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BackgroundPatient outcomes are improved and the burden to the health care system is reduced when individuals are active self-managers of their own health. There is a need for technology that facilitates self-management of rheumatoid arthritis (RA) and can reduce the number of patient visits, promptly identify treatment needs, and reduce the costs associated with poor RA management. A mobile app named LiveWith Arthritis (eTreatMD, Vancouver, BC) has been developed that allows patients with RA to use their mobile device to regularly collect self-management data and to take objective measurements of the impact of RA on their finger joints using optical imaging technology. ObjectiveThe objectives of this pilot study were to (1) gather preliminary data as to whether a mobile app with hand optical imaging capabilities improves self-management behaviors (self-efficacy in managing symptoms and patient activation), (2) determine if app use shows promise in improving health outcomes (Pain, Health Assessment Questionnaire-II [HAQ-II]), and (3) determine barriers to using the mobile app in adults with RA. MethodsThis pilot study used a mixed-methods design. The quantitative portion was a traditional 2-group experimental design, and the qualitative portion was a follow-up telephone interview for intervention participants who did not complete the study. Measures of self-management included the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy in managing symptoms (P-SEMS) and Patient Activation Measure (PAM). Health outcomes included pain by Visual Analog Scale and disability by HAQ-II. ResultsThe final sample consisted of 21 intervention participants and 15 controls. There was a statistically significant improvement in P-SEMS and promising trends for improvement in PAM, HAQ-II, and pain scores for participants who used the app. Of the intervention participants who did not complete the study, 12 completed the qualitative interview on barriers to use. Qualitative content analysis revealed 3 themes for barriers to using the app, including (1) frustration with technology, (2) RA made the app difficult to use, and (3) satisfaction with current self-management system. ConclusionsThe LiveWith Arthritis app shows promise for improving self-management behaviors and health outcomes in adults with RA. Future study with a larger sample size is required to confirm findings. Initial app experience is important for adoption and continual use of the app. Individuals with significant disability to the hand would benefit from voice-activated app features. Participants who already have a system of managing their RA may not feel compelled to switch methods, even when a novel optical imaging feature is available.

Refugees and immigrants have experienced heightened health inequities related to COVID-19. As community-embedded frontline health personnel, refugee and immigrant community health workers (riCHWs) played essential roles in the provision of informational, instrumental, and emotional support during the unprecedented first year of the pandemic. Despite the importance of this workforce, riCHWs are at high risk for burnout due to low recognition and demanding workloads. This was exacerbated as riCHWs navigated a new and uncertain health delivery landscape. We sought to glean insight into riCHWs' stressors, coping strategies and resources, and self-efficacy to identify ways to support their work and wellbeing. Using a narrative inquiry approach, we conducted semi-structured, in-depth interviews with 11 riCHWs working in a midsized city in the midwestern United States. We generated three distinct yet interrelated themes: (1) Rapid and trustworthy information is key, (2) Creativity and perseverance are good ... structural support is better, and (3) Integrating riCHW expertise into health promotion programming and decision-making. Although riCHWs were deeply committed to enhancing community wellbeing, quickly shifting responsibilities in tandem with structural-level health inequities diminished their self-efficacy and mental health. riCHWs relied on work-based friends/colleagues for informational and emotional support to enhance their capacity to deliver services. Findings suggest increasing opportunities for peer support and idea-exchange, professional development, and integration of riCHW expertise in health promotion decision-making are effective strategies to enhance riCHWs' professional self-efficacy and personal wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: Incarcerated women are a vulnerable and unique population of special concern to nurses as they have high rates of mental illness. In this article, the authors discuss how trauma exposure contributes to mental illness in incarcerated women through abuse, socioeconomic factors, and the prison environment, how this trauma exposure manifests in the inmate survivor, and the related implications for practice. Conclusions: A history of trauma and victimization is related to complex mental health issues which affect the majority of justice‐involved women. The correctional environment can exacerbate these issues. Practice Implications: Nursing implications include discussion of the trauma‐informed care model. The authors recommend a model of trauma‐informed care named “the 4 Es” that can guide nurses in preparing a trauma‐informed correctional environment and discuss the importance of nurse‐led policy change in finding alternatives to incarceration for women with mental illness. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is an important area of women's health research internationally and across disciplines. There is no guiding paradigm, however, to ensure that PPD research results translate to women on a global level. This commentary builds on the work of Doucet, Letourneau, and Stoppard (2010) to determine a “best fit” paradigm with which to guide PPD research. Postpositivism, critical theory, constructivism, and pragmatism are combined with a feminist ideology and critiqued as potential guiding paradigms for PPD research. After thorough examination, I conclude the need for further use of a feminist pragmatist paradigm in PPD research. [ABSTRACT FROM PUBLISHER]

Introduction: Each year approximately 3,000 individuals with heart failure (HF) receive a left ventricular assist device (LVAD). LVAD implantation requires a lengthy post-operative hospitalization and recovery period that often leads to decompensation of physical function beyond what was already compromised due to the characteristic symptoms of HF. Little is known about how LVAD recipients perceive their post-implantation physical function and recovery. This study is the first to explore LVAD recipient perceptions of guidelines for home-based physical activity in the post-implantation period. Objective: The objectives of this study were to explore the perceptions of post-implantation physical function and recovery described by LVAD recipients and to examine home-based physical activity guidelines received by LVAD recipients. Methods: This qualitative, descriptive study recruited LVAD recipients from an advanced HF clinic at a Midwestern academic medical center. All participants were asked to complete a one-time, 60-minute telephone interview. The interviews focused on participants' experiences in the post-implantation period with physical function, recovery, and physical activity. Following transcription, data cleaning, and accuracy checking, interviews were analyzed by three independent reviewers. These reviewers then came to a group consensus on findings and agreed on themes. Results: Ten participants completed interviews; six were male, four were female, all were White/Caucasian, non-Hispanic, and mean age was 54.5. More than half (60%) of participants had been implanted 6 months or less from the time of interview. Themes included: Listen to your body?: Vague physical activity guidelines, The bed is your enemy: Earlier integration of physical activity , and Seeking normal: Overcoming fear and self-imposed restrictions. Conclusions: Post-implantation limitations in physical function are a considerable issue for LVAD recipients. Guidelines for physical activity in this unique population are needed and desired. Innovative, home-based strategies, like exergaming or virtual reality, should be considered for early initiation of physical activity and to improve post-implantation physical function in LVAD recipients. [ABSTRACT FROM AUTHOR]

The article presents a comment on M. Moshki and colleagues' study "The effect of educational intervention on prevention of postpartum depression: an application of health locus of control," which concluded that women with high level of internal health control (IHLC) had lower levels of postpartum depression (PPD). Topcis discussed include two important findings of the study on diagnosing and management of PPD and limitations of the study.

Background: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness., Objective: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group., Methods: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model., Results: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024., Conclusions: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention., Trial Registration: ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615., International Registered Report Identifier (irrid): DERR1-10.2196/58580., (©Elizabeth Mollard, Deirdre Cooper Owens, Christina Bach, Cydney Gaines, Shannon Maloney, Tiffany Moore, Christopher Wichman, Neel Shah, Michele Balas. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.08.2024.)

Abnormal uterine bleeding is a common clinical concern for adolescent women. This research study aims to improve the clinical reasoning skills of advanced practice nursing students instructed in blended Objective Simulation Competency Assessment clinical experiences by enhancing feedback loops given to students during simulated experiences. A sequential explanatory mixed-methods study design was conducted with two cohorts of first-year women's health nurse practitioner graduate nursing students enrolled in the Women's Health Program at a large Midwestern university. Data were collected across 2 years from two separate cohorts, and analyses included data from 15 participants. The Abnormal Uterine Bleeding module designed with decision pathways was a worthy effort, and faculty value using data analytics from the e-learning module to evaluate student learning. This study describes how nursing faculty created abnormal uterine bleeding content in an online module format that can aid the diagnostic reasoning process and enable feedback to students., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)