Social Determinants of Health in the Lives of Urban-Dwelling, Pregnant Puerto Rican Women and Families: Nursing Implications From a Secondary Narrative Analysis.

Urban-dwelling childbearing Puerto Rican women and families on the U.S. mainland face a myriad of social determinants that affect pregnancy and overall health outcomes. Historically, Puerto Ricans have poorest pregnancy outcomes of all Hispanic women. Acknowledgment of the cyclic, structural barriers faced by this patient population is essential to providing wholistic care. Here, we discuss family nursing implications derived from narrative analysis of a parent study that investigated ecological systems affecting 21 pregnant Puerto Rican women residing in an impoverished and crime-ridden neighborhood in Philadelphia. Content analysis of interviews revealed interwoven social determinants of health embedded in participant narratives. Furthermore, we present case vignettes based on integration of participant interviews that encapsulate the everyday experiences of these women and their families and provide clinicians with guidance and strategies for interacting with and advocating for this population.

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

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

Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia.

OBJECTIVES: The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively influencing their health seeking behaviors related to prenatal care. METHODS: Qualitative, descriptive methods were used including individual interviews and focus groups to obtain maximum understanding of the women's lives. The interviews and focus groups were conducted using a semi-structured interview guide based on various components of the study's conceptual framework. Content analytic strategies included rigorous and systematic processes to increase trustworthiness: training, supervision, audits, electronic technologies, and ongoing input of the research team. RESULTS: Factors on all levels of the study's conceptual framework compound the effects of stressors and restrictions on the lives of urban, childbearing Puerto Rican woman. The intersectionality of issues for Puerto Rican women can either mitigate or heighten the pressure on their daily lives. CONCLUSIONS: This initial research sets the groundwork for further studies, such as narrative analysis, to better understand how to build appropriate and relevant interventions. Uncovering the women's stories gives them the opportunity to be a critical part of cross-sector partnerships towards the development of sustainable interventions.

A Practice-Based Research Database to Study Perinatal Nurse Home Visiting to Pregnant Women With Diabetes.

BACKGROUND AND AIMS: Accumulation of real-world evidence from practice-based perinatal nurse home visits to pregnant women with diabetes prompted this translational perinatal health disparities research. Given the global diabetes epidemic, this academic-community partnered research team is studying the utilization, processes, and outcomes of this understudied model of perinatal nurse home visiting that provide home-based enhanced diabetes care to pregnant women. Because the nursing records provide the rich source of data for the study, our aim is to provide an in-depth description of the Philadelphia Pregnancy and Diabetes Home Visiting (PPD-HV) research database developed from data in the longitudinal nursing records. METHODS: This descriptive study uses retrospective data abstracted from paper-based perinatal nurse home visiting clinical records to create the PPD-HV, a HIPAA compliant, secure REDCap electronic research database. The sample includes 248 urban, pregnant women with diabetes who received a total of 1,644 home visits during the year 2012. The setting was Philadelphia, a large metropolitan city in the northeastern part of the United States. The PPD-HV database followed the information fields of the paper-based clinical nursing forms, which were originally designed by following the Omaha System to guide documenting the nursing process used in caring for patients in their homes. RESULTS: Using REDCap, the PPD-HV research database is robust with 239 variables and captures longitudinal clinical nursing data. Among the pregnant women with diabetes receiving nurse home visits, the mean age was 30.7 years, most were single, and had given birth to other children. LINKING EVIDENCE TO ACTION: Real-world clinical nursing practice data provide a rich source of research data to advance understandings about this model of enhanced diabetes care and the pregnant women with diabetes receiving the care. Considering the global epidemic of diabetes, this is a perinatal nurse home visiting model to replicate and evaluate.

Lessons in community health activism: the maternity care coalition, 1970-1990.

This study employed historical methodologies to explore the means through which the Maternity Care Coalition used grassroots activism to dismantle the power structures and other obstacles that contributed to high infant mortality rates in Philadelphia's health districts 5 and 6 during the 1980s. Infant mortality within the black community has been a persistent phenomenon in the United States. Refusing to accept poverty as a major determinant of infant mortality within marginalized populations of women, activists during the 1980s harnessed momentum from a postcivil rights context and sought alternative methods toward change and improvement of infant mortality rates.

Narrative Analysis of Urban-Dwelling Pregnant Puerto Rican Women: Fuerza y Tenacidad.

Among Latina subgroups residing in the mainland United States, Puerto Rican women have the highest infant mortality rates when compared to all Latinas. Despite this, little is known about their daily lives in urban settings. This narrative analysis describes the stories regarding the life course of 21 pregnant Puerto Rican women living in an urban area in the mainland United States to identify plot types and underlying dimensions of their social ecology. Holistic form analysis was used to identify the structure of the narratives with graphical representations of the three identified types of plots (series of events that make up a story). Holistic content analysis was used to describe the major components of the narratives. Three primary plot types emerged from the narratives: Progressive, Neutral, and Circular. The women exhibited strength and tenacity to survive within a challenging urban setting often complicated by social pressures of their culture. The findings show the diversity of their lives and their social contexts even though from the viewpoint of being pregnant, Puerto Rican women who lived in a single neighborhood they may seem remarkably similar to an outsider.

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

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

Qualitative Descriptive Study of Childbirth Educators' Perspectives on Prenatal Education for Women With Physical Disability.

OBJECTIVE: To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability. DESIGN: Qualitative descriptive design. SETTING: Telephone interviews. PARTICIPANTS: Seventeen childbirth educators. METHODS: We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis. RESULTS: We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability. CONCLUSION: Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.

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

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

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

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

Engagement of Urban, Pregnant Puerto Rican Women in Health Disparities Research.

Persistent challenges surround the recruitment of minority women from marginalized communities in health disparities research. These challenges include lack of the following: interest in research participation, trust, positive relationships between researchers and participants/community, and principal investigators from minority groups. The purpose of this article is to describe successful recruitment strategies used in health disparities research with pregnant Puerto Rican women and to suggest ways to ensure the future success of studies on health disparities. Suggested strategies include creating trust, facilitating active participation of stakeholders, and strengthening the research pipeline with undergraduate and graduate nursing students.

Lyophilization cycle development for a high-concentration monoclonal antibody formulation lacking a crystalline bulking agent.

An efficient freeze-dry cycle was developed for a high concentration monoclonal antibody formulation lacking a crystalline bulking agent. The formulation, at multiple protein concentrations, was characterized using differential scanning calorimetry (DSC) and freeze-dry microscopy. At low protein concentrations the glass transition temperature of the maximally freeze-concentrated solution (T(g)') determined by DSC was similar to the collapse temperature determined by freeze-dry microscopy. However, at higher protein concentrations, the difference between collapse temperature and T(g)' became progressively larger. The difference between the onset temperature for collapse and the complete collapse temperature also became progressively larger as protein concentration increased. JMP Design of Experiment studies were used to assess the effect of freezing rate, primary drying shelf temperature, and chamber pressure on primary drying product temperature, length of primary drying, and product quality attributes. Primary drying was shortened significantly by adjusting to conditions where the product temperature substantially exceeded T(g)' without any apparent detrimental effect to the product.

Latinas and Intergenerational Caregiving: An Integrative Review of the Literature.

BACKGROUND: Identifying gaps in the literature regarding Puerto Rican childbearing women and intergenerational caregiving will facilitate future nursing practice and research regarding the amelioration of poor maternal-fetal outcomes. METHOD: A literature search using PubMed and CINAHL, sensitized by Bronfenbrenner's Ecological-Environmental Model on Latinas and intergenerational caregiving, generated 18 peer-reviewed research articles (2009-2014) for analysis. RESULTS: Categories and themes included the following: Latinas are the primary caregivers within their families and communities; caregiving is described; however, none of the studies classified caregiving as intergenerational and none sought to understand the overall impact on Latinas simultaneously caring for other members of their caregiving networks. CONCLUSION: Gaps in the literature need to be addressed to facilitate design of health care programs to address disparities and increase supports for childbearing Latinas involved in intergenerational caregiving who are at risk for higher incidences of challenging life experiences.

Maternal Caregiving Demands for Adolescent and Young Adult Survivors of Pediatric Brain Tumors.

PURPOSE/OBJECTIVES: To examine the daily maternal caregiving demands for adolescent and young adult survivors of pediatric brain tumors who live with their families. DESIGN: A secondary analysis was conducted on interview data gathered during a large mixed-methods study that focused on perceived maternal caregiver competency and survivor health-related quality of life. SETTING: Home interviews. SAMPLE: A purposive sample of 46 maternal caregivers was selected from participants in the larger study. METHODS: Semistructured interviews were conducted with mothers. A directed content analysis was informed by Sullivan-Bolyai's framework describing the components of primary caregiving. MAIN RESEARCH VARIABLES: Caregiving demands. FINDINGS: Data regarding four main categories of maternal daily caregiving demands were identified from 25 of the 46 interviews. CONCLUSIONS: Potential day-to-day management tasks or demands of mothers of adolescent and young adult survivors of pediatric brain tumors were identified. IMPLICATIONS FOR NURSING: The major demands of caregiving are similar to those for children with other chronic conditions, with the addition of assisting with everyday responsibilities and fostering psychosocial health.

Acute Intravenous Tissue Plasminogen Activator Therapy does not Impact Community Discharge after Inpatient Rehabilitation.

BACKGROUND AND PURPOSE: Discharge status and acute re-hospitalization are used as indicators of stroke severity and recovery. Intravenous t-PA (tissue plasminogen activator) is one of two treatments shown to have a positive impact. Stroke rehabilitation patients are an important population who will end up integrated back into the community, institutionalized or hospitalized due to late stroke complications. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy. METHODS: Retrospective analysis of census data from ischemic stroke patients on the UTHealth Stroke/Neurorehabilitation Services at Memorial Hermann Hospital - Texas Medical Center between Jan 2011 and Nov 2013, discharged to the Community, SNF (Skilled Nursing Facility) or AC (Acute Care). Demographics and NIHSS (National Institutes of Health Stroke Scale) were collected. Discharge FIM (Functional Independence Measure) was the reference standard. Genitourinary infections were a negative mediator in the multivariate regression. RESULTS: Of 346 patients, 274 returned to the community, 47 to SNF, and 25 to AC. NIHSS AND T-PA THERAPY: Median NIHSS values were 8 in the community group, 11 in SNF and 9.5 in AC. 31.8% of patients received IV t-PA in the community group, 23.4% in SNF and 24% in AC. There were no statistically differences in community discharge rates. COMMUNITY VS AC: One day increase in rehabilitation hospitalization correlated with 19% decreased odds of AC readmission (OR 0.81; P=0.001). One unit discharge FIM increase correlated with 13% decreased odds of AC readmission (OR 0.87; P=0.003). COMMUNITY VS SNF: One year age increase correlated with 4% increased odds of SNF admission (OR 1.04; P=0.02). CONCLUSIONS: Intense rehabilitation evidenced by FIM improvement and length of stay, impacts community discharge in mild to moderate stroke patients. t-PA had no effect. This study is limited by sample size, retrospective design and undetermined psychosocial factors.

Resuscitation team perceptions of family presence during CPR.

The literature supports family presence during cardiopulmonary resuscitation (CPR) and its many perceived benefits for patients and their families. It also suggests that, overall, health care professionals are supportive of this practice. There have not been any published studies to date that have looked at the perception of family presence from the multidisciplinary resuscitation or code team's perspective. The purpose of this study was to describe the multidisciplinary care provider's understanding and perceived barriers of family presence during CPR in an academic medical center. This study is a quantitative, exploratory, descriptive study that utilized survey methodology. The sample included all members of an urban academic medical center's resuscitation response team. The study findings reveal that, overall, code team members feel that family members should be allowed to remain at the bedside during CPR but that challenges exist including education deficits and mixed feelings that may result from family presence; the study participants caring for neonates and children were more favorable to family presence during CPR than their adult counterparts. Barriers remain related to family presence during resuscitation. Education is needed for all members of the health care team to facilitate collaborative changes in resuscitation practices. Education should include information regarding institutional policies, methods for incorporating family members into the code process, and interventions to support the psychosocial needs of family members.