A satisfação da grávida com os cuidados das enfermeiras obstétricas durante a pandemia COVID-19 / Pregnant women's satisfaction with the care provided by nurse midwives during the COVID-19 pandemic / Satisfacción de las embarazadas con la atención de las enfermeras obstétricas durante la pandemia de COVID-19

Resumo Enquadramento: Em tempo de pandemia, as consultas de enfermagem de vigilância da gravidez sofreram alterações, nomeadamente na restrição de acompanhantes. Por esse motivo, é importante a avaliação da satisfação das grávidas com a assistência de enfermagem durante este contexto pandémico. Objetivo: Avaliar a satisfação da grávida com a assistência das enfermeiras obstétricas nas consultas de vigilância da gravidez durante o contexto de pandemia COVID-19. Metodologia: Estudo transversal descritivo de natureza quantitativa, com uma amostra de 196 grávidas. Aplicado a Escala de Satisfação dos Pacientes com a Assistência de Enfermagem (General Practice Nurse Satisfaction Scale - GPNS), constituída pelas dimensões: relacionamento interpessoal e comunicação, confiança, credibilidade e dedicação. Resultados: As grávidas apresentam-se em média mais satisfeitas na dimensão relacionamento interpessoal e comunicação e menos satisfeitas na dimensão dedicação. Conclusão: As grávidas apresentam-se satisfeitas com a assistência de enfermagem percecionando a sua importância. Tal reforça a pertinência das consultas serem realizadas por um Enfermeiro Especialista em Enfermagem de Saúde Materna e Obstétrica.

Abstract Background: Prenatal nursing appointments underwent changes during the COVID-19 pandemic, namely in the restriction of companions. For this reason, it is important to assess pregnant women's satisfaction with nursing care during this period. Objective: To assess pregnant women's satisfaction with nurse midwife-led prenatal appointments during the COVID-19 pandemic. Methodology: A qualitative descriptive cross-sectional study was conducted with a sample of 196 pregnant women. The Portuguese version of the General Practice Nurse Satisfaction Scale (Escala de Satisfação dos Pacientes com a Assistência de Enfermagem) was administered to the sample. The tool consists of the following dimensions: interpersonal relationship and communication, confidence, credibility, and dedication. Results: Pregnant women are, on average, more satisfied in the interpersonal relationship and communication dimension and less satisfied in the dedication dimension. Conclusion: Pregnant women are satisfied with nursing care and acknowledge its importance. This finding reinforces the importance of nurse midwife-led consultations.

Resumen Marco contextual: En tiempos de pandemia, las citas de enfermería para el seguimiento del embarazo cambiaron, sobre todo la restricción de acompañantes. Por esta razón, es importante evaluar la satisfacción de las mujeres embarazadas con los cuidados de enfermería durante este contexto pandémico. Objetivo: Evaluar la satisfacción de las mujeres embarazadas con la atención prestada por las enfermeras obstétricas en las consultas de seguimiento del embarazo durante la pandemia de COVID-19. Metodología: Estudio descriptivo transversal de carácter cuantitativo, con una muestra de 196 mujeres embarazadas. Se aplicó la Escala de Satisfacción de los Pacientes con Asistencia de Enfermería (General Practice Nurse Satisfaction Scale - GPNS), compuesta por las siguientes dimensiones: relaciones interpersonales y comunicación, confianza, credibilidad y dedicación. Resultados: Las mujeres embarazadas están, de media, más satisfechas en la dimensión relaciones interpersonales y comunicación, y menos satisfechas en la dimensión dedicación. Conclusión: Las embarazadas se mostraron satisfechas con los cuidados de enfermería y se dieron cuenta de su importancia. Esto refuerza la pertinencia de que las consultas sean realizadas por una enfermera especializada en Enfermería de Salud Materna y Obstétrica.

Charting the Course of the Nursing Professional Identity: A Qualitative Descriptive Study on the Identity of Nurses Working in Care for Older Adults.

AIMS: To explore and describe the meaning of nurses working in care for older adults give to the nursing professional identity. DESIGN: A qualitative approach was taken. METHODS: Semi-structured interviews were conducted with 50 bachelor and vocational-educated nurses working in care for older adults. Interviews were conducted between December 2019 and May 2020. Data were analysed and interpreted through inductive content analysis. RESULTS: Five themes embody the meaning of the nursing professional identity of nurses who work in care for older adults. The five themes are: born to care: a lifelong motivation to nursing; nursing through the noise: dedication in a demanding profession; the silent backbone: caught in the crossfire of interdisciplinary teams; learning under pressure: the demand for expanded nursing expertise and against the current: the barriers to advocacy in nursing. CONCLUSION: The professional nursing identity of nurses working in care for older adults is multi-faceted. A personal dedication to patient care, where patients 'human' aspect is heavily valued, commits nurses to their profession and underscores their dedication to upholding the quality standard in nursing practice. IMPLICATIONS FOR THE PROFESSION: The older adults' nursing identity highlights that nursing deserves acknowledgement as a professional occupation. Nurses should speak to the public about their professional roles to improve the public view of older adult nursing. IMPACT: A clear understanding of the older adult nursing professional identity clarifies specific roles, experiences and expectations. This can help attract and retain nurses whose views of older adult nursing align with the nursing professional identity. This could help resolve nurse turnover and reduce shortages in older adult care. REPORTING METHOD: We adhered to Consolidated Criteria For Reporting Qualitative Research guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

[Preliminary Study on the Relationship Between Organizational Climate, Leadership Style, and Job Satisfaction in the Context of Nurse Practitioners].

BACKGROUND: Job satisfaction in nurse practitioners is influenced by the level of autonomy and empowerment they perceive within their practice environment. Little in-depth research has been done to explore the relationship among organizational climate, leadership style, and job satisfaction in the context of nurse practitioners. PURPOSE: This study was developed to explore the relationship among organizational climate, leadership style, and job satisfaction in nurse practitioners with the goal of enhancing their job satisfaction. METHODS: A cross-sectional correlational approach and snowball sampling method were employed to recruit 400 qualified nurse practitioners to complete an online survey. This survey was a structured questionnaire consisting of the Practice Organizational Climate Scale, Leadership Style Scale, and Job Satisfaction Scale. Statistical analyses used included the independent t test, one-way ANOVA, Pearson's correlation, and multiple linear regression analysis. RESULTS: Most of the participants were 31 to 50 years old. A significant and positive correlation was identified among overall organizational climate, leadership style, and job satisfaction. In terms of organizational climate components, only professional visibility was not found to significantly correlate with job satisfaction. Transformational leadership, servant leadership, independent work, and relationships with support and management departments collectively explained nearly 72.4% of overall job satisfaction. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings demonstrate job satisfaction in nurse practitioners to be significantly influenced by organizational climate and leadership style. Thus, fostering a positive organizational climate and enhancing transformational and servant leadership styles may be expected to improve job satisfaction in this group substantively. Therefore, it is recommended healthcare institutions focus on improving the organizational climate, providing more autonomy and support, and enhancing leadership training for supervisors with the goal of increasing overall job satisfaction and retention rates among nurse practitioners.

Navigating the Complexities of Nursing Documentation When Patients Have Access to the Content: A Qualitative Study.

AIM: To explore how Danish registered nurses (RNs) in hospitals experience documenting nursing care in electronic patient records when the content is accessible to patients. METHODS: In a qualitative research design, data were generated in six focus groups conducted in late 2022 and early 2023, comprising 31 RNs employed in inpatient wards at a university hospital in Denmark. Subsequently, qualitative content analysis was applied to the gathered data. RESULTS: The findings include three themes: (1) weighing one's words, (2) building trust or triggering conflicts and (3) risking loss of knowledge. Together, these three themes illustrate the complexities that RNs navigate when patients have access to the content of nursing documentation. CONCLUSION: Patients' access to nursing documentation requires RNs to navigate a complex interplay of factors, including awareness of language-use, influence on the nurse-patient-relative relationships, and the risk of losing essential knowledge. Therefore, although patients' access to nursing documentation can induce a positive change in terms of strengthening the professional focus on documentation, it can also result in changes in documentation practices in ways that may compromise nursing documentation as a working tool. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The findings emphasize an urgent need to explore and discuss how sensitive nursing observations can be shared in a safe and appropriate way when patients have access to the documentation. Furthermore, to prevent misunderstandings and conflicts with patients, it is essential to focus on and prioritize patient involvement in nursing documentation. IMPACT: RNs navigate complex practices when patients have direct online access to nursing documentation content. It is crucial to clarify which content nursing documentation should entail and how sensitive nursing observations can be shared in a safe and appropriate way. REPORTING: The COREQ checklist was used for reporting.

Implementation of Positive Advanced Recovery Connections in Primary and Secondary Mental Health Care-A Registered Advanced Nurse Practitioner-Led Initiative.

AIM(S): This study reports on the implementation of a registered advanced nurse practitioner intervention. Aims include improving access, service user outcomes and integration between primary and secondary care. DESIGN: This paper reports the quantitative results of a mixed methods implementation study. Qualitative data are reported separately. The PARiHS framework informs the implementation process itself, with considerations for nurses and other healthcare professionals explored. METHODS: The CORE-OM 34 item rating scale was administered both pre- and post-intervention. Service user attendances in secondary care was monitored. RESULTS: Findings suggest that the intervention was associated with clinically significant improvements in global or generic distress, reported by service users, as evidenced by changes in the CORE-OM scores. Access to care was recorded at an average of 3.6 days. Implementation science supported effective and safe implementation with clear governance structures. CONCLUSION: Registered advanced nurse practice in mental health clinics which provide full episodes of care results in improved integration and may be associated with positive patient outcomes. Implementation science is taught on Irish nursing programmes and this is important if innovative services are to be embedded in the healthcare system. IMPACT: The development of a model of care for mental health Registered Advanced Nurse Practitioners at the interface of primary and secondary care settings may be merited. Positive Advanced Recovery Connections may be associated with improving mental health outcomes and bolstering integration of primary and secondary care services. The utilisation of implementation science highlights the need for collaboration with all stakeholders to overcome barriers and recognise facilitators to attain the necessary model of integrated care. PATIENT AND PUBLIC CONTRIBUTION: Peer recovery input was provided by members of the service Recovery College, with participation evident in all stages of the project. The psychosocial assessment template was also co-designed.

Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013-2021.

PURPOSE: This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021. METHODS: Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. RESULTS: From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. CONCLUSIONS: There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. CLINICAL RELEVANCE: With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Perspectives of health care providers on obstetric point-of-care ultrasound in lower-level health facilities in Kenya.

BACKGROUND: Ultrasound technology has become integral in antenatal care for its diagnostic effectiveness and potential to improve maternal and neonatal outcomes. Despite its proven benefits, challenges persist in its widespread adoption, particularly in low-resource settings like Kenya. AIM: The aim of this study was to explore the perspectives of healthcare providers regarding the integration of obstetric point-of-care ultrasound into routine maternal services in low-level facilities Kenya. METHODS: Using a descriptive qualitative study embedded in a large scale implementation study 76 healthcare providers who had undergone obstetric point-ofcare ultrasound training and were providing maternal services were purposively sampled from healthcare facilities across eight counties. Data was collected using structured audiotaped interviews, which were transcribed, and analyzed using thematic analysis. RESULTS: Five main themes with several subthemes emerged from the analysis: (1) Clinical Decision-Making (2) Quality of Services, (3) Training, (4)Technology Issues, and (5) Sustainability. DISCUSSION: Findings from this study suggest that use of obstetric Point-of-Care Ultrasound in resource-limited primary care settings, can enhance clinical decision making and influence patient management, ultimately resulting in significant health outcomes. CONCLUSION: Equipping health care providers with skills to conduct obstetric point of care ultrasound can lead to better-informed clinical decisions and ultimately contribute to improved health outcomes in underserved populations.

Effect of evidence-based nursing practices on individualised care: A cross-sectional descriptive study.

AIM: This study was conducted to determine the effect of nurses' attitudes towards evidence-based practices on individualised nursing care. METHODS: This study is a cross-sectional descriptive trial. The descriptive analysis included 200 clinical nurses working in a private hospital between April and September 2022. Data were collected with a personal information form, Individualised Care Scale (A-Nurse Version), and Evidence-Based Nursing Attitude Questionnaire. The relationship between the scales and effect was examined by Pearson correlation and linear regression analyses. T-test, one-way analysis of variance (ANOVA), and post hoc (Tukey, LSD) analysis were used in the statistical analysis of nurses according to their descriptive characteristics. This study has adhered to the STROBE checklist for reporting. RESULTS: They had high mean scores on Individualised Care Scale total (3.68 ± 1.25) and from Clinical Situation (3.78 ± 1.30) and Decisional Control (3.82 ± 1.35) subscales and average score from the Personal Life (3.32 ± 1.29) subscale. Their mean score from the Evidence-Based Nursing Attitude Questionnaire was average (47.64 ± 10.99). There was a positive moderate (r = 0.50, p = 0.000 < 0.05) significant correlation between the scales. CONCLUSION: Positive attitude towards evidence-based nursing practices positively affects individualised care. Variables such as professional experience positively affect nurses' attitudes towards evidence-based nursing. A positive and significant relationship was found between nurses' attitudes towards evidence-based practice and their attitudes towards individualised care.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach.

Background: There is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study. Objective: The objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care. Design: A cross-sectional study was conducted between November 2021 and June 2022. Setting: 180 primary health care clinics in two South African provinces of Gauteng and North West. Participants: 665 nurses of all categories. Methods: A causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables. Results: The nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses' participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses' job outcomes and standards of care. Conclusions: We have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses' job outcomes and satisfaction with standards of care. Improving nurses' practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.

Development and verification of community development index for improving functioning of aged people in rural districts (third report): data collection and analysis system on social mutual aid are desired for community development for elderly persons living in rural districts.

Objective: The author conducted a survey on social mutual aid and the social stimulative effect of older adults living in a rural district, and compared young old and old-old persons to clarify the roles of public health nurses in promoting community development. Materials and Methods: A cross-sectional study based on Andersen's Behavioral Model of Health Care Utilization was conducted with 2,500 residents aged 65 years or older of City A in Akita Prefecture. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on "social mutual aid in the rural district". Responses were recorded on a Likert scale. Results: As a result of factor analysis, the following four factors were extracted; [Blessing of a rural district and mutual help and assistance unique to a rural district], [Closeness of healthcare welfare service and family doctors in conjunction with their own health], [Decline of culture and community unique to rural districts accompanied by depopulation] and [Closeness of the town where they live]. Differences were observed in the closeness of social mutual aid and local societal stimulative effects, even between generations of old and old-old persons. In young-old persons, a negative correlation was observed between [Closeness of the town where they live] and other factors. In old-old persons, a negative correlation was found between [Decline of culture and community unique to rural districts accompanied by depopulation] and other factors. Conclusion: Since not only individual health indices but also local social mutual aid, which relates to individuals' influence on the construction of a Community-based Integrated Care System in a rural district, the author posits that a data collection and analysis system on social mutual aid would be beneficial for community development for older adults living in rural districts.

Successful use of point-of-care ultrasound for an elderly patient with heart failure in a primary care setting: a case report.

Background: Appropriate assessment of fluid status of patients with heart failure (HF) is challenging in outpatient settings, e.g. primary care, especially among elderly HF patients with multiple comorbidities. The use of handheld ultrasound devices for point-of-care ultrasound (POCUS) has increased. Case summary: An 80-year-old male had HF with preserved ejection fraction with New York Heart Association (NYHA) classification II. He had multiple comorbidities including chronic obstructive pulmonary disease and been followed up in both a nurse-led HF clinic and a nurse-led chronic obstructive pulmonary disease clinic in primary care. During a scheduled visit to the nurse-led HF clinic in primary care, he exhibited orthopnoea and moderate leg oedema. A HF nurse, using a handheld ultrasound device (Vscan, GE Healthcare), detected B-lines in the left lung, indicating the presence of fluid in the left lung, and an enlarged and non-varying inferior vena cava (IVC) during the POCUS examination. Based on these results, the HF nurse concluded that the patient was experiencing decompensated HF, rather than a chronic obstructive pulmonary disease exacerbation. As a result, his loop diuretics were promptly increased. The patient and his wife received advice on self-care from the HF nurse and the chronic obstructive pulmonary disease nurses. At a follow-up visit 2 weeks later, his breathlessness and swelling were reduced, with no B-lines or dilated IVC found during the POCUS examination. Discussion: The POCUS can be a good decision support tool for not only physicians but also other healthcare professionals to identify worsening HF and to monitor treatment responses in HF patients in primary care settings.

Association of hospital safety climate and compliance with occupational safety practices among nurse interns: A cross-sectional study using canonical correlation analysis.

Background and Aims: Nurse interns may be at a similar or higher risk than registered nurses. The key elements and mechanisms involved in the effects of safety climate on safety performance are not well understood. This study explores the relationship between the perceived hospital safety climate and compliance with occupational safety practices among nurse interns. Methods: A cross-sectional study was conducted among 178 nurse interns in three tertiary university hospitals in Chongqing city, China. The Chinese version of the Hospital Safety Climate Scale (HSCS) was used to measure the perceived hospital safety climate of nurse interns. Compliance behavior was measured using the Compliance with Occupational Safety Practice Scale (COSPS). Canonical correlation analysis and multiple linear regression modeling were used to examine their relationship. Results: Total scores for the HSCS and COSPS were 92 (80,100) and 185 (175,185) [M (P25, P75)], respectively. Canonical correlation coefficients for canonical variates 1 and 2 were 0.636 (p < 0.001) and 0.414 (p < 0.001), respectively. Nurse interns' compliance with occupational safety practices was mainly influenced by management support, feedback/training, personal protective and engineering control equipment availability, and absence of job hindrance. Multiple linear regression showed that management support of HSCS accounted for 37.1% of the variance in compliance (ß = 0.283, p = 0.039). Conclusion: Nurse interns reported high levels of perceived hospital safety climate and compliance with occupational safety practices. Younger nurse interns reported a lower level of perceived hospital safety climate. Nurse educators can improve interns' compliance by promoting better management support, feedback/training, personal protective and engineering control equipment availability, and fewer job hindrance.

Exploring Lived Experiences of Vulnerability in Nursing Management during the Coronavirus Disease 2019 Pandemic: A Phenomenological Study of Nurse Managers and Nurses.

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic placed enormous pressure on healthcare systems around the world, but it also provided valuable insights for healthcare organizations during this challenging period. Objective: This study aimed to explore nurses' lived experiences of vulnerability in hospital nursing management during the COVID-19 pandemic, and reflect on the lessons learned. Methods: In this phenomenological study, 14 participants, including nurse managers at different levels and staff nurses, were selected by purposive sampling from one center university hospital. Data collection was done through in-depth individual semistructured interviews with participants and a review of weekly reports of crisis management meetings at the university hospital. Interviews were analyzed using Colaizzi's method in seven phases by MAXQDA software Version 10. Results: One overarching theme, four themes, and 15 subthemes were obtained from analyses of interviews. Four themes of "nurses' attrition," "distrust of society to the organization," "fragility in the organization's performance," and "intensified inequalities" were extracted as threats to nursing management at the hospital. Subsequently, the weekly reports of crisis management meetings at the university hospital were analyzed to extract the solutions and lessons. Conclusion: The unpreparedness of the healthcare system against a crisis can led to the loss of organizational assets, including medical staff and the credibility of the healthcare system. Limitations of the infrastructure at hospital became more obvious during the pandemic and caused serious threats to the healthcare system. Despite severe challenges along with the pandemic, it offered four valuable lessons in nursing management.

Using single-dose liposomal amphotericin B for cryptococcal meningitis induction therapy: nurse pearls and practical perspectives.

Background: In Uganda where the burden of HIV-associated cryptococcal meningitis is high, conventional amphotericin B deoxycholate has been standard to manage patients with cryptococcal meningitis in research settings. However, liposomal amphotericin B (AmBisome) is now available via the efforts of UNITAID. We sought to describe our nursing experience using AmBisome within a clinical trial for cryptococcal meningitis. Methods: We describe the experience of using single-dose 10mg/kg liposomal amphotericin B from the perspective of a research nurse in Uganda. Second, we described the process of preparing and administering amphotericin. Third, we assessed the nursing time required for the administration of daily amphotericin B versus single-dose liposomal amphotericin. Fourth, we discuss the major challenges faced while using liposomal amphotericin B. Results: We provide estimates for the nursing time required for reconstituting, filtering, diluting and administering liposomal amphotericin B and a visual aid for nursing tasks. Based on five trained nurses, the process of reconstitution and filtration lasts an average of 52 minutes (Range: 40 to 60 minutes), to reconstitute a mean of 11 (range: 8 to 15) 50mg vials (median weight 55kg). Overall, less nursing time was required for single-dose administration than for daily amphotericin B dosing. From a nursing perspective, liposomal amphotericin B was preferable to amphotericin B deoxycholate due to its reduced infusion reactions and other toxicities. Conclusions: Single-dose liposomal amphotericin B is a better alternative to daily amphotericin B. In addition to less toxicity, nosocomial infections, reduced hospital stay, and the potential for lower hospitalisation costs, the nursing implications should not be discounted. Quality nursing care is a finite resource in low- and middle-income countries, and single-dose amphotericin B reduced the nursing time required for the care of patients with cryptococcal meningitis.

In Uganda where the burden of HIV-associated cryptococcal meningitis is high, conventional amphotericin B deoxycholate has been standard to manage patients with cryptococcal meningitis in research settings. However, liposomal amphotericin B is now available via the efforts of UNITAID. Liposomal amphotericin B is known to be less nephrotoxic than amphotericin B deoxycholate. We demonstrated that liposomal amphotericin B is a better alternative to amphotericin B deoxycholate with less toxicity, nosocomial infections, reduced hospital stay, and the potential for lower costs of hospitalisation for both the patient and the healthcare system given the single, 10 mg/kg regimen. Despite the perceived high cost of liposomal amphotericin B and the tedious reconstitution process requiring training and adequate manpower, we believe that single-dose liposomal amphotericin B has enough advantages over the deoxycholate formulation to compel Ministries of Health to consider procuring liposomal amphotericin B as the drug of choice for the management of HIV-associated cryptococcal meningitis. The rollout will require training to facilitate widespread implementation, and we hope that this paper will serve to facilitate this training for nurses who will be using liposomal amphotericin B.

Nurses' returning to work after cancer: A focus group study.

BACKGROUND: Nurses diagnosed with cancer face unique challenges when returning to work, yet there is limited understanding of their transition. PURPOSE: To explore nurses' return-to-work experiences post cancer diagnosis and clarify related facilitators and challenges. METHODS: This focus group study employed a content analysis with constant comparative approach and member checking. This study recruited nurses treated for any type of cancer who had experience returning to clinical positions. FINDINGS: Five focus groups with 17 female nurses (mean age=51.8) were performed; 47.1% had breast cancer. Four main themes were identified: (a) motivation, incentives, and the need to return to work; (b) setbacks hindering the return; (c) navigating new work dynamics; and (d) evolving professional role during the return to work. DISCUSSION: This study illustrates personal and professional growth and struggles that attend returning to work as a nurse with cancer. This insight informs strategies to support continuing these nurses' careers.

The association between nurse practitioner race and ethnicity and intent to leave in primary care practices.

BACKGROUND: Retaining nurse practitioners (NPs) from diverse racial and ethnic groups is critical to achieving health equity as NPs disproportionately care for minoritized populations. Yet, little is known about intent to leave (ITL) among these NPs. PURPOSE: To examine whether NP race and ethnicity were associated with ITL and if this relationship was affected by the work environment. METHODS: Survey data from 1,232 NPs across six states were used. NPs completed measures of their ITL, work environment quality, and demographics. Regression models were used to determine if NP race and ethnicity resulted in differential reports of ITL. FINDINGS: Minoritized NPs had significantly higher cumulative odds of ITL compared with White NPs. DISCUSSION: Minoritized NPs had higher ITL, and the work environment did not demonstrate a protective effect against ITL. Future research should identify work environment features that may help retain a diverse NP workforce.

Trauma nursing practitioners' preferences for training for trauma specialist nurses based on job competencies.

INTRODUCTION: Optimizing trauma nurse training is of great significance in enhancing nurses' professional skills, strengthening their emergency response capabilities, facilitating career development, and improving patient rescue success rates. This study aims to investigate the preferences of trauma nursing practitioners for trauma specialist nurse training based on job competency. METHODS: 631 Trauma nursing practitioners from 20 hospitals in Guizhou Province, China, participated in this cross-sectional study. The instruments used were the General Information Questionnaire and the Self-designed training preference questionnaire for trauma specialist nurses based on job competency theory. Questionnaires are distributed and collected through online questionnaires. RESULTS: 93.03% of trauma nursing practitioners expressed their willingness to participate in trauma nurse specialist training, of which 80.35% had high-level training needs. 78.92% of trauma nursing practitioners expressed their hope to receive trauma nurse specialist training through operational demonstration training, online live broadcasts, and scenario simulation drills. Among the various dimensions of job competency, the highest demand was for professional knowledge, skills, and ability. CONCLUSION: Trauma nursing practitioners highly value and recognize the professional training of trauma nurse specialists and prefer training methods that are highly practical and can directly improve clinical skills. The research results provide an important basis for further optimizing the training program for trauma nurse specialists.

Reliability of the risk of bias assessment in randomized controlled trials for nursing: A cross-sectional study.

AIM: To evaluate the percentage and reasons for disagreements in the risk of bias (RoB) assessments for randomized controlled trials (RCTs) included in more than one Cochrane review in the field of nursing. BACKGROUND: Disagreement in RoB assessments reduces the credibility of the evidence summarized by systematic reviews (SRs). There is no study that evaluates the reliability of RoB assessments in nursing studies. DESIGN: Secondary data analysis based on research reports. METHODS: RCTs included in more than one review in the nursing have been included. The disagreement of the assessment was analysed, and the possible reasons for disagreements were investigated. RESULTS: Twenty-three RCTs were included in more than one review. The agreement of assessment ranged from 36.84% for "selective reporting" to 91.30% for "random sequence generation". "Allocation concealment" showed the optimal agreement (84.21%). The items "blinding of participants and personnel", "blinding of outcome assessment" and "incomplete outcome data" showed poor agreement, with 50.00%, 58.82% and 66.67%, respectively. Most disagreements came from extracting incomplete or different RCTs' information. CONCLUSIONS: The level of agreement of the assessment between reviews has varied greatly in the field of nursing. More complete and accurate information of RCTs needs to be collected when conducting a SR.

Examining the impact of internet-enabled nursing practices, guided by specialist nurses on patients with hypertension and their caregivers.

PURPOSE: To aim of this study is to assess the impact of an internet-enabled nursing model, led by specialized nurses within a framework of multidisciplinary collaboration, on both, patients diagnosed with hypertension, and their respective caregivers. METHODS: A total of 158 patients with hypertension, along with their corresponding caregivers, were meticulously selected and paired. By using a random number table method, participants were allocated into either a control group or an observation group. The control group received conventional health education, blood pressure monitoring, and routine telephone follow-ups administered by designated nurses. Conversely, patients in the observation group underwent treatment within an internet-enabled nursing model, led by specialist nurses within a multidisciplinary collaborative framework. Parameters including systolic and diastolic blood pressure readings of the patients, as well as their scores in compliance with the hypertension treatment, quality of life, and caregiving proficiency of family members, which were meticulously documented prior to intervention (T0), as well as at 3- and 6-month intervals post-intervention (T1 and T2). RESULTS: Statistically significant differences were observed in both systolic and diastolic blood pressure levels among patients, as well as in their scores reflecting compliance with hypertension treatment, quality of life, and caregiving proficiency of family members, when comparing pre- and post-intervention periods within each group, across groups, and within the interaction effect (p < 0.05). Also, there were statistically significant differences in the aforementioned parameters between the two groups at adjacent time points (p < 0.05). Specifically, patients within the observation group exhibited notable reductions in systolic and diastolic blood pressure levels at both T1 and T2, alongside heightened scores indicative of enhanced compliance with hypertension treatment, enhanced quality of life, and increased caregiving proficiency among family members, when compared to patients within the control group (p < 0.05). CONCLUSION: The implementation of an internet-enabled nursing model, overseen by specialized nurses within a framework of multidisciplinary collaboration, demonstrates superior efficacy in preserving the stability of blood pressure among patients with hypertension. This model significantly enhances patient compliance with treatment regimens, enhances their overall quality of life, and fosters heightened caregiving proficiency among their respective caregivers.

Advanced Practice Providers in Cellular Therapy: survey results from the ASTCT APP Special Interest Group exploring clinical roles, compensation and job satisfaction.

BACKGROUND: Advanced practice providers (APPs), which include physician assistants/associates and advanced practice nurses, are critical members of the transplant and cellular therapy (TCT) care team. Despite broad utilization in transplant centers, there is little published literature on the clinical roles and responsibilities, staffing models, compensation structure, and job satisfaction of TCT APPs. This study represents the results of a national survey administered by the APP Special Interest Group to better characterize the TCT APP workforce. OBJECTIVE: To characterize the TCT APP workforce by investigating clinical roles and responsibilities, compensation and institutional support, and job satisfaction. METHODS: A 25-item web-based survey addressing four domains (transplant center data, APP roles and responsibilities, compensation and institutional support, and job satisfaction). Surveys were sent to participants through a chain-referral sampling method. Data were analyzed using descriptive statistics and multinomial logistic regression. RESULTS: A total of 198 responses were analyzed, representing 64 transplant centers of varying size from 29 states. APPs report working in inpatient and outpatient settings and performing a broad array of TCT-associated procedures including bone marrow biopsy (78%), lumbar puncture (43.2%), intrathecal chemotherapy (47.0%), and cellular infusions (45.9%). Median salary of respondents was $110,000 - $119,000 and was significantly associated with geographic location of transplant center and years of experience. A minority of respondents reported no funding (4.2%) or time (9.8%) supporting continuing education. A majority of APPs (55.1%) do not feel they are appropriately paid. A majority (54.3%) did not feel that their center supported a good work-life balance. Nearly 35.4% of respondents did not feel valued in their role. CONCLUSIONS: This survey represents the first to characterize the TCT APP workforce in the United States. APPs are highly integrated into the TCT care team and can serve as means to improve patient access to TCT therapies given a worsening physician shortage. However, the lack of satisfaction with compensation and work-life balance could represent barriers to recruitment and retention of TCT APPs and warrant future studies to better characterize.