Multiple Myeloma: Validation of the Values and Preferences Elicitation Questionnaire- Cure and Survival Preference Scale (VPEQ-CSPS).

BACKGROUND: With the emergence of many novel therapies, the treatment decisions for multiple myeloma (MM) are increasingly guided by concerns of quality of life, achievement of cancer-free remission, living a longer overall survival, and a relentless search for a cure; however, the impact of various decision-making factors on patients' actual therapy choices and the patients' desire for cure and survival is mainly unknown. The lack of a valid and reliable measure for uncovering patients' preferences for cure and survival makes it more challenging to put this factor into the actual treatment decision equation. PURPOSE: This study examined the psychometric properties of the Values and Preferences Elicitation Questionnaire-Cure and Survival Preference Scale (VPEQ-CSPS) instrument. METHODS: The VPEQ-CSPS instrument was deployed using an anonymous Qualtrics online survey to patients diagnosed with MM within the network of International Myeloma Foundation online patient support groups across the United States. One hundred seventy-four (N = 174) valid responses were obtained and used to examine the validity and reliability of the VPEQ-CSPS. RESULTS: Exploratory factor analysis (EFA) revealed a Kaiser-Meyer-Olkin value of 0.72 indicating excellent sample adequacy. A statistically significant Bartlett's test of sphericity (P < .001) indicated significant correlations among the variables of the dataset to conduct the EFA. The internal consistency coefficients indicated adequate reliability of the instrument with Cronbach's alpha value at 0.80. The EFA and parallel analysis revealed the 5-item VPEQ-CSPS as a valid and reliable unidimensional scale that can be used by oncology clinicians to elicit their patient's preferences for cure and survival. This new instrument has the potential to contribute to the achievement of shared decision-making for myeloma treatment decisions.

Exploring US Nursing Leadership During the Initial COVID-19 Pandemic Response: A Qualitative Descriptive Study to Guide Leadership Development for Future Emergent Situations.

OBJECTIVE: This study aimed to describe the experiences of nurse leaders during the 1st wave of the COVID-19 pandemic to enhance understanding in preparation for future disasters. BACKGROUND: The COVID-19 pandemic has posed significant challenges to the healthcare system globally. Nurse leaders play an essential part and have a significant impact on the efficacy of disaster management in future emergent situations. METHODS: The parent study conducted interviews with 100 nurses in the United States across specialty areas. This article presents a subgroup analysis of interview data from 13 self-identified nurse leaders. The research team used qualitative descriptive methodology and thematic analysis to identify patterns within the data. RESULTS: Five themes were identified for effective nurse leadership during an emerging pandemic: 1) responsiveness; 2) anticipating needs; 3) care innovations; 4) collaboration; and 5) adaptability. CONCLUSION: Supporting nurse leaders to exhibit effective leadership during periods of crisis is imperative to increase preparedness for future health events, protect population health, and create a pipeline of future nursing leadership. Involving nursing in developing and reforming policy is integral.

Examining the Qualitative Experiences of Latinx Nurses During the First Wave of COVID-19.

Introduction: The world has been impacted by the coronavirus disease 2019 (COVID-19) pandemic since March of 2020. Latinx nurses have been some of the most underrepresented in being studied during this time and have been greatly affected by it. To the best of our knowledge, there are no published studies that focus on the qualitative experiences of Latinx nurses during the first wave of the pandemic. Methods: Data analysis included thematic analysis to identify main themes experienced by Latinx nurses. A qualitative descriptive study design was employed to conduct a parent study with 100 nurses across the United States reflecting on their experiences during the first wave of the COVID-19 pandemic, data collected from May to September 2020. Formal coding of the interview data was conducted utilizing Dedoose cloud-based software. Results: Five main themes emerged, including (1) connection to patients' personal touch and empathy, (2) connection to Latinx nurses, (3) connection to family and friends, (4) connection to food as care, and (5) coping. Within the theme of coping, subthemes of (5.1) faith, (5.2) maladaptive behaviors, and (5.3) self-care activities emerged. Conclusion: These experiences can help shape the pathway to be better prepared for any emergency or future pandemic.

A Systematic Review of the Relationship Between Discrimination, Racism, and Type 2 Diabetes Healthcare Outcomes for Black Americans.

BACKGROUND: Disparities in type 2 diabetes (T2DM) risk, care, and complications impact Black Americans more than that of their White counterparts. This study aims to examine the association between discrimination, racism, and T2DM care and outcomes in Black Americans. METHOD: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: A total of six original research articles met the inclusion criteria, comprising three quantitative and three qualitative studies. Overall, the systematic review findings revealed that among Black Americans, perceived interpersonal discrimination and racism by healthcare professionals are associated with patients' behaviors that impact T2DM outcomes. The findings also revealed that provider-level factors such as communication, provider assumptions and attitudes, information sharing, shared decision-making, and disease management behaviors might influence T2DM outcomes in this population. DISCUSSION: Better T2DM-related outcomes depend on optimal disease control through adequate disease management. Building a therapeutic and culturally appropriate relationship free of discrimination and racism is vital for optimal disease management and decreasing health disparities in this patient population. CONCLUSION: Perceived interpersonal racism and discrimination by healthcare providers, among other sociocultural factors, play a crucial role in influencing some patient behaviors that affect T2DM health outcomes in this population. Efforts to decrease health disparities in this specific community should also focus on interventions addressing provider-level factors and behaviors perceived as racist or discriminatory.

Motivators and Barriers to COVID-19 Vaccination in Young Adults Living in the USA.

High rates of COVID-19 infection and lower vaccination rates among young adults aged 18 to 26 in the United States prompted this study to examine motivating factors and barriers to COVID-19 vaccination and identify preferences in COVID-19 vaccine education. Three focus group discussions were completed. Transcribed data were analyzed using thematic analysis. Three key themes were identified including (1) motivating factors to vaccination, (2) barriers to vaccination, and (3) COVID-19 vaccination educational intervention design recommendations. Motivating factors included five relevant subthemes: civic duty, fear related to the disease process; fear related to emerging variants and breakthroughs; fear regarding the suffering of others; and freedom. Barriers included four subthemes: lack of trust, misinformation, politics, and pressure. Attempts to further educate young adults about the COVID-19 vaccine should consider strategies that target motivating factors and barriers while also making accurate information accessible through social media.

A Qualitative Examination of Opioid Sparing Anesthesia Practices Among CRNAs.

PURPOSE: The purpose of this study was to examine the experiences of CRNAs using opioid sparing techniques in their perioperative anesthesia practice. DESIGN: This study used a qualitative descriptive methodology. METHODS: Semistructured individual interviews were conducted with Certified Registered Nurse Anesthetists who use opioid sparing anesthesia in their clinical practice in the United States. FINDINGS: Sixteen interviews were completed. Thematic network analysis revealed two major themes: (1) perioperative benefits of opioid sparing anesthesia and (2) prospective benefits of opioid sparing anesthesia. Perioperative benefits described include reduction or elimination of postoperative nausea and vomiting, superior pain control, and improved short-term recovery. Prospective benefits described include higher surgeon satisfaction, superior surgeon-managed pain control, increased patient satisfaction, reduction of opioids in the community, and awareness of positive prospective benefits of opioid sparing anesthesia. CONCLUSIONS: This study highlights the significance of opioid sparing anesthesia and its role in comprehensive perioperative pain control, reduction of opioids in the community, and patient recovery beyond the postanesthesia care unit.

Exploring food environment interventions for diet-related outcomes using a food sovereignty framework: a systematic review.

Building local food systems through a food sovereignty lens, harnessing the right of people to control their own food systems, may enhance healthy food access and increase the consumption of fruits and vegetables in local communities. While research to date has described the outcomes of various multilevel, multicomponent food systems interventions, no known literature reviews to date have systematically examined food system interventions and dietary and health outcomes through the context of a food sovereignty lens. Utilization of a food sovereignty framework allows for the incorporation of key food systems and community-based concepts in the food environment literature. The purpose of this systematic review was to describe and summarize the efficacy of community-based local food system interventions, using the food sovereignty framework, for both pediatric and adult populations and their impact on health behaviors and physiological outcomes. We searched for peer-reviewed articles using Scopus, PubMed, PsychInfo and CINAHL databases and identified 11 articles that met the inclusion criteria for this study. Seven studies found that food systems interventions had a significant positive effect on improving health outcomes, three had null findings and one had null or negative results. Two studies utilized a community-based participatory approach. The most successful interventions involved community-based engagement involving multiple aspects of the food system and involving both children and adults for maximum impact. Our results inform how community-based food systems interventions can be guided by food sovereignty principles to improve health outcomes, such as body weight and fruit and vegetable intake, for both pediatric and adult populations.

Called to Lead: A Qualitative Examination of the Experiences and Contributions of Certified Registered Nurse Anesthetists During the COVID-19 Pandemic Response in the United States.

The COVID-19 pandemic strained healthcare providers, particularly certified registered nurse anesthetists (CRNAs). To date, little research has focused on the effects of the COVID-19 pandemic on CRNAs, whose unique skillset conferred on them expanded roles and responsibilities, increasing their stress load. Therefore, the purpose of this study was to utilize qualitative descriptive methodology to examine the experiences of CRNAs during the COVID-19 pandemic. Twelve CRNAs providing patient care in the US during the COVID-19 pandemic completed the interview protocol. Five key themes were identified including 1) roles of CRNAs, 2) collaboration, 3) challenges, 4) mental health implications for CRNAs, and 5) pride in profession. This study's descriptions of CRNA experiences during this unprecedented time in contemporary history identifies critical areas for further investigation and provides insights into anesthetic, mental health, and policy priorities to better support CRNAs now and through future infectious disease outbreaks.

Qualitative Study of the Experience of Caring for Women During Labor and Birth During the First Wave of the COVID-19 Pandemic.

OBJECTIVE: To examine the experiences of labor and delivery (L&D) nurses and certified nurse-midwives who cared for women during labor and birth in the United States during the first wave of the COVID-19 pandemic. DESIGN: Subgroup analysis of a larger study with a qualitative descriptive design. SETTING: Telephone interviews. PARTICIPANTS: The parent study included 100 nurses across various specialty areas who provided patient care during the first wave of COVID-19 in the United States. Our subgroup analysis included 19 participants: L&D nurses (n = 11) and certified nurse-midwives (n = 8). METHODS: Semistructured interview guide. RESULTS: Participants described their experiences providing patient care in L&D settings during the first wave of the COVID-19 pandemic. We identified five major themes: Separation of COVID-19-Positive Mothers and Newborns, Isolation of Women in Active Labor, Disparities in Access to Care, Barriers to Communication, and Effect on the Mental Health of Members of the Care Team. CONCLUSION: Our findings captured the experiences of maternity care team members who worked during the COVID-19 pandemic when standards of quality maternity care were compromised. The challenges of caring for COVID-19-positive mothers, including isolation during active labor and infant removal from mothers at birth, affected their psychological well-being and their mental health and must now be addressed to prevent burnout and turnover.

Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice.

INTRODUCTION: Although general safe sleep guidelines have been established, their utility and implementation have yet to be examined systematically for inpatient populations for application to infants in the pediatric intensive care unit (PICU) setting. This study aimed to complete a systematic review of inpatient safe sleep practices studies to develop then safe sleep clinical guidelines for implementation in the care of medically complex infants in the PICU. METHOD: This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. RESULTS: Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. DISCUSSION: Consistent and comprehensive safe sleep education and modeling by health care professionals in the inpatient setting is an effective technique to reduce the risk of harm and promote safe sleep behaviors in the home setting.

Mental health disparities in Latinx immigrant communities residing in the United States during COVID-19: Implications for policy and practice.

Objectives: Studies have demonstrated that Latinx populations face significant health disparities in access to mental health care. The objective of this study was to describe the impact of the COVID-19 pandemic on the mental health needs of Latinx families, from the perspectives of direct service providers working with Latinx communities. Methods: Twenty-one semi-structured interviews were conducted virtually with direct service providers to the Latinx community from August to October 2020. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: Two-thirds of providers were female, with a median age of 33 years, and provided direct services to Latinx clients and had extensive experience working with immigrant families, particularly in Massachusetts. Key themes identified describing the impact of COVID-19 on the mental health needs of Latinx families included: (1) exacerbation of mental health symptoms, (2) financial stressors, (3) preoccupation regarding transnational lives, (4) secondary needs becoming more salient, and (5) immigration status as a main driver of inequality. Conclusions: Our findings highlight the importance of focusing on the mental health needs of Latinx immigrants and ensuring their access to mental health services. Telehealth seems to be a potential tool that promotes mental health access among Latinx clients. Future research needs to continue investigating the role of telehealth in decreasing mental health access disparities.

A systematic review examining the pulmonary effects of electronic vapor delivery systems.

STUDY OBJECTIVE: Despite the popularity of vaping and electronic vapor delivery systems (EVDS), the healthcare community remains largely unfamiliar with their potential to induce harm. The purpose of this systematic review is to identify how EVDS use affects the pulmonary system in order to support future anesthetic guidelines for patients who vape. DESIGN: Systematic Review. An electronic search of databases CINAHL and PubMed was performed in October 2020. STUDY ELIGIBILITY CRITERIA: Studies were included if they were deemed original research published in English, if they were performed exclusively in humans or on human tissue, if they examined the effects of EVDS on pulmonary function or tissue, and/or if they produced quantitative data. Studies were excluded if they utilized animal samples, studied subjects under the age of 18, presented expert opinions or reviews, offered qualitative data, reported case studies, or only evaluated EVDS' efficacy as a smoking cessation tool. MAIN RESULTS: This review identified six EVDS-induced pulmonary implications warranting anesthetic consideration: alterations in pulmonary function tests, disrupted ventilation, impaired mucociliary clearance, tissue destruction, a disrupted immune response, and oxidative stress with DNA fragmentation. CONCLUSION: A total of 38 studies described the effects of EVDS on pulmonary function, airway epithelial tissue, and inflammatory mechanisms that may lead to chronic pulmonary disease. Anesthesia providers are encouraged to assess patients for EVDS use during the preoperative period and use the information generated by this systematic review to drive subsequent care.

Validation of an instrument assessing certified nurse-midwives' attitudes toward breastsleeping.

To date, attitudes toward breastsleeping among certified nurse-midwives caring for postpartum women are not well known. This study describes the validation procedures of two instruments assessing the attitudes of certified nurse-midwives toward breastsleeping. These tools were validated using an 18-item survey administered to a convenience sample of certified nurse-midwives. Participating certified nurse-midwives were recruited for anonymous participation in an online survey in September-November 2019. Factor analysis and parallel analysis each revealed a two-factor solution, suggesting that there were two main concepts representing the attitudes of certified nurse-midwives toward breastsleeping: breastsleeping safety and breastfeeding experience. Statistically significant differences for mean breastsleeping safety scores were noted by age group, place of practice, and United States' geographical region.

Faith Practices Reduce Perinatal Anxiety and Depression in Muslim Women: A Mixed-Methods Scoping Review.

Higher rates of depression and anxiety are reported among women who belong to racial and ethnic minority groups, contributing to adverse birth outcomes, and remains a taboo topic within the global Muslim community. Non-pharmacological coping mechanisms such as prayer may be employed to reduce perinatal depression and anxiety, however the literature is sparse on the use of this intervention among pregnant Muslim women. Therefore, we aimed to conduct a scoping review examining the use of Muslim faith practices on anxiety and depression in perinatal period. Nine studies were identified that demonstrate that Muslim faith practices reduce perinatal anxiety and depression symptoms. These studies demonstrate that prayers and other faith-based practices, including reciting parts of the Quran, saying a Dua, and listening to audio recordings of prayers are all effective in decreasing anxiety, depression, stress, pain and fear in Muslim women during pregnancy, during childbirth, during an unexpected cesarean section, and when experiencing infant loss. Despite the scoping review's small sample size, findings confirm that incorporation of faith practices effectively reduces perinatal depression and anxiety among Muslim women and should be utilized in clinical settings for non-pharmacological management of perinatal mood disorders.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice.

Introduction: The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response. Methods: One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team. Results: Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress. Conclusion: Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.

Home Visiting as an Equitable Intervention for Perinatal Depression: A Scoping Review.

Objective: Maternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing additional risk factors. The aim of this scoping review is to investigate the effect of home visiting on perinatal depression grounded in published studies. Methods: We conducted a scoping review of the existing literature of studies relevant to perinatal depression and home visiting. We entered keywords in five search databases: MEDLINE, PsycInfo, CINAHL, Social Work Abstracts, and Google Scholar. All relevant literature published between January 1999-December 2019 was reviewed. Duplicates, books, and errata were excluded from the study. As a scoping review, we included all studies published in English describing the inclusion of maternal depression in home visits. We hypothesize birthing people with perinatal depression will benefit from home visiting interventions. Results: The results from the scoping review and describe the use of home visiting to improve perinatal mental health. An initial 12,652 records were identified in the search. After duplicates were removed, the titles of 2,140 articles were assessed for applicability, however 29 identified for full-text eligibility and were included in this analysis. The majority of the studies included in this review were quantitative (n = 23), followed by qualitative (n = 3), and mixed methods (n = 3). Nearly all studies (n = 28) using validated instruments such as the Edinburgh Postnatal Depression Scale to determine depressive symptoms. Discussion: This review offers preliminary qualitative insights on the efficacy of home visiting for administrating perinatal depression care. Studies show that home visiting programs can provide treatment for perinatal depression and reduce the effects of depression for birthing people. Our review suggests that the efficacy of home visiting programs beginning in the postpartum period are less predictable than prenatal home visiting intervention among various populations, including people experiencing both high-risk and low-risk situations.

Barriers to Dialysis Home Therapy Utilization: A Systematic Review.

Barriers to the utilization of home therapy among patients with chronic kidney disease (CKD) impact progression to kidney failure and access to treatment options. The impact of health disparities on home therapy utilization receiving kidney replacement therapy requires investigation. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted to examine health disparity barriers to home therapy utilization among patients with kidney failure. Twelve articles published from 2010-2020 identified relationships between health disparities and home dialysis utilization among adults receiving kidney replacement therapy. Findings included association between the utilization of home therapy and the barriers of race/ethnicity (n = 5), economic barriers (n = 4), and insurance type (n = 3). Implications of findings are provided.

Mutual aid organisations and their role in reducing food insecurity in Chicago's urban communities during COVID-19.

The COVID-19 pandemic has disproportionately impacted food security and food access in urban communities of colour. Loss of income, often associated with food insecurity, has affected Hispanic, Black, low-wage workers, single mothers and women of colour more than other groups of individuals. Mutual aid organisations have proliferated in response to the COVID-19 pandemic, yet a description of the contributions of these organisations in addressing food insecurity has yet to be described in the literature to date. This article aims to describe the unique role and contributions of mutual aid organisations in addressing food insecurity and food access disparities in Chicago's communities of colour during the COVID-19 pandemic. Local mutual aid organisations can function as hubs to feed urban communities while reducing food waste and building community. During the pandemic, mutual aid organisations in Chicago have distributed thousands of pounds of food to families and individuals. Mutual aid organisations provide short-term food security while engaging with community members to create a more equitable and sustainable food system. The development of robust mutual aid hubs facilitated unique opportunities for collaboration and expansion of infrastructure that may allow mutual aid organisations to address food access in their communities well into the future.

WIC Staff Views and Perceptions on the Relationship between Food Insecurity and Perinatal Depression.

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the relationship between food insecurity and perinatal depression among their WIC clients. Four, semi-structured focus groups with WIC staff (n = 24) were conducted across four diverse nonmetropolitan public health districts in Midwestern counties in the United States. WIC staff included social workers, nurses, nutritionists and ancillary staff. All interviews were audio-recorded, transcribed, and verified, and data were organized using NVivo 11.4.2. Thematic networking analysis was employed as the qualitative analysis to identify organizing themes. Three themes emerged including (1) depression experienced by clients; (2) food insecurity experienced by clients; and (3) barriers preventing clients from accessing services for themselves and their children. Research on food insecurity and perinatal depression is sparse, with fewer studies having included health staff of low-income women. Our findings suggest that the association between food insecurity and mental health needs among WIC clients is a significant public health issue to which policy change and interventions are required.

Envisioning Nursing Education for a Post-COVID-19 World: Qualitative Findings From the Frontline.

BACKGROUND: This study sought to qualitatively describe the implications of coronavirus disease 2019 (COVID-19) on nursing education and provide recommendations for curricular changes expressed by frontline nurses practicing during the first wave of the pandemic. METHOD: Nurses throughout the United States (N = 100) completed the study protocol. The study sample was diverse and included White (37%), Black (20%), Latinx (20%), Asian (14%), multiracial (7%), and Native American (2%) participants; the sample also included transgender and nonbinary nurses (2%). Thematic network analysis was used to determine the implications of COVID-19 for nursing education. RESULTS: Findings included four distinct themes: teamwork and communication, flexibility and critical thinking, leadership and using your voice, and advocacy and policy. CONCLUSION: Shifting nursing education curriculum to focus on these key attributes will help better prepare new nurses to be adaptable in practice settings, thereby improving nursing care, clinical outcomes, and the well-being of the communities that nurses serve. [J Nurs Educ. 2021;60(12):668-673.].