Compassion fatigue and COVID-19: A global view from nurses.

BACKGROUND: Due to the rapid spread of COVID-19 variants, the number of people hospitalized for COVID-19 may create psychological burdens on nurses. Nurses with high levels of compassion fatigue (CF) are more likely to make work errors, deliver poor-quality care, and have greater intent to leave their position. OBJECTIVES: This study utilized the social-ecological model to examine factors associated with nurses' CF and compassion satisfaction (CS) during the COVID-19 pandemic. METHODS: Data were collected from the United States, Japan, and South Korea from July to December 2020. The Professional Quality of Life Scale was used to measure burnout (BO), secondary traumatic stress (STS), and CS. RESULTS: Data from 662 responses were used in the analysis. Mean scores were 25.04 (±6.44) for BO, 24.81 (±6.43) for STS, and 37.85 (±7.67) for CS. Multiple regression analyses indicated that resilience and intention to leave nursing were related to each study outcome (i.e., BO, STS, and CS). Greater resilience predicted lower BO and STS but greater CS, whereas intention to leave nursing indicated greater BO and STS, but lower CS. Furthermore, intrapersonal factors and organizational factors (i.e., nurses involved in developing policies to prepare for COVID-19 patients, organizational support, and personal protective equipment [PPE] provisions) were related to BO, STS, and CS. LINKING EVIDENCE TO PRACTICE: To promote nurses' psychological well-being, improvement of organizational factors such as support, PPE, and programs to enhance resilience is recommended to prepare for future emerging infectious disease crises.

A New American University Model for Training the Future MCH Workforce Through a Translational Research Team.

OBJECTIVES: To describe the process of developing and implementing experiential learning through translational research teams that engage diverse undergraduate and graduate students. METHODS: After a college redesign, translational research teams were developed to foster multidisciplinary research and better integrate students with faculty research, community, and clinical activities. Three primary approaches were used to engage undergraduate and graduate students in the maternal and child health translational research team (MCH TrT). These included an undergraduate experiential learning course; participation in translational research team meetings and events; and mentorship activities including graduate student theses and supplementary projects. RESULTS: Since 2019, a total of 56 students have engaged with the MCH translational research team. The majority (64%) of students engaging in translational research were undergraduates. Racial and ethnic diversity was evident with 16% Latinx, 14% Black/African American, 12% Asian, 10% two or more races, and 4% Native American or Native Hawaiian. A large proportion (42%) of students indicated that they were first-generation college students, while 24% indicated they had a disability. Five themes emerged from student feedback about their involvement in the experiential learning course: the value of translational research, development of research skills, collaboration, practice development, and value for community partners. CONCLUSIONS FOR PRACTICE: Through an MCH translational research team, we have established a pathway to enhance diversity among the MCH workforce which will increase recruitment and retention of underrepresented groups, and ultimately improve MCH research and practice.

The Impact of a Theory-Based mHealth Intervention on Disease Knowledge, Self-efficacy, and Exercise Adherence Among Ankylosing Spondylitis Patients: Randomized Controlled Trial.

BACKGROUND: Patient education is recommended as an integral part of disease management in ankylosing spondylitis (AS), a chronic rheumatic disease that predominantly affects young males and requires long-term disease management. Convenient and cost-effective approaches to deliver patient education are required to these patients. OBJECTIVE: This study aimed to examine the effects of a theory-based educational intervention delivered through a social networking app, WeChat, on disease knowledge, self-efficacy, exercise adherence, and health outcomes in Chinese AS patients. METHODS: This study was a single-blind randomized controlled trial conducted in a tertiary hospital in Chengdu, China. Eligible participants were randomly allocated to the intervention or control group. Participants in the control group received standard care. The intervention group received the health belief model (HBM)-based educational intervention, consisting of 4 individual educational sessions and educational information sharing through WeChat, the predominant social networking app in China. The primary outcomes were disease knowledge, self-efficacy, and exercise adherence. The secondary outcomes were disease activity and physical function. Data were collected at baseline and at the end of the intervention (12th week). Chi-square test, t test, Mann-Whitney U tests were used to examine the effects of educational intervention. RESULTS: This study included 118 patients with AS. The majority of participants were male (93/118, 78.8%). Around half of them were married (56/118, 47.5%), never smoked (70/118, 59.3%), and had college educational level or above (62/118, 52.5%). At posttest, participants in the intervention group had higher disease knowledge (all P<.001) and self-efficacy (P<.001), and a larger proportion of participants in the intervention group adhered to regular exercise routines than those in the control group (P=.003). The within-group analyses for the intervention group showed increases in all scores of disease knowledge (all P<.001) and self-efficacy score (P<.001), but only correct answer score (P=.04) and general knowledge score (P=.002) of disease knowledge in the control group improved. The within-group analysis for the control group found a decline of physical function (P=.002) but no significant change in disease activity (P>.05). The within-group analysis for the intervention group showed no significant change in disease activity or physical function (P>.05). At posttest, no statistically significant difference was found on disease activity or physical function between the intervention and control groups (P>.05). CONCLUSIONS: The HBM-based educational intervention through WeChat can effectively improve patient disease knowledge, self-efficacy, and exercise adherence. WeChat is feasible and effective to deliver patient education for patients with chronic diseases such as AS. This mHealth intervention can be integrated into routine rheumatology care. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-16009293; https://tinyurl.com/swxt8xk7.

Knowledge and Attitudes toward Dementia among Undergraduate Health Professional Students in China: A Cross-Sectional Survey.

PhenomenonDementia is a huge burden to the economic and health care system in China. As the next generation of health care providers, undergraduate health professional students play a pivotal role in caring for dementia patients during their clinical placements and in independent practice. Nevertheless, they may not be adequately prepared to care for patients with dementia by their undergraduate programs. Measuring the knowledge and attitudes of health professional students could be an important step in providing evidence regarding the need to enhance dementia care training in the curriculum. Approach: Responses from 325 Chinese health professional (nursing, medical, and public health) students were included in the analyses. After providing informed consent, students answered questionnaires including a demographic data questionnaire, the Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitudes Scale (DAS). Univariate analyses were performed to test the association between outcomes and potential explanatory variables. Multiple linear regression analysis was used to determine the predictive factors for knowledge and attitudes toward dementia. Findings: Chinese health professional students had a mean ADKS score of 18.92 (SD = 3.20). Better knowledge was associated with advanced education, having family members with medical knowledge, having heard of dementia, and having interest in learning about dementia. Students had a mean DAS score of 89.10 (SD = 8.93), and their attitudes were significantly associated with majoring in public health and having heard of dementia. Students' knowledge was positively, but weakly related with attitudes (r = 0.122, P = 0.028). Insights: Chinese undergraduate health professional students demonstrate insufficient knowledge and less positive attitudes toward dementia than their counterparts in developed countries. Enhanced dementia care-specific curriculum and training are urgently needed in China to meet the growing demand for dementia care services.

Protocol of the Snuggle Bug/Acurrucadito Study: a longitudinal study investigating the influences of sleep-wake patterns and gut microbiome development in infancy on rapid weight gain, an early risk factor for obesity.

BACKGROUND: Overweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG. METHODS: The Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG. DISCUSSION: Repeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity.

Exploring Chinese College Students' HPV Awareness, Knowledge, Attitudes, and Intent of HPV Vaccination: a Qualitative Study.

Human papillomavirus (HPV) infection is the world's most prevalent sexually transmitted infection and causes cancers. In China, about 47,739 deaths occur annually from HPV-related cervical cancer, and this number continues to increase. HPV vaccines have shown promising results in preventing HPV-associated cancers; however, the vaccination rate in Chinese college students remains extremely low. This qualitative research explored Chinese college students' HPV-related awareness, knowledge, attitudes and beliefs, and their vaccination intention as well as the strategies promoting vaccination in China. We conducted four focus groups with 18 male and 20 female students; prompts were developed based on the health belief model (HBM). Discussions were audiotaped, transcribed, and translated from Chinese to English by three bilingual researchers. Content analysis of the data revealed eight themes addressing HBM. Participants demonstrated high awareness (71% had heard of HPV) with limited knowledge. They perceived very low risks of being infected but expressed high vaccination intention if the cost was covered by the government. Participants identified reasons that facilitate and prevent vaccination and proposed culturally and developmentally congruent strategies to promote vaccination in China. It is essential to address facilitators and barriers at individual, societal, political, and cultural levels to promote HPV vaccination in Chinese college students.

Review of Chinese young adults' human papillomavirus knowledge, attitudes, and vaccine acceptability.

OBJECTIVE: The human papillomavirus (HPV) vaccine is effective in reducing HPV-related disease. The 2-, 4-, and 9-valent HPV vaccines have been approved by the Chinese FDA since 2016; however, factors associated with HPV vaccine acceptability and use in Chinese young adults remain unclear. DESIGN AND SAMPLE: We conducted a systematic review to analyze factors affecting HPV vaccine acceptability and use in Chinese young adults. A comprehensive search of databases (e.g., PubMed, CINAHL, and PsycINFO) was conducted, and articles between 2011 and 2020 were included. RESULTS: Seventeen studies were included in the final review, and eleven were conducted in mainland China and six in Hong Kong. All studies reported low level of HPV-related knowledge. Better knowledge, more concerns about HPV-associated diseases, and being female were found associated with higher vaccine acceptability. The vaccine cost and safety were the major concerns for vaccination. CONCLUSIONS: Findings suggested a low level of HPV-related knowledge and suboptimal vaccination rate in Chinese young adults. Theory-based interventions addressing knowledge and other influencing factors and involving both males and females are urgently needed to increase vaccine acceptability and use in Chinese young adults.

Community development for improved housing, health equity, and education in rural Honduras.

This paper describes an international, long-term, population health project in rural Honduras among Mayan villagers, focused on collaboration, community building, partnership formation, and improvement of their living situation. Improved housing, health checks, education for their children, and clean water were chosen by the Honduran residents as the projects they thought were most important to improve their health and living conditions. During the short mission trips, the North Americans (NAs) and the villagers worked side-by-side on house building and participated in village life. The Hondurans organized into communities that mutually decided on which families received homes and together worked on each other's homes with the NAs' assistance. Nurse-led health clinics and scholarships for students were provided by the visitors during their time in the villages. Health has improved from better housing and periodic health checks, and most significantly, sustainable community organizing occurred. Public Health Nurses can work towards health equity and population health improvement by basing efforts on what the community partners request and create outcomes through relationships with those who stand to benefit from the improvement.

Recruitment and retention of underrepresented and vulnerable populations to research.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Nurses' resilience in the face of coronavirus (COVID-19): An international view.

The purpose of this cross-sectional study was to examine factors associated with nurses' resilience during the COVID-19 pandemic. Data were collected in the latter half of 2020 from 904 nurses across Japan, Republic of Korea, Republic of Turkey, and the United States. The questionnaire included the Connor-Davidson Resilience Scale 10, plus demographics and 20 questions about practice environment, workplace safety concerning infection control, COVID-related experience, and organizational support. Fear of becoming infected, intention to leave nursing, and having had a positive COVID-19 test were inversely associated with resilience (p < 0.05). Regression analysis indicated that U.S. nurses had significantly greater resilience than nurses in the other countries examined (p < 0.001). Nurses reporting organization support and those who participated in policy and procedure development had higher resilience scores (p < 0.01). Organizational support, involving nurses in policy development, and country of practice were found to be important resilience factors in our research, which aligns with other findings. Further research is recommended to determine the optimal practice environment to support nurse resilience.

Chinese Medical Students' Attitudes toward Older Adults and Willingness To Consider a Career in Geriatric Medicine: A Cross-Sectional Survey.

Phenomenon: Ageism is a significant social issue, especially in China. Ageism adversely affects willingness to consider a career in geriatric medicine. However, few studies have examined this topic among Chinese medical students. This study aimed to investigate attitudes toward older people among medical students in China, examine the factors related to these attitudes, and determine the relationships between attitudes and willingness to consider geriatric medicine as a career after graduation. Approach: Responses from 1,022 Chinese medical students were included in the analyses. Students provided demographic information and completed the Fraboni Scale of Ageism (FSA). The data were analyzed using the Statistical Package for Social Sciences, version 24.0 (IBM SPSS Corp). Findings: The mean score of the FSA was 64.42 ± 6.58. Multiple regression analysis showed that the significant predictors of ageism were being male, longer years of training in medical school, and no caregiving experiences with older adults during clinical practice (R 2 = .038, F = 13.520, p < .001). Students who had higher FSA scores were more unwilling to consider a career in geriatric medicine after graduation (t = 4.281, p < .001, Cohen's d = .268). Insights: Chinese medical students have fewer positive attitudes toward older adults than what has been reported in other countries. Future studies should examine the determinants of ageism among medical students in various cultures to guide the development, implementation, and assessment of interventions designed to nurture a more positive attitude toward older adults and increase willingness to consider a career in geriatric medicine.

A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients.

AIMS: To examine the effects of a tailored telehealth educational intervention on medication adherence and disease activity in discharged patients with rheumatoid arthritis (RA). DESIGN: An un-blinded randomized controlled trial. METHODS: A total of 92 eligible patients were recruited from January 2015-December 2015. Participants were randomly assigned to either the intervention (N = 46) or control group (N = 46). The intervention group received four educational sessions delivered through a telephone across a 12-week intervention. The content of the education mainly included: subject's knowledge about disease; treatment goals; the importance of taking medication correctly; side effect management; remembering to take medication. The control group received only standard care including discharge instructions. Outcome measures included medication adherence and disease activity. RESULTS: The intervention group had significantly higher medication adherence compared with the control group at 12th and 24th week. There was no significant difference between two groups in disease activity at 12th and 24th week. CONCLUSIONS: The telephone-delivered tailored educational intervention effectively improved medication adherence among discharged patients with rheumatoid arthritis. However, no significant benefits of the intervention on disease activity were detected. IMPACT: Good medication adherence in rheumatoid arthritis patients contributes to controlling symptom and inflammation, preventing the progressive structural damage. This study demonstrated that the telehealth educational intervention could improve patients' medication adherence but did not have a direct impact on clinical condition in the short-term. The intervention for discharged patients with rheumatoid arthritis can be integrated into the clinical setting by the nursing staff as follow-up care. TRIAL REGISTRATION NUMBER: ChiCTR-IPR-14005722.