A protocol for the safe recruitment of Indigenous and Black women experiencing intimate partner violence during the COVID-19 pandemic into a large mixed methods study: The Sisters by Choice Study.

Intimate partner violence (IPV) is a complex and pervasive public health problem disproportionately affecting Indigenous and Black women. During the COVID-19 pandemic, IPV became more complicated for advocates because social distancing, quarantine, and isolation measures further endangered women experiencing IPV. This manuscript is based on an ongoing community-engaged study in an upper Midwestern state. Our primary goal for this study is to generate urgently needed knowledge on the impact of the COVID-19 pandemic on Indigenous and Black women's help-seeking behaviours following IPV by systematically documenting barriers women faced during the pandemic. Engaging women in a large study that seeks to garner information about their experiences of violence is complex and challenging and requires significant planning, especially for ensuring participants' safety. In this write-up, we detail the safety planning protocol developed for the purposes of recruiting and engaging women in rural and urban areas in an upper Midwestern state in the United States. Our goal is to provide scholars conducting research in the area of violence with practical considerations for safely conducting a study of this nature.

Homeopathy: A State of the Science Review With Recommendations for Practical Therapies in Midwifery Practice.

A substantial proportion of adults and children in the United States use complementary and alternative health practices, including homeopathy. Many homeopathic therapies are readily available over the counter, and many individuals access and self-administer these therapies with little or no guidance from health care practitioners. In addition, patients and health care providers are often confused by terminologies associated with complementary practices and may be unable to distinguish homeopathy from naturopathy, herbalism, holistic medicine, Ayurveda, traditional Chinese medicine, or other forms of health care. Compared with European and Asian countries, education in the United States about complementary and alternative health practices is not typically found within traditional nursing, midwifery, or medical education curricula. Given this lack of education and the broad acceptance and popularity of homeopathy, it is necessary for health care practitioners to improve their knowledge regarding similarities and differences among therapies so they can fully inform and make appropriate recommendations to patients. The intent of this article is therefore to examine the state of existing science of homeopathy, distinguish it from other complementary methods, and provide midwives and women's health care providers with an introduction to common homeopathic therapies that may be recommended and safely used by persons seeking midwifery care. This review also presents the evidence base, pharmacology, manufacturing, and regulation of homeopathic therapies. We also consider controversies and misunderstandings regarding safety and efficacy of homeopathic remedies relevant to women and birthing persons. Examples of practical applications of homeopathic therapies for use in midwifery practice are introduced. Implications for practice and sample guidelines are included.

Modeling the social determinants of resilience in health professions students: impact on psychological adjustment.

Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.

Understanding How Community Health Workers Build Trust with Low-Income Women of Color At-Risk for Maternal Child Health Disparities: A Grounded Theory Study.

This article examines how Community Health Workers (CHWs) build trust with low-income women of color who have a historical distrust of the healthcare system, and are at risk for maternal-child health disparities. This qualitative study used a grounded theory methodology guided by Charmaz's inductive social constructivist approach. Data were collected using open-ended semi-structured interviews and focus groups with CHWs who worked in community-based and hospital-based programs in California, Oregon, Illinois, Texas, South Carolina, New York, and Maine. Thirty-two CHWs participated, with 95% of participants being of Latinx and African American ethnicity. They served women from Latinx, African American, and Migrant communities. The CHW communication strategies represent aspects of respect and client-centered care and are applied in the development of a theoretical framework. CHWs were able to build and sustain trust at the initial encounter through these specific strategies: 1) addressing immediate needs related to social determinants of health; 2) embodying mannerisms and dress; 3) speaking appropriately to the client's age, culture, and knowledge; 4) easing client's fears through locus of control, and 5) allowing for time flexibility. These findings have implications for practice through interventions to train healthcare providers to build trust with low-income women of color who have a historical distrust of the healthcare system and who are at risk for maternal-child health disparities. Future research is recommended to explore how the communication trust-building constructs also benefit all other groups at similar risk, including those with mental health disorders and infectious diseases. The findings indicate specific communication strategies through which trust can be built, beginning at the initial encounter with low-income women at risk for maternal-child health disparities and who have a historical distrust of the healthcare system.

Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students.

OBJECTIVE: Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS: Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS: Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS: Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.

Should we be targeting sleep architecture to more effectively treat schizophrenia?

The sleep architecture (or sleep kinetics) of schizophrenia is different from that of other mental illnesses, including major depressive disorder. However, clinicians rarely consider these parameters in clinical settings during treatment. This article discusses the use of polysomnography to characterize the sleeping patterns of patients diagnosed with schizophrenia and the positive influence of clozapine on sleep in patients with schizophrenia.

Integrative Treatment of Chronic Abdominal Bloating and Pain Associated With Overgrowth of Small Intestinal Bacteria: A Case Report.

Context • Small intestinal bacterial overgrowth (SIBO) is commonly defined as an increased number of bacteria and/or an abnormal type of bacteria in the small intestine. Conventional treatment for SIBO is typically focused on antibiotics to eradicate the bacterial overgrowth. Numerous studies have demonstrated the antimicrobial activity of herbs, and a diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) has been shown to enhance antibiotic therapy. Objective • The current case study intended to evaluate the benefits of an alternative, multifaceted approach-including botanical and homeopathic therapies in conjunction with a low-FODMAP diet-in the treatment of SIBO and its associated symptoms. Design • The research team performed a case study. Setting • The study was conducted at SCNM Medical Center (Tempe, AZ, USA). Participant • The participant was a female patient at the SCNM Medical Center with chronic, daily, severe abdominal bloating and pain that particularly worsened after meals and by the end of the day. The patient also had a significant history of chronic constipation that had begun approximately 10 y prior to her experiencing the daily abdominal pain. Intervention • Based on a lactulose breath test for hydrogen and methane, the research team diagnosed the patient with a case of mild SIBO. The treatment approach was multifaceted, involving a low-FODMAP diet, antimicrobial botanical therapy, and homeopathic medicine. Results • The patient's abdominal pain and bloating resolved with the treatment of the SIBO, although her underlying constipation, which was likely associated with other factors, remained. Conclusions • This case study supports an alternative, multifaceted approach to the treatment of SIBO and commonly associated symptoms.

Pathways to the PhD in Nursing: An Analysis of Similarities and Differences.

New educational pathways are needed to increase the number of doctor of philosophy (PhD)-prepared nurses. To address this need, an early-entry PhD option designed to engage students in PhD coursework and research during the undergraduate nursing major was developed at the University of Wisconsin-Madison. An evaluation comparing the early-entry option with two more conventional entry points was conducted. Three groups (N = 84) comprised the sample: (a) early-entry students admitted as undergraduates or immediately upon graduation (N = 29), (b) mid-entry students with baccalaureate degrees and at least 1 year of work experience (N = 27), and (c) delayed-entry students with master's degrees and 1 or more years of work experience (N = 28). Qualitative and quantitative data were collected from the 3 groups of students who were admitted from 2002 to 2011. The sources of data were transcriptions of individual interviews and reviews of existing data. Seventy-seven percent of the sample participated in the individual interviews. The database review included all students who matriculated into the PhD program. Common themes among the 3 groups included a need for educational funding, the importance of a faculty mentor, and concern about preparation for the teaching role and the academic work environment. The groups were also comparable in terms of research productivity during doctoral study and postgraduation employment. Differences were found on measures of diversity, program progression, and perceptions of clinical competence. The findings provide needed data for the development and expansion of educational pathways to the PhD in nursing.

What are patients saying about sex after a kidney or simultaneous kidney/pancreas transplant?

Context-Chronic illnesses such as kidney failure and diabetes and their treatments can affect people's identity, including their sexual identity. Little is known about patients' perspective on the effect of transplant on their sexual identity. Objective-To explore the sexual concerns of kidney and simultaneous pancreas/kidney transplant recipients. Design-Descriptive, qualitative. Setting-Major Midwestern university hospital. Patients-143 kidney and 70 pancreas/kidney transplant recipients; most were male (63.0%), married (64.7%), and white (83.7%), and the mean age was 49 years. Intervention-The qualitative data reported in this manuscript are derived from 2 larger quantitative studies of sexuality and quality of life in kidney and pancreas/kidney transplant recipients. The questionnaire in those studies included 2 open-ended questions that allowed participants to share their experiences as transplant recipients. Main Outcome Measure-Two faculty and 3 students did a conventional content analysis on patients' responses to the open-ended questions. Codes were extracted from the responses and then themes were created that best represented the codes. Results-Participants shared how sexual concerns affected their identity as sexual beings after transplant. Based on the responses to these open-ended questions, 4 themes were identified: sexual functioning, health care concerns, relationship with partner, and appearance changes. The study results indicate the need for improved education and provider-initiated dialogue related to sexuality after transplant.

Early entry to a doctoral degree in nursing program: analysis of student experiences.

Educational innovations that encourage younger students to pursue doctoral research training are timely and important. To this end, an evaluation of an early-entry doctoral (PhD) program in nursing was conducted. One component of this evaluation examines qualitative data from students admitted to the PhD program as undergraduates or immediately upon graduation from the undergraduate program. The evaluation included all students (N = 29) admitted over a 10-year period, from 2002 to 2011. Eighty-three percent of this population agreed to participate. Transcriptions of individual interviews were analyzed using a qualitative descriptive method. The results are categorized into three general areas: decision making about becoming a nurse and a PhD student, facilitators of admission to and progression in an early-entry PhD program, and the challenges of being an early-entry PhD student. The findings provide the data necessary to guide revisions of existing programs and stimulate the development of new early-entry PhD programs.

Transition to the tenure track for nurse faculty with young children: a case study.

Recent efforts to ease the nursing shortage focus on recruiting and retaining younger faculty. The first years in a tenure-track position are especially challenging for new faculty who struggle to negotiate demands of academia along with parenting young children. These struggles may influence retention and require further exploration. A case study using qualitative content analysis was conducted on the transitioning experiences of three assistant professors of nursing, who had young children, during their first two years on tenure track at a research-intensive public university. Three main content areas emerged: adapting to the academic role, negotiating work/life demands, and benefiting from mentoring. To help ease the nurse faculty shortage, colleges and universities should strive to implement family-friendly policies and mentoring programs to retain faculty with young children.

Promoting an egalitarian approach to research with vulnerable populations of women.

AIM: This paper is a presentation of issues that arise when conducting research with women from vulnerable populations. BACKGROUND: Conducting research with ethnic minority populations has accentuated the challenges inherent in research, particularly when the populations participating are considered 'vulnerable' due to additional variables such as low levels of income. DATA SOURCES: The paper is based on the experiences of three authors using feminist methods in separate but similar research trajectories that include (a) low-income women in the Southern African country of Malawi, (b) women diagnosed with schizophrenia in the United States of America, and (c) rural, indigenous Aymara women of the highlands of Peru. The data forming the basis of this paper were collected over 3- to 6-month periods between 2005 and 2006. DISCUSSION: We examine the impact of the researcher's power on the research process. Our research provides examples that illuminate the limitations of informed consent in research with vulnerable populations of women. We offer critical questions about and recommendations for nursing and other health care researchers, both in the third world and the western world, regarding appropriate research methods with vulnerable populations: methods that acknowledge the oppressive realities of the participants, methods that deliberately avoid further marginalization of participants, and methods that have the potential to improve the life situations of the women who participate in our research. CONCLUSION: These examples show the need for new methods to ensure that participants in research understand their role and the benefits they may expect to receive from research.

Schizophrenia and violence: accepting and forsaking.

Violence remains highly problematic for women. Women diagnosed with schizophrenia are at particularly high risk for numerous types of violence. Many of these women receive services in the community through mental health case managers. These case managers have developed ongoing and close relationships with women, and are often the front-line service providers to assist them in negotiating with physical, mental, and social service agencies. This interpretive phenomenological study examined the perspective of mental health case managers to better understand how they cope with the intersection of violence with a diagnosis of schizophrenia among their clientele. Accepting and forsaking was a theme developed to describe how case managers gradually accepted violence in the lives of women with schizophrenia, and how this acceptance was eventually coupled with forsaking hope for a reduction or elimination of violence in women's lives.

Schizophrenia, violence, and case management: being supportive and overwhelmed.

OBJECTIVE: The aim of this study is to understand the experiences of case managers as they delivered care to women who were diagnosed with schizophrenia and live with histories of violence. METHODS: Interpretive phenomenology. RESULTS: Providers valued their relationships with women, yet felt overwhelmed and frustrated with aspects of the case management role. Case managers at times blamed women for the violence in their lives and lacked clarity with regard to their role assisting women in recovery. CONCLUSIONS: The violence and poverty that is common for these women is a key factor that increased providers' alienation and confusion as to their role in the provision of care. The educational and supportive needs of case managers must be addressed to uphold recovery-oriented services.

The invisibility of violence against women diagnosed with schizophrenia: a synthesis of perspectives.

Women diagnosed with severe mental illness experience twice the rates of violence compared with women without mental illness. Despite awareness of violence, mental healthcare providers feel powerless to combat the problem. This article synthesizes 2 previous interpretive studies that examined violence perpetrated against women diagnosed with schizophrenia. This synthesis critically examines the perspectives of women who experience violence and schizophrenia and case managers who care for them. Stigma was an overarching theme in participants' stories but each group differed in its understanding of how stigma impacted women's lives. This disconnection perpetuates stigma and allows violence to remain invisible.

Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital.

AIM: To determine the prevalence and contributing factors of moral distress in medical and surgical nurses. BACKGROUND: Moral distress from ethical conflicts in the work environment is associated with burnout and job turnovers in nurses. METHOD: A prospective cross-sectional survey using the Moral Distress Scale tool was administered to medical and surgical nurses at an adult acute tertiary care hospital. RESULTS: The survey was completed by 260 nurses (92% response rate). The intensity of moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies for situations associated with futile care and deceptions were particularly high. Encounter frequencies increased with years of nursing experience and caring for oncology and transplant patients. CONCLUSION: Moral distress is common among nurses in acute medical and surgical units and can be elicited from different types of situations encountered in the work environment. Nursing experience exacerbated the intensity and frequency of moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies aimed to minimize exposure to situations of moral distress and augment mechanisms mitigating its effect on nurses are necessary to enhance job satisfaction and retention.

Evidence base for developing a palliative care service.

A retrospective study was designed to collect objective data to support need for a palliative care service at Mayo Clinic Hospital. Based on the results, a pilot program was initiated.

Schizophrenia and violence: the perspective of women.

Violence against women is a major public health problem. Women with a diagnosis of schizophrenia suffer higher rates of violence compared with women without mental illnesses. Little research has focused on what it means for women to live with schizophrenia and a history of violence. This interpretive phenomenological study identified three themes of schizophrenia and violence: Being Stigmatized, Foreclosing a Future of Possibilities, and Finding Meaning in Symptoms. The results suggest mental health professionals should assess women with diagnoses of schizophrenia for violence and provide opportunities for trauma stories to be heard. These listening types of patient-centered interventions may promote recovery.

Novel heparanase-inhibiting antibody reduces neointima formation.

Basic fibroblast growth factor (bFGF), stored bound to heparan sulfate proteoglycans in the extracellular matrix (ECM) of the arterial media, may initiate smooth muscle cell (SMC) proliferation after coronary intervention, thus contributing to restenosis. bFGF mobilization from ECM stores after injury may be induced by platelet degranulation products such as heparanase. Therapies aimed at the inhibition of bFGF release and activation may assist in prevention of restenosis. To test this theory, we first examined the mobilization and activation of bFGF in the arterial media by platelet-derived heparanase. Heparanase, locally delivered to the rat carotid artery, was found to release bFGF and induce substantial SMC proliferation in the absence of actual vascular injury. An antibody that neutralizes heparanase was then developed and evaluated in a rat carotid balloon injury model. Local delivery of anti-heparanase IgG was found to inhibit bFGF release by approximately 60% ( p < 0.001) at 4 d; this correlated with the significant reduction in neointima formation observed at 14 d (intimal area/medial area: control 1.3 +/- 0.3, anti-heparanase 0.35 +/- 0.12, p < 0.0001). Platelet-derived heparanase is therefore likely to be important in initiating events leading to restenosis via bFGF mobilization. Furthermore, heparanase neutralization may assist in the prevention of restenosis following vascular injury.