A Systematic Review of the Relationship Between Discrimination, Racism, and Type 2 Diabetes Healthcare Outcomes for Black Americans.

BACKGROUND: Disparities in type 2 diabetes (T2DM) risk, care, and complications impact Black Americans more than that of their White counterparts. This study aims to examine the association between discrimination, racism, and T2DM care and outcomes in Black Americans. METHOD: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: A total of six original research articles met the inclusion criteria, comprising three quantitative and three qualitative studies. Overall, the systematic review findings revealed that among Black Americans, perceived interpersonal discrimination and racism by healthcare professionals are associated with patients' behaviors that impact T2DM outcomes. The findings also revealed that provider-level factors such as communication, provider assumptions and attitudes, information sharing, shared decision-making, and disease management behaviors might influence T2DM outcomes in this population. DISCUSSION: Better T2DM-related outcomes depend on optimal disease control through adequate disease management. Building a therapeutic and culturally appropriate relationship free of discrimination and racism is vital for optimal disease management and decreasing health disparities in this patient population. CONCLUSION: Perceived interpersonal racism and discrimination by healthcare providers, among other sociocultural factors, play a crucial role in influencing some patient behaviors that affect T2DM health outcomes in this population. Efforts to decrease health disparities in this specific community should also focus on interventions addressing provider-level factors and behaviors perceived as racist or discriminatory.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice.

Introduction: The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response. Methods: One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team. Results: Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress. Conclusion: Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.

A shadowing program for PAs and APRNs to promote collaborative care.

ABSTRACT: This article describes a shadowing program aimed at promoting collaborative care among PAs and NPs at an academic medical center. The program fostered interprofessional and interdisciplinary experiences to improve collaborative skills. Clinicians who completed the program had a significant improvement in collaborative competencies, as measured by the Interprofessional Collaboration Competency Attainment Survey.

Recruitment Strategies to Optimize Participation by Diverse Populations.

The authors describe the methodological strategies used to effectively recruit a diverse sample of nurses in a qualitative study. Adequate representation of diverse populations is necessary to advance science and health equity. A multimodal research approach (research team composition, flyers, social media, and purposive sampling) was used. When undertaking research with underrepresented groups, recruitment efforts should begin in the early phases of study planning with research team development that can assist in employing multiple recruitment strategies accordingly.

Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study.

AIM: The aim of this study was to conduct a primary examination of the qualitative communication experiences of nurses during the first wave of the COVID-19 pandemic in the United States. BACKGROUND: Ambiguity in ever-evolving knowledge on how to provide care during COVID-19. Remaining safe has created a sense of urgency, which has in turn created the need for organizations to quickly alter their operational plans and protocols to support measures that increase capacity and establish a culture of safe care and clear communication. However, no known study has described communication in nursing practice during COVID-19. METHODS: Utilizing qualitative descriptive methodology, semi-structured interviews were conducted with 100 nurse participants from May to September 2020 and recorded for thematic analysis. The consolidated criteria for reporting qualitative studies (COREQ), a 32-item checklist, were used to ensure detailed and comprehensive reporting of this qualitative study protocol. FINDINGS: Study participants shared descriptions of how effective communication positively impacted patient care and nursing practice experiences during the first wave of the COVID-19 pandemic. The thematic network analyses identified the importance of effective communication across three levels: (1) organizational leadership, (2) unit leadership and (3) nurse-to-nurse communication. Within this structure, three organizing themes, essential to effective communication, were described including (a) presence, (b) education and (c) emotional support. CONCLUSION: Examining existing crisis communication policies and procedures across healthcare organizations is imperative to maintain highly relevant, innovative, and data-driven policies and strategies that are fundamental to preserving quality patient care and supporting optimal nursing practice. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Effective communication is critical to support nurses through extended periods of crisis. COVID-19 represents a unique contemporary challenge to the nursing workforce given the high stress and prolonged strain it has created for both human and healthcare supply resources. There is value in nurses' presence at local, unit level and organizational leadership levels to convey critical information that directly informs leadership decision-making during unprecedented emergencies such as the COVID-19 pandemic.

Communication, leadership and organizational support facilitate successful transition into practice for nurse practitioners in the emergency department.

BACKGROUND: Postgraduate programs, specialized academic programs, and national health organizations such as the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills, and factors for successful transition into practice. PURPOSE: The purpose of this study is to examine the relationships and differences among the personal and community resources that promote successful transition for nurse practitioners (NP) who practice in the emergency department (ED) and the skills or procedures they find difficult to perform independently. METHODS: A descriptive, correlational, comparative study design was conducted using an online survey administered to a convenience sample of NPs with 6 months to 5 years of experience as an NP. RESULTS: Findings from this study identified factors associated with successful and unsuccessful transition into practice and help support positive outcomes for health care institutions, ED patients, and NPs practicing in this specialty area. IMPLICATIONS FOR PRACTICE: Support in transition recognizes recommendations set by health care organizations in promoting professional development, safe clinical practice, job satisfaction, and retention. Further study will provide clarity in financial gains and improved patient health outcomes during a time in which complex disease processes and provider shortages continue to weigh heavily on society.