Dedication in a Difficult Context: Faith-Based Nursing in Haiti.

ABSTRACT: Haitian nurses live in a precarious environment, with healthcare disparity and low wages. In the presence of significant politico-social-economic disparities, adverse effects of natural disasters, deleterious infrastructure, challenged self-boundaries, and the burden of caring for high-need patients, the authors sought a better understanding of nurses' perspective of the situation. During qualitative interviews, Haitian nurses in two faith-based hospitals (N = 17) reported feeling powerless yet exhibited resilience and dedication to nursing as a calling. These conditions cry out for support of nurses' self-care needs. Future interventions may help nurses identify better resources to care for themselves and guide their practice.

Prostate Cancer Screening among High-Risk Black Men.

We explored potential barriers and facilitators for prostate cancer screening choices among high-risk Black men. In our sample of 264 Black men over 45 years of age living in the U.S. who met the American Cancer Society criteria for screening, we found that only 49.6% had ever been screened. We investigated potential barriers including screening intention, access to care, medical mistrust, and fatalism. Potential facilitating factors investigated were provider-patient conversations encompassing the pros and cons of screening, ethnicity taken into account, insurance, and previous prostate cancer screening. Recommendations and resources are suggested to increase screening of high-risk Black men.

Conflicting Cultural Values, Gender Role Attitudes, and Acculturation: Exploring the Context of Reproductive and Mental Health of Asian-Indian Immigrant Women in the US.

Asian-Indians, one of the fastest growing US immigrant groups, experience depression and anxiety, particularly among women. In this mixed-methods study, quantitative (n = 217) and qualitative (n = 36) data explored egalitarian vs. traditional views regarding women's roles and rights. Bicultural integration, family planning decision-making ability, and anxiety were associated with more egalitarian views, while Punjabi language preference, depression, and more births were associated with traditional views. Health care professionals serving this population need to be aware of the potential cultural values conflicts and gender role expectations that influence decisions around reproductive health and mental health care for Asian-Indian immigrant women.

Mental Health and Sociocultural Determinants in an Asian Indian Community.

In a US population of adult male and female Sikh immigrant participants (N = 350), we explored sociocultural factors related to depression, giving participants a choice between English or Punjabi surveys. Language preference pointed to a subgroup with higher levels of depression and lower satisfaction with life. Underreporting of depression suggests a general reluctance to discuss depression. While multiple sociocultural variables were associated with depression bivariably, multivariate analysis identified negative religious coping and anxiety as unique predictors of depression. Community interventions should tap into the protective close-knit social fabric of this community as an opportunity to change the stigma of mental health.

Mindfulness-Based Intervention for Perinatal Grief in Rural India: Improved Mental Health at 12 Months Follow-Up.

Stillbirth is a significant global health problem that frequently results in perinatal grief with compound negative psychosocial impact. In low-resource settings with exceedingly high stillbirth rates, such as rural Chhattisgarh, India, it is vital to utilize low-cost, effective interventions. Mindfulness-based stress reduction is an evidence-based intervention utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The objective of this study was to explore the sustained effectiveness of a shortened, culturally adapted mindfulness-based intervention (MBI) designed to address complex grief after stillbirth. We used an observational, mixed-methods pre-post study design with 6-week and 12-month follow-up assessments among women with a history of stillbirth (N = 22). Analyses explored study outcomes and continued use of mindfulness skills. Pretest results showed elevated psychological symptoms and high levels of perinatal grief. General linear modeling repeated measures was used to explore 6-week and 12-month follow-up changes from baseline, controlling for significantly correlated demographic variables. Longitudinal results indicated significant reductions in perinatal grief and psychological symptoms; four of the five facets of mindfulness changed in the desired direction; and resilience scores indicated thriving. The shortened, culturally adapted, MBI pilot brought about sustained, significant reductions of perinatal grief and mental health symptoms, and participants reported use of mindfulness skills in day-to-day life. This study shows that the significant mental health needs among rural women of various castes and ethnicities in Chhattisgarh following stillbirth were successfully addressed by a promising MBI with potential scalability and sustainability.

India's Distorted Sex Ratio: Dire Consequences for Girls.

Female gender discrimination related to cultural preference for males is a common global problem, especially in Asian countries. Numerous laws intended to prevent discrimination on the basis of gender have been passed in India, yet the distorted female-to-male sex ratio seems to show worsening tendencies. Using detailed, two-year longitudinal chart abstraction data about delivery records of a private mission hospital in rural India, we explored if hospital birth ratio data differed in comparison to regional data, and what demographic and contextual variables may have influenced these outcomes. Using quantitative chart abstraction and qualitative contextual data, study results showed the female-to-male ratio was lower than the reported state ratio at birth. In the context of India's patriarchal structure, with its strong son preference, women are under tremendous pressure or coerced to access community-based, sex-selective identification and female fetus abortion. Nurses may be key to turning the tide.

Feasibility of Mindfulness-based Stress Reduction Intervention for Parents of Children with Developmental Delays.

Mindfulness-based stress reduction (MBSR) interventions are popular as a treatment strategy for myriad diagnoses in various settings, and may be beneficial for parents of children with developmental delays (DD). However, prior research suggests extreme levels of stress and extraordinary demands on time among these parents, making the feasibility of effectively implementing MBSR with this population questionable. This study examined the feasibility of administering standard MBSR to a diverse community-based sample of parents of young children with DD. The potential impact of MBSR interventions includes improvement in parents' mental health, and collateral benefits for the family environment, including improved child behavior. Nurses may have an integral role in interdisciplinary teams providing MBSR.

Mindfulness-based Intervention for Perinatal Grief after Stillbirth in Rural India.

We explored the concept of using a Mindfulness-based intervention to reduce perinatal grief among Indian women. Data were collected using mixed methods to explore concept acceptability, receptivity, modality, and feasibility of the intervention. The intervention was piloted and evaluated with measures of perinatal grief, psychosocial wellbeing, religious coping, perceived social provision of support, and mindfulness. The intervention was well received and effective in teaching skills to help women deal with high levels of grief and subsequent mental health challenges. To overcome attendance barriers modification is necessary. Partnership with a local nursing school is critical to enhance sustainability of the intervention.

Autonomy and social norms in a three factor grief model predicting perinatal grief in India.

Perinatal grief following stillbirth is a significant social and mental health burden. We examined associations among the following latent variables: autonomy, social norms, self-despair, strained coping, and acute grief-among poor, rural women in India who experienced stillbirth. A structural equation model was built and tested using quantitative data from 347 women of reproductive age in Chhattisgarh. Maternal acceptance of traditional social norms worsens self-despair and strained coping, and increases the autonomy granted to women. Greater autonomy increases acute grief. Greater despair and acute grief increase strained coping. Social and cultural factors were found to predict perinatal grief in India.

Bereavement care guidelines used in health care facilities immediately following perinatal loss: a scoping review.

OBJECTIVE: The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines. INTRODUCTION: Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic. INCLUSION CRITERIA: Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded. METHODS: The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed (NLM), ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative form as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023. RESULTS: The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n = 195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 33,834 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being. CONCLUSIONS: Conceptually the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research pertaining to bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.

Nurse practitioners and the Fulbright Scholar Program: My experience in India.

ABSTRACT: The Fulbright Scholar Program offers numerous awards, presenting nurse practitioners with opportunities to interact with colleagues around the world. As increasing acceptance of the nurse practitioner role is gaining acceptance and being defined in various countries across the world, with expanding role definitions, this represents a trailblazing opportunity to influence global representation. The recent completion of a Fulbright award experience in India is provided as an exemplar of the Fulbright opportunity. Nurse practitioner program development and continuing education are key to enhancing patient care and access to care among patients who need it most. To be a part of the effort to prepare nurse practitioners everywhere expands the reach beyond that of an individual nurse practitioner. We can learn from each other, share strategies for implementation across settings, and together address barriers to practice.

PhD-Prepared Nurses' Areas of Inquiry.

BACKGROUND: Nursing science is heavily dependent on nurse scientists with adequate funding. Nurse scientists should be aware of organizations' research agendas and, to the extent possible, align research with stated research priorities. Current information on the demographics of nurse scientists, their projects, and the alignment to known priorities is illusive. PURPOSE: To describe areas of inquiry pursued by PhD-prepared nurses and congruence with the research agendas of nursing organizations. METHODS: A descriptive, exploratory approach was undertaken with PhD-prepared nurse scientists to gather data about their PhD program, dissertation topic, current work status, productivity, and future recommendations. RESULTS: Key findings were that dissertation topics were broad and aligned with research priorities. Elements influencing research productivity are described. CONCLUSIONS: Understanding current nursing science stewardship and intentionally strategizing for the future of research, academia, and clinical practice will enhance our ability to tailor PhD programs accordingly.

A Health Profile of African Immigrant Men in the United States.

African immigrants (AI) are the fastest growing group of immigrants to the U.S. however, their health and health practices remains poorly characterized. Thus, this study aimed to describe the health profile of this under-described U.S. population. In order to contextualize their health profiles, we compared AI (n=95) to other U.S. Black populations, namely African Americans (AA, n=271) and Caribbean American (CA, n=203) immigrants. We used cross-sectional survey data from a prostate cancer health study with 569 Black adult male participants, ages 21 years or older. Demographic characteristics were compared using Chi-square tests and prevalence ratios, and prevalence odds ratios (POR) were estimated for AIs compared to AA and CA immigrants using a log-binomial regression model. Results revealed that AI exhibited significantly lower prevalence of asthma and diabetes, when compared to AA and CA immigrants. Furthermore, AI reported lower consumption of alcohol than AA (POR, 0.43, 95%CI 0.24, 0.75) and lower smoking prevalence than AA (POR, 0.19, 95%CI 0.05, 0.70) and CA immigrants (POR, 0.21, 95%CI 0.05, 0.76). Additionally, AI reported significantly lower medical mistrust than CA (POR, 0.51, 95%CI 0.26, 0.95), significantly low financial strain than CAs immigrants (POR, 1.66, 95%CI 1.00, 2.75) and significantly higher levels of religious coping than both AA (POR, 2.43, 95%CI 1.43, 4.12) and CA immigrant men (POR, 1.78, 95%CI 1.03, 3.08). This study further supports emerging evidence that Blacks in the U.S. are not a monolithic group and that it is necessary to assess the Black subgroups separately. In addition, as one of the fastest growing immigrant populations, it is critical for future research to understand African immigrant's health needs and its correlates.

Factors Predicting Mental Health Among Women in Low-Income Communities of a Changing Society: A Mixed-Methods Study.

Purpose: To explore women's mental health in India's rapidly changing society. Participants and Methods: A convenience sample of low-income women (N = 286) in a medium-sized city in South-India participated in a mixed-methods, exploratory study in 2022. Institutional Review Board (IRB) approval was received from Loma Linda University in the US, and Christian Medical College-Vellore in India, in accordance with the declaration of Helsinki, prior to data collection. All study materials were forward and back translated for Tamil, the local language. Phase 1(n = 25) involved audio recorded key-informant interviews and focus groups. Verbatim transcripts were inductively coded, and emerging themes identified. Phase 2 (n = 261) entailed a quantitative survey including demographics, health history, and validated scales measuring mental health symptoms, coping strategies, social support, living situation, and life satisfaction. Data collectors were gender and language matched, research trained, community health nurses. Results: Qualitative themes included: 1) benefits of living in the city, 2) double duty for women doing household work and paid work, 3) challenges of living in the urban environment, 4) advantages of living in the village, 5) struggles associated with village life. Quantitative results: the average Hopkins Symptoms Checklist (HSCL) score of 1.82 (SD = 0.70) exceeded the 1.65 cut-off score for anxiety and depression symptomology. Among participants with elevated HSCL scores (n = 129) the average was markedly elevated (M = 2.39, SD = 0.56). These women were more likely to rely on wishful thinking, religious coping, and reported more post-migration living difficulties, less social support, and less satisfaction with life. Regression analysis further explored variables associated with participant HSCL scores. Conclusion: In this sample of low-income urban-dwelling women depression and anxiety symptomology was elevated. Given the limited mental health workforce and cultural stigmatization of mental health issues, further attention is required.

Social and cultural factors associated with perinatal grief in Chhattisgarh, India.

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N=355) who had experienced stillbirth (n=178) and compared to those who had not (n=177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

Bereavement care immediately after perinatal loss in health care facilities: a scoping review protocol.

OBJECTIVE: This scoping review will summarize what is known about formal and informal perinatal bereavement care guidelines used in health care facilities before discharge, and map the mental health outcomes of parents against characteristics of the guidelines. INTRODUCTION: Conflicting evidence for bereavement care guidelines, the lack of randomized controlled trials and experimental studies, and older synthesized information with a limited focus or population make synthesis complex. A scoping review will help determine the breadth and depth of the literature. INCLUSION CRITERIA: Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and measuring parents' mental health outcomes will be included. Sources relating to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines will be excluded. METHODS: The proposed review will be conducted using the JBI methodology for scoping reviews. The team will consider quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. Databases to be searched will include CINAHL, PsycINFO, SocINDEX, Cochrane Library, Embase, MEDLINE, and Web of Science. The earliest empirical study found (1976) will serve as the starting date limit. After pilot testing, the two-step screening process (titles and abstracts, then full-text articles), data will be extracted, collated, and presented in narrative form as well as in tables and diagrams. The results will provide facilities with a broad view of bereavement care to support grieving parents' mental health.

Burnout, Self-Efficacy, and Resilience in Haitian Nurses: A Cross-Sectional Study.

Purpose of Study: Though nursing burnout is a global problem, research on nurse burnout in Haiti is scarce. In a context of multiple personal, social, and environmental challenges, this study assessed burnout and associated factors among Haitian nurses. Design of Study: A multi-site cross-sectional study. Methods: A survey in French and Haitian Creole was conducted in five Haitian hospitals using forward and back translated scales measuring burnout (emotional exhaustion [EE], depersonalization [DP], personal accomplishment [PA]), self-efficacy, nursing work environment, resilience, and demographics. Findings: Haitian nurses (N = 179) self-reported moderate EE (M = 21, SD = 11.18), low DP (Mdn = 2.0, range = 29), and high personal accomplishment (Mdn = 41.0, range = 33). General self-efficacy (M = 32.31, SD = 4.27) and resilience (M = 26.68, SD = 5.86) were high. Dissatisfaction with salary, autonomy, and staffing were evident. Conclusions: It is noteworthy that burnout was lower than expected given the scarce resource, difficult socio-politico-economic environment. High levels of self-efficacy and resilience likely mitigated a higher level of burnout. Adaptation enables these nurses to manage their critical conditions and practice holistic nursing, which may inspire hope among nurses in similar contexts.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses.

PURPOSE: The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected. METHODS: This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them. RESULTS: Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated ("vaccine hesitant"). The χ 2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others. CONCLUSION: The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed.

Stress Correlates Related to Depressive Symptoms Among Young Black Men in Southern California.

Black men experience higher levels of chronic stress, life stressors, and discrimination due to oppressive social and economic conditions. Black men are at greater risk of depression, but most published research on stress and depression has focused on Black people in general, Black women, or older Black men. We sought to determine whether discrimination, perceived stress, major life stress, daily hassles, and social capital were associated with depressive symptoms in young Black men. Survey data were collected from April 2010 to March 2012 in Southern California from a convenience sample of Black men (N = 201). We used two-sample t tests and one-way analysis of variance (ANOVA) to examine the association of stress correlates with depressive symptoms. Logistic regression was conducted to estimate the likelihood of reporting depressive symptoms for each significant correlate. Over half of the sample reported depressive symptoms. Health status, perceived discrimination, urban hassles, perceived stress, and neighborhood trust and safety were significantly related to depressive symptoms. Those who reported higher perceived stress had higher odds of reporting depressive symptoms, whereas lower everyday discrimination experiences were associated with lower odds of depressive symptoms. Future studies should consider examining the effectiveness of embedding coping mechanisms for stress, including perceived discrimination, in health interventions for young Black men to prevent or reduce depression.