Challenges for Nurse Anesthetists Reentering Practice Following Substance Use Disorder Treatment.

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared with other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of certified registered nurse anesthesiologists (CRNAs) to obtain or maintain employment after treatment for SUD treatment is not well documented. The purpose of this qualitative study was to explore challenges encountered by CRNAs in recovery as they attempt to reenter practice following SUD treatment. The phenomenon was explored through multiple-case study, using qualitative semistructured interviews with participants in four cases: CRNAs in recovery, CRNA colleagues, CRNA employers, and professional health program employees. Thirty-six participants conveyed their perspectives about challenges that CRNAs in recovery face upon reentry into practice following SUD treatment. The Worker Well-Being conceptual model was used to guide this study. The study revealed that more SUD education is a key facilitator for reentry, risk of relapse was a major concern, and stigma was the most significant barrier for CRNAs in recovery. Stigma persists as a considerable barrier in many facets of SUD, contributing to an increase in shame associated with having the disease.

Sleep, mental health, and access to health care of women truck drivers.

BACKGROUND: The numbers of women in trucking are growing steadily, yet because they represent a minority group, little is known about their health issues. Most studies of truck drivers have focused on the mental and physical health, sleep, and health care access of male truck drivers. PURPOSE: The purpose of this study was to characterize chronic stress, sleep, and mental health service and overall access to care among women truck drivers. METHODOLOGY: Twenty-five female truck drivers were a subsample of participants from a larger parent study of truck drivers. After approval from the institutional review board, participants completed a 59-item Qualtrics survey; data were transferred from Qualtrics to SPSS v. 24 for analysis. RESULTS: No acute sleepiness or excess daytime sleepiness was observed, but participants only slept 6 hr per night, and all experienced poor sleep quality. Although 28% of participants met or exceeded the threshold score for posttraumatic stress disorder (PTSD), only 8% sought care for feelings of upset or distress. Also, 80% of the women had health insurance, yet there were those who did not seek care because of job-related conflicts. CONCLUSION/IMPLICATIONS: Participants were sleep deprived and experienced poor-quality sleep. Mental health and other health services utilization was low. Implications for practice include consideration of telehealth services to improve health care access and screening and referral as needed to mental health care providers by Department of Transportation medical examiners. Future research should include younger women truck drivers to determine the potential contribution of perimenopause/menopause to some of the health issues experienced by this group of workers.

Program Evaluation of Fit to Pass®, a Remotely Accessible Health Promotion Program for Commercial Motor Vehicle Truck Drivers.

BACKGROUND: Chronic health conditions are highly prevalent among truck drivers due to many unique occupational and environmental stressors. Health promotion programs are shown to be effective in improving truck driver health outcomes; however, there is no research on whether such programs can increase the length of a driver's Department of Transportation (DOT) medical certificate. The purpose of this quality improvement project was to evaluate Fit to Pass (FTP), a remotely accessible health promotion program available for truck drivers on improved health outcomes and increased DOT medical certificate length. METHOD: Program evaluation included an evaluation of the FTP coaching guide against evidence-based practice guidelines. An analysis of a limited dataset of 22 truck driver records examined the effectiveness of the program in achieving improved health outcomes and increased medical certification length. FINDINGS: A review of the literature revealed three major themes: (a) motivational interviewing to increase driver intention and self-efficacy; (b) mobile health care technology to connect hard-to-reach truck drivers; and (c) effectiveness of structured multicomponent health promotion programs. After participation in FTP, truck drivers experienced a mean decrease in weight and body mass index (BMI) of 4.6 lbs and 1.3 kg/m2, respectively. The lengths of initial DOT medical certificates were compared with DOT medical certificates received at the time of recertification (post-FTP). Only eight participants had the potential for improvement in certificate length. Of those, three truck drivers achieved an increased DOT medical certificate length at the time of recertification. CONCLUSION/APPLICATIONS TO PRACTICE: FTP offers tailored and comprehensive health coaching for truck drivers using current evidence-based practice guidelines to educate and reinforce healthy lifestyle habits. Analysis of a limited dataset revealed a mean decrease in BMI and a trend of increased DOT medical certification lengths after participation in FTP; however, further research with larger sample sizes is recommended.

Systematic Review and Meta-Analysis of Psychological Distress and Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Consequences.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) occasionally develop acute exacerbation of COPD-a potentially fatal condition. Psychological distress was associated with acute exacerbation of COPD. However, the evidence on the effect of psychological distress on acute exacerbation of COPD remains unclear. OBJECTIVE: The aim of this study was to explore the influence of psychological distress on acute exacerbation of COPD and its consequences. METHODS: The current review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using three databases (PubMed, CINAHL, and PsyINFO) that were searched to identify relevant articles. Pooled risk ratios and 95% confidential interval were calculated from the included studies' data with random-effect methods to estimate the effect of psychological distress on acute exacerbation of COPD and its consequences. RESULTS: Nineteen articles were included in the review. Most revealed that psychological distress was significantly associated with increased risk of acute exacerbation of COPD and its consequences. The meta-analyses showed that psychological distress increased risk of acute exacerbation of COPD, COPD-related hospitalization, and death. CONCLUSION: Psychological distress had negative effects on acute exacerbation of COPD and its consequences. The results of the meta-analyses show that persons with COPD and psychological distress had a greater risk of acute exacerbation of COPD, hospitalization, and death.

Do Experienced Nurses Benefit From Training on Bleeding Control in the Community Setting?

INTRODUCTION: Nurses' preparedness to provide hemorrhage control aid outside of the patient care setting has not been thoroughly evaluated. We evaluated nurses' preparedness to provide hemorrhage control in the prehospital setting after a proof-of-concept training event. METHODS: We performed a secondary analysis of evaluations from a voluntary hemorrhage control training offered to a group of experienced nurses. Education was provided by a nurse certified in Stop the Bleed training and using the Basic Bleeding Control 2.0 materials. The training lasted approximately 1 hour and included a didactic portion followed by hands-on practice with task trainer legs. Participants were surveyed after training to assess their preparedness to provide hemorrhage control aid using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree); comments and feedback were also requested. Mean (SD) was used to analyze Likert scale data. Content analysis was performed to identify common themes in qualitative data. RESULTS: Forty-five experienced nurses participated in the voluntary training. Nursing experience included obstetrics, pediatrics, critical care, acute care, community health, and psychiatric/mental health. Only 39% of participants reported having previously completed a similar course. After training completion, participants reported an increase in their preparedness to provide hemorrhage control aid (mean 3.47 [SD = 1.40] vs mean 4.8 SD [.04], P < .01). Major themes identified included wanting to feel prepared to help others, refreshing skills, and knowing how to respond in an emergency. DISCUSSION: Regardless of background and experience, nurses may benefit from more advanced hemorrhage control education to prepare them to provide aid in prehospital emergency settings.

Relapse Prevention and Prediction Strategies in Substance Use Disorder: A Scoping Review.

BACKGROUND: Relapse prevention for those with substance use disorder (SUD) is an evolving practice. Initiatives focused on relapse prevention from other populations may provide the foundation for future considerations and recommendations for recovering anesthesia providers in the workplace. The purpose of this scoping review was to examine what is known about return-to-use prediction and prevention strategies in various populations struggling with SUDs to inform future considerations and implications for recovering anesthesia providers with a history of SUD. METHODS: The Arksey and O'Malley framework was used to conduct a scoping review of the literature. A systematic search was conducted across three databases (PubMed, CINAHL, and PsycInfo) for relevant literature. Search terms used were "measures predicting relapse in substance use disorder" and "relapse prevention in substance use disorder AND anesthesia." Data from articles that met the eligibility criteria were extracted and summarized by the primary author. RESULTS: The search identified 46 articles highlighting various relapse prediction and prevention strategies related to craving and stress, underlying biological factors, neuroimaging, and mindfulness. Relapse prediction and prevention strategies ranged from cell phone applications, monitoring biological markers, and functional neuroimaging of the brain. CONCLUSIONS: Relapse is a concern for individuals with a history of SUD. For anesthesia providers, immediate access to powerful anesthesia medications requires return-to-use prediction and prevention strategies when anesthesia providers return to work after SUD treatment. Although some identified strategies are practical, more research is needed to predict and prevent return to use for recovering anesthesia providers.

Antecedents to Sexual Harassment of Women in Selected Male-Dominated Occupations: A Systematic Review.

BACKGROUND: Approximately 50% of women in all workplaces experience sexual harassment. Women who work in male-dominated occupations may be more susceptible to sexual harassment than those who work in non-male-dominated occupations. Research on factors contributing to workplace sexual harassment in male-dominated occupations is limited. This paper reviews the known antecedents that put female workers at risk of sexual harassment in select male-dominated occupations and to identify gaps in the literature and opportunities for future occupational health nursing research. METHODS: A search was conducted using PubMed, CINAHL, PsycINFO, and Web of Science. Included articles addressed sexual harassment of female workers in male-dominated occupations such as law enforcement, firefighting, truck driving, and construction. RESULTS: The search yielded 25 relevant research articles. Antecedents to sexual harassment in the workplace included lower rank, shorter tenure, physicality of the job, job insecurity, negative relationships with peers and/or supervisors, treating women as outsiders, exaggerated gender differences, unequal gender ratios, and promotions based on gender. Common antecedents to sexual harassment in the workplace identified in the literature include organizational culture and gender composition. CONCLUSION/APPLICATION TO PRACTICE: Workplace sexual harassment of women is a problem in male-dominated occupations. Research is needed to better understand the organizational antecedents of sexual harassment in male-dominated occupations within community settings to prevent workplace sexual harassment.

Identifying and Decreasing Sharps Injuries Through Root Cause Analysis in a Large Urban Hospital System.

BACKGROUND: Despite safety mandates and interventions, sharps injuries remain an occupational risk for registered nurses (RNs). Sharps and needlestick injuries increase the risk of exposure to blood-borne pathogens. Post-exposure direct and indirect costs of these percutaneous injuries have been estimated at about US$700 per incident. The goal of this quality improvement project was to identify root causes of sharps injuries for RNs at a large urban hospital system. METHODS: A retrospective evaluation of sharps injuries sustained by RNs, identification epsication of themes or root causes, and the development of a fishbone diagram to sort the causes into categories to identify workable solutions were conducted. Fisher's exact tests were performed to identify association between variables and root causes. FINDINGS: A total of 47 sharps injuries were reported from January 2020 through June 2020. Among sharps injuries sustained by nurses, 68.1% were among nurses 19 to 25 years of age and 57.4% reported job tenure of 1 to 2 years. There was a statistically significant association between root causes and tenure range, gender, and procedure type (p < .05) with moderate effect size (Cramer's V = 0.35-0.60). Technique also was a primary cause of sharps injuries for blood draw (77%), discontinuing line (75%), injection (46%), intravenous (IV) start (100%), and suturing (50%). CONCLUSIONS/APPLICATIONS TO PRACTICE: Technique and patient behavior were primary root causes of sharps injuries in this study. More sharps injuries caused by technique occurred among nurses with job tenure of 1 to 10 years, female, blood draw, discontinuing line, injection, IV start, and suturing procedures. The root cause analysis identified tenure, technique, and behavior as potential root causes of sharps injuries specifically occurring most during blood draw and injections at a large urban hospital system. These findings will inform nurses, especially new nurses in the proper use of safety devices and behaviors to prevent injury.

Association Between COPD Symptoms and Psychological Distress Among Farmers.

BACKGROUND: Farmers have an increased risk of developing chronic obstructive pulmonary disease (COPD) and psychological distress. The potential role of psychological distress in worsening COPD symptoms has been reported among the general population, but no studies have examined this relationship among farmers with COPD, which is the purpose of this study. METHODS: This study used the data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). Farmers reporting both psychological distress and COPD symptoms were included in this study (n = 239). Both unadjusted and adjusted logistic regressions were used to explore the association among psychological distress, age, health status, smoking, and COPD symptoms, with crude and adjusted odds ratio (OR) and 95% CIs reported. FINDINGS: The unadjusted analysis suggested that COPD symptoms were significantly associated with psychological distress among farmers (OR = 2.05 [1.18, 3.58]). While adjusted models showed the significant association between COPD symptoms and psychological distress among farmers after controlling for smoking, age, and health status (adjusted OR = 2.08 [1.10, 4.01]). CONCLUSION/IMPLICATIONS FOR PRACTICE: These results suggest that psychological distress is associated with an increased risk of COPD symptoms in farmers, which is consistent with observations from studies in non-farmers. Occupational health professionals need to provide screen for COPD among farmers as well as psychological distress screening and mental health promotion among farmers with COPD.

Returning to Work After an Orthopaedic Injury.

Workers' compensation and orthopaedic nursing are often intertwined for the treatment of an injured worker and returning them to work. The workers' compensation system can be complex, and knowing the regulations can be beneficial in the treatment of an injured worker and returning them to work safely. Orthopaedic nurses often play an integral role in the evaluation, treatment, and discharge of an injured worker, so understanding workers' compensation, workers' job, and expectations is important for the safe return of a worker back to duty. Orthopaedic nurses are in key positions to assist with the planning, treatment, and return of a worker back to their job.

Socioeconomic, Psychosocial, and Clinical Factors Associated With Employment in Women With HIV in the United States: A Correlational Study.

ABSTRACT: Employment is a social determinant of health, and women living with HIV (WLWH) are often underemployed. This correlational study examined the socioeconomic, psychosocial, and clinical factors associated with employment among WLWH (n = 1,357) and women at risk for HIV (n = 560). Descriptive and inferential statistics were used to evaluate factors associated with employment status. Employment was associated (p ≤ .05) with better socioeconomic status and quality of life (QOL), less tobacco and substance use, and better physical, psychological, and cognitive health. Among WLWH, employment was associated (p ≤ .05) with improved adherence to HIV care visits and HIV RNA viral suppression. Using multivariable regression modeling, differences were found between WLWH and women at risk for HIV. Among WLWH, household income, QOL, education, and time providing childcare remained associated with employment in adjusted multivariable analyses (R2 = .272, p < .001). A better understanding of the psychosocial and structural factors affecting employment is needed to reduce occupational disparities among WLWH.

Distinguishing the Diagnosis and Management of Sleep Disturbance and Sleep Disorders in Multiple Sclerosis.

Sleep is a critical issue for quality of life, cognition, and safety among patients with MS. Sleep disturbances from poor sleep hygiene, and multiple sclerosis symptomology, sleep disorders are prevalent; yet evaluation of sleep and screening of sleep disorders are inconsistent. This article presents commonly observed sleep disturbances and disorders, appropriate screening and diagnostic considerations, and management options. Nurses providing care for patients with MS must recognize sleep as an important component in care planning. A comprehensive sleep history and appropriate screening instruments should be incorporated into initial and ongoing assessments, with referral to sleep medicine providers as indicated.

Description of the Nature of Musculoskeletal Shoulder Injuries in a Cohort of Commercial Truck Drivers: A Retrospective Cross-Sectional Study.

BACKGROUND: Commercial truck drivers (CTDs) are significantly affected by shoulder injuries; however, little is known about the unique mechanisms of injury (MOIs), specific injuries, or possible preventive measures among this group of workers. This study characterized the MOIs, musculoskeletal disorders (MSDs), and factors associated with MSDs of the shoulder among a group of CTDs. METHODS: A retrospective medical record review was conducted of CTDs between 21 and 65 years of age who were seen for MSDs of the shoulder between 2007 and 2015. RESULTS: A total of 130 CTDs were included, who were aged 21 to 65 years. Commercial truck drivers were most often injured during a fall (35%) or while using chains, tarps, or straps (31%). The two most common MSDs were unspecified sprains/strains (58%) and rotator cuff tears (24%). Age was found to be associated with all MSDs (p = .001) and an increased risk of developing rotator cuff tears (p =.005). Seventy-four percent of CTDs who experienced a rotator cuff tear were 46 years of age or older. CONCLUSION/APPLICATION TO PRACTICE: This study highlights the course of the injury in terms of diagnostics such as magnetic resonance imaging (MRI) and referral for surgery and describes the occupational activities associated with CTDs. These findings can inform employer injury prevention programs, patient and health care provider education, and future interventional research.

Sexual behaviors and human papillomavirus vaccine non-initiation among young adult cancer survivors.

BACKGROUND: Young adult cancer survivors are at risk for subsequent human papillomavirus (HPV)-related malignancies. High-risk sexual behavior increases risk for HPV acquisition; HPV vaccination protects against infection. We aimed to determine the prevalence of sexual behaviors, factors related to high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among survivors. METHODS: Survivors at comprehensive cancer centers, aged 18-26 years and 1-5 years post-treatment, reported sexual behaviors and HPV vaccine initiation (i.e., ≥ 1 dose). Multivariable logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with high-risk sexual behaviors (age at first intercourse < 16 years, ≥ 3 lifetime sexual partners, or condom use ≤ 50% of the time) and to explore the relationship between sexual behaviors and vaccine non-initiation. RESULTS: Of the 312 participants (48.1% female, median age at cancer diagnosis 17.2 years and at survey 20.9 years), sexual intercourse was reported by 63.1%. Of those reporting intercourse, 74.6% reported high-risk sexual behavior. Factors related to high-risk sexual behavior included currently dating/partnered (OR = 4.39, 95%CI 2.5-7.7, P < 0.001) and perceived susceptibility to HPV (OR = 1.76, 95%CI 1.3-2.5, P < 0.001). Most survivors (75.3%) reported HPV vaccine non-initiation; sexual behaviors were not associated with vaccine non-initiation (P = 0.4). CONCLUSIONS: Many survivors participate in high-risk sexual behaviors, yet HPV vaccine initiation rates are low. Factors related to high-risk sexual behaviors can inform interventions to reduce risk for HPV acquisition among survivors. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors participate in sexual behaviors that increase risk for HPV acquisition and would benefit from vaccination.

Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients.

PURPOSE: Lifestyle changes associated with end-stage renal disease may be a factor in depression and quality of life (QOL) for patients receiving hemodialysis. This cross-sectional study examined the relationship between nutritional status, QOL, and depression in 124 hemodialysis patients. METHODS: Nutritional markers included serum albumin, normalized protein catabolic rate (nPCR), body mass index (BMI), body fat percentage, and daily protein intake. Physical and Mental dimension scores of the Kidney Disease QOL-Short Form (KDQOL-SF), and the Center for Epidemiological Studies of Depression (CESD) survey were used to measure QOL and depression, respectively. Data were analyzed using regression analyses. Measures of effect size were used for interpretation. RESULTS: Nutritional status indicators explained a moderate amount of the variability of the Physical dimension of QOL (crude R2 = .14, covariate-adjusted ΔR2 = .06) but had weak explanatory ability for the Mental dimension of QOL (crude R2 = .05, covariate-adjusted ΔR2 = .02) and CESD (crude R2 = .02, covariate-adjusted ΔR2 = .005). Additional findings suggested the presence of non-linear relationships between protein intake and both the Physical and Mental QOL dimension scores. Longer dialysis vintage was also correlated with lower psychosocial patient outcomes. CONCLUSION: While nutritional status is an important element in predicting hemodialysis patient outcomes, its relationship to depression and QOL, in this sample, demonstrated only moderate explanatory ability. However, dialysis vintage and level of education had a significant relationship with depression and QOL. These findings suggest that patients with longer dialysis vintage and limited health literacy require unique plans of care. Future studies aimed at understanding the interrelationships between non-modifiable patient characteristics and psychosocial outcomes are imperative.

Sleep and Safety Decision-Making Among Truck Drivers.

BACKGROUND: Restorative sleep is essential for the level of cognitive performance required of truckers to drive safely. The purpose of this qualitative descriptive study was to describe and explore sleep-related and safety decision-making among truck drivers. METHODS: Flyers and snowball sampling were used to recruit truck drivers into the study. Semi-structured interviews were conducted to determine personal and professional influences on sleep and safety decision-making and preferences for receiving health information. Thematic analysis was conducted to generate descriptions of participants' experiences. FINDINGS: The sample consisted of 10 White males with a mean of 22 years of truck-driving experience. Weather conditions and drowsiness were the most commonly described conditions that required sleep decision-making by the participants. Four themes impacting sleep- and safety-related decision-making emerged including sentinel events, evolving driver characteristics, relationships, and company-level factors. CONCLUSION/APPLICATION TO PRACTICE: Findings from this study suggest that there are both internal and external factors influencing sleep and safety decision-making among truck drivers. Personal relationships with important others, such as family members, and professional relationships with company dispatchers were important influences among participants. During encounters with truck drivers, occupational health nurses should assess sleep quality and quantity and review healthy sleep hygiene strategies with them and their family members, if they are available. Future larger studies are necessary to inform the development of interventions and company policies to promote healthy sleep among truck drivers.

Employment and Occupational Productivity Among Women Living With HIV: A Conceptual Framework.

ABSTRACT: Women living with HIV (WLWH) have lower employment rates and more difficulty finding and keeping employment compared with their counterparts without HIV. These disparities affect physical, psychological, and socioeconomic outcomes, and they may compound the disadvantages associated with living with HIV. Although historical literature has emphasized the impact of clinical factors on employment, current evidence suggests that socioeconomic and psychosocial factors associated with HIV should be included for a more comprehensive view. Based on this broader inclusion, a conceptual framework is presented describing how socioeconomic and psychosocial characteristics influence employment acquisition and maintenance among WLWH. The framework posits that there is a reciprocal relationship between employment acquisition and occupational productivity, and psychological health, physical health, social support, and empowerment. Implications for future research and interventions include (a) an extended conceptualization of vocational rehabilitation and (b) the use of peer support groups to increase social capital, empowerment, knowledge, and resources among WLWH.

Alignment of a PhD program in nursing with the AACN report on the research-focused doctorate in nursing: A descriptive analysis.

Those involved in preparing the next generation of nurse scientists face numerous challenges, including but not limited to: relatively older age at completion of doctoral studies, insufficient funding for full-time PhD students in nursing, inadequate funding for nursing research, and the limited number of well-funded mentors in nursing doctoral programs. These issues have limited the number of students enrolled in PhD nursing programs and graduates to supply the research faculty of the future and generate nursing science. This phenomenon persists despite numerous calls to increase the number of PhD doctoral students and graduates and expedite the PhD process without compromising educational integrity. This article describes the BSN-to-PhD Pathway and the Accelerated (3 year) Pathway to the nursing PhD at an established research doctoral program that required a shift in the approach to student recruitment, curriculum development, and timely progression. Implications for practice and research are discussed.