regressions indicated that Black pregnant women were less likely to be married (OR = 0.01), less likely to have higher income levels (OR = 0.31) and less likely to be employed (OR = 0.52). However, Black pregnant women were more likely to be younger (OR = 1.82). For the health‐eroding behaviours, Black pregnant women were less likely to smoke (OR = 0.53) and use alcohol (0.52). After assessing the SES Household‐level stressors (access to healthcare), Black pregnant women were more likely to have Medicaid/CHIP (OR = 3.21) and health coverage through government assistant programmes (OR = 3.80); however, less likely to have private health insurance (OR = 0.38). There are differences in risk factors of adverse pregnancy outcomes between White and Black pregnant women based on measures of individual level/social stressors, institutionalised racism, health behaviours and access to care. [ABSTRACT FROM AUTHOR]

Home-based family support programs provide early intervention to support families with young children. Home visiting models typically serve pregnant and parenting women with risk factors known to influence the caregiver-child relationship including history of trauma, low academic achievement, low income, limited support networks, maternal depression, and maternal substance use. Few, if any, home visiting models, however, were developed specifically to support families affected by maternal substance use. The Team for Infants Exposed to Substance use (TIES) Program is a home-based family support program exclusively serving families affected by maternal substance use. The model design and intensive services allow TIES participants to achieve significant positive outcomes in the program's six goal areas: maternal substance use, parenting skills, child mental and physical health, maternal mental and physical health, family income, and family housing. Goal scores are assessed jointly by participants and staff throughout the program using a validated scale. Program staff hypothesize that goal attainment in these areas may be influenced by the therapeutic relationship developed between home visitors and participants. This relationship is assessed using the Working Alliance Inventory (WAI), a validated assessment of therapeutic alliance administered to both participants and staff. An analysis of 127 program participants shows that when controlling for home visitor WAI scores in multilevel models (MLMs), goal attainment scores improved from intake to discharge across all goal areas except for housing stability. These results stress the importance of the therapeutic relationship in maximizing TIES participants' growth and success. [ABSTRACT FROM AUTHOR]

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state‐recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community‐based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life‐course interviews with participants of a state‐recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state‐recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs. [ABSTRACT FROM AUTHOR]

Using a qualitative phenomenological design, the objective of this study was to explore in‐depth how US‐born Latinos provide social support to their immigrant counterparts during a time of heightened anti‐immigrant rhetoric. A sample of 22 US‐born Latino adult was recruited in 2019 for qualitative interviews, following a period of intense immigration raids. Eligible participants were adults who reported experiencing an immigration‐related stressor and screened positive for a mental health concern or substance misuse. Open‐ended questions focused on topics of immigration and health. Using a thematic analysis approach, interview transcripts were coded to identify common themes within the domains of social support: instrumental; informational; emotional; and appraisal. We found that US‐born Latinos provide diverse forms of social support to immigrants with the intention of protecting them from immigration enforcement encounters (e.g. deportation), thereby safeguarding the livelihoods of their communities. US‐born Latinos are integral pillars of support and resiliency for immigrant communities, and the domains identified within this study suggest important implications for immigrant health. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the healthcare needs and experiences of women of refugee background in Chicago—home to one of the largest and most diverse refugee populations in the United States. We used a phenomenological study design with a desire‐centered rather than damage‐centered approach to conduct a series of focus group discussions with 24 women of refugee background in their native languages in Chicago, Illinois between December 2018 and February 2019. Convenience sampling was used to recruit women of refugee background at least 18 years of age living in the Chicago metropolitan area who attended educational women's health workshops at local refugee community centers. An inductive approach to the analysis was used to code transcripts and generate themes. Our study identified four major healthcare priorities for women of refugee background in a major metropolitan area: (1) central and centralised healthcare, (2) continuity of care, (3) trauma‐informed care and (4) community engagement and partnerships. The healthcare priorities identified by the participants in this study should inform existing and future healthcare models and clinics providing care for women of refugee background in urban and sub‐urban contexts across the United States. [ABSTRACT FROM AUTHOR]

Social work has been a part of the essential workforce historically and throughout the COVID‐19 pandemic, yet lack recognition. This work explores the experiences and invisibility of social workers within the pandemic response. Data are drawn from a large cross‐sectional survey of US‐based social worker from June to August of 2020. A summative content analysis of responses to the question 'What do you wish people knew about social work during the COVID‐19 pandemic' was undertaken. Participants (n = 515) were majority white (72.1%) and female (90.8%). Seven coding categories were subsequently collapsed into three domains: (1) meeting basic needs, (2) well‐being (emotional distress and dual role) and (3) professional invisibility (workplace equals, physical safety, professional invisibility and organisational invisibility). Meeting social needs requires broad‐based policies that strengthen the health and social safety net. Social workers have and will continue to play a critical role in the response, and recovery from COVID‐19. Organisational and governmental policies must expand to increase the visibility and responsiveness to the needs of social care providers. [ABSTRACT FROM AUTHOR]

Nearly 1 in every 14 youth have had a parent incarcerated at some point. In any given year, over 9 million adults from jail and 700,000 adults from prison return to their families and communities. However, few studies have explored the family experiences during re‐entry or have provided suggestions on how to best support children during this time. The goal of this qualitative study was to describe family experiences and provide their considerations on how to better support children during the period of parent's re‐entry. Qualitative data was gathered from 26 participants using semi‐structured, in‐depth phone interviews from March to August 2020. The sample included 10 youth (12–18 years) who have had a parent incarcerated, 10 custodial caregivers of youth who have had incarcerated parents, and 6 parents released from incarceration. Qualitative content analysis and open‐coding procedures were used to determine themes across raters. Experiences centred on the challenges of assimilating to new family roles upon the parent returning home and to the community. Families also shared the difficulty in navigating parole restrictions and managing fears surrounding the recidivism of the parent. Three primary themes were deduced as relationship‐building obstacles, unaligned family expectations and parole‐related family burdens. Results from this study revealed suggestions that may address youth, caregiver and returning parent's needs during the re‐entry phase. Family counselling and peer support groups may improve the process of mending or forming relationships. Access to re‐entry programs, mental health services, and parental education may better align family expectations. Transparent wrap‐around social services and decreasing legal challenges may reduce the parole‐related burdens on the family. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 – 15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well‐child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non‐Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five‐session home visitation program using the Problem‐Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self‐efficacy. Based on these results, a short‐term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms. [ABSTRACT FROM AUTHOR]

Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high‐tech and high‐touch service delivery option. Families can receive evidence‐based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well‐documented engagement barriers to digital health/computer‐mediated interventions exist across treatment modalities and technology platforms. Semi‐structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice‐based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth‐based home visitation. Findings include evidence that providers should be able to move between telehealth and on‐ground service provision with relative ease. [ABSTRACT FROM AUTHOR]

Millions of people in the United States provide unpaid care to family and friends with long‐term illnesses and disabilities. Research shows that informal caregiving can be beneficial for recipients of care, but taxing for those providing care. Studies have not explored associations between informal caregiving and the risk of experiencing different forms of material hardship. In this study, we use data from the Survey of Income and Program Participation (N = 31,633) to address this gap in the literature. The sample was drawn from a multistage‐stratified sample of the civilian, non‐institutionalised population of the United States. We analyse data that were collected in 2011 and find that providing informal care to others is associated with an increased risk of experiencing healthcare hardship, bill‐paying hardship and food insecurity. Moreover, we find that household financial resources mediate the association between caregiving and material hardship. As a result, while caregiving households face a higher risk of experiencing material hardships at all income levels, the disparity is largest at low incomes and smallest at high incomes. The findings highlight the need for a stronger safety net for informal caregivers. [ABSTRACT FROM AUTHOR]

Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health‐promoting behaviours of healthy eating and physical activity among community‐dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post‐injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health‐promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi‐structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis. Participants included informal caregivers of individuals with SCI living in the community (n = 24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and (8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health‐promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self‐identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health‐promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested. [ABSTRACT FROM AUTHOR]

One in four American women will experience a miscarriage, stillbirth or neonatal death each time she becomes pregnant. These perinatal losses occur even more frequently in women who are immigrants from developing countries. Care of Muslim families after perinatal loss is based primarily on expert opinion as opposed to research evidence, as few, if any, studies exist on this topic. It is critically important to know what parent's preferences for care actually are, since care that is incongruent with the desires of the bereaved parents may intensify their grief. The purpose of this study was to examine the perceptions and attitudes of immigrant Arab Muslims regarding psychosocial bereavement practices common in the United States after perinatal loss and to pilot test an investigator‐developed instrument for collecting data regarding culturally relevant psychosocial bereavement practices of immigrant Arab Muslims after perinatal loss. The study employed a cross‐sectional survey design using an investigator‐developed instrument entitled the Arab Muslim Perceptions of Perinatal Loss Care (AMPPLC). The AMPPLC, available in both English and Arabic, was used to collect data on perinatal loss care from a convenience sample of 79 immigrant Arab Muslim adults (male n = 43 [54.4%]; female n = 36 [45.6%]). The study opened in June 2017 and closed in August 2019. The AMPPLC instrument demonstrated good reliability (α = 0.89) in measuring participants' responses. Responses by survey participants did not always agree with prior published literature on Muslim preferences after a loss. Optimal care for Arab Muslim immigrants involves offering all options that are typically part of Western bereavement care as well as options that may be more specifically associated with Islam. This information will enable healthcare providers to provide more culturally sensitive and compassionate care to Middle Eastern Muslim parents during this difficult and tragic experience. [ABSTRACT FROM AUTHOR]

Globally, the rate of incarceration among women is rising, and in the U.S., women's incarceration has grown at twice the rate for men over the last four decades. Louisiana has the second highest rate of incarceration in the U.S. There is evidence that men in Louisiana prisons do not receive adequate healthcare, but little is known about their women counterparts. We aimed to document formerly incarcerated women's experiences with receiving healthcare during incarceration in Louisiana to inform policy and practice change. In partnership with two community‐based organisations in New Orleans, Louisiana, between August 2016 and April 2018, we conducted semi‐structured 1‐hr interviews with 22 formerly incarcerated women who had been incarcerated in the state for at least one consecutive year. A convenience sample of participants was recruited through community‐based organisations' re‐entry and health programmes. Our interview guide included questions about experiences with accessing care, reproductive health needs, interactions with providers and preventive care during incarceration. We used applied thematic analysis techniques to interpret data. Over 90% of interviewees identified as Black. Their mean age was 50.7. The average length of incarceration was 8.4 years. Participants reported multiple barriers to accessing care including punishment for seeking care, long wait times, costs, lack of respect from providers and health concerns being dismissed. Participants reported limited mental health, preventive and dental services; an insufficient number of providers; and poor health outcomes as a result of delayed care. Overall, women did not have access to adequate, timely care during incarceration. Findings suggest a need for policy changes related to the provision of carceral healthcare services and external oversight of prison conditions and healthcare delivery. Further research into women's experiences of ageing during incarceration and tailored transitional health models is needed. [ABSTRACT FROM AUTHOR]

The quality of life (QOL) of the approximately 1.5 million nursing facility (NF) residents in the US is undoubtedly lower than desired by residents, families, providers, and policy makers. Although there have been important advances in defining and measuring QOL for this population, there is a need for interventions that are tied to standardized measurement and quality improvement programs. This paper describes the development and testing of a structured, tailored assessment and care planning process for improving the QOL of nursing home residents. The Quality of Life Structured Resident Interview and Care Plan (QOL.SRI/CP) builds on a decade of research on measuring QOL and is designed to be easily implemented in any US nursing home. The approach was developed through extensive and iterative pilot testing and then tested in a randomized controlled trial in three nursing homes. Residents were randomly assigned to receive the assessment alone or both the assessment and an individualized QOL care plan task. The results show that residents assigned to the intervention group experienced improved QOL at 90- and 180-day follow-up, while QOL of residents in the control group was unchanged. [ABSTRACT FROM AUTHOR]

Unmet health‐related social needs are common amongst older US adults and impact both quality of life and health outcomes. One of the ways that unmet health‐related social needs impact health is through malnutrition, an imbalance in a person's intake of energy and/or nutrients. Lack of reliable access to a sufficient quantity of nutritious food is a specific health‐related social need that can be assessed rapidly and, when unmet, is a direct risk factor for malnutrition and may be indicative of a broader range of unmet health‐related social needs. We conducted a cross‐sectional study to characterise malnutrition and food insecurity amongst older adults receiving emergency department (ED) care using brief, validated measures and to assess the burden of a broader range of health‐related social needs amongst these patients. Patients were asked about their need for and willingness to receive a range of social services. The study was conducted in an academic ED serving a racially and socioeconomically diverse population in the Southeastern United States. A convenience sample of noncritically ill adults aged 60 years and older was approached between November 2018 and April 2019. Study patients (n = 127) were predominantly non‐Hispanic white (67%), community dwelling (91%) and urban residents (66%) with 28% screening positive for malnutrition risk, 16% for food insecurity and 5% for both. Of those at risk for malnutrition, 25 (69%) reported ≥2 unmet health‐related social needs and 14 (38%) were receptive to social services. Amongst food insecure patients, 18 (90%) reported additional unmet health‐related social needs and 13 (65%) were receptive to receiving social services. In conclusion, a brief set of questions can identify subgroups of older ED patients who are food insecure or at risk for malnutrition. Individuals who screen positive for food insecurity have a high burden of unmet health‐related social needs. [ABSTRACT FROM AUTHOR]

Among the various negative outcomes of intimate partner violence (IPV) exposure to children, depression symptoms are worthy of attention given the effects on well‐being and long‐term achievement. This study examined the effects of early childhood exposure to IPV between ages 1 and 3 on depression symptoms at age 15 and investigated whether maternal physical punishment at age 5 and peer bullying victimisation at age 9 affected the association. Data came from five waves of the Fragile Families and Child Wellbeing Study. The study was based on 20 U.S. cities with populations of over 200,000 people. The most recent wave of data collection occurs during the period between 2014 and 2017. The final analytic sample was 1,690 children. Structural equation modeling was utilised to examine the effects of exposure to IPV on physical punishment, bullying victimisation, and depression symptoms. Early exposure to IPV was associated with experiencing physical punishment at Year 5, which subsequently increased peer bullying victimisation at Year 9 and then depression symptoms at Year 15. Early exposure to IPV had a direct effect on depression symptoms at Year 15. Early exposure to IPV also had indirect effects on Year 15 depression symptoms through its effects on physical punishment and bullying victimisation. The total standardised effect of early exposure on depression symptoms was 0.06. Consistent with trauma theory and the ecobiodevelopmental framework, the results indicate that exposure to IPV appeared to have a long‐term effect on children, manifested in teen depression symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Uninsured patients are more likely than the general population to use tobacco and less likely to quit. Aims: To determine if the mode of delivering the PHS Guidelines influenced the effectiveness of smoking cessation among patients in a safety net setting. Methods: Six free clinics were randomly assigned to a training program delivered by an academic physician or community partner plus video support. A repeated cross-sectional survey of patients was conducted at three waves to assess effectiveness to promote quitting. Results: Tobacco use was triple the rate of the US population: 57.7% (Wave 1), 44.7% (Wave 2), and 48.9% (Wave 3). Patients were more likely to report receipt of at least one evidence-based strategy to promote quitting at Wave 2 (AOR = 2.33, 95% CI (1.18–4.58)). Patients treated in clinics trained by the community partner were significantly more likely to report receiving cessation assistance at Wave 2 (AOR 2.54, 95%CI 1.29–5.00) and the trend was similar, but not significant at Wave 3. Patients in the community partner-led arm were significantly less likely to report tobacco use at Wave 3 (AOR 0.59, 95% CI 0.35–0.99). Conclusions: Implementation of the PHS Guidelines in free clinics demonstrates preliminary efficacy, with delivery by community partners offering greater scalability. [ABSTRACT FROM AUTHOR]

Aims: To examine prevalence of bullying among nurses and explore associations of organizational betrayal and support with well‐being among nurses exposed to bullying. Background: Bullying is a problem in many nursing workplaces, and organizations have an obligation to support nurses who are bullied. Support or betrayal after bullying could affect nurse well‐being, including burnout. Methods: In this cross‐sectional study among U.S. nurses, data were collected in a survey using the Negative Acts Questionnaire‐Revised for Nursing, the Institutional Betrayal Questionnaire for Health, the Well‐Being Index, a job satisfaction scale and demographic questions. Results: Prevalence of weekly/daily bullying was 31% (N = 242). Among nurses exposed to any bullying (N = 173), organizational betrayal increased odds of burnout (OR 2.62, p =.02), job dissatisfaction (OR 2.97, p =.04) and absenteeism (OR 6.11, p <.001). Organizational support decreased odds of job dissatisfaction (OR 0.30, p =.001) and absenteeism (OR 0.50, p =.04). Conclusion: Analysis of study findings suggests organizational betrayal increases likelihood of burnout, job dissatisfaction and absenteeism, and support decreases likelihood of dissatisfaction and absenteeism. Implications for Nursing Management: Nurse leaders should be aware of the issue of organizational betrayal and support in relation to well‐being. Future studies can further explore the concepts of betrayal and support to provide additional evidence. [ABSTRACT FROM AUTHOR]

Iraqi refugees in the US experience a high prevalence of non‐communicable diseases. In this article, we explore how cultural and structural realities intersect to influence utilisation of preventative healthcare and cancer screening with the aim of understanding health disparities in this population. We conducted three focus group discussions with a total of 14 Iraqi refugee women living in a northeastern US city in 2016 and analysed the qualitative data using a thematic analysis. Eight themes emerged from our data: (a) 'prevention is better than cure:' Iraqi refugee women maintain wellness; (b) physical and mental health are interrelated in causing and curing ill‐health; (c) Iraqi refugee women embrace both biomedical and other healing practices; (d) God contributes to healing; (e) cancer is caused by dangerous environments. Three of the eight themes related to barriers to care; (f) multi‐level problems within hospitals and clinics prevent the delivery of care; (g) financial barriers prevent access to care and good health; (h) competing priorities are a barrier to good health. We argue that understanding refugee health requires critical analysis of both culturally informed understandings of health and illness as well as the structural aspects of health disparities that result in limited access to life opportunities, racism and inequality for refugees and their communities. [ABSTRACT FROM AUTHOR]

Background: Demographic characteristics play a role in influencing the decision to make end‐of‐life (EOL) directives among older adults living in the United States. Aims: To examine the associations between older adults' demographic characteristics (age, sex, marital status, residential site, and educational level) and their perceived importance of four self‐care actions for EOL planning, as well as their desire and ability to perform these actions. Settings: A cross‐sectional survey study of community‐dwelling adults living in the southern United States from 2015 to 2016. Participants: Community‐dwelling adults aged 65 years and older (N = 123). Methods: A self‐administered tool, the Patient Action Inventory for Self‐Care and a demographic questionnaire were used. Multiple logistic regression was performed. Results: Forty‐seven of (38.2%) participants lived in an urban community and 76 (61.8%) in a rural community. Demographic variables that were significant across the predictive models were older adults' residence, education levels, age, and marital status. Four demographic characteristics of living in rural areas, without a high school education, being 75 years or older, and married could be social determinants of EOL planning. Conclusions: Older adults may need community‐based support to address their end‐of‐life needs, especially those elders who want to remain independent in their home environment. [ABSTRACT FROM AUTHOR]

The flipped classroom continues to garner increasing interest in nursing education; however, few research studies fully document faculty experiences with its implementation. This study's purpose was to explore undergraduate nurse educators' transition from traditional teacher‐centered, content‐driven strategies to the flipped classroom and describe perceived successes and challenges during the process. A qualitative approach using interpretive description gave voice to a purposive sample of sixteen undergraduate nurse educators across the United States and Canada. Semistructured interviews, audio‐recorded and transcribed verbatim, yielded a set of experiential themes. Participants revealed marked challenges as they rethought classroom design in relation to evidence‐based educational principles, and met a surprising level of resistance from students and faculty colleagues. Still, faculty observations reflected increased student problem solving, self‐determination and a greater correlation between teacher‐made and standardized test scores. Participants advocated continued integration of flipped classrooms into nursing curricula and recommended greater collegial and administrative support from academic environments. [ABSTRACT FROM AUTHOR]

There is a paucity of information concerning adaptive parenting strategies utilised by mothers with physical disabilities, particularly during early motherhood. The purpose of this study is to describe the adaptive strategies used by mothers with physical disabilities during early motherhood. This qualitative study included semi‐structured telephone interviews between January and March 2014 with US mothers with a range of physical disabilities who had a baby within the past 10 years (N = 25). Interviews were audio‐recorded, professionally transcribed, and coded using content analysis. Analysis revealed five broad themes indicating important adaptive parenting strategies for mothers with physical disabilities caring for infants and toddlers: They are as follows: (a) acquiring or modifying baby‐care equipment, (b) adapting the home environment, (c) accessing information and supports, (d) developing communication strategies to facilitate safety, and (e) receiving assistance from others. This study indicates that mothers with physical disabilities employ a variety of adaptive strategies during early motherhood. The findings from the study suggest the need for more availability of supports and equipment for mothers with physical disabilities as well as information for prospective mothers with disabilities. In addition, healthcare and social work professionals must receive training about adaptive parenting strategies. [ABSTRACT FROM AUTHOR]

Intro. Both discrimination and harassment directly impact mental and physical health. Further, workplace discrimination degrades workplace culture and negatively impacts health behaviors, job-related outcomes, and family dynamics. Women represent a small proportion of the fire service and are often the targets of discrimination/harassment, yet little research documents the impact of such experiences. The purpose of this study was to evaluate the relationship between chronic work discrimination and/or harassment and women firefighters' (FFs) physical and mental health, substance abuse, and job efficacy, stress, and satisfaction. Methods. Snowball sampling was used to solicit participation from women career FFs. Participants completed an online survey regarding physical and mental health, health behavior, job efficacy/stress/satisfaction, and family well-being. Logistic regression examined the impact of work discrimination-harassment severity on dichotomous variables. Results. 1,773 had complete data on their experiences with work-related discrimination and harassment. Women reported experiencing verbal (37.5%) and written (12.9%) harassment, hazing (16.9%), sexual advances (37.4%), and assaults (5.1%) in the fire service. FFs in the highest tertile of work discrimination-harassment severity reported over 40% more poor health days in the last 30 days (OR=1.42; 95%CI=1.33-1.51; p<0.001). Women who experienced moderate and severe discrimination/harassment had negative mental health outcomes including higher prevalence of depressive symptoms, anxiety, and PTSD symptoms. Those who experienced high rates of discrimination and/or harassment also were more likely to report issues with alcohol consumption. Conclusion. The impact of discrimination and harassment, related negative physical and mental outcomes, low levels of job satisfaction, and negative impact of these experiences on family/home stress likely take a significant toll on women in the fire service. Findings confirm and extend previous work suggesting there is a need to improve the mental and physical health of women FFs. Future work should examine the prospective relationship between discrimination/harassment and poor health outcomes and potential policies/practices to reduce these negative behaviors. [ABSTRACT FROM AUTHOR]

Abstract: Despite surviving extreme forms of violence, torture and other traumas during the Khmer Rouge genocide and forced migration, Cambodian Americans experience devastating health inequities and barriers to health access in the United States (U.S.). From the perspective of Cambodian American community health workers (CHWs), we explored three aims in this community‐based participatory research (CBPR), qualitative study: Cambodian Americans’ understanding of health, community health work strategies that improve health access of Cambodian Americans, and action steps that improve health access for Cambodian Americans. From 2014 to 2016, our two‐phased study spanned seven U.S. states, which included a focus group (n = 5) and 16 semistructured interviews. Participants identified an indigenous concept of health, and micro‐level (e.g. service navigation, peer education) and mezzo‐level interventions (e.g. community building, coalition work) to improve health access. Finally, Khmer Health Advocates, a community‐based health advocacy organisation, served as a vital study partner in this CBPR study. [ABSTRACT FROM AUTHOR]

Objective To examine chief nurse executives' perspectives on: (1) the provision of culturally and linguistically appropriate services in hospitals and (2) to identify barriers and facilitators associated with the implementation of culturally and linguistically appropriate services. Background Hospitals continue to face challenges providing care to diverse patients. The uptake of standards related to culturally and linguistically appropriate services into clinical practice is sluggish, despite potential benefits, including reducing health disparities, patient errors, readmissions and improving patient experiences. Method A qualitative study with chief nurse executives from one eastern United States (US). Data were analysed using content analysis. Results Seven themes emerged: (1) lack of awareness of resources for health care organisations; (2) constrained cultural competency training; (3) suboptimal resources (cost and time); (4) mutual understanding; (5) limited workplace diversity; (6) community outreach programmes; and (7) the management of unvoiced patient expectations. Conclusions As the American population diversifies, providing culturally and linguistically appropriate services remains a priority for nurse leaders. Being aware and utilizing the resources, policies and best practices available for the implementation of culturally and linguistically appropriate services can assist nursing managers in reaching their goals of providing high quality care to diverse populations. Implications for Nursing Management Nurse managers are key in aligning the unit's resources with organisational goals related to the provision of culturally and linguistically appropriate services by providing the operational leadership to eliminate barriers and to enhance the uptake of best practices related to culturally and linguistically appropriate services. [ABSTRACT FROM AUTHOR]

Aim This study examined nurses' work, comparing nursing interventions and locations across three units in a United States hospital using Omaha System standardized terminology as the organizing framework. Background The differences in nurses' acute-care work across unit types are not well understood. Prior investigators have used time-motion methodologies; few have compared differences across units, nor used standardized terminology. Methods Nurse-observers recorded locations and interventions of nurses on three acute-care units using hand-held devices and web-based TimeCaT™ software. Nursing interventions were mapped to Omaha System terms. Unit-differences were analysed. Results Nurses changed locations approximately every 2 min, and averaged approximately one intervention/minute. Unit differences were found in both the interventions performed and the locations. Most interventions were case-management related, demonstrating the nurses' patient management/coordination role. Conclusions Unit differences in nursing interventions and location were found among three unit types. Omaha System terminology, as well as the observational method used, were found to be feasible and practical. Implications for Nursing Management Nursing work varies by unit, yet managers have not been armed with empirical data with which to make more informed decisions about nurses' work priorities, clinical outcomes, patient satisfaction, staff satisfaction and cost. The results from this study will help them to do so. [ABSTRACT FROM AUTHOR]

Purpose The aim is to improve the uptake of psychiatric services for new patients being referred from primary care, counseling, and hospital discharge follow-up care. Design and Methods A convenience sample of 18 new patients participated in a provider-initiated telephone protocol to increase knowledge related to psychiatric treatment and remind patients of appointments the day before the initial visit. Findings Fifteen patients attended the initial visit, resulting in a 26% reduction rate of no-show rates from 27% the previous year to 20% in a 3-month period. Practice Implications Introduction and reminder calls by psychiatric providers improve no-show rates. [ABSTRACT FROM AUTHOR]

Aim The purpose of this analysis is to determine US minority nurses' job satisfaction and turnover using three outcome variables: job dissatisfaction; change of jobs; and intent to quit. Background A balanced nursing workforce is essential for supporting a racially diverse nation. Understanding minority nurses' job satisfaction is the first step in achieving this balance. Methods A secondary data analysis was conducted using the 2008 National Sample Survey of Registered Nurses. The association between race and job satisfaction was examined using logistic regression. Results Black nurses were more likely to intend to quit than white ones ( OR = 1.46, 95% CI = 1.31-1.64), as were Hispanics ( OR = 1.35, 95% CI = 1.18-1.55). Asians were less dissatisfied ( OR = 0.69, 95% CI = 0.57-0.84), and less likely to have changed jobs ( OR = 0.71, 95% CI = 0.60-85) or intend to quit ( OR = 0.84, 95% CI = 0.75-0.95) than white nurses. Conclusions This analysis demonstrated that black and Hispanic nurses are more likely to intend to quit, even while controlling for dissatisfaction. The reasons for this, and the increased job satisfaction demonstrated by Asian nurses, are directions for future research. Implications for nursing management Nurse managers should endeavour to create a workplace free of discrimination. Efforts to increase the job satisfaction of all nurses are of equal importance. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to examine the relationship of congruency of leadership support and value of patient outcomes between nurses and nurse managers and nurses' job satisfaction and turnover intent. Background Turnover most often has a negative effect on an organization. Leadership support and patient outcomes have been identified as important factors, but congruency has not been studied in great detail. Method(s) This quantitative non-experimental study included registered nurses (92) and nurse managers (21) in five non-magnet hospitals in the United States. Results Value congruence on leadership support was correlated with job satisfaction: Satisfaction in Nursing Scale ( SINs) - Workload Barriers ( r = 0.327, Administrative Support r = 0.544 and Collegiality = 0.920, P < 0.05). Value congruence and leadership support ( Leadership Practices Inventory, LPI) was negatively correlated with turnover intent ( r = 0.317, P < 0.05). When all variables were combined a correlation of Value of Patient Outcomes ( VOPOS) and the Anticipated Turnover Scale ( ATS) ( r = 0.099, P > 0.05) was noted. Conclusion Value congruence of leadership support is related to job satisfaction and may be a factor in turnover intent. Implications for nursing management Nurse Administrators can use these results to develop policies to address the turnover especially in the area of leadership support. [ABSTRACT FROM AUTHOR]