A thematic analysis of shared experiences of essential health and support personnel in the COVID-19 pandemic.

AIMS AND OBJECTIVES: Studies have shown that the COVID-19 pandemic has taken a toll on individuals who interact with patients with SARS-CoV-2 but focused largely on clinicians in acute care settings. This qualitative descriptive study aimed to understand the experiences and well-being of essential workers across settings during the pandemic. BACKGROUND: Multiple studies of the well-being of individuals who have cared for patients during the pandemic have included interviews of clinicians from acute care settings and revealed high levels of stress. However, other essential workers have not been included in most of those studies, yet they may also experience stress. METHODS: Individuals who participated in an online study of anxiety, depression, traumatic distress, and insomnia, were invited to provide a free-text comment if they had anything to add. A total of 2,762 essential workers (e.g., nurses, physicians, chaplains, respiratory therapists, emergency medical technicians, housekeeping, and food service staff, etc.) participated in the study with 1,079 (39%) providing text responses. Thematic analysis was used to analyze those responses. RESULTS: Four themes with eight sub-themes were: Facing hopelessness, yet looking for hope; Witnessing frequent death; Experiencing disillusionment and disruption within the healthcare system, and Escalating emotional and physical health problems. CONCLUSIONS: The study revealed major psychological and physical stress among essential workers. Understanding highly stressful experiences during the pandemic is essential to identify strategies that ameliorate stress and prevent its negative consequences. This study adds to the research on the psychological and physical impact of the pandemic on workers, including non-clinical support personnel often overlooked as experiencing major negative effects. RELEVANCE TO CLINICAL PRACTICE: The magnitude of stress among all levels of essential workers suggests the need to develop strategies to prevent or alleviate stress across disciplines and all categories of workers.

Biological assessment of western USA sandy bottom rivers based on modeling historical and current fish and macroinvertebrate data.

Biological monitoring is important for assessing the ecological condition of surface waters. However, there are challenges in determining what constitutes reference conditions, what assemblages should be used as indicators, and how assemblage data should be converted into quantitative indicator scores. In this study, we developed and applied biological condition gradient (BCG) modeling to fish and macroinvertebrate data previously collected from large, sandy bottom southwestern USA rivers. Such rivers are particularly vulnerable to altered flow regimes resulting from dams, water withdrawals and climate change. We found that sensitive ubiquitous taxa for both fish and macroinvertebrates had been replaced by more tolerant taxa, but that the condition assessment ratings based on fish and macroinvertebrate assemblages differed. We conclude that the BCG models based on both macroinvertebrate and fish assemblage condition were useful for classifying the condition of southwestern USA sandy bottom rivers. However, our fish BCG model was slightly more sensitive than the macroinvertebrate model to anthropogenic disturbance, presumably because we had historical fish data, and because fish may be more sensitive to dams and altered flow regimes than are macroinvertebrates.

Vulnerability, loss, and coping experiences of health care workers and first responders during the covid-19 pandemic: a qualitative study.

INTRODUCTION: The ongoing COVID-19 pandemic substantially affects health care workers from multiple disciplines, including nurses, physicians, therapists, and first responders. The aims of this study were to 1) explore and describe the experiences of health care workers and first responders working with individuals with COVID-19 infection, and 2) identify the support and strategies that were helpful during their experience. METHODS: A qualitative descriptive study was conducted via online video interviews of 29 health care workers and first responders who agreed to be contacted for an interview. Thematic analysis resulted in three themes and corresponding subthemes. RESULTS: The three overriding themes were 1) experiencing vulnerability, 2) suffering loss and grief, and 3) coping with vulnerability. A sense of vulnerability and high levels of stress were described and affected participants during their professional work as health care workers and first responders as well as their roles in their homes and communities. DISCUSSION AND CONCLUSION: The findings indicate the need for effective measures to assist health care workers and first responders to minimize the negative consequences of persistent and severe stress and vulnerability as they care for individuals with COVID-19 and their families.

Psychological responses of hospital-based nurses working during the COVID-19 pandemic in the United States: A cross-sectional study.

Studies show decreased well-being during the COVID-19 pandemic, especially for healthcare providers from Asia. Less is known about the psychological responses of working during the pandemic on hospital-based registered nurses (RNs) in the United States (US). Therefore, the purpose of this paper is to report the well-being of U.S.-based hospital RNs working during the initial acute phase of COVID-19 and compare it with well-being among healthcare workers described in two global meta-analyses. We conducted a cross-sectional survey in May-June 2020 (N = 467). Well-being was measured using the following tools: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depressive symptoms, Impact of Events Scale-Revised for traumatic stress, and the Insomnia Severity Index. Compared with global rates from two meta-analyses, US-based RNs reported significantly more traumatic stress (54.6% vs. 11.4% and 21.5%; p < .001) and depressive symptoms (54.6% vs. 31.8% and 21.7%; p < .001). Rates of insomnia were also higher in U.S.-based RNs than in the meta-analysis that reported insomnia (32.4% vs 27.8%; p < .033). Rates of anxiety symptoms among US-based RNs did not differ from that reported in one meta-analysis (37.3% vs. 34.4%), while it was significantly higher in the other (37.3% vs. 22.1%; p < .001). Hospital-based RNs from the US exhibited over twice the rates of trauma and nearly double the rates of depressive symptoms than shown in reports from hospital workers globally during the acute phase of the COVID-19 pandemic. The lasting effects of this distress are unknown and warrant ongoing evaluation and solutions to better support emotional well-being and prevent burnout in the workplace.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

A biological condition gradient for coral reefs in the US Caribbean Territories: Part I. Coral narrative rules.

As coral reef condition and sustainability continue to decline worldwide, losses of critical habitat and their ecosystem services have generated an urgency to understand and communicate reef response to management actions, environmental contamination, and natural disasters. Increasingly, coral reef protection and restoration programs emphasize the need for robust assessment tools for protecting high-quality waters and establishing conservation goals. Of equal importance is the need to communicate assessment results to stakeholders, beneficiaries, and the public so that environmental consequences of decisions are understood. The Biological Condition (BCG) model provides a structure to evaluate the condition of a coral reef in increments of change along a gradient of human disturbance. Communication of incremental change, regardless of direction, is important for decision makers and the public to better understand what is gained or lost depending on what actions are taken. We developed a narrative (qualitative) Biological Condition Gradient (BCG) from the consensus of a diverse expert panel to provide a framework for coral reefs in US Caribbean Territories. The model uses narrative descriptions of biological attributes for benthic organisms to evaluate reefs relative to undisturbed or minimally disturbed conditions. Using expert elicitation, narrative decision rules were proposed and deliberated to discriminate among six levels of change along a gradient of increasing anthropogenic stress. Narrative rules for each of the BCG levels are presented to facilitate the evaluation of benthic communities in coral reefs and provide specific narrative features to detect changes in coral reef condition and biological integrity. The BCG model can be used in the absence of numeric, or quantitative metrics, to evaluate actions that may encroach on coral reef ecosystems, manage endangered species habitat, and develop and implement management plans for marine protected areas, watersheds, and coastal zones. The narrative BCG model is a defensible model and communication tool that translates scientific results so the nontechnical person can understand and support both regulatory and non-regulatory water quality and natural resource programs.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study.

BACKGROUND: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. OBJECTIVE: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. METHODS: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. RESULTS: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. CONCLUSIONS: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30757.

Incorporating adaptation and resilience into an integrated watershed and coral reef management plan.

Changing environmental conditions are forcing natural resource managers and communities to adapt their strategies to account for global shifts in precipitation, temperature, sea level and more, all of which are occurring in addition to local human impacts. Adapting to threats from climate change requires a fundamental shift in the practice of natural resource management through the development of forward-looking "climate-smart" goals and strategies. Here we present a proof-of-concept application of a decision-support tool to help design climate-smart management actions for the watershed and coral reef management plan for Guánica Bay watershed in southwest Puerto Rico. We also explore the connection between adaptation planning and coral reef resilience, using a recently developed Puerto Rico-wide reef resilience assessment. In the first phase of the study, we used the publicly available Adaptation Design Tool to draft initial climate-smart versions of twelve proposed management actions. In the second phase, two actions (dirt road management on steep slopes, and coral reef restoration) were further refined through consultations with local experts to make more detailed design adjustments; this included the option to use information from the coral reef resilience assessment to inform design improvements. The first phase resulted in moderately detailed assessments that broadly accounted for anticipated direct and indirect effects of climate change on the planned management actions. The second phase resulted in more site-specific technical assessments and additional important design details. The expert panel charged with discussing climate-smart reef restoration around Guánica used the reef resilience assessment to guide discussion of reef restoration, highlighting the importance of having such information available for adaptation planning. This study demonstrates how climate change impacts can be effectively incorporated into a management plan at the most granular level of planning and how a structured, formalized process can be as valuable as the resulting adaptation information.

It's a little bit like prison, but not that much: Aboriginal women's experiences of an acute mental health inpatient unit.

This research aimed to gain an understanding of the acute mental health inpatient experience as described by Aboriginal women during admission. It recorded for the first time the words of Aboriginal women within the inpatient unit, including their perceptions of factors which may promote or impede a culturally safe environment. Eleven Aboriginal women inpatients gave interviews before discharge from the inpatient unit. Five Aboriginal Reference Group (ARG) members with experience of the inpatient unit also gave interviews, adding 'insider-outsider' perspectives. Interviews were recorded, transcribed, entered into NVivo software, and analysed inductively to raise codes and develop themes. Five interconnecting themes emerged: Social Context: life experience preceding, shaping, and following admission; Connection: with kin, community, and culture. Control: self-determination, legally and physically curtailed; Caring: actions promoting reconnection and self-determination; Communication: conveying caring and supporting agency, reconnection, and return to community. Findings reflected inpatient issues reported in previous studies, adding insights into the cultural concerns of Aboriginal women and offering practical clinical implications for culturally secure service delivery in an inpatient setting. Existing literature offered a basis for developing the model offered here for transcultural interaction for recovery in an inpatient setting. Attention to these findings can enhance Aboriginal women's inpatient experience and promote further research. The article complies with the COREQ-32 checklist for describing qualitative studies.

Development of a reef fish biological condition gradient model with quantitative decision rules for the protection and restoration of coral reef ecosystems.

Coral reef ecosystems are declining due to multiple interacting stressors. A bioassessment framework focused on stressor-response associations was developed to help organize and communicate complex ecological information to support coral reef conservation. This study applied the Biological Condition Gradient (BCG), initially developed for freshwater ecosystems, to fish assemblages of U.S. Caribbean coral reef ecosystems. The reef fish BCG describes how biological conditions changed incrementally along a gradient of increasing anthropogenic stress. Coupled with physical and chemical water quality data, the BGC forms a scientifically defensible basis to prioritize, protect and restore water bodies containing coral reefs. Through an iterative process, scientists from across the U.S. Caribbean used fishery-independent survey data and expert knowledge to develop quantitative decision rules to describe six levels of coral reef ecosystem condition. The resultant reef fish BCG provides an effective tool for identifying healthy and degraded coral reef ecosystems and has potential for global application.

Biochemical, Anthropometric, and Physiological Responses to Carbohydrate-Restricted Diets Versus a Low-Fat Diet in Obese Adults: A Randomized Crossover Trial.

Some research supports high-fat carbohydrate (CHO)-restricted diets for weight and fat loss and improvement of cardiovascular disease risk factors. To test this, a randomized crossover study was designed. Subjects (17 obese men and women [BMI: 30-38 kg/m2]) were fed three diets (supplying 1600 and 2200 kilocalories (kcal)/day for women and men, respectively) for 4 weeks, with each trial separated by 4-week washout periods. One CHO-restricted diet (10% CHO, 50% fat, and 40% protein content) was rich in plant foods and mushrooms, while the other CHO-restricted diet included more animal foods (10% CHO, 60% fat, and 30% protein content). The third diet was lower in fat and protein content (LF) and higher in CHOs (61% CHO, 21% fat, and 18% protein content). Body composition was assessed through hydrostatic weighing before and after each diet trial. Fasting blood samples were collected weekly for analysis of hormones and lipids. Data were analyzed through repeated measures analysis of variance with post hoc paired comparison t-tests. Weight and fat loss were similar (P > .05) among trials. Subjects lost lean mass (P < .05) during CHO-restricted trials, but not in the LF trial. Insulin concentrations decreased (P < .05) during the CHO-restricted trial and tended (P = .05) to decrease during the LF trial. Total cholesterol decreased (P < .05) for all trials; however, high-density lipoprotein cholesterol decreased (P < .05) and triacylglycerols were higher (P < .05) following the LF trial. Taken together, energy restriction regardless of diet composition promoted similar weight loss; however, CHO-restricted diets based on either plants/mushrooms or animal foods elicited a more beneficial lipid-altering effect in comparison with the LF diet.

Biological Assessment of Coral Reefs in Southern Puerto Rico: A Technical Approach for Coral Reef Protection Under the U.S. Clean Water Act.

States and other jurisdictions may protect coral reefs using biological water quality standards outlined by the United States Clean Water Act (CWA). Such protection will require long-term, regional monitoring of the resource using biological indicators and a probability-based sampling design. A 60-station survey targeting nearshore linear coral reef was conducted across southern Puerto Rico in December 2011 to document the status of reef inhabitants using a probabilistic, regional sampling design. The quantity, type and condition of stony corals, fish, gorgonians and sponges were documented from each station, providing a robust representation of linear reef status and composition across the region. Fish represented 106 unique taxa and stony corals 32 unique taxa. Benthic organisms (stony corals, sponges and gorgonians) averaged nearly 12 colonies per square meter, more than half of which were gorgonians. Assessment results can be used as a baseline to compare with future regional surveys to quantify change in reef condition over time (trend). Both temporal and spatial changes can be expected after large-scale disturbances like hurricanes Maria and Irma in 2017. The indicators and probabilistic sampling design support the long-term regional monitoring envisioned by the Environmental Protection Agency to implement CWA protections in Puerto Rico and elsewhere.

Adaptation Design Tool for Climate-Smart Management of Coral Reefs and Other Natural Resources.

Scientists and managers of natural resources have recognized an urgent need for improved methods and tools to enable effective adaptation of management measures in the face of climate change. This paper presents an Adaptation Design Tool that uses a structured approach to break down an otherwise overwhelming and complex process into tractable steps. The tool contains worksheets that guide users through a series of design considerations for adapting their planned management actions to be more climate-smart given changing environmental stressors. Also provided with other worksheets is a framework for brainstorming new adaptation options in response to climate threats not yet addressed in the current plan. Developed and tested in collaboration with practitioners in Hawai'i and Puerto Rico using coral reefs as a pilot ecosystem, the tool and associated reference materials consist of worksheets, instructions and lessons-learned from real-world examples. On the basis of stakeholder feedback from expert consultations during tool development, we present insights and recommendations regarding how to maximize tool efficiency, gain the greatest value from the thought process, and deal with issues of scale and uncertainty. We conclude by reflecting on how the tool advances the theory and practice of assessment and decision-making science, informs higher level strategic planning, and serves as a platform for a systematic, transparent and inclusive process to tackle the practical implications of climate change for management of natural resources.

Native Voices: Native Peoples' Concepts of Health and Illness in New Mexico: opening a local conversation by hosting a national traveling exhibit.

BACKGROUND: The University of New Mexico Health Sciences Library and Informatics Center hosted the National Library of Medicine's Native Voices: Native Peoples' Concepts of Health and Illness traveling exhibit. The authors' goal was to promote local interest in the Native Voices exhibit, with an emphasis on making the exhibit content and materials available to American Indian communities throughout rural New Mexico. CASE PRESENTATION: We convened a daylong summit to highlight the exhibit and encourage discussion among 30 American Indian community health educators. The summit prompted the compilation and distribution of descriptions of 23 community projects that promote health and wellness. We also took a scaled-down version of the exhibit to 4 rural college campuses around the state that serve significant Native American student populations. Approximately 140 students and faculty interacted with the exhibit materials, and all 4 sites incorporated the exhibit into curriculum activities. CONCLUSIONS: A hosted national exhibit developed into a multifaceted, funded project that engaged with American Indian communities. We demonstrated successful field deployment of a downsized, portable version of the full traveling exhibit to make meaningful connections with members of our outreach population.

Post-treatment problems of African American breast cancer survivors.

PURPOSE: African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79 %) compared with White survivors (92 %) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5 years after treatment completion and identifies subgroups at risk for these problems. METHODS: A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18 years of age who completed primary treatment for breast cancer in the past 5 years. A mailed survey was used to document survivorship problems. RESULTS: Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems. CONCLUSIONS: The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.

New Mexico practitioners' access to and satisfaction with online clinical information resources: an interview study using qualitative data analysis software.

QUESTIONS: What information resources are available to health care practitioners not affiliated with the University of New Mexico? How satisfied are they with those resources? SETTING: The state is rural and medically underserved. METHODS: The authors interviewed practitioners, using a nine-item guide. Interview transcripts were coded using QSR NVivo 9 software. MAIN RESULTS: Fifty-one practitioners were interviewed. Most use online information resources. Many have access to a point-of-care resource within an electronic health records system. They often expressed dissatisfaction with available patient education resources. CONCLUSION: New Mexico practitioners routinely use electronic information resources but indicate they need better patient information.

"Towards justice in health": an exemplar of speaking truth to power.

A critical textual analysis of the 6 issues of Towards Justice in Health, a magazine published by Nurses for Social Responsibility (NSR) between 1992 and 1995, makes visible their work. True to their purpose, NSR provided an alternative and courageous voice on the political nature of health and health care that was largely missing in mainstream nursing literature at that time. Towards Justice in Health both documents the emergence of the new economic world order and concomitant shift to the right in Canadian politics during the early 1990s with its impacts on health care and the nursing workplace and provides a grassroots response.

Regional status assessment of stony corals in the US Virgin Islands.

States may protect coral reefs using biological water quality standards outlined by the Clean Water Act. This requires biological assessments with indicators sensitive to human disturbance and regional, probability-based survey designs. Stony coral condition was characterized on a regional scale for the first time in the nearshore waters of the US Virgin Islands (USVI). Coral composition, abundance, size, and health were assessed at 66 stations in the St. Croix region in fall 2007 and at 63 stations in the St. Thomas and St. John region in winter 2009. Indicators were chosen for their sensitivity to human disturbance. Both surveys were probability-based (random) designs with station locations preselected from areas covered by hardbottom and coral reef substrate. Taxa richness was as high as 21 species but more than half the area of both regions exhibited taxa richness of <10 species in the 25 m(2) transect area. Coral density was as high as 5 colonies m(-2) but more than half the area of both regions had <2 colonies m(-2). Both regions showed similar dominant species based on frequency of occurrence and relative abundance. Because of large colony sizes, Montastrea annularis provided more total surface area and live surface area than more abundant species. The surveys establish baseline regional conditions and provide a foundation for long-term regional monitoring envisioned by the USVI Department of Planning and Natural Resources. The probabilistic sampling design assures the data can be used in Clean Water Act reporting.