Pediatric nurses' fatigue descriptions in occupational injury reports: A descriptive qualitative study1.

Background: Despite the high risks associated with occupational fatigue in healthcare, few organizations require nurses to screen and report fatigue symptoms. As a result, little is known about if and how nurses would report fatigue while on the job. Objective: To determine if hospital-based pediatric nurses reported fatigue as part of an active injury reporting method. Methods: This secondary analysis of qualitative data used a descriptive design with content analysis. Data from the parent study were collected at a U.S. pediatric hospital where nurses verbally reported on-shift injuries or near misses and pre- and post-shift health status via a digital voice recorder. Researchers used content analysis to independently code data for nurses' references to fatigue. Codes were then analyzed for patterns and themes. Results: Approximately 30% (n = 104) of participants reported fatigue-related content. Emergent themes were Work Stressors, Individual Risk Factors, Fatigue Descriptors, Adverse Outcomes from Fatigue, Fatigue Buffers, Descriptors for Buffered Fatigue, and Favorable Outcomes from Buffered Fatigue. Fatigue descriptions align with prior literature, demonstrating the accuracy of the voice recorder data collection method. In addition, nurses expressed uncertainty about the appropriateness of reporting fatigue symptoms. Conclusion: Findings from this study support pediatric nurses will report fatigue, when provided an opportunity. Additional efforts are needed to better understand effective ways to improve fatigue reporting among nurses, including harnessing current technology for real-time reporting and how to change the culture around fatigue reporting.

Andragogy in Practice: Applying a Theoretical Framework to Team Science Training in Biomedical Research.

This study is the first to apply the theoretical principles of Malcolm Knowles' theory of andragogy to evaluate data collected from learners who participated in team science training workshops in a biomedical research setting. Briefly, andragogy includes six principles: the learner's self-concept, the role of experience, readiness to learn, orientation to learning, the learner's need to know, and intrinsic motivation. Using an embedded study design, the primary focus was on qualitative data, with quantitative data complementing the qualitative findings. The deductive analysis demonstrated that approximately 85% of the qualitative data could be connected to at least one andragogical principle. Participant responses to positive evaluation questions were largely related to two principles: readiness to learn and problem-based learning orientation. Participant responses to negative questions were largely connected to two different principles: the role of experience and self-direction. Inductive analysis found an additional theme: meeting biological needs. Quantitative survey results supported the qualitative findings. The study findings demonstrate that andragogy can serve as a valuable construct to integrate into the development of effective team science training for biomedical researchers.

A qualitative study of ethnic Korean women and men's experiences of HPV and HPV vaccination in the United States.

INTRODUCTION: Approximately 42.5% of adults aged 18-59 in the United States is estimated to be affected by human papillomavirus (HPV) infection. However, Asian Americans have the lowest HPV vaccination initiation rate compared to other racial groups. This study aims to explore the experiences of HPV and the HPV vaccination among ethnic Korean women and men in the United States. METHODS: A total of 33 ethnic Korean and Korean Americans aged 27-45 years living in the U.S. were recruited via word-of-mouth and social media using a purposive sampling strategy. They participated in an online survey. Of the 33 participants, 29 (14 females and 15 males) participated in in-depth interviews via password-protected Zoom. A content analysis approach was used to analyze the interviews. RESULTS: Only 32% of participants had received the HPV vaccine at least once (female: 35.3%, male: 12.5%). Six major themes emerged from data analysis: (1) awareness of HPV, HPV vaccine, and HPV-associated cancers; (2) attitudes toward the HPV vaccine; (3) barriers to HPV vaccination; (4) women's experiences and preferences for pap smear testing; (5) experiences with HPV diagnosis; and (6) HPV and HPV vaccination education preferences. CONCLUSION: The findings highlight cultural factors that may impede the discussion about and uptake of HPV vaccination and HPV-associated cancer screening, which emphasize the need for culturally appropriate interventions to overcome stigma around HPV and enhance vaccination rates. Healthcare providers should consider ethnic and cross-cultural differences perceptions to effectively HPV-related health information. This study provides insight into the experiences and understanding of HPV and vaccination among ethnic Korean men and women, laying the groundwork for developing culturally-tailored programs that sim to increase HPV vaccination rates and mitigate the stigma and impact of HPV-related disease in this community.

Shared Risk Factors Among Women for Intimate Partner Violence in the United States: A Secondary Analysis.

Multilevel risk factors may increase the risk of experiencing intimate partner violence among women. The overall goal of this study was to provide a comprehensive view of factors that may be associated with three forms of intimate partner violence. The primary aim was to explore associations between understudied factors and women's experiences of physical and sexual violence and stalking by an intimate partner. Secondary analysis of existing health registry data was conducted. Our evidence-driven strategy was based on a multipronged analytical approach informed by existing literature and the social-ecological model. We created an evidence-based hierarchical list comprised of three tiers. Three separate multiple logistic regression analyses were performed. Several shared risk factors were retained across all three forms including low levels of formal education, past experiences of non- partner sexual violence, residential instability, presence of children, experiences of a traumatic event and panic attacks, status of receiving US government benefits, and barriers to healthcare access. Results contribute to future research on intimate partner violence prevention by providing preliminary evidence of emerging factors associated with experiencing three forms of intimate partner violence.

The influences of sociocultural norms on women's decision to disclose intimate partner violence: Integrative review.

Sociocultural norms against women can contribute to promoting intimate partner violence (IPV) and shape women's decision to disclose IPV. A cross-cultural analysis of the existing literature is needed to present an overview of the influences of sociocultural norms on women's decisions regarding the disclosure of IPV across different cultural contexts. The purpose of the review was to synthesize published quantitative, qualitative, and mixed methods (MMs) studies to identify known sociocultural norms across different cultures that may influence women's decision to disclose IPV. The Whittemore and Knafl framework, Rayyan software, and PRISMA flow diagram were used. Databases included APA PsycInfo, CINAHL, PubMed, SocINDEX, and Women's Studies International. The quality of studies was assessed by the MMs appraisal tool. A total of 15 research articles written in English and published in peer-reviewed journals were included. Main categories emerged: (1) stigma surrounding IPV disclosure, victimization, and divorce; (2) gender roles; (3) preserving family honor; and (4) Children's well-being and future. A one-size-fits-all approach is not adequate for women who are considering disclosing IPV. Findings underscore that regardless of residing in individualistic countries, those sociocultural norms related to traditional gender roles and gender inequality are still important barriers to the disclosure of IPV among women with collectivist roots.

Interdisciplinary Collaboration in Appointment, Reappointment, Promotion, and Tenure Criteria: Does It Matter?

University faculty are called upon to address complex, contemporary problems using interdisciplinary approaches. But do appointment, reappointment, promotion, and tenure (ARPT) criteria reflect and reward this fundamental change in the nature of scholarly inquiry? We conducted a content analysis of ARPT criteria at one university to determine how interdisciplinary work is valued across disciplines and over time. We found noteworthy differences between colleges and disciplines: generally, creative disciplines placed higher value on individual contributions while the sciences supported interdisciplinary work. The emphasis on interdisciplinary work over time increased in only a few disciplines, as criteria became more current.

Identifying Strategies for the Management of Interruptions for Novice Triage Nurses Using an Online Modified Delphi Method.

PURPOSE: To use the Delphi Method to identify strategies used by triage nurses to effectively manage interruptions. DESIGN: This study was based on the concepts of Benner's Novice to Expert Model. An online, modified Delphi approach was used to engage triage, education, and operational management experts in generating consensus recommendations on successful strategies to address triage interruptions in the emergency department. METHODS AND ANALYSIS: A panel of nine triage, education, and operational management experts were selected based on their publication and presentation history. This panel participated in three Delphi rounds, providing individual responses during each round. All responses were entered into a RedCap database, which allowed research team members to synthesize the results and return summaries to the participants. Final consensus was reached among this panel regarding recommendations for successful strategies to address triage interruptions that can be encompassed in a training module. The experts were then asked to identify the best instructional modality for teaching each of the interruption management strategies. FINDINGS: Eight strategies to mitigate the impact of interruptions were identified: (a) ensure nurses understand impact of interruptions; (b) ensure nurses understand consequences of interruptions on cognitive demands of healthcare workers that could influence behavior and lead to errors; (c) apologize to current patient before tending to interruption and give expectation of when you will return; (d) triage the interruption and decide to (i) ignore interruption, (ii) acknowledge, but delay servicing, interruption, or (iii) acknowledge and service interruption, delaying completion of interrupted task; (e) identify urgent communication as anything clinically significant that impacts the patient immediately or requires immediate intervention; (f) use focused questions to clarify whether interruption can wait; (g) redirect nonpriority interruptions; and (h) finish safety-critical task or tasks near completion before tending to an interruption. The Delphi participants recommended the best teaching modality was simulation for six of the strategies. CONCLUSIONS: Participants agreed that there are strategies that can be taught to novice triage nurses to mitigate the impact of interruptions. The experts in operations management, emergency nursing, and education agree that creating simulations to teach each of these strategies is an effective way to educate nurses. CLINICAL RELEVANCE: Interruptions impact the quality of care provided to patients. Training nurses to prevent interruptions and mitigate the impact of interruptions when they occur has the potential to improve patient outcomes.

Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks.

The COVID-19 pandemic demands reassessment of head and neck oncology treatment paradigms. Head and neck cancer (HNC) patients are generally at high-risk for COVID-19 infection and severe adverse outcomes. Further, there are new, multilevel COVID-19-specific risks to patients, surgeons, health care workers (HCWs), institutions and society. Urgent guidance in the delivery of safe, quality head and neck oncologic care is needed. Novel barriers to safe HNC surgery include: (1) imperfect presurgical screening for COVID-19; (2) prolonged SARS-CoV-2 aerosolization; (3) occurrence of multiple, potentially lengthy, aerosol generating procedures (AGPs) within a single surgery; (4) potential incompatibility of enhanced personal protective equipment (PPE) with routine operative equipment; (5) existential or anticipated PPE shortages. Additionally, novel, COVID-19-specific multilevel risks to HNC patients, HCWs and institutions, and society include: use of immunosuppressive therapy, nosocomial COVID-19 transmission, institutional COVID-19 outbreaks, and, at some locations, societal resource deficiencies requiring health care rationing. Traditional head and neck oncology doctrines require reassessment given the extraordinary COVID-19-specific risks of surgery. Emergent, comprehensive management of these novel, multilevel surgical risks are needed. Until these risks are managed, we temporarily favor nonsurgical therapy over surgery for most mucosal squamous cell carcinomas, wherein surgery and nonsurgical therapy are both first-line options. Where surgery is traditionally preferred, we recommend multidisciplinary evaluation of multilevel surgical-risks, discussion of possible alternative nonsurgical therapies and shared-decision-making with the patient. Where surgery remains indicated, we recommend judicious preoperative planning and development of COVID-19-specific perioperative protocols to maximize the safety and quality of surgical and oncologic care.

Experiences of Care in the Emergency Department Among a Sample of Homeless Male Veterans: A Qualitative Study.

INTRODUCTION: Homeless populations are historically high users of the emergency department for low-acuity issues that could be treated in more appropriate settings such as primary care. Veterans make up 11% of the homeless adult population and are often seen in community and Veterans Affairs Medical Center (VAMC) emergency departments. The purpose of this study was to describe the experiences of a sample of homeless male veterans as they attempt to access health care in the emergency department. METHODS: Grounded theory methodology provided the overarching framework for this research project. Structured interviews were conducted with 34 male homeless veterans, with 25 discussing their ED care. Veterans were recruited and interviewed from one VAMC emergency department, an all-male emergency shelter, and 1 soup kitchen. Text units about ED use were extracted and compared from 25 recorded transcripts to identify categories. RESULTS: Three categories defined ED experiences: "no other option," "lack of voice," and "feeling valued." DISCUSSION: The sample of homeless veterans in this study provided first-person knowledge about their experiences receiving care in emergency departments. These results are consistent with previous research indicating that homeless populations are high users of ED care; however, they often feel undervalued and lack of empathy from health providers. Emergency nurses are an integral part of the ED health care delivery system for the homeless, providing advocacy and much needed education about health problems and alternatives to ED care. The insight obtained about the lives and experiences of veterans in the ED is valuable to the practice of emergency nurses.

Pursuing the Mission: How Homeless Veterans Manage Chronic Disease.

The purpose of this study was to describe and explain the process by which homeless veterans manage their chronic health problems. In the United States, over 550,000 people experience homelessness on any given night. Of these, over 11% are veterans of the military, many whom suffer from at least one chronic disease. Study participants included male homeless veterans with at least one chronic health problem recruited at a Veterans Affairs emergency department, a homeless shelter, and a soup kitchen. Semi-structured interviews with 32 veterans from the Vietnam/post-Vietnam era were audio-recorded, verified, and coded resulting in a theory entitled "pursuing the mission," which describes and explains four ways (deferring, exploring, embarking, embracing) they manage their chronic health problems. The findings from this study provide insight from individuals living this experience and will help guide the future delivery of health care to homeless veterans.

Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool.

: Background: Establishing peripheral IV access for infusions is one of the most common invasive procedures performed in the hospital setting, but it isn't always successful on the first attempt. Multiple attempts delay treatment and cause stress in patients and nurses. The literature reports that venipuncture skills are among the most challenging for novice nurses to master. OBJECTIVES: The goal of this quality improvement (QI) initiative was to develop, validate, and refine a simple evidence-based tool that novice nurses can use in the clinical setting to better identify those patients with preexisting conditions or anatomical variances that result in difficult IV access. METHODS: Novice nurses employed in an urban medical center were enrolled in a vascular access education program with didactic and skill-enhancement components. Based on evidence found in the literature, the QI team developed and piloted a difficult intravenous access (DIVA) tool tailored to the adult patient population served by this institution. Following an initial trial, the tool was further refined and retested with a larger group of novice nurses. In the first phase, there were 94 IV insertion attempts; in the second, there were 971 attempts, for a total of 1,065. The two samples were analyzed independently using descriptive statistics, and Pearson product moment correlation coefficients were calculated to examine the relationship between the DIVA tool and the various factors that could affect the establishment of IV access. RESULTS: Analysis of the first sample showed moderate positive correlations between DIVA tool scores and five variables: tough skin (scars, tattoos, or both), vein not palpable with tourniquet, vein not visible with tourniquet, IV drug use, and chronic renal failure. Analysis of the second sample showed high positive correlations between DIVA tool scores and the two vein visibility variables; moderate positive correlations between DIVA tool scores and chronic renal failure, altered fluid status, diabetes, IV drug use, tough skin (scars, tattoos, or both), and only one arm available; and low positive correlations between DIVA tool scores and frail and/or elderly skin and chemotherapy. Analysis of the degree of correlation between DIVA tool scores and the total number of IV insertion attempts per patient showed a moderate correlation (r = 0.32). All correlations were significant at P < 0.01. Eighty percent of the novice nurses who used the pilot tool and 84% who used the modified tool rated it as a good indicator of the degree of difficulty of IV access. CONCLUSIONS: The DIVA tool gave novice nurses a reliable indication of the probable difficulty of an IV insertion and resulted in a change in the IV policy standard at the institution, which now limits the number of peripheral IV insertion attempts to two per nurse and four per patient, bringing current policy into alignment with the 2016 Infusion Therapy Standards of Practice. Use of the revised and validated DIVA tool has the potential to enhance patient comfort and satisfaction and effect significant change in nursing practice.

Understanding the health of veterans who are homeless: A review of the literature.

The United States Department of Housing and Urban Development estimates that almost 50,000 veterans are homeless on any given night. Homeless veterans are at greater risk of health disparities than their housed counterparts due to the multifactorial nature of their health and social needs. The Department of Veterans Affairs, in collaboration with more than a dozen other federal agencies, has concentrated efforts to improve the health of this vulnerable population while enacting a plan to eliminate veteran homelessness within the near future. Understanding the unique health needs of veterans who are homeless allows the profession of nursing to better support these efforts. The purpose of this literature review was to provide comprehensive knowledge to nurses about the health of homeless veterans for their use in clinical practice, research, and in contributing to the positive health outcomes for this vulnerable population.

Employment Maintenance and Intimate Partner Violence.

Intimate partner violence (IPV) is a major public health problem in the United States. Negative outcomes of IPV affect women's attainment and maintenance of employment. The purpose of this study was to develop a theoretical framework that described and explained the process by which women who have experienced IPV attain and maintain employment. Grounded theory methodology was used to analyze interviews of 34 women who had experienced IPV. Analysis suggested that women who had experienced IPV could attain employment; however, they had difficulty maintaining employment. Entanglement of work and IPV was experienced by all 34 participants because of the perpetrator controlling their appearance, sabotaging their work, interfering with their work, or controlling their finances. Some women described ways in which they disentangled work from IPV through a dynamic unraveling process, with periods of re-entanglement, resulting in job security and satisfaction.

Designing and evaluating a health belief model-based intervention to increase intent of HPV vaccination among college males.

Since 2009, HPV vaccine has been approved by the FDA for use in boys and young men, but less than 1% of eligible males in the United States have taken this vaccine. This study developed and evaluated a Health Belief Model (HBM)-based intervention to increase vaccination rates in college men. In a randomized controlled trial, HBM-based intervention was compared with a traditional knowledge-based intervention in 90 U.S. college-aged men ages 18-25 years. Repeated measures of ANOVA indicated significant positive changes in the intervention group for knowledge and HBM constructs. Results from the pretest/posttest regression analysis indicated self-efficacy for taking the vaccine (p = 0.000), perceived barriers (p = 0.007), and perceived severity (p = 0.004) were significant positive predictors of vaccine acceptability. The model had an adjusted R2 of 0.351. Overall, the intervention proved to be effective in creating positive change toward HPV vaccine acceptability.

The influence of the metaparadigm of nursing on professional identity development among RN-BSN students.

This paper is a report of an interview about the metaparadigm of nursing and the influence of the metaparadigm on the professional identity development of students enrolled in an online RN-BSN program.

Family homelessness viewed through the lens of health and human rights.

Families with children, many of whom are headed by a single mother, are the fastest growing segment of the homeless population. Guided by Leininger's Culture Care Theory and the ethnonursing research method, the purpose of this study was to discover the care meanings and expressions for a group of 12 Appalachian mothers living with their children in an urban homeless shelter. Reflected in each mother's words and embedded within the 3 universal themes that emerged was the need to be treated with human dignity and respect. This need was seen as vital to the health and well being of these families.

Using the health belief model in qualitative focus groups to identify HPV vaccine acceptability in college men.

This study determines predictors of HPV vaccine acceptability among college-aged male students through the qualitative data collection strategy of focus groups. Over the course of 2 months, six focus groups were conducted with 50 participants, with approximately 10 participants in each focus group. Participants were predominately single, heterosexual, about 20 years old, Caucasian males attending a large Midwestern University. The Health Belief Model (HBM) was used as a guide in developing questions for the focus groups. Each question related to a construct of the HBM. A lack of perceived susceptibility, perceived severity of HPV, and barriers toward taking the HPV vaccine were major themes identified from the focus groups. Overall, the focus group proved to be effective in understanding predictors toward HPV vaccine acceptability. Results enabled the researchers to develop an understanding of content needed for effective interventions. This study indicates a need for more qualitative studies exploring attitudes, beliefs, and behaviors related to HPV vaccine acceptability among at-risk populations.