"It Takes a Village" to Implement Family-Centered Care in the Neonatal Intensive Care Unit.

BACKGROUND: Although research has demonstrated positive impacts of family-centered care (FCC), many neonatal intensive care unit (NICU) nurses hesitate to fully engage in its practice. There has been little scientific focus on investigating the challenges of FCC implementation in the NICU setting. PURPOSE: The purpose of this study was to generate a grounded theory explaining the process by which neonatal nurses experience facilitators and challenges through engaging in FCC practices in the context of the NICU setting. METHODS: This qualitative, grounded theory portion of a mixed-methods study employed individual, semistructured, video-based dyadic interviews with 20 neonatal nurses. RESULTS: Successful implementation of FCC by neonatal nurses is affected by various factors. The adage that "it takes a village to raise a child" described this process for the nurse participants. The delivery of FCC involves respectful engagement and participation by multiple internal and external stakeholders. The process of delivering FCC was influenced by factors across 6 categories: equitable relationships, bond of trust, knowledge sharing, empowerment in workplace, environment and culture, and regulations. The findings suggest that FCC implementation is not an individual initiative; rather, it involves a complex set of interrelationships between care team members. NICU nurses may consider these findings when they are proposing a change to a FCC model. IMPLICATIONS FOR PRACTICE AND RESEARCH: Flexibility is necessary by multidisciplinary teams to achieve maximum benefits of FCC and minimize potential harm, despite the unit design. Facilities may support nurses with continuing education programs to expand their FCC knowledge and skills.

Patient-centred care, diabetes self-management and glycaemic control among Omani patients with type-2 diabetes.

AIM: This study examined the relationships between patient-centred care, diabetes self-management and selected health outcomes for Omani patients with type-2 diabetes. METHODS: Cross-sectional surveys were administered for 237 patients with type-2 diabetes. Hierarchical regression analyses examined the relationships between the selected study variables. RESULTS: The sample was middle-aged (M = 48, SD = 11.0 years) with nearly a decade (M = 9.68, SD = 6.11) since being diagnosed with type-2 diabetes, with higher than ideal glycaemic control measures (M = 8.8%, SD = 2.4%). In bivariate analyses, patient-centred care was positively associated with diabetes self-management but not with glycaemic control or quality of life. However, after controlling demographic and clinical characteristics, patient-centred care was positively associated with both physical and mental aspects of health-related quality of life. In the final regression model, controlling for demographic and clinical characteristics and patient-centred care, diabetes self-management significantly predicted both glycaemic control and both physical and mental aspects of health-related quality of life. CONCLUSIONS: The findings support that providing individualized care may contribute to the self-management of chronic conditions. For achieving optimal outcomes, it may be necessary for providers to effectively assess patients' unique challenges and motivations. Increasing diabetes self-management may improve quality of life and reduce diabetes complications.

Mediating role of self-efficacy in the relationship between family social support and hypertension self-care behaviours: A cross-sectional study of Saudi men with hypertension.

BACKGROUND: Self-efficacy and family social support are significantly associated with hypertension self-care behaviours. However, little is known about their mechanism in Saudi Arabia. This cross-sectional study aimed to examine the relationships among family social support, self-efficacy, and self-care behaviours among men with hypertension in Saudi Arabia. METHODS: Data were collected from May to August of 2018. The Hypertension Self-Care Profile and the Perceived Social Support from Friends and Family scales were used to measure the study variables. Multiple linear regression was used to analyse the relationships between the variables, and the Baron and Kenny test was used to assess if self-efficacy mediated the relationship between family social support and hypertension self-care behaviours. RESULTS: Respondents (N = 158) from the Jizan and Al-Sharqia regions of Saudi Arabia completed the survey. Family social support and self-efficacy were significantly associated with hypertension self-care behaviours. In regression, self-efficacy was the only variable significantly associated with hypertension self-care behaviours. Self-efficacy fully mediated the relationship between family social support and hypertension self-care behaviours. CONCLUSIONS: Interventions to enhance hypertension self-care behaviours among Saudi men could focus on increasing individual's self-confidence to perform specific healthy behaviours. Family support can also contribute to the performance of hypertension self-care behaviours.

US Nurses' Perceptions Regarding Caring for Suspected, Probable, and Confirmed Ebola Virus Disease Patients, Part 1: A Quantitative Analysis.

OBJECTIVE: This study examined US hospital, ambulatory/outpatient facility, and clinic nurses' perceptions regarding care of persons under investigation (PUIs) and confirmed Ebola virus disease (EVD) patients and EVD nursing workforce impact. BACKGROUND: Timely research was warranted to better understand nurses' perceptions. METHODS: This survey research used convenience sampling of RNs, LPNs, and nurse technicians. Respondents completed a 45-item electronic validated survey. RESULTS: Overall average perceived risk with providing care was higher for confirmed EVD patients (5.2) than PUIs (4.8) (0 = no risk, 10 = highest risk). Few had cared for confirmed EVD patients (0.3%) or PUIs (0.7%). Whereas 48.4% felt prepared in protecting themselves from contracting EVD, 25.2% were concerned with contracting EVD. More nurses (45.9%) felt they should be able to opt out of caring for confirmed EVD patients as compared with those caring for PUIs (39.2%). EVD emergence had not affected (85.8%) nurses' willingness to provide direct patient care; however, 6.8% reported EVD has decreased years planned in the nursing workforce. CONCLUSIONS: Nurses reported moderate risk for EVD-related patient care; 6.8% may leave the workforce earlier.

Nurses' Perceptions on Ebola Care in the United States, Part 2: A Qualitative Analysis.

OBJECTIVE: This study examined qualitative comments from an online survey of nurses' perceptions regarding care of persons under investigation and patients with confirmed Ebola virus disease (EVD) in the United States. BACKGROUND: Additional insight into nurses' perceptions regarding EVD was warranted. METHODS: Survey design used convenience sampling of RNs, licensed practical nurses, and nurse technicians, who responded to 8 open-ended survey questions. RESULTS: Most respondents (618/966 [64.0%]) provided comments. The top 5 of the 13 primary themes were lack of preparedness/readiness; training, education, and improved communications needed; fear of EVD transmission; lack of personal protective equipment (PPE) and infection prevention; and nurses not treated professionally. CONCLUSIONS: Noting multiple concerns, most respondents reported that EVD care could be most safely provided when all parties involved are prepared and when nurses are educated and trained in evidence-driven practices with appropriate PPE and infection control procedures.

Improving the Forensic Documentation of Injuries Through Alternate Light: A Researcher-Practitioner Partnership.

ABSTRACT: An alternate light source (ALS) is a practitioner-driven technology that can potentially improve the documentation of injuries among victims of interpersonal violence. However, evidence-based guidelines are needed to incorporate and document an ALS skin assessment into a forensic medical examination that accurately reflects the science, context of forensic nursing practice, trauma-informed responses, and potential impact on criminal justice stakeholders. This article introduces the forensic nursing community to a current translation-into-practice project focused on developing and evaluating an ALS implementation program to improve the assessment and documentation of bruises among adult patients with a history of interpersonal violence. Our researcher-practitioner collaboration uses theory-based approaches that consider both the developed program's practice context and stakeholder impact. The goal is to provide evidentiary support for adult victims of violence and a more equitable forensic nursing practice that benefits diverse patient populations.

Transcultural Nurse Views on Culture-Sensitive/Patient-Centered Assessment and Care Planning: A Descriptive Study.

INTRODUCTION: Culture-sensitive (CS) and patient-centered (PC) care are considered essential to achieve high-quality equitable care. The purpose of this study was to determine how expert nurses incorporate CS/PC care into their assessment and care planning practices, especially for culturally diverse and marginalized patients. METHODOLOGY: Using a qualitative, descriptive design, we conducted a focus group at the October 2019 Transcultural Nursing Society Conference. Participants (n = 9) discussed how they instilled cultural sensitivity and patient-centeredness into their assessment and care planning skills. RESULTS: Participants revealed attitudes, knowledge, and skills associated with CS/PC assessment and care planning. They also identified specific strategies for translating CS/PC theory into assessment and care planning practices. DISCUSSION: Three principles and many pragmatic strategies for incorporating CS/PC care into daily practice emerged from the data. Nurses may find these principles and strategies helpful in integrating CS/PC care into their daily care of patients in busy clinical settings.

A Cross-Sectional Study of Psychological Flexibility as a Mediator for the Relationship Between Acculturative Stress and Cardiovascular Health Behaviors Among Second-Generation Arab Americans.

INTRODUCTION: Second-generation Arab Americans may be at risk for poor cardiovascular health behaviors, but these behaviors are poorly understood. The purpose of this study was to examine the effects of acculturative stress and psychological flexibility on cardiovascular health behaviors among second-generation Arab Americans. METHOD: In a cross-sectional study, survey data were collected in 2018 at local mosques, churches, and a university campus. Cardiovascular health behaviors were measured with a questionnaire based on the American Heart Association Life's Simple 7. Acculturative stress and psychological flexibility were assessed using reliable and valid measures. RESULTS: Participants (n = 325) with higher acculturative stress were significantly more likely to report intermediate overall cardiovascular health behaviors (p = .01) and poor to intermediate diet (p = .00). Psychological flexibility partially mediated poor/intermediate smoking (p = .02) and intermediate diet (p = .00) scores. DISCUSSION: Nurses may consider the role of acculturation when designing culturally sensitive interventions to promote cardiovascular health in second-generation populations.

Sexual Assault Survivors' Perceived Helpfulness of University-Affiliated Resources.

The goal of this study was to examine sexual assault survivors' use and perceived helpfulness of university-affiliated resources. Data were collected in online anonymous surveys from women (n = 98) at two universities who experienced a sexual assault during college and used university resources. Participants who perceived university-affiliated survivor resources as helpful had significantly better mental health outcomes than women who perceived resources as unhelpful. The most often used resources were mental health counseling (60.6%) and university health centers (24%). The most helpful resources were survivor advocates, peer counseling, and peer support groups.

Sexual Assault, Campus Resource Use, and Psychological Distress in Undergraduate Women.

Undergraduate women are at high risk of experiencing sexual assault during their college years. Research has established a strong link between sexual victimization and psychological distress. Although the relationship between sexual victimization and distress has been established, little is known about how the use of university-affiliated sexual assault resources influences mental health outcomes for survivors. The aims of this cross-sectional study were to describe the characteristics of women who used campus survivor resources following a sexual assault during college, examine correlates of campus resource use, and examine correlates and predictors of mental health of women who have been sexually assaulted during college. An online anonymous survey was sent to undergraduate women at two public universities in a mid-Atlantic state. Participants were female, undergraduate students (N = 362) who had been sexually assaulted during their time at college. Few women (n = 98, 27.1%) used campus resources following a sexual assault. We found significant relationships between participants' use of campus survivor resources and experiencing a sexual assault prior to entering college, experiencing more severe sexual assaults, acknowledging the assault as a rape, feeling more self-blame, and experiencing more psychological distress. Campus resource use was significantly associated with poorer mental health outcomes. The cross-sectional nature of this study limited our ability to explore the reason for this. Further research is needed to explore the role campus resources play in supporting survivors during the recovery process. Given the high rate of sexual assaults on college campuses and the known negative psychological impact of sexual assault, it is imperative that campuses offer resources that are effective in meeting the needs of survivors.

Knowledge of intrapartum care among obstetric care providers in rural Kenya.

BACKGROUND: Kenya did not meet its maternal mortality ratio (MMR) target under the Millennium Development Goals. The aim of this study was to examine the gaps in knowledge of intrapartum care among obstetric care providers (OCPs) in rural Nandi County, Kenya. METHODS: This cross-sectional study in 2015 surveyed 326 nurses, midwives, clinical officers and physicians about their knowledge, attitudes and practices related to normal labor and childbirth, immediate newborn care and management of obstetric complications. RESULTS: Self-reported intrapartum knowledge among OCPs was insufficient according to accepted international standards. The mean total knowledge score for all OCPs based on a validated 30-question inventory was 62% (range 23-90%). Only 14 providers (4%) scored as 'competent' (a score ≥80%). Scores were higher for OCPs who had received pre- and postemployment emergency obstetric care training and those with higher levels of confidence in their skills. Survey respondents identified a lack of knowledge as one of the greatest barriers to high-quality patient care. CONCLUSIONS: Increasing training opportunities for OCPs may improve the quality of obstetric care provided to women in Kenya and other high-MMR locations in sub-Saharan Africa and enable progress toward achieving the ambitious Sustainable Development Goals target for maternal survival.

The provider role in client engagement in HIV care.

This multisite, qualitative study examined the process by which persons living with HIV/AIDS (PLWHA) engage in primary HIV medical care for treatment. Using a grounded theory approach, the analysis of narrative data from semi-structured in-depth interviews with PLWHA (n = 76) led to the development of a model describing a cyclic process of engaging in--and falling out of--care. Perceptions of the client-provider relationship emerged as a central element of the process by which persons with HIV engaged--or remained--in care. Provider behaviors that were characterized as engaging, validating, and partnering facilitated engagement and retention in care; behaviors described as paternalistic served as barriers to care. Participants indicated that they desired a care partnership with an empathetic provider who had effective communication skills. These findings provide recommendations for health providers to engage and retain hard-to-reach PLWHA in timely and appropriate HIV care and services.

"Getting me back on track": the role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care.

This qualitative study investigated the process of engagement in HIV medical care from the perspective of people living with HIV/AIDS (PLWHA). In-depth interviews were conducted with 76 participants in six cities. All participants were considered underserved because of histories of substance use, mental illness, incarceration, homelessness, or cultural barriers to the traditional health care system. A semistructured interview guide elicited narratives related to health care and the role of program interventions in facilitating access to care. Data analysis revealed that participants cycled in and out of care, a process that was influenced by (1) their level of acceptance of being diagnosed with HIV, (2) their ability to cope with substance use, mental illness, and stigma, (3) their health care provider relationships, (4) the presence of external support systems, and (5) their ability to overcome practical barriers to care. Outreach interventions played a role in connecting participants to care by dispelling myths and improving knowledge about HIV, facilitating access to HIV care and treatment, providing support, and reducing the barriers to care. The findings suggest that outreach programs can interrupt this cyclical process and foster sustained, regular HIV care for underserved PLWHA by conducting client-centered risk assessments to identify and reduce sources of instability and improve the quality of provider relationships; implementing strategies that promote healthy practices; creating a network of support services in the community; and supporting adherence through frequent follow-ups for medication and appointment keeping.

Maintaining normalcy: a grounded theory of engaging in HIV-oriented primary medical care.

Despite advances in the medical treatment of HIV disease, marginalized populations continue to shoulder a disproportionate burden of HIV/AIDS-related morbidity and mortality. This study explored the process by which clients at HIV-oriented primary care clinics transition from being sporadic users of care to engaging as regular users of care. A model illustrating how participants were striving to maintain normalcy, manage perceptions, and develop life mastery skills contributes to an understanding of living with HIV disease in a social context. Elements of the model are sensitive to nursing interventions aimed at improving health outcomes and reducing health disparities among persons at highest risk.

Perceptions of HIV/AIDS by deaf gay men.

Deaf gay men represent a subpopulation of the gay male community at particularly high risk for HIV/AIDS due to numerous barriers including language, stigma, and inequitable access to health services. The participants in this exploratory pilot study (N = 5) struggled with the ongoing threat of HIV infection and the pervasive nature of AIDS-related debilitation, death, and grief. Whether HIV infected or not, they described living at the intersection of multiple communities--the deaf, gay, and hearing--each characterized by unique communication styles, cultural expectations, and a propensity to marginalize outsiders. Health care providers were perceived as lacking compassion and largely ignorant to the needs of deaf persons, in general, and deaf gay men, in particular. Printed HIV materials were considered culturally inappropriate, incomprehensible, and ineffective. These findings suggest an extraordinary risk for adverse mental and physical health outcomes if care is not appropriately designed for this vulnerable population.

A grounded theory of families responding to mental illness.

Despite decades of research documenting family burden related to mental illness of a relative, little is known about families' responses over time. A grounded theory study was designed to describe families' responses to these severe mental illnesses. Twenty-nine participants representing 17 families were interviewed 3 times over 2 years. Interviews were analyzed using constant comparison. Living with ambiguity of mental illness was the central concern. The basic social process was pursuing normalcy and included confronting the ambiguity of mental illness, seeking to control impact of the illness, and seeing possibilities for the future. Goals were managing crises, containing and controlling symptoms, and crafting a notion of "normal." Strategies were being vigilant, setting limits on patients, invoking logic, dealing with sense of loss, seeing patients' strengths, and taking on roles. The study revealed that families were profoundly affected by the social contexts of mental illnesses.

Grief in the context of HIV: recommendations for practice.

Grief is a universal human response to loss. While the symptoms of grief are distressing and uncomfortable, they usually diminish over time without therapy. For persons grieving an HIV-related death, however, a variety of unique factors may interfere with the healthy resolution of symptoms. When the grief process becomes complicated, a person may experience serious alterations in physical health and/or disruptions in daily functioning. To assess grief, nurses need to apply interpersonal skills and therapeutic communication techniques in a compassionate manner; currently, no one screening instrument is optimal for evaluating grief in the clinical setting. The person experiencing grief or complicated grief may be referred for support services or counseling, pharmacologic interventions, or cognitive behavioral therapy. This report summarizes evidence from the literature and clinical practice to support recommendations for the practice of nurses caring for persons with HIV-associated grief; recommended strategies are illustrated through an exemplar case study.

Essential nursing competencies related to HIV and AIDS: Executive summary.

With nearly 33 million global citizens living with HIV or AIDS, the need for a highly qualified, competent nursing workforce is critical. With the recent increase in global funding to expand access to antiretroviral therapy, there have been considerable efforts to improve the capacity of nurses to initiate and maintain antiretroviral therapy while evaluating its effectiveness, monitoring for side effects, reducing the incidence of drug-drug interactions (including drug interactions related to therapies provided by traditional healers), promoting adherence to therapies, and providing management of symptoms. Therefore, using a participatory action approach, nursing leaders from six sub-Saharan African countries collaborated to develop the essential nursing competencies related to HIV and AIDS. These competencies can help to guide preservice education related to HIV and AIDS, to strengthen in-service or capacity-building programs designed for already qualified nurses, and to guide policy and regulatory reform in the context of taskshifting, task-sharing, and scope of nursing practices.

Essential nursing competencies related to HIV and AIDS.

With nearly 33 million global citizens living with HIV or AIDS, the need for a highly qualified, competent nursing workforce is critical. With the recent increase in global funding to expand access to antiretroviral therapy, there have been considerable efforts to improve the capacity of nurses to initiate and maintain antiretroviral therapy while evaluating its effectiveness, monitoring for side effects, reducing the incidence of drug-drug interactions (including drug interactions related to therapies provided by traditional healers), promoting adherence to therapies, and providing management of symptoms. Therefore, using a participatory action approach, nursing leaders from six sub-Saharan African countries collaborated to develop the essential nursing competencies related to HIV and AIDS. These competencies can help to guide preservice education related to HIV and AIDS, to strengthen in-service or capacity-building programs designed for already qualified nurses, and to guide policy and regulatory reform in the context of task-shifting, task-sharing, and scope of nursing practices.