Barriers and Challenges Experienced by Latina Nurse Leaders

Introduction: Leadership reflecting and representing the diversity of the workforce and patient population has been an ongoing challenge for healthcare institutions. As hospitals strategically plan to improve diversity, equity, and inclusion within their intuitions, especially in executive and other leadership roles, it must be acknowledged that only about 5.3% of the nursing workforce is Latinx and few serve in leadership positions. This study aims to learn about the barriers and challenges Latina nurse leaders have experienced in their ascension into leadership roles. Methods: Using a qualitative descriptive study approach, Latina nurse leaders were interviewed one-on-one about their nursing journey and the challenges experienced. A conventional thematic content analysis approach was used to identify common themes. Results: Seventeen Latina nurse leaders shared their experiences. The themes that emerged included: imposter syndrome being the only one, the need to work harder to be seen, age discrimination, racism and racial discrimination, lack of mentorship, and motherhood. Conclusion: Findings from this study help to highlight barriers to leadership development and success of Latina nurses. The findings can be used to encourage, mentor, and support Latina nurses throughout their careers, so they are provided with opportunities for advancement and nurtured as they become leaders.

Examining the Qualitative Experiences of Latinx Nurses During the First Wave of COVID-19

Introduction: The world has been impacted by the coronavirus disease 2019 (COVID-19) pandemic since March of 2020. Latinx nurses have been some of the most underrepresented in being studied during this time and have been greatly affected by it. To the best of our knowledge, there are no published studies that focus on the qualitative experiences of Latinx nurses during the first wave of the pandemic. Methods: Data analysis included thematic analysis to identify main themes experienced by Latinx nurses. A qualitative descriptive study design was employed to conduct a parent study with 100 nurses across the United States reflecting on their experiences during the first wave of the COVID-19 pandemic, data collected from May to September 2020. Formal coding of the interview data was conducted utilizing Dedoose cloud-based software. Results: Five main themes emerged, including (1) connection to patients' personal touch and empathy, (2) connection to Latinx nurses, (3) connection to family and friends, (4) connection to food as care, and (5) coping. Within the theme of coping, subthemes of (5.1) faith, (5.2) maladaptive behaviors, and (5.3) self-care activities emerged. Conclusion: These experiences can help shape the pathway to be better prepared for any emergency or future pandemic.

Motivators and Barriers to COVID-19 Vaccination in Young Adults Living in the USA

High rates of COVID-19 infection and lower vaccination rates among young adults aged 18 to 26 in the United States prompted this study to examine motivating factors and barriers to COVID-19 vaccination and identify preferences in COVID-19 vaccine education. Three focus group discussions were completed. Transcribed data were analyzed using thematic analysis. Three key themes were identified including (1) motivating factors to vaccination, (2) barriers to vaccination, and (3) COVID-19 vaccination educational intervention design recommendations. Motivating factors included five relevant subthemes: civic duty, fear related to the disease process; fear related to emerging variants and breakthroughs; fear regarding the suffering of others; and freedom. Barriers included four subthemes: lack of trust, misinformation, politics, and pressure. Attempts to further educate young adults about the COVID-19 vaccine should consider strategies that target motivating factors and barriers while also making accurate information accessible through social media.

Fetal hemoglobin regulating genetic variants identified in homozygous (HbSS) and heterozygous (HbSA) subjects from South Mexico

Hemoglobin S is caused by a nucleotide change in HBB gene (HBB:c.20A>T, p.Glu6Val), is presented in diverse forms: simple carriers (HbSA), homozygotes (HbSS) also known as sickle cell anemia, and compound heterozygotes with other β-hemoglobinopathies. It is worldwide distributed, in Mexico, is frequently observed in the southern states Guerrero, Oaxaca and Chiapas. Elevated fetal hemoglobin (HbF) is associated with mild phenotype; single-nucleotide variants (SNVs) in modifier genes, such as BCL11A, HBG2, HBBP1 pseudogene and HBS1L-MYB intergenic region, upregulate HbF synthesis. The aim of this study was to identify HbF regulating genetic variants in HbSS and HbSA Mexican subjects. We studied 39 individuals (HbSS = 24, 61%, HbSA = 15, 39%) from Chiapas (67%) and Guerrero (33%), peripheral blood was collected in ethylenediamine tetraacetic acid (EDTA) for molecular and hematological studies, DNA was isolated by salting-out technic and genotyping was performed through allelic discrimination by real time polymerase chain reaction (RT-PCR) using Taqman® probes for 15 SNV (in BCL11A: rs6706648, rs7557939, rs4671393, rs11886868, rs766432, rs7599488, rs1427407; HBS1L-MYB: rs28384513, rs7776054, rs9399137, rs4895441, rs9402686, rs1320963; HBG2: rs7482144; and HBBP1: rs10128556). The obtained data were analyzed using IMB SPSS v.22.0 software. All minor alleles were observed in frequencies over 0.05, the most frequent was rs9402686 (0.82), while the less frequent was rs101028556 (0.08). In HbSS group, the mean fetal hemoglobin was 11.9 ± 5.9% and was significantly elevated in BCL11A rs11886868 wildtype homozygotes and in carriers of HBS1L-MYB intergenic region rs7776054 (p = 0.04 and p = 0.03, respectively). In conclusion, in HbSS Mexican patients, two SNVs were observed related to increased HbF; BCL11A rs11886868 and HBS1L-MYB rs7776054.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice

Introduction

The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21^st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response.

Methods

One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team.

Results

Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress.

Conclusion

Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.

Predictors associated with new nursing faculty's intent to leave nursing academia: teaching preparation in doctoral program, institutional supports, and job satisfaction

OBJECTIVES

The purpose of this study was to examine the relationships among demographics, doctoral teaching preparation, nurse faculty institutional support, faculty job satisfaction, and intent to leave current nursing academic position in PhD- and DNP-prepared faculty.

METHODS

Using a survey research design, invitations to a Qualtrics survey were emailed to nursing program directors. Independent samples t-tests and logistic regression models were used to determine the nature of the relationships.

RESULTS

In total, 149 participants completed the survey. Degree type, age, and job satisfaction were significant predictors related to intent to leave nursing academia. Doctoral program teaching preparation and institutional support were not statistically associated with intent to leave nursing academia.

CONCLUSIONS

Findings suggest older age, PhD-prepared faculty, and job dissatisfaction were significant factors influencing decisions to leave nursing academia among the doctoral prepared new nursing faculty. Efforts to retain or increase the number of nurse faculty must be prioritized.

Barriers to Dialysis Home Therapy Utilization: A Systematic Review

Barriers to the utilization of home therapy among patients with chronic kidney disease (CKD) impact progression to kidney failure and access to treatment options. The impact of health disparities on home therapy utilization receiving kidney replacement therapy requires investigation. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted to examine health disparity barriers to home therapy utilization among patients with kidney failure. Twelve articles published from 2010-2020 identified relationships between health disparities and home dialysis utilization among adults receiving kidney replacement therapy. Findings included association between the utilization of home therapy and the barriers of race/ethnicity (n = 5), economic barriers (n = 4), and insurance type (n = 3). Implications of findings are provided.

Recruitment Strategies to Optimize Participation by Diverse Populations

The authors describe the methodological strategies used to effectively recruit a diverse sample of nurses in a qualitative study. Adequate representation of diverse populations is necessary to advance science and health equity. A multimodal research approach (research team composition, flyers, social media, and purposive sampling) was used. When undertaking research with underrepresented groups, recruitment efforts should begin in the early phases of study planning with research team development that can assist in employing multiple recruitment strategies accordingly.

Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study

Aim

The aim of this study was to conduct a primary examination of the qualitative communication experiences of nurses during the first wave of the COVID‐19 pandemic in the United States.

Background

Ambiguity in ever‐evolving knowledge on how to provide care during COVID‐19. Remaining safe has created a sense of urgency, which has in turn created the need for organizations to quickly alter their operational plans and protocols to support measures that increase capacity and establish a culture of safe care and clear communication. However, no known study has described communication in nursing practice during COVID‐19.

Methods

Utilizing qualitative descriptive methodology, semi‐structured interviews were conducted with 100 nurse participants from May to September 2020 and recorded for thematic analysis. The consolidated criteria for reporting qualitative studies (COREQ), a 32‐item checklist, were used to ensure detailed and comprehensive reporting of this qualitative study protocol.

Findings

Study participants shared descriptions of how effective communication positively impacted patient care and nursing practice experiences during the first wave of the COVID‐19 pandemic. The thematic network analyses identified the importance of effective communication across three levels: (1) organizational leadership, (2) unit leadership and (3) nurse‐to‐nurse communication. Within this structure, three organizing themes, essential to effective communication, were described including (a) presence, (b) education and (c) emotional support.

Conclusion

Examining existing crisis communication policies and procedures across healthcare organizations is imperative to maintain highly relevant, innovative, and data‐driven policies and strategies that are fundamental to preserving quality patient care and supporting optimal nursing practice.

Implications for Nursing Policy and Health Policy

Effective communication is critical to support nurses through extended periods of crisis. COVID‐19 represents a unique contemporary challenge to the nursing workforce given the high stress and prolonged strain it has created for both human and healthcare supply resources. There is value in nurses’ presence at local, unit level and organizational leadership levels to convey critical information that directly informs leadership decision‐making during unprecedented emergencies such as the COVID‐19 pandemic.

Unsafe abortion in Brazil: a systematic review

Background

In Brazil, abortion is legally allowed in cases of risk to the woman's life, pregnancy resulting from rape and cases of fetal anencephaly. Despite the restrictive legislation, studies estimated that around 1 million abortions took place in the country in 2005. Abortions occurred regardless of womeńs socioeconomic position, race, age and religion, but unsafe practices were more common among young women, with low educational levels, single, students or domestic workers. This study sought to update knowledge on unsafe abortion in Brazil.

Methods

We carried out a systematic review with study search on Medline and LILACS, with no language restriction, from 2008 to 2018. We evaluated article quality using the Joanna Briggs Institute instruments. We evaluated 50 articles.

Results

There was a decrease in the ratio of induced abortions by 1,000 women of reproductive age reaching 16 per 1,000 in 2013. However, direct estimates do not indicate a decrease in the prevalence of induced abortion, estimated to be 13% in 2016. Higher prevalences were observed in more socially vulnerable populations. Half of all women reported using medications for terminating pregnancies and the number of hospital admissions due to complications from abortion decreased from 1992 to 2009. Maternal morbimortality from abortion had a reduced frequency but it is likely that maternal deaths from abortion are under-reported.

Conclusions

Abortion is frequently used in Brazil, especially in less-developed regions and by more socially-vulnerable women. Access to safer methods probably contributed to the reduction of complications, hospitalizations and morbimortality from abortion. However, half of all women still used other unsafe methods and the number of admissions due to complications from abortion is still high. The small scientific production and lack of methodological adequacy led to the development of a special issue on Abortion in Brazil in the jornal Reports in Public Health.

Key messages

Restrictive legislation does not prevent abortion, but limits access to safe abortion and makes it diffiult to prevent morbidity and mortaliity from abortion. Restrictive legislation and the stigma associated with abortion make studies difficult to estimate the rates, complications and factors associated with abortion.

Culturally Congruent Health Care of COVID-19 in Minorities in the United States: A Clinical Practice Paper From the National Coalition of Ethnic Minority Nurse Associations

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial-ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial-ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.

Exploring the Need of HPV Education Programs in Korean American Communities

Given the significantly higher cervical cancer risks faced by Korea Americans (KA), the aim of this study was to explore cultural influences and barriers affecting human papillomavirus (HPV) vaccination decisions and preferred educational methods to effectively deliver HPV information. Focus groups included 20 KA parents. This study found a lack of knowledge about HPV and the vaccine, along with negative perceptions about the vaccine, affects HPV vaccination decision-making. Ineffective conversations and a lack of HPV vaccine recommendations by health care providers influenced by cultural beliefs were found to be another major barrier. These findings reveal new insights to guide the development of HPV education programs.

Increasing Awareness of the All of Us Research Program in Latino Communities

Introduction:

The All of Us Research Program is funded by the National Institutes of Health. The aim of the program is to gather data from at least 1 million people of diverse backgrounds living in the United States to accelerate research and improve health. The purpose of this article is to discuss the collaboration of the All of Us Research Program and the National Association of Hispanic Nurses (NAHN) to increase awareness of the All of Us Research Program in Latino communities.

Method:

A community-based education approach by NAHN chapters across the country was used. The Sprint 1 grant was funded to increase awareness in health care providers of Latino communities. The Sprint 2 grant was funded to increase awareness in Latino communities.

Results:

A total of 8 NAHN chapters were selected to disseminate the All of Us Research Program information. These initiatives reached more than 156,000 health care providers and the chapters participated in 31 community-based activities across the country reaching thousands of Latinos.

Discussion:

The collaboration between the All of Us Research Program and NAHN was instrumental in disseminating information to the Latino population. Developing trust in Latino communities is an essential component of program success.

The impact of burnout on doctorate nursing faculty's intent to leave their academic position: A descriptive survey research design

BACKGROUND

Despite the fact that the great demands placed on many nursing faculty put them at high risk for job burnout; there are limited studies exploring the relationship between burnout and leaving their academic positions.

OBJECTIVE

The objective of this study is to address the national nursing faculty shortage by examining demographics, teaching preparation in the doctoral program, and burnout to determine intent to leave nursing academia among PhD and DNP-prepared nursing faculty.

DESIGN

A descriptive survey research design was used to identify the most significant factors related to faculty intent to leave their academic position.

SETTINGS

An online national survey of doctorate faculty throughout the U.S. was administered.

PARTICIPANTS

Full-time nursing faculty who had earned a PhD or DNP degree in nursing with four or less years ofteaching experience after doctoral program graduation were recruited.

METHODS

Data was collected from an the online survey posted on Qualtrics. Logistical regression models were used to interpret data significance.

RESULTS

A total of 146 nursing faculty responded to the online survey. 51.4% of the respondents (n = 75) had a DNP degree and 48.6% (n = 71) had a PhD degree. 61% of the respondents were over the age of 50 with the remaining 39% of the respondents between ages 20 and 49. PhD-prepared faculty reported higher emotional exhaustion compared to DNP-prepared faculty. Findings revealed that degree type (PhD versus DNP), age, and emotional exhaustion and depersonalization in burnout were significant predictors related to intent to leave nursing academia.

CONCLUSIONS

To address the nursing faculty shortage issue, it is critical to create supportive and positive working environments to promote the well-being of nursing faculty, provide additional emotional support for the specific PhD-prepared faculty needs that contribute to burnout, and encourage nurses to begin an academic career earlier to help retain nursing faculty in academic settings.

A Needs Assessment for Development of the TIME Anesthesia Handoff Tool

Standardized handoff is critical to providing safe and effective patient care. Limited studies assess the need for developing a handoff tool for anesthesia providers. The purpose of this descriptive study was to assess the need for a standardized anesthesia handoff tool and to identify the most essential components to develop an anesthesia handoff tool. A descriptive survey design was used. Anesthesia providers were asked to complete an online survey. Fifty-three (64%) of 82 respondents did not currently use a systematic process during anesthesia handoff. Most (73%) believed they were given inadequate information, and 40 (48.8%) sometimes discovered information that was not shared by the prior anesthesia provider. The most frequently provided components by respondents were airway type, airway difficulty, analgesia, anesthetic type, invasive lines, patient medical history, procedure, and vital signs. The most frequently received were airway difficulty, invasive lines, medical history, and procedure. Most participants perceived that anesthesia providers currently provide inadequate handoff. Anesthesia providers indicated the most essential components for effective anesthesia handoff were airway difficulty, invasive lines, medical history, procedure and casespecific concerns, allergies, medications, and plan/ goals. The study findings guided the development of the concise and efficient TIME (transaction, induction, maintenance, emergence) anesthesia handoff tool.

Caveolin isoform expression during differentiation of C6 glioma cells

Caveolae, a specialized form of lipid rafts, are cholesterol- and sphingolipid-rich membrane microdomains implicated in potocytosis, endocytosis, transcytosis, and as platforms for signal transduction. One of the major constituents of caveolae are three highly homologous caveolin isoforms (caveolin-1, caveolin-2, and caveolin-3). The present study expands the analysis of caveolin isoform expression in C6 glioma cells. Three complementary approaches were used to assess their differential expression during the dibutyryl-cyclic AMP-induced differentiation of C6 cells into an astrocyte-like phenotype. Immunoblotting, conventional RT-PCR, and real-time RT-PCR analysis established the expression of the caveolin-3 isoform in C6 cells, in addition to caveolin-1 and caveolin-2. Similar to the other isoforms, caveolin-3 was associated with light-density, detergent-insoluble caveolae membrane fractions obtained using sucrose-density gradient centrifugation. The three caveolin isoforms display different temporal patterns of mRNA/protein expression during the differentiation of C6 cells. Western blot and real-time RT-PCR analysis demonstrate that caveolin-1 and caveolin-2 are up-regulated during the late stages of the differentiation of C6 cells. Meanwhile, caveolin-3 is gradually down-regulated during the differentiation process. Indirect immunofluorescence analysis via laser-scanning confocal microscopy reveals that the three caveolin isoforms display similar subcellular distribution patterns. In addition, co-localization of caveolin-1/caveolin-2 and caveolin-1/caveolin-3 was detected in both C6 glioma phenotypes. The findings reveal a differential temporal pattern of caveolin gene expression during phenotypic differentiation of C6 glioma cells, with potential implications to developmental and degenerative events in the brain.

Characterization of the antitumor activity of a polyantigenic immunomodulator (PAI): II--Involvement of NK cells and adoptive immunotherapy

Natural killer (NK) cell activity and adoptive immunotherapy were used to characterize the anticancerous effect of a polyantigenic immunomodulator (PAI). PAI consists of a mixture of inactivated bacteria and influenza virus in a peanut oil-arlacel A-aluminum monoesterate emulsion, shown previously to have antitumoral activity in mice implanted with Ehrlich's ascites tumor. The administration of PAI, its bacterial or viral component strongly increased the in vitro activity of NK cells of splenocyte populations obtained from Swiss-Webster (allogeneic) and C57BL/6J (syngeneic) mice, specially during the early post-induction period. On the other hand, PAI-sensitized, allogeneic or syngeneic lymphocytes were transferred successfully to tumor-bearing mice implanted with Ehrlich's ascites tumor, reducing tumor growth and increasing survival. The results confirm our previous suggestions that PAI acts probably at the level of cellular immunity. Therefore complex polyantigenic substances such as PAI could be used directly alone, in combination with other immunoadjuvants or to sensitize in a global manner immunocompetent cells to be employed in adoptive immunotherapy.

Deep venous thrombosis in high-risk hemiplegic patients: detection by impedance plethysmography

Clinically significant thromboembolic disease originating from the paralyzed leg of hemiplegic patients can occur unexpectedly and may affect morbidity and mortality in the rehabilitation setting. Impedance plethysmography (IPG), a simple, noninvasive technique, can accurately reveal deep vein thrombosis (DVT) in the large veins of the thigh. IPG studies were performed on the lower extremities of 20 hemiplegic patients considered at high risk for DVT. Each patient had one or several of the following potential risk factors: mild swelling, vague leg discomfort, loss of sensation, poor or absent muscle power at the ankle, at least one week of complete bedrest, repeated minor trauma. None of the patients had major signs or symptoms of DVT at the time of testing (ie, severe pain and tenderness, increased temperature or redness, a palpable venous cord, or positive Homans' sign). Seven patients had an abnormal IPG in the paralyzed lower limb and DVT was confirmed in each case by venography. After appropriate anticoagulation therapy, the seven patients resumed their rehabilitation programs. It was concluded that IPG can be successfully used in the early detection of DVT in high-risk hemiplegic patients, thus leading to prompt medical management, reduced morbidity and mortality, and improved rehabilitation outcome.