Search

Objective To test whether an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program for older adults attenuates symptoms of depression and anxiety. Methods Adults aged [greater than or equal to] 55 with insomnia were randomized to SHUTi-OASIS (Sleep Healthy Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness; N = 207) or Patient Education (PE; N = 104). Depression and anxiety were assessed (HADS-D and HADS-A, respectively) at baseline, post-assessment, and 6- and 12-month follow-ups. Results Multilevel modeling of HADS-D showed a condition by time interaction (F[3,779] = 3.23, p = .02): SHUTi-OASIS participants reported lower symptoms than PE at post-assessment. There was no such interaction effect for HADS-A (F[3,779] = 2.12, p = .10). Generalized linear modeling showed no moderation of effects by baseline symptom severity. Conclusions Participants randomized to Internet-delivered CBT-I showed stable depression and anxiety across time, while control participants' depressive symptoms briefly increased. CBT-I may help prevent development or worsening of psychological distress among older adults with insomnia. TRIAL REGISTRATION [Registered at ClinicalTrials.gov; identifier removed for anonymity], Author(s): Kelly M. Shaffer [sup.1] , Jessica G. Smith [sup.1] , Jillian V. Glazer [sup.1] , Fabian Camacho [sup.1] , Philip I. Chow [sup.1] , Meghan Mattos [sup.1] , Karen [...]

Aims: To synthesize literature examining (1) rural hospital or obstetric unit closures as a social determinant of maternal/infant health outcomes and (2) closures as a social determinant of racial/ethnic disparities in maternal/infant health outcomes. Design: Scoping review. Data Sources: MEDLINE, OVID/Embase and CINAHL were searched systematically to identify sources from 31 July 2003 to 31 July 2023. The Arksey and O'Malley methodology for scoping reviews was used. Results: Four studies from the United States and Australia documented the impact of rural hospital or obstetric unit closures on maternal/infant health outcomes, such as increased births in hospitals without obstetric units, out‐of‐hospital births or babies born before arrival, preterm birth, infant mortality and sociocultural risks that contribute to clinical risk. No eligible studies investigated hospital or obstetric unit closure as a social determinant of racial disparities in rural maternal/infant health outcomes. Conclusion: Despite significant racial and ethnic rural maternal health disparities, associations between rural closures and maternal health outcomes for racial and ethnic minorities are understudied. More research is needed to understand the extent to which rural closures, a social determinant of health, could disproportionately, negatively affect the health of racially and ethnically minoritized women. Implications for the Profession and Patient Care: Rural women have a greater risk of maternal and infant mortality and morbidity compared with urban women, and the impact of rural closures on racial and ethnic maternal health disparities is not well documented. Research about the impact of rural closures on maternal health disparities could inform policy to assure essential obstetric care is available for rural populations globally. Impact: Findings provide a call to action for research to understand relationships between rural closures and racial and ethnic maternal health disparities, which is especially important for serving rural Non‐Hispanic Black and American Indian/Alaska Native women. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim(s) Design Methods Data Sources Results Conclusion Impact Statement The aim of this systematic literature review was to determine the extent and quality of quantitative evidence regarding associations between hospital organizational features, person‐centred care (PCC) and nursing‐sensitive outcomes among persons with dementia in the acute care setting.Systematic review.Key terms were utilized to guide searches in four databases. The two reviewers deduplicated articles and came to a consensus for the final sample using inclusion and exclusion criteria.MEDLINE/OVID, CINHAL, COCHRANE and WEB OF SCIENCE.There were 10 studies included. PCC was associated with better outcomes for persons with dementia (i.e. decreased restraint use, decreased length of stay, increased involvement with families and the patient, and increased nurse confidence and competence in caring for this population). Of the studies, none explicitly identified an association between nursing‐sensitive outcomes, PCC and hospital organizational features in the acute care setting among persons with dementia.This review highlights a clinically significant gap in knowledge regarding associations between hospital organizational features, PCC and nursing sensitive outcomes. The impact of face‐to‐face dementia competency training as a standard practice among acute care facilities, the importance of leadership engagement, support and involvement to improve nurse confidence and competence in caring for persons with dementia needs to be explored.These findings support future research to understand the relationship between organization features and patient‐centred care and how these collectively impact nursing‐sensitive outcomes, specifically in persons with dementia in acute care settings. [ABSTRACT FROM AUTHOR]

Purpose: Rural populations face healthcare access challenges, including rural care provider shortages and rural hospital closures. Simulation-based education could help prepare prelicensure nursing students to address healthcare access challenges for rural populations in their nursing practice through an empathetic approach, however, there is minimal evidence comparing the effectiveness of simulation and to non-simulation education methods on this topic. The purpose of this study was to compare the effectiveness of a simulation and non-simulation online nursing education intervention on nursing student empathy, confidence, knowledge, and advocacy to care for rural populations. Sample: Prelicensure nursing students (n=25) enrolled in their final semester of nursing school completed this study. Method: This study used a two-group pre-post-test design. The authors designed and created simulation-based and non-simulation-based interventions about rural population health piloted in a population and community health nursing course. Pre-post-survey data were collected about participant self-assessment of their empathy, confidence, knowledge, and advocacy. Findings: Confidence and knowledge mean scores increased for both the simulation and non-simulation groups. The mean empathy score did not change for the simulation group from baseline, and a one point mean score increase in empathy was observed for the non-simulation group. The mean score for advocacy did not change for either simulation group. Using a mixed model to estimate effects of interventions, time, and age on confidence, there was a significant effect between time 1 and time 2 for confidence (F=9.02, p=0.01), but not a significant effect observed between the different simulation types, the interaction between time and the intervention type, or age. Conclusions: Both the simulation and non-simulation online interventions created for this study provide an effective approach to instilling knowledge and confidence in prelicensure nursing students toward the rural population's healthcare needs by introducing potential solutions to address the challenges of caring for rural populations. [ABSTRACT FROM AUTHOR]

The article offers information on global health challenges in nursing, including facilitating healthcare delivery in conflict and crisis, expanding access to healthcare, and mitigating infectious diseases. It discusses the importance of emerging qualitative and quantitative research methodologies to address these challenges, highlighting the publication of various methodologies in the Journal of Advanced Nursing (JAN) to enhance nursing research and its impact on global health.

The purpose of this case study was to determine the feasibility of delivering a course on-campus and in real time, simultaneously transmitting it to students who were remotely accessing the same course. In future years, it is anticipated that universities will have inadequate physical facilities to meet the demands of an increasing student population. Additionally, with warnings of impending pandemics, universities need to be prepared to deliver courses in alternative ways to ensure continuity of instruction. Thus, this pilot project was designed to deliver a course to a large section of students while also allowing off-campus students access to the course in real time. The planning and delivery of the course is described, including the technology used, the support provided by the university and technology support staff, the course that was used for the pilot project, and how students were selected to participate as the off-campus students. The perspectives of the instructor, teaching assistant, students (both on- and off-campus), and technology support personnel are summarized.

The Republic of South Africa has the highest documented fetal alcohol syndrome prevalence globally. In the Limpopo province, little is known about students' or community members' knowledge of fetal alcohol syndrome or fetal alcohol spectrum disorder rates and risk behaviors. The aim of this study was to characterize and compare knowledge about fetal alcohol syndrome and other fetal alcohol spectrum disorders and the related behaviors such as drinking among University of Venda students and local community residents in villages to inform educational efforts to prevent fetal alcohol syndrome. Participants (n = 404) were from the University of Venda and two villages, Maungani and Ha-Mangilasi, and completed an epidemiological survey about their characteristics, behaviors, and fetal alcohol spectrum disorder risks. We analyzed differences between the university students and community residents in fetal alcohol syndrome knowledge and the related risk behaviors. University students have heard of fetal alcohol syndrome (Fisher's exact test p <.001), have seen warning labels about drinking during pregnancy (Fisher's exact test p =.003), and were aware that a baby is born with birth defects if diagnosed with fetal alcohol syndrome (Fisher's exact test p =.03) with more knowledge of fetal alcohol syndrome compared to community residents. Most respondents thought it was unacceptable to drink during pregnancy. Despite this, a substantial number of participants thought it was acceptable to have one drink after pregnancy recognition. There was little knowledge of best practices about alcohol consumption to prepare for pregnancy, or once recognized. We recommend an education campaign to raise awareness of fetal alcohol spectrum disorders across Limpopo, especially in smaller villages, and further research to determine demographic and experiential risk factors to aid in prevention efforts. [ABSTRACT FROM AUTHOR]

Intimate partner violence is an ongoing issue in South Africa, which has the highest rates of violence against women and girls in the world. Intimate partner violence is common in Limpopo, where women, including university students, experience elevated rates of violent crime. This qualitative study was conducted to examine university students' perspectives regarding intimate partner violence among their peers. A culturally tailored vignette was used to prompt reflection from 38 female university students in Limpopo. Audiotaped responses to the vignette were transcribed, coded and analysed using thematic analysis. Four main themes were developed from participants' responses to the vignette: cultural beliefs, the university's role in intimate partner violence, likely outcomes of intimate partner violence, and future interventions. Intimate partner violence was seen as a common problem within the university. Students' responses indicated that cultural beliefs perpetuated violence against women, with women entering and remaining in abusive relationships for financial security or resources such as housing. Students also reported lack of adequate on-campus housing options, limited knowledge of intimate partner violence, and few actions to reduce intimate partner violence, all of which placed then at heightened risk of intimate partner violence. [ABSTRACT FROM AUTHOR]

Aims: To explore factors associated with nurses' moral distress during the first COVID-19 surge and their longer-term mental health. Design: Cross-sectional, correlational survey study. Methods: Registered nurses were surveyed in September 2020 about their experiences during the first peak month of COVID-19 using the new, validated, COVID-19 Moral Distress Scale for Nurses. Nurses' mental health was measured by recently experienced symptoms. Analyses included descriptive statistics and regression analysis. Outcome variables were moral distress and mental health. Explanatory variables were frequency of COVID-19 patients, leadership communication and personal protective equipment/cleaning supplies access. The sample comprised 307 nurses (43% response rate) from two academic medical centres. Results: Many respondents had difficulty accessing personal protective equipment. Most nurses reported that hospital leadership communication was transparent, effective and timely. The most distressing situations were the transmission risk to nurses' family members, caring for patients without family members present, and caring for patients dying without family or clergy present. These occurred occasionally with moderate distress. Nurses reported 2.5 days each in the past week of feeling anxiety, withdrawn and having difficulty sleeping. Moral distress decreased with effective communication and access to personal protective equipment. Moral distress was associated with longer-term mental health. Conclusion: Pandemic patient care situations are the greatest sources of nurses' moral distress. Effective leadership communication, fewer COVID-19 patients, and access to protective equipment decrease moral distress, which influences longer-term mental health. Impact: Little was known about the impact of COVID-19 on nurses' moral distress. We found that nurses' moral distress was associated with the volume of care for infected patients, access to personal protective equipment, and communication from leaders. We found that moral distress was associated with longer-term mental health. [ABSTRACT FROM AUTHOR]

Purpose: Rural hospital closures result in the loss of lifesaving acute care for rural residents and threaten the health of rural communities significantly. Understanding short- and longer-term effects nurses experiences related to a rural hospital closure can pose a unique challenge, as nurses may relocate and become difficult to identify. In this paper, the authors describe the strategies used during a pandemic to recruit and retain rural nurse research participants who experienced a rural hospital closure. Strategies presented may help nurse researchers recruit a unique and difficult-to-reach rural nurse population during a pandemic. Sample: The sample consisted of nurses who worked in a rural hospital that closed between 2014 to 2020 in one Southwestern state. Method: The authors describe multiple strategies used to recruit rural nurses such as public outreach, social media outreach, and personal outreach. Public outreach was used through professional organization e-mail listservs and printed newspaper advertisements. Social media outreach included public posts online. Personal outreach to former rural hospital employees who were existing contacts was through personal social media messages, phone calls, and texts. Findings: The most effective method for recruitment and retention was personal outreach through rural hospital champions who sent personal messages using social media. The final sample included 10 nurses from two rural hospitals that closed. Five nurses reported about a hospital that closed in 2014, while five nurses reported about a hospital that closed in 2015. Conclusion: For successful recruitment, future researchers should use a direct, personal recruitment strategy to recruit and retain rural nurse research participants for studies about rural hospital closures. Other strategies for successful rural nurse recruitment for research include planning for an extended recruitment timeline, being flexible with participants regarding data collection procedures, cultivating research interest among rural nurses, and building a culture of research in rural settings. [ABSTRACT FROM AUTHOR]

Aim: To identify evidence related to association between the nurse work environment and severe maternal morbidity in high‐income countries. Design: Quantitative Systematic review. Data Sources: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PubMed/Medline, and Scopus were systematically searched for studies published in English from January 1990‐December 2019. Studies were selected based on a priori eligibility criteria. Review Methods: Two independent reviewers used a two‐phase screening process. First, the reviewers assessed the eligibility of studies based on titles and abstracts; followed by assessing the full text of all remaining studies based on the eligibility criteria. An adapted version of the Joanna Briggs Institute data extraction tool was created to extract relevant information from studies reviewed during the second screening phase. Results: Of the 535 de‐duplicated articles examined by two independent reviewers, there were no eligible empirical studies that assessed the association between nurse work environment and severe maternal morbidity. Conclusion: There is a critical gap in knowledge regarding how characteristics of the nurse work environment may influence severe maternal morbidity in high‐income countries. Future directions for nursing research include using available maternal health surveillance hospital‐level data, conducting high‐quality studies, and using evidence‐based frameworks to guide future studies. Future directions for nursing practice include leveraging professional learning communities for nursing education and training and leveraging quality improvement initiatives. Impact: As the first known systematic review of its kind, this 'empty review' provides evidence of a lacking body of literature on the association between nurse work environment, as a modifiable organizational characteristic and preventable severe maternal morbidity in high‐income countries. This article provides a call to action in the form of five recommendations for future nursing research and practice, which could serve to elucidate research, practice, and policy opportunities to reduce preventable severe maternal morbidity in high‐income countries. [ABSTRACT FROM AUTHOR]

The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses (N = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units. Nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. The most common activities missed involved patient comfort and counseling and parent education. Workloads have increased and work environments have deteriorated compared with 8 years ago. Nurses' assignments should account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes. [ABSTRACT FROM AUTHOR]

Missed nursing care is a significant threat to quality patient care. Promoting collective efficacy within nurse work environments could decrease missed care. The purpose was to understand how missed care is associated with nurse work environments and collective efficacy of hospital staff nurses. A cross-sectional, convenience sample was obtained through online surveys from registered nurses working at five southwestern U.S. hospitals. Descriptive, correlational, regression, and path analyses were conducted (N = 233). The percentage of nurses who reported that at least one care activity was missed frequently or always was 94%. Mouth care (36.0% of nurses) and ambulation (35.3%) were missed frequently or always. Nurse work environments and collective efficacy were moderately, positively correlated. Nurse work environments and collective efficacy were associated with less missed care (χ2 = 10.714, p = .0054). Fostering collective efficacy in the nurse work environment could reduce missed care and improve patient outcomes. [ABSTRACT FROM AUTHOR]