Administrative and Related Barriers to Covering the Costs of Preexposure Prophylaxis at a Safety-net Clinic in Seattle, Washington.

One barrier to human immunodeficiency virus preexposure prophylaxis (PrEP) is lack or perceived lack of health insurance or financial assistance. We performed a medical records review at a safety-net PrEP clinic in Seattle, Washington, and found that barriers to obtaining financial assistance were commonly recorded in association with initiation and persistence on PrEP.

Taking action: An exploration of the actions of exemplary oncology nurses when there is a sense of hopelessness and futility perceived by registered nurses at diagnosis, during treatment, and in palliative situations.

"There is nothing more that can be done" is a phrase that may occasionally cross the minds of oncology nurses. This paper reports on the actions of exemplary oncology nurses who were faced with such situations where their colleagues gave up or turned away. The research question, "What actions do exemplary clinical oncology nurses (RNs) undertake in patient-care situations where further nursing interventions seem futile?" prefaced data collection via a secure website where 14 Canadian clinical oncology registered nurses (RNs) provided narratives documenting their actions. Thematic analysis utilized QRS NVivo 10 software and hand coding. Four themes were generated from data analysis: advocacy, not giving up, genuine presence, and moral courage. Implications for practice and future research are provided.

A Case for Open Pedagogy in Nursing Education.

BACKGROUND: Open pedagogy increases access to equitable nursing education with its commitment to the scholarship of "teaching and learning" and critically framed, student-centered, relational, and open knowledge principles. PURPOSE: This study examined the operation of and factors that nurture and challenge the practice of open pedagogy in an undergraduate digital distance nursing education program. METHODS: An exploratory qualitative methodology was used to examine linkages between open pedagogy and a nursing education program in an open digital distance Canadian university. A critical realist research paradigm provided the framework for the study. RESULTS: Our findings shed light on how open pedagogy is practiced in relation to its 5 principles and delve into the major themes of nurse educator agency, course design, and institutional structure. CONCLUSIONS: The study addresses a dearth in the literature by exploring the potential of open pedagogy to increase access to meaningful and critically framed nursing education.

Using Open Educational Practices: Implications for Nursing Education.

BACKGROUND: This paper reports on our use of open educational practices (OEPs) with online students in nursing. PURPOSE: Our aim was to provide nurse educators with knowledge about (and examples of) OEPs they could use to enhance student learning and their career satisfaction. METHOD: Using collaborative autoethnography, we probed our open teaching strategies. With Swanson's middle-range theory of caring as a theoretical framework and thematic analysis of our data set (which included literature annotations, dialogic conversation transcripts, individual reflections, and course evaluations), we uncovered 5 themes relevant to nursing education. RESULTS: The themes are student achievement of affective domain learning outcomes, our values as a blueprint for action, alignment of our OEPs and relational pedagogy, mutuality of the experience, and the ongoing process of learning to be an open educational practitioner. CONCLUSION: Using OEPs can help develop skilled and caring nurses.

Differential regulation of cell functions by CSD peptide subdomains.

BACKGROUND: In fibrotic lung diseases, expression of caveolin-1 is decreased in fibroblasts and monocytes. The effects of this deficiency are reversed by treating cells or animals with the caveolin-1 scaffolding domain peptide (CSD, amino acids 82-101 of caveolin-1) which compensates for the lack of caveolin-1. Here we compare the function of CSD subdomains (Cav-A, Cav-B, Cav-C, Cav-AB, and Cav-BC) and mutated versions of CSD (F92A and T90A/T91A/F92A). METHODS: Migration toward the chemokine CXCL12 and the associated expression of F-actin, CXCR4, and pSmad 2/3 were studied in monocytes from healthy donors and SSc patients. Fibrocyte differentiation was studied using PBMC from healthy donors and SSc patients. Collagen I secretion and signaling were studied in fibroblasts derived from the lung tissue of healthy subjects and SSc patients. RESULTS: Cav-BC and CSD at concentrations as low as 0.01 µM inhibited the hypermigration of SSc monocytes and TGFß-activated Normal monocytes and the differentiation into fibrocytes of SSc and Normal monocytes. While CSD also inhibited the migration of poorly migrating Normal monocytes, Cav-A (and other subdomains to a lesser extent) promoted the migration of Normal monocytes while inhibiting the hypermigration of TGFß-activated Normal monocytes. The effects of versions of CSD on migration may be mediated in part via their effects on CXCR4, F-actin, and pSmad 2/3 expression. Cav-BC was as effective as CSD in inhibiting fibroblast collagen I and ASMA expression and MEK/ERK signaling. Cav-C and Cav-AB also inhibited collagen I expression, but in many cases did not affect ASMA or MEK/ERK. Cav-A increased collagen I expression in scleroderma lung fibroblasts. Full effects on fibroblasts of versions of CSD required 5 µM peptide. CONCLUSIONS: Cav-BC retains most of the anti-fibrotic functions of CSD; Cav-A exhibits certain pro-fibrotic functions. Results obtained with subdomains and mutated versions of CSD further suggest that the critical functional residues in CSD depend on the cell type and readout being studied. Monocytes may be more sensitive to versions of CSD than fibroblasts and endothelial cells because the baseline level of caveolin-1 in monocytes is much lower than in these other cell types.

Facilitating family-focused Care of Older adults living in Long-Term Care in Canada during Restricted Visiting due to COVID-19.

BACKGROUND: The focus of this paper is exemplary gerontological nursing interventions that effectively supported families and long-term care residents in Canada during visiting restrictions resulting from COVID-19. OBJECTIVE: The aim was to describe exemplary gerontological nursing interventions that families and long-term care residents in Canada found supportive during visiting restrictions resulting from COVID-19. METHODS: An analysis of data artefacts including news reports, blogs and social media postings was completed. RESULTS: Thematic analysis resulted in four themes: dedication amidst challenge, innovation and continuous learning, living their nursing values and purposeful knowledge sharing. These themes are described using a framework that depicts four pillars of exemplary nursing practice: professionalism, scholarly practice, leadership and stewardship (Riley, Beal, & Ponte, 2021). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A link is made between these pillars of exemplary practice and enactment of family-focused care. Recommendations focused on gerontological nursing approaches that facilitate family-focused care for older adults residing in long-term care are included.

Aligning Nursing Ethics With Critical and Open Pedagogy in Nursing Education: A Literature Review.

BACKGROUND: There is a need to increase access to nursing education that is meaningful and socially just. PURPOSE: To investigate the alignment of critical and open pedagogy in nursing education with nursing principles of ethics. METHOD: Narrative thematic synthesis literature review of Canadian and American sources related to nursing education. RESULTS: Thematic analysis of 29 full-text sources that align nursing ethical principles with critical and open pedagogy in nursing education. CONCLUSION: Critical and open pedagogy aligns with nursing practice ethics and facilitates meaningful and socially just nursing education experiences.

Health-care providers' experiences during the COVID-19 pandemic: lessons for leaders.

PURPOSE: The purpose of this qualitative research study is to explore health-care providers' perspectives and experiences with a specific focus on supports reported to be effective during the COVID-19 pandemic. The overarching goal of this study is to inform leaders and leadership regarding provision of supports that could be implemented during times of crisis and in the future beyond the pandemic. DESIGN/METHODOLOGY/APPROACH: Data were collected by semi-structured, conversational interviews with a sample of 33 health-care professionals, including Registered Nurses, Nurse Practitioners, Registered Psychologists, Registered Dieticians and an Occupational Therapist. FINDINGS: Three major themes emerged from the interview data: (1) professional and personal challenges for health-care providers, (2) physical and mental health impacts on health-care providers and (3) providing supports for health-care providers. The third theme was further delineated into three sub-theses: formal resources and supports, informal resources and supports and leadership strategies. ORIGINALITY/VALUE: Health-care leaders are advised to pay attention to the voices of the people they are leading. It is important to know what supports health-care providers need in times of crisis. Situating the needs of health-care providers in the Carter and Bogue Model of Leadership Influence for Health Professional Wellbeing (2022) can assist leaders to deliberately focus on aspects of providers' wellbeing and remain cognizant of the supports needed both during a crisis and when circumstances are unremarkable.

#Morethanavisitor: Experiences of COVID-19 visitor restrictions in Canadian long-term care facilities.

Objective: The purpose of this study was to understand the experiences of families, residents, and staff around visitor restriction policies in long-term care during the COVID-19 pandemic in Canada. Background: Beginning in March 2020, public health orders across Canada restricted visitors to long-term care facilities to curb the spread of the infection. This included family caregivers who provide significant support to residents to meet their physical, psychological, social, and safety needs. Method: We collected data from publicly available news and social media. News articles, blogs, and tweets from Canada were collected from March 2020 to April 2021. In total, 40 news articles, eight blogs, and 23 tweets were analyzed using generic qualitative description. Results: Reports from family members indicate that some residents may have died from malnutrition, dehydration, and isolation, rather than from COVID-19, because of the sudden and prolonged absence of family caregivers. There are long-term impacts on family suffering and long-term care worker burnout. Policy and structural issues were identified. Conclusion: Experiences in long-term care reflected not only impacts of pandemic-related visitor restrictions, but also long-standing funding and workforce issues. Implications: Involvement of family, and specifically family caregivers, is crucial in policy decisions, even in unusual circumstances, such as the pandemic.

Direct and Indirect Effects of a Project ECHO Longitudinal Clinical Tele-Mentoring Program on Viral Suppression for Persons With HIV: A Population-Based Analysis.

BACKGROUND: Project Extension for Community Health Outcomes (ECHO) aims to connect community providers to academic specialists, deliver longitudinal clinical mentorship and case consultations, plus encourage dissemination of knowledge and resources. The impact on outcomes for persons with HIV (PWH) is uncertain. SETTING: PWH in Washington and Oregon outside of the Seattle and Portland metro areas, January 2011 to March 2018. METHODS: Using viral load (VL) surveillance data, we assessed difference in the percentage of PWH who were virally suppressed among PWH whose providers participated versus did not participate in Project ECHO. Analyses included multiple mixed-effects regression models, adjusting for time and for patient, provider, and clinic characteristics. RESULTS: Based on 65,623 VL results, Project ECHO participation was associated with an increase in the percentage of patients with VL suppression (13.7 percentage points greater; P < 0.0001), although the effect varied by estimated provider PWH patient volume. The difference was 14.7 percentage points ( P < 0.0001) among patients of providers who order <20 VL's/quarter and 2.3 and -0.6 percentage points among patients of providers who order 20-40 or >40 VL's/quarter, respectively ( P > 0.5). The magnitude of difference in VL suppression was associated with the number of sessions attended. Among patients of lower-volume providers who did not participate, VL suppression was 6.2 percentage points higher if providers worked in a clinic where another provider did participate ( P < 0.0001). CONCLUSION: Project ECHO is associated with improvement in VL suppression for PWH whose providers participate or work in the same clinic system as a provider who participates, primarily because of benefits for patients of lower-volume providers.

An exploration of the experience of compassion fatigue in clinical oncology nurses.

Compassion fatigue (CF) is "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers' stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided.

Family caregivers' compassion fatigue in long-term facilities.

AIM: The aim of this study was to explore the presence of compassion fatigue in family carers who assist staff with care of older relatives in long-term settings. METHOD: Narrative data were collected through observation and conversations with five purposively selected family carers. FINDINGS: Thematic and poetic analysis suggest that family carers exhibit symptoms associated in the literature with compassion fatigue in nurses and other healthcare professionals. Two major themes emerged: role engulfment and enveloping sadness. CONCLUSION: Nurses working in long-term care settings should educate family carers about compassion fatigue, recognise its presence in them and provide support to family carers experiencing the condition.

Establishing Meaningful Learning in Online Nursing Postconferences: A Literature Review.

BACKGROUND: Effective teaching and learning strategies in online postconference can assist students to find meaning within clinical experiences. PURPOSE: To explore this, we completed a literature review about meaningful learning in online clinical postconferencing in prelicensure nursing education. METHODS: Articles that were peer-reviewed, published within the last 10 years, written in English, and addressed online learning in clinical postconferences in prelicensure nursing programs were included. RESULTS: Analysis revealed the following themes: connecting theory to practice, reflective practice, impact on future practice, peer and instructor support, mentoring and leadership development, giving and receiving feedback effectively, critical thinking, and engagement of active learners. Gaps were evident with minimal evidence-based practice described related to postconferences in general. Additionally, there is limited discussion of online postconferencing. CONCLUSIONS: Understanding the nuances of meaningful learning in online postconference is critical to facilitating students' ability to connect theory to practice.

Being an exemplary role model: it begins with an optimistic attitude.

This phenomenological research study focused on a sample of eight registered nurses identified by their colleagues as outstanding. Data were collected by interviewing and observing the participant nurses. Narrative analysis and poetic interpretation were the two routes of data analysis. The major theme revealed was that these outstanding nurses were also excellent role models. The foundation of their effectiveness was the maintenance of an optimistic attitude. The role of the staff development educator in encouraging and supporting optimistic attitudes is described.

Conveying compassion through attention to the essential ordinary.

AIM: To discover some of the means by which nurses let older people know that they sense their suffering and are willing to try to relieve or at least reduce it. METHOD: A purposive sample of seven nurses employed in long-term care in Canada was recruited by network sampling. Data from unstructured interviews and participant observations were analysed and themes identified. FINDINGS: The overarching theme identified was attention to the essential ordinary, with two sub-themes being 'attention to the little things' and 'keeping the promise to never abandon'. CONCLUSION: Paying attention to the little things, and the resulting patient-centred approach that this care provided, seemed to send a message to patients that they had value. When nurses were able to enhance the esteem needs of patients in this way they also found meaning in their work and a sense of professional fulfilment.

Shine on: achieving career satisfaction as a registered nurse.

This phenomenological study focuses on the experience of career satisfaction among registered nurses. Potential participants were asked, "Do you love your work as a nurse?" A random sample of eight nurses who answered yes to this question was questioned further during semistructured conversations. Conversations were recorded and transcribed. Data collected were in the form of descriptions of times during the participants' careers when they felt most professionally fulfilled. Through narrative and poetic analysis, themes of "upholding the vulnerable," "going the extra mile," and "attending to the essential ordinary" were identified. Nurse educators play an important role facilitating career satisfaction for registered nurses. Practical implications for continuing education for educators and practicing nurses are addressed.

Why exemplary oncology nurses seem to avoid compassion fatigue.

The goal of this phenomenological study was to explore what within the lived experiences of exemplary oncology nurses facilitates the avoidance of compassion fatigue. A purposive sample of seven oncology nurses (RNs) who were identified by their colleagues as exemplary caregivers was recruited. Data were collected through semi-structured conversations that were subsequently transcribed. Transcripts were analyzed for recurring themes using three points of reference: recurrence of ideas, repetition of ideas, and forcefulness with which ideas were expressed (Owen, 1984). Findings focus on three themes: moments of connection, making moments matter, and energizing moments. Discussion highlights practical implications for clinical nurses, nurse educators, and health care administrators.

Finding professional fulfilment in caring for older people.

This paper describes the findings of a phenomenological study of professional fulfilment in nurses who care for older people. The author sought to uncover what brings career satisfaction to nurses who care for older people and subsequently what motivates these caregivers to continue to care. The findings have implications for clinical nurses who may see reflections of their own approaches to care in the narratives presented. The examples of care reported may inspire nurses who work with older adults by affirming their own nursing interventions.

Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses.

PURPOSE/OBJECTIVES: To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses. 
. DESIGN: Randomized, controlled trial.
. SETTING: Online.
. SAMPLE: 54 oncology nurses.
. METHODS: Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing.
. MAIN RESEARCH VARIABLES: Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling.
. FINDINGS: Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention. 
. CONCLUSIONS: The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention.
. IMPLICATIONS FOR NURSING: This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.