Leadership Behaviors of Frontline Nurse Managers: A Mixed-Methods Research Study Identifying Essential Areas for Social Support.

OBJECTIVE: This study examined how frontline nurse managers (FLNMs) perceive and experience formal and informal social support and how personal factors and social support relate to their transformational leadership (TL) behaviors. BACKGROUND: Ineffective leadership by FLNMs is associated with costly outcomes. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed. METHODS: A convergent mixed-methods design was used. The quantitative strand included a cross-sectional survey in a sample of FLNMs. The qualitative strand used a semistructured interview and a descriptive qualitative approach with a subset of this sample. RESULTS: Formal and informal social support is positively related to the TL behaviors of FLNMs as evidenced by the convergent data. The influence of family members in the work-related decisions of FLNMs has been underreported in the literature and is an area for consideration in supporting retention and desired leadership behaviors. CONCLUSION: The findings of this study imply a need for organizations to establish systems that endorse the growth of FLNMS, create opportunities for career advancement, and integrate members of the FLNMs' personal support systems into recognition initiatives.

A mixed-methods exploration of nurse loneliness and burnout during COVID-19.

AIM: This study investigated the phenomenon of nurse loneliness as a potential contributor to burnout. BACKGROUND: Nurse wellbeing is critical for safe and efficient healthcare delivery. However, evidence indicates nurses' wellbeing is at risk. The levels of burnout, the most commonly measured symptom of suboptimal wellbeing, are rising and may relate to a largely unexplored phenomenon: loneliness. METHODS: A mixed-methods approach was used to investigate burnout and loneliness in direct-care nurses in four diverse hospitals in the midwestern and southeastern United States. Burnout and loneliness were measured, prevalence was estimated, and correlation was examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. While this study did not explicitly explore the impact of the global pandemic, data was collected in late 2021 and early 2022, during the Delta variant wave. RESULTS: In the study population (n = 117), rates of burnout are high and positively correlate with loneliness. Qualitative interviews (n = 11) revealed that nurses feel unseen, emotionally detached from their work, and dehumanized. However, social connection with peers is protective and nurses still report a strong sense of devotion to the profession and solidarity with peers. CONCLUSIONS: This study offers insight into nurse loneliness, highlighting the importance of social connectedness to improve nurse wellbeing.

Challenges and opportunities faced by nurse scientists in integrating data and technology in research to promote health equity.

Advances in technologies including omics, apps, imaging, sensors, and big data are increasingly being integrated into research by nurse scientists, but the impact on improving health equity is still unclear. In this article, nursing research faculty from one institution discuss challenges and opportunities experienced when integrating various technologies into their research aimed at promoting health equity. Using exemplars from faculty experiences, a three-pronged approach to keeping patients and communities and the goal of health equity central in research while incorporating advancing technologies is described. This approach includes establishing long-term engagement with populations underrepresented in research, adopting strategies to increase diversity in study participant recruitment, and training and collaboration among a diverse workforce of educators, clinicians, and researchers. Training nurse scientists in integrating data and technology for advancing the science on health equity will shift the culture of how we understand, collaborate, and grow with the communities in which we train and practice as nurse scientists.

Perinatal meaning-making and meaning-focused coping in the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic caused unprecedented levels of stress amongst pregnant women and new mothers. The current qualitative study explored the ways in which perinatal women made meaning of their experiences during the COVID-19 pandemic. METHODS: Data came from a parent study in which 54 perinatal (pregnant and postpartum) women in the United States completed semi-structured interviews from October 2021 to January 2022 describing their experiences during the COVID-19 pandemic. The data was interpreted using a hermeneutic, phenomenological approach to delve deeply into the concept of meaning-making. RESULTS: Despite high levels of stress and challenging circumstances, participants reported engaging in meaning-making through finding connection, focusing on gratitude, and identifying openings for change. Unique forms of meaning-making amongst this population include a sense of connection to women throughout history, connection to their baby, and recognition of the need for systemic change for perinatal women. CONCLUSIONS: Perinatal women coped with the stress of the COVID-19 pandemic by making meaning from their experiences. Future research should further explore the importance of these aspects of meaning-making to perinatal women and implement these findings to adapt prevention and treatment approaches to address perinatal stress, especially during times of crisis.

A qualitative exploration of goals-of-care discussions with seriously ill patients in Jordan.

OBJECTIVES: This study aims to explore seriously ill patients' experiences during goals-of-care discussions and perspectives of end-of-life (EOL) decision-making in the Middle Eastern country of Jordan. METHODS: This is a qualitative descriptive study with semi-structured, one-on-one interviews. Settings were 2 large hospitals in Jordan. Patients were a purposeful sample of 14 Arabic-speaking adults who were seriously ill and hospitalized with palliative care needs. RESULTS: Conventional content analysis identified 4 main themes: perceived suffering during serious illness, attitudes toward discussing EOL decision-making, goals of care and preferences for EOL, and actions to enhance EOL decision-making. Disease and treatment burdens and concerns about life, family, and death were sources of suffering during serious illness. What matters most to patients at EOL were alleviating suffering and getting support from family, friends, and care providers. Although patients expressed reluctance and inaction toward EOL decision-making due to uncertainties, lacking awareness, and assumptions of fear, their potential goals of care were to live longer, be with their families, and die with dignity. SIGNIFICANCE OF RESULTS: Jordanians and culturally similar Arabs could benefit from goals-of-care discussions. The proper, culturally sensitive implementation of goals-of-care discussions in Arab populations with similar cultural norms requires raising public awareness and clarifying the legitimacy of goals-of-care discussions, preparing patients and their families for the discussions, and considering individual variations in handling the discussions.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic.

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Correlates of Early Prenatal Care Access among U.S. Women: Data from the Pregnancy Risk Assessment Monitoring System (PRAMS).

OBJECTIVES: Early first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change. METHODS: The study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions-when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care. RESULTS: On average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card. CONCLUSIONS FOR PRACTICE: This study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted. WHAT IS ALREADY KNOWN ON THIS SUBJECT?: Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit. WHAT THIS STUDY ADDS?: Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.

The connection between loneliness and burnout in nurses: An integrative review.

Nurse burnout is a threat to safe, efficient health care delivery, yet estimated rates of nurse burnout are above 40 %. A critical step in reducing burnout is identifying phenomena that are amenable to intervention. Loneliness may be one such factor, yet the relationship between loneliness and burnout is not clearly described. This review aims to summarize existing literature documenting this connection. A systematic search was performed to identify studies reporting a relationship between burnout and loneliness with social support serving as a proxy construct. Twenty-four articles met inclusion criteria: 18 quantitative, two mixed-methods, and four qualitative studies. These studies identified a relationship between burnout and social support, with social support explaining approximately a third of the variability in burnout. Qualitative data suggest that social support is critical to coping with work stressors and is likely related to burnout. This review provides evidence that reducing nurse loneliness is a promising strategy for improving nurse wellbeing.

Strategies to enhance the success of mid-career nurse scientists.

BACKGROUND: The mid-career nurse scientist, defined as an associate professor with/without tenure, is often faced with a multitude of challenges and opportunities PURPOSE: This paper shares strategies to assist mid-career scientists as they juggle required career demands and navigate the mid-career phase in pursuit of the rank of full professor. METHOD: A review of the literature was performed on mid-career nurse scientists. DISCUSSION: A combination of increased research responsibilities, increased institutional teaching and service demands, and dwindling support can result in a sense of overwhelm and burnout. The mid-career nurse scientist must balance several balls in the air at one time to remain successful. CONCLUSION: Strategies aligned with the Ecological Framework, focus on intrapersonal, interpersonal, institutional, organizational, and public policy domains to provide a wide scope of strategies that target the mid-career scientist and engage the larger nursing community.

Feasibility, Acceptability, and Preliminary Effects of "Mindful Moms": A Mindful Physical Activity Intervention for Pregnant Women with Depression.

BACKGROUND: Nonpharmacological and accessible therapies that engage individuals in self-management are needed to address depressive symptoms in pregnancy. The 12-week "Mindful Moms" intervention was designed to empower pregnant women with depressive symptomatology to create personal goals and engage in mindful physical activity using prenatal yoga. OBJECTIVES: This longitudinal pilot study evaluated the feasibility, acceptability, and preliminary effects of the "Mindful Moms" intervention in pregnant women with depressive symptoms. METHODS: We evaluated enrollment and retention data (feasibility) and conducted semistructured interviews (acceptability). We evaluated the intervention's effects over time on participants' depressive symptoms, anxiety, perceived stress, self-efficacy, and maternal-child attachment, and we compared findings to an archival comparison group, also assessed longitudinally. RESULTS: Enrollment and retention rates and positive feedback from participants support the intervention's acceptability and feasibility. "Mindful Moms" participants experienced decreases in depressive symptoms, perceived stress, anxiety, ruminations, and maternal-child attachment and no change in physical activity self-efficacy from baseline to postintervention. Comparisons of the "Mindful Moms" intervention to the comparison groups over time indicated differences in depressive symptoms between all groups and a trend in differences in perceived stress. DISCUSSION: Results support the feasibility and acceptability of "Mindful Moms" for pregnant women with depressive symptoms and suggest that further research is warranted to evaluate this intervention for reducing depressive and related symptoms. Lack of a concurrent control group, with equivalent attention from study staff, and no randomization limit the generalizability of this study; yet, these preliminary findings support future large-scale randomized controlled trials to further evaluate this promising intervention.

Study protocol for a multisite randomized controlled trial of an internet and mobile-based intervention for preventing and reducing perinatal depressive symptoms.

Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. These women may benefit from easily accessible, nonpharmacologic, and inexpensive self-management approaches, such as via internet and mobile-based interventions, to prevent development of symptoms and/or intervene with current symptoms. This paper summarizes the research protocol of a nationally-funded large-scale randomized controlled study to evaluate "Mamma Mia," a self-guided program with 44 modules that women use throughout pregnancy to 6 months postpartum. The program contains a novel combination of components designed to enable women to enhance self-efficacy, emotional self-regulation, and perceived social support. The overall goal of this three-arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self-management approach in diverse women in the U.S. (n = 1950). Enrolled pregnant women will be randomly assigned to one of three groups: (1) "Mamma Mia" alone, which is self-guided; (2) "Mamma Mia Plus" in which participants engage in the "Mamma Mia" modules plus receive brief guided support from a registered nurse; or (3) usual prenatal/postpartum care. The first specific aim is to evaluate effects by group on the primary outcome of interest, depressive symptoms, over time. The second aim is to evaluate effects by group on subjective well-being, anxiety, and stress. Using a conceptual framework based upon Individual and Family Self-Management Theory, the third aim is to evaluate possible mediators (self-efficacy, emotion self-regulation, perceived support) and possible moderators (e.g., race/ethnicity, type of healthcare clinician) of this self-management approach.

A Comprehensive Conceptual Framework to Guide Clinical Practice and Research About Mental Health During the Perinatal Period.

Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence ("becoming a mother") plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.

Happiness in Pregnant African American Women: What Are the Biobehavioral Correlates?

The detrimental effects of prenatal stress on maternal-infant well-being have been well established and highlight increased concern for pregnant African American women. Research supports the notion that positive emotions may have a beneficial impact on the stress process and outcomes. However, the data have been largely restricted to non-African American pregnant women. This study's purpose was to examine potential relationships of both positive (happiness) and negative (stress, anxiety, and depressive symptoms) emotions and pro-inflammatory cytokines (interleukins-1ß, -6, -8, -12, -17, tumor necrosis factor, and interferon-γ) in 72 pregnant African American women for a more complete picture of the stress process in this at-risk population. Results of this exploratory secondary data analysis show strong positive correlations between negative emotions and strong negative correlations between happiness and negative emotions. Interleukin-8 was positively correlated with negative emotions and negatively correlated with happiness. Results show mean ratings of negative emotions were higher than previously reported with more heterogeneous samples, while happiness ratings were in the moderate range. Findings suggest that pregnant African American women may experience higher stress and depressive symptoms than women in more heterogeneous samples. However, moderate levels of happiness might contribute to buffering the stress response.

"I'm Not the Only One With Depression": Women's Perceptions of In-Person Group Formats of Depressive Symptom Interventions.

A standard format for depression management has long been the in-person group-based intervention, yet recent calls for scalable interventions have increased interest in individual online formats. However, the perspectives and preferences of women are largely missing in the literature. This secondary qualitative data analysis using a phenomenological method of inquiry explored the lived experiences of pregnant and nonpregnant women with depressive symptoms (N = 44) who participated in 2 studies involving group-based face-to-face mindful physical activity interventions for depressive symptom self-management. Four main themes emerged regarding the group format: shared experiences enhanced the feeling of safety and impact of the group interventions; group instructors played a key role in fostering a safe environment; participants wished for more group interactions; and participants preferred a synchronous group-based intervention over a technology-based or asynchronous alternative for depressive symptom management. The findings from this study suggest that women with depression enjoy synchronous group-based interventions and find them to be beneficial for the shared experiences with other women and the safe environment created by group instructors. Future research should include study designs that consider these factors in the context of hybrid or fully online intervention formats for depression management.

The perceived reality and environment of the mid-career nurse scientist.

BACKGROUND/PURPOSE: A qualitative study was designed to explore facilitators and barriers to success from the perspectives of self-identified mid-career nurse scientists. METHODS: Data were collected from 84 respondents using open-ended items as part of an electronic survey of self-identified mid-career nurse scientists who were members of regional nursing research societies. DISCUSSION/CONCLUSION: Two main themes emerged: "Perceived Realities" and "What's Needed to Achieve Career Success." Mid-career nurse scientists experience both joy from teaching and research roles and dissatisfaction with research support; difficulty balancing heavy teaching workload, administrative responsibilities, and research, and ineffective mentoring. Based on the challenges in their environment, respondents identified numerous ways to enhance career success including (1) increasing or enhancing release time for research activities, (2) formal infrastructure to support research activities, and (3) targeted, effective mentoring by senior scientists.

Areas of satisfaction and challenges to success of mid-career nurse scientists in academia.

BACKGROUND: Mid-career nurse scientists in academia face many challenges that can lead to burnout and exiting the profession. Finding ways to increase satisfaction and support will help retain these critical faculty in research positions. PURPOSE: Describe areas of satisfaction and challenges to success in the faculty role for mid-career nurse scientists in academia. METHOD: Cross-sectional, descriptive. A total of 65 self-identified mid-career nurse scientists completed an online survey. FINDINGS: Mid-career nurse scientists were most satisfied with their role at their organization, least satisfied with time for research and opportunities to receive mentoring. They felt moderately supported by colleagues and deans, least supported by their ADR. Differences in satisfaction among nurse scientists in different levels of research institutions were noted. DISCUSSION: Challenges to success in mid-career nurse scientists exist. Loss of nurse scientists at mid-career threatens to undermine the knowledge base of the individuals who mentor the next generation of scientists. The discipline must support mid-career scientists in their efforts to be successful in research.

Protocol for Pilot Study on Self-Management of Depressive Symptoms in Pregnancy.

BACKGROUND: Pregnant women with depressive symptoms face significant treatment challenges and are in great need of safe, effective, accessible, inexpensive, and nonpharmacological self-management therapies to enhance well-being, reduce the burden of symptoms both during their pregnancy and postpartum, and prevent chronic sequelae. OBJECTIVES: In this article, we describe the protocol for our pilot study testing a self-management intervention entitled, "Mindful Moms," designed to foster women's ability to address current depressive symptoms and enhance resilience to prevent recurrence. METHODS: We will conduct a longitudinal pilot trial of the 12-week intervention with pregnant women with depressive symptoms (n = 40); the primary aim is to determine the feasibility and acceptability of the intervention. The secondary aim is to examine preliminary effects of the intervention on maternal psychobehavioral outcomes in pregnancy and 6 weeks postpartum. The third aim will quantify genome-wide and gene-specific DNA methylation patterns associated with depressive symptoms during pregnancy and investigate whether intervention participation influences these patterns. RESULTS: This study is currently ongoing. DISCUSSION: Findings from this study will inform future research addressing the need for nonpharmacological self-management interventions for pregnant women with depressive symptoms.

An Integrative Review of Yoga and Mindfulness-Based Approaches for Children and Adolescents with Asthma.

PROBLEM: Asthma affects almost 15% of children in the United States. Despite the availability of treatments and educational methods, children with asthma continue to report an impaired quality of life, including symptoms of anxiety and inability to participate in physical activity. As complementary health approaches are becoming more popular and show promise in the management of many chronic diseases, the purpose of this integrative review is to examine the state of the science regarding popular complementary health approaches- yoga and mindfulness- for children and adolescents with asthma. ELIGIBILITY CRITERIA: A comprehensive search of five databases for peer reviewed articles was performed to identify experimental and non-experimental studies. The search for each database was performed from the inception of each to January 2020 and limited to the English language. The search included terminology that addressed the concepts of "asthma", "yoga" and "mindfulness". SAMPLE: A total of eleven articles met the criteria for review from the years 1991 to 2019. RESULTS: Nine publications focused on the use of yoga in children and adolescents with asthma and two publications focused on mindfulness in adolescents with asthma. CONCLUSIONS: Interventions involving either mindfulness or yoga may be effective in reducing stress and anxiety and improving quality of life and lung function in this population. IMPLICATIONS: Mindfulness intervention studies in the pediatric and adolescent asthma population are warranted as are additional studies that include the use of yoga with skills in mindfulness in order to evaluate their physiological and psychological effects.

Call to action to support the success of midcareer nurse scientists.

Mid-career nurse scientists in academia are at risk for burnout and departing scientific careers, particularly those in research-intensive academic settings. With the shortage of nursing faculty and the public health need for high-quality nursing research, it is critical to retain current research-focused individuals in nursing. In this paper, we discuss definitions and expectations of mid-career scientists, challenges and barriers faced by mid-career scientists, and opportunities for mid-career scientists, informed by both nursing and non-nursing literature. Finally, we focus on definitions and expectations, challenges, and opportunities specifically related to mid-career nurse scientists in research-intensive academic settings.

Burnout, depression and suicidal ideation in dental and dental hygiene students.

INTRODUCTION: The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study. SUBJECTS AND METHODS: Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted. RESULTS: A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout. DISCUSSION: These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.