Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data.

Introduction: Women experience numerous barriers to patient-centered health care (e.g., lack of continuity). Such barriers are amplified for women from marginalized communities. Virtual care may improve equitable access. We are conducting a partner-engaged, qualitative evidence synthesis (QES) of patients' and providers' experiences with virtual health care delivery for women. Methods: We use a best-fit framework approach informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework and Public Health Critical Race Praxis. We will supplement published literature with qualitative interviews with women from underrepresented communities and their health care providers. We will engage patients and other contributors through multiple participatory methods. Results: Our search identified 5525 articles published from 2010 to 2022. Sixty were eligible, of which 42 focused on women and 24 on provider experiences. Data abstraction and analysis are ongoing. Discussion: This work offers four key innovations to advance health equity: (1) conceptual foundation rooted in an antiracist action-oriented praxis; (2) worked example of centering QES on marginalized communities; (3) supplementing QES with primary qualitative information with populations historically marginalized in the health care system; and (4) participatory approaches that foster longitudinal partnered engagement. Health Equity Implications: Our approach to exploring virtual health care for women demonstrates an antiracist praxis to inform knowledge generation. In doing so, we aim to generate findings that can guide health care systems in the equitable deployment of comprehensive virtual care for women.

Life after loss: Parent bereavement and coping experiences after infant death in the neonatal intensive care unit.

The death of an infant in the neonatal intensive care unit (NICU) is a profound and unexpected loss for parents that results in a complex process of coping with bereavement. A descriptive qualitative approach was used to explore parent bereavement and coping experiences after infant death in the NICU. The dual process model of coping with bereavement was used as a conceptual framework to help understand how parents cope with grief after infant death. Living with infant death was a process that resulted in major life changes and a process of oscillating among various coping strategies.

Parent Perspectives of Neonatal Intensive Care at the End-of-Life.

This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death.

Mentoring and Self-Efficacy: Implications for the Neonatal Nurse Practitioner Workforce.

BACKGROUND: Mentoring facilitates positive self-efficacy. Individuals with high self-efficacy emulate professional resiliency and possess a strong sense of optimism in their ability to adapt, overcome, and persevere in the professional arena. PURPOSE: The purpose of this study was to identify characteristics that encourage mentoring relationships between neonatal nurse practitioner (NNP) students and preceptors, as well as student perceptions of mentoring relationships. METHODS: A 29-item survey composed of demographic items, the Freeman Mentoring Survey, the Self-Efficacy Scale, and the Confidence Scale, along with qualitative questions, was disseminated to NNP students enrolled in their final clinical practicum course from August to October 2014. RESULTS: Students who sought out their own preceptor "by choice" reported higher self-efficacy scores (P = .046) and mentoring scores (P = .047). Students who perceived their preceptor as a mentor (91%) expressed readiness to assume the role of advanced practice registered nursing after graduation. An average of 37.2 hours is required for a student to adapt to a clinical site and preceptor. IMPLICATIONS FOR PRACTICE: Mentorships between preceptors and NNP students, grounded in the provisions of trust, stability, encouragement, and hope, facilitate positive self-efficacy for the student learner. All NNPs must commit to the integration of mentoring programs in the clinical setting as well as seek out teaching-coaching opportunities with NNP students to demonstrate their unwavering commitment to the NNP workforce. IMPLICATIONS FOR RESEARCH: Further investigation of the impacts of mentoring relationships upon job satisfaction, recruitment and retention, the teaching-coaching role, and scholarship activities of actively practicing NNPs is indicated.

Problem behaviors of children adopted from the former soviet union.

PURPOSE: The purpose of this article is to report the results of behavioral assessments collected at three time points of a cohort of children adopted from the former Soviet Union with particular emphasis on the impact of the adoptive family on problem behaviors. PROBLEM: Families adopting from the former USSR are concerned about the influence of pre-adoptive circumstances on their child's future health. METHODS: The study utilized data gathered in 1998 when the children's mean age was close to 8 years, in 2001 when the children were entering early adolescence, and in 2006 when the average age of the children was just over 15 years. The authors hypothesized that the negative impact of risk factors decreases over time, and that a family environment that is stable and supportive is inversely related to problem behaviors. The Child Behavior Checklist, the Family Environment Scale, and a parental report form were used for data collection. FINDINGS: Significant relationships between family environment and problem behaviors over time were found, with lower levels of conflict and higher levels of cohesion associated to lower problem behaviors. Being female does contribute to problem behavior with the passage of time. CONCLUSION: Although the magnitude of these effects was small to moderate, a protective family environment may assist in decreasing problem behaviors.

Update on international adoption: focus on Russia.

American families will continue to adopt children from foreign countries; the desire to have a child transcends national boundaries. Sadly, not all adoptions have happy outcomes. A recent and well-reported incident involved an American mother, who, exasperated with her adopted son's severe behavioral problems, returned him to Russia, alone, on an aircraft. Other tragic reports involve internationally adopted children who have died at the hands of their American parents. This article provides an overview of the consequences of institutionalization as a risk factor for behavioral health of children; implications for nursing care of adoptive families follow.

Advocacy: it is what we do.

Our nation is on the verge of change in the healthcare system. Although we do not yet know how this change will affect our patients, our practice, or us, we do know that with change comes opportunity. We have the opportunity to become more involved in health policy and advocacy than ever before. Many nurses are already taking the first steps, which are recognizing the importance of advocacy and articulating the issues that they believe are of greatest importance. To communicate their views to the right elected officials, nurses need to be aware of how government operates and how legislation is created and shepherded through the legislative process. Nurses must learn the fundamental principles of expressing themselves and making clear requests for what they want of their elected officials. With these skills, every nurse can become an advocate in the political arena and partner with other individuals or groups to facilitate change. Nurses who find this experience rewarding and exhilarating can pursue additional education in health policy and advocacy.

U.S. Government Accountability Office criticizes the PEPFAR.

On April 4th 2006, the U.S. Government Accountability Office (GAO) released a report criticizing the administration of HIV/AIDS prevention funds from the President's Emergency Plans for AIDS Relief (PEPFAR). The report concluded that the U.S.-mandated requirement of abstinence promotion was hindering international HIV prevention efforts by limiting funding to other types of HIV-prevention programs.

South Africa: Court orders government to provide antiretrovirals to prisoners.

On 28 August 2006, the High Court of South Africa denied the government's attempt to suspend an earlier Court order to provide antiretroviral (ARV) treatment to eligible HIV-positive prisoners in Westville Correctional Centre (WCC). In reaching its decision, the Court considered, among other factors, the irreparable harm and neglect that would be suffered by the prisoners should the access to ARV treatment be delayed. The judgment is the latest development in an eleven-month struggle by WCC prisoners living with HIV, the Treatment Action Campaign (TAC) and the AIDS Law Project (ALP) to compel the government to provide ARVs to WCC prisoners.

Protective influences of families for children adopted from the former Soviet Union.

PURPOSE: To (a) characterize the total competence of 9- to 12-year old children adopted from the former Soviet Union who have resided in the United States at least 5 years, and (b) evaluate risks and protective influences of adoptive families and their relationships to competence. DESIGN: Longitudinal, descriptive study. METHODS: In the previously reported phase, the families of 105 internationally adopted children and their families from 23 U.S. states were assessed via telephone interviews and postal survey. In this phase, 3.5 years later, 46 of the families from 16 states were located and reassessed. Measures included: Total Competence scale of the Child Behavior Checklist (CBCL), Family Environment Scale (FES), and demographic information. Multivariate regression analysis was conducted to determine which risk and protective factors contributed to competence scores of the adopted children. FINDINGS: Between Time 1 (mean age of children, 7.7 years) and Time 2 (mean age of children, 11 years), average scores on the Total Competence scale of the CBCL did not change significantly, despite impending challenges of early adolescence. Subdomain scores on the FES were more positive than norms. Results from the regression analysis showed that, of the risk and protective factors considered, only birth weight and the cohesion subscale of the FES were statistically significant in explaining variation in the competence score of the CBCL. CONCLUSIONS: Families continued to face challenges, but findings were consistent with other studies showing that, despite early adversities, these adopted children generally fared well developmentally with protective family environments of major importance.

Structural features of the acyl chain determine self-phospholipid antigen recognition by a CD1d-restricted invariant NKT (iNKT) cell.

Little is known about the antigen specificity of CD1d-restricted T cells, except that they frequently recognize CD1d-expressing antigen-presenting cells in the absence of exogenous antigen. We previously demonstrated that the 24.8.A iNKT cell hybridoma was broadly reactive with CD1d-transfected cell lines and recognized the polar lipid fraction of a tumor cell extract. In the present study, the antigen recognized by the 24.8.A iNKT cell hybridoma was purified to homogeneity and identified as palmitoyl-oleoyl-sn-glycero-3-phosphoethanolamine (16:0-18:1 PE). The 24.8.A iNKT cell hybridoma recognized synthetic 16:0-18:1[cis] PE, confirming that this phospholipid is antigenic. Recognition correlated with the degree of unsaturation of the acyl chains. Using a panel of synthetic PEs, the 24.8.A iNKT cell hybridoma was shown to be activated by PEs that contained at least one unsaturated acyl chain. The configuration of the double bonds was important, as the 24.8.A iNKT cell hybridoma recognized unsaturated acyl chains in the cis, but not the trans, configuration. PEs with multiple double bonds were recognized better than those with a single double bond, and increasing acyl chain unsaturation correlated with increased binding of PE to CD1d. These data illustrate the potential importance of the acyl chain structure for phospholipid antigen binding to CD1d.