Investigation of social support as a mediator of the relationship between physical and psychological health among hospitalised patients.

AIM: To investigate the self-reported levels of social support from friends and family and from nurses as mediators of the relationship between self-rated physical and psychological condition in hospitalised patients. DESIGN: Cross-sectional study of adult inpatients at a large tertiary-care hospital in the northeast United States. METHODS: Multiple mediation analysis of survey data. RESULTS: In surveys received from 324 inpatients, one fourth of the variation in patients' self-rated psychological condition was explained by self-rated physical condition. Social support from family and friends mediated a significant proportion (11.0%) of the relationship between self-rated physical and psychological condition, however social support from nurses did not. CONCLUSION: Social support from family and friends can positively influence the psychological health of inpatients, but nurses are not an adequate replacement for the social support provided by family and friends. IMPLICATIONS FOR NURSING: Although nurses cannot replace the social support provided by family and friends, the assessment of social isolation and care planning of interventions to support patients is a fundamental nursing role. Technology to connect patients with friends and family should be used to mitigate isolation for hospitalised patients unable to receive in-person visits from loved ones. IMPACT: The influence of social support from family and friends and nurses was addressed. The study found social support from family and friends, but not nurses, to influence the relationship between physical and psychological ratings. This finding has implications for the role of nurses in the hospital setting. REPORTING METHOD: Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed.

Grit: The Essential Trait of Nurses During a Disaster.

Natural and man-made disasters have increased dramatically over time, requiring healthcare systems to develop and sustain emergency preparedness plans. Nurse leaders and frontline clinical nurses are often the first and long-term responders during these traumatic events. Emergency preparedness requires nurses exceed expectations beyond the daily level of performance in caring for patients in the presence of obstacles. A disaster creates additional burdens on nurses psychosocially due to work and home demands. Despite this adversity, nurses are able to work under harsh conditions and make critical clinical decisions. This commitment is often described as being resilient. A deeper reason why nurses perform during disasters is that they possess the personality trait known as grit. Grit motivates them to endure challenges and be successful over time. The critical attributes of grit are passion and perseverance. Cultivating grit among nurse leaders and clinical nurses is essential to sustaining interest in emergency preparedness and ensuring the needs of patients and caregivers are met when a disaster occurs.

Implementation of a continuing education model for nurses in Bangladesh.

An abundance of information is available to help nurses to provide evidence-based patient care. Professional nursing practice depends on the commitment of nurses to obtain new knowledge through continuing education. In many global settings, regulatory agencies oversee nurse registration and licensing. However, once they complete their formal nursing education, nurses often receive no further professional education. To ensure their continued competency, all nurses need to participate in continuing education and professional development. A partnership between a clinical agency and practicing nurses to implement an educational program allows nurses to obtain new nursing knowledge and apply it immediately in the clinical setting. This article discusses the need for continuing education for all practicing nurses and describes the implementation of a model for professional development of nurses in Bangladesh.

The Pregnant Women with HIV Attitude Scale: development and initial psychometric evaluation.

AIM: This paper is a report of the development and initial psychometric evaluation of the Pregnant Women with HIV Attitude Scale. BACKGROUND: Previous research has identified that attitudes toward persons with HIV/AIDS have been judgmental and could affect clinical care and outcomes. Stigma towards persons with HIV has persisted as a barrier to nursing care globally. Women are more vulnerable during pregnancy. An instrument to specifically measure obstetric care provider's attitudes toward this population is needed to target identified gaps in providing respectful care. METHODS: Existing literature and instruments were analysed and two existing measures, the Attitudes about People with HIV Scale and the Attitudes toward Women with HIV Scale, were combined to create an initial item pool to address attitudes toward HIV-positive pregnant women. The data were collected in 2003 with obstetric nurses attending a national conference in the United States of America (N = 210). Content validity was used for item pool development and principal component analysis and analysis of variance were used to determine construct validity. Reliability was analysed using Cronbach's Alpha. RESULTS: The new measure demonstrated high internal consistency (alpha estimates = 0.89). Principal component analysis yielded a two-component structure that accounted for 45% of the total variance: Mothering-Choice (alpha estimates = 0.89) and Sympathy-Rights (alpha estimates = 0.72). CONCLUSION: These data provided initial evidence of the psychometric properties of the Pregnant Women with HIV Attitude Scale. Further analysis is required of the validity of the constructs of this scale and its reliability with various obstetric care providers.

Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta.

OBJECTIVE: To compare outcomes between planned and urgent cesarean hysterectomy for morbidly adherent placenta managed by a multidisciplinary team. METHODS: This is a retrospective case-control study of women with singleton pregnancies with antenatally suspected and pathologically confirmed morbidly adherent placenta who underwent cesarean hysterectomy between January 1, 2011, and February 30, 2017. Timing of delivery was classified as either planned (delivery at 34-35 weeks of gestation) or urgent (need for urgent delivery as a result of uterine contractions, bleeding, or both). The primary outcome variable was composite maternal morbidity. Logistic regression analysis was used to evaluate risk factors for urgent delivery. RESULTS: One hundred thirty patients underwent hysterectomy. Sixty (46.2%) required urgent delivery. Composite maternal morbidity was identified in 34 (56.7%) of the urgent and 26 (37.1%) of the planned deliveries (P=.03). Fewer units of red blood cells and fresh frozen plasma were transfused in the planned delivery group (red blood cells, median interquartile range 3 [0-8] versus 1 [0-4], P=.02; fresh frozen plasma, median interquartile range 1 [0-2] versus 0 [0-0], P=.001). Rates of low Apgar score and respiratory distress syndrome were higher in the urgent compared with the planned delivery group (5-minute Apgar score less than 7, 34 [59.6%] versus 14 [23.3%], P<.01; respiratory distress syndrome, 34 [61.8%] versus 16 [27.1%], P<.01). A history of two or more prior cesarean deliveries was an independent predictor of urgent delivery (adjusted odds ratio 11.4, 95% CI 1.8-71.1). CONCLUSION: Women with morbidly adherent placenta requiring urgent delivery have a worse outcome than women with planned delivery. Women with morbidly adherent placenta and two or more prior cesarean deliveries are at increased risk for urgent delivery. In such women, scheduling delivery before the standard 34- to 35-week timeframe may be reasonable.

Obstetric nurses' attitudes and nursing care intentions regarding care of HIV-positive pregnant women.

OBJECTIVE: To define attitudes toward pregnant women with HIV and how these attitudes correlate with and affect prejudice and nursing care intentions. DESIGN: Cross-sectional descriptive correlational study of obstetric nurses. SETTING: Eight hundred (800) mailed surveys in the United States (N = 350). PARTICIPANTS: A random sample of nurses certified in inpatient obstetrics. MAIN OUTCOME MEASURES: Background information tool, the Pregnant Women with HIV Attitude Scale, the Prejudice Interaction Scale in response to four vignettes, and the Marlowe-Crowne Social Desirability Scale-Form C. RESULTS: Obstetric nurses had more positive Mothering-Choice attitudes than Sympathy-Rights attitudes (p= .000). Nurses who knew more than four people affected by HIV/AIDS had more positive attitudes (p

Pregnancy with chronic illness.

OBJECTIVE: To describe the experience of pregnancy with a chronic illness. DESIGN: Qualitative description. SETTING: Tertiary Medical Center, Northeast United States. PARTICIPANTS: A purposive sample of eight pregnant women with various chronic conditions. METHODS: Telephone interviews. RESULTS: The participants described their chronic illnesses as deviations from normality and their pregnancies brought them closer to normality. They described pregnancy as a balancing act between the fantasy of being normal and the reality of having a chronic disease. At the same time, women acknowledged the blessings and burdens of physical changes and intense vigilance. Participants also described emotional demands related to the need to be vigilant, additional physiological alternations, and information overload. CONCLUSION: Pregnancy may alter chronic illness, increase stress, and create new health care needs for women. In turn, increased stress associated with chronic illness may alter perinatal outcomes. Pregnant women with chronic illness may benefit from interventions aimed at helping them balance the blessings and burdens associated with the symptoms of pregnancy.

Predictors of medication adherence among HIV-positive women in North America.

OBJECTIVE: To explore the relationships among contextual, environmental, and regulatory factors with antiretroviral (ARV) medication adherence to assist care providers in improving care for women living with HIV. DESIGN: Descriptive, multicenter study. SETTING: Sixteen HIV clinics and service organizations in North America. PARTICIPANTS: This convenience sample was drawn from a larger study of 2,182 persons living with HIV recruited from clinics and service from September 2009 to January 2011. We included 383 women living with HIV who were taking ARV medications. METHODS: We assessed the relationship of contextual, environmental, and psychological factors specific to women living with HIV in relation to adherence to ARV medication. Descriptive and multivariate statistics were used to examine the effects of these factors on self-reported ARV drug adherence. RESULTS: Age, depression symptoms, stigma, engagement with health care provider, and four psychological factors were correlated with self-reported ARV medication adherence (p = .01). Regression analysis indicated that adherence self-efficacy and depression symptoms accounted for 19% for 3-day and 22% for 30-day self-reported medication adherence. CONCLUSIONS: Adherence self-efficacy and depression symptoms predict ARV medication adherence in women and should be evaluated by nurses. Future research is needed to identify antecedents to and interventions that support adherence self-efficacy and decrease depression symptoms.

Addressing poverty, education, and gender equality to improve the health of women worldwide.

The Millennium Development Goals (MDG) that target alleviating poverty, improving primary education, and fostering gender equity are important as a foundation to promote world health. Achieving these goals will create an environment for healthy lives for women and children. Poverty, education, and gender equality, although undeniably linked, need to be addressed individually. Nurses have the capacity and political will to address MDGs and to contribute to the health and well-being of the world population.