Healthcare Worker Perceptions of LGBTQ+ Older Adults: Integrative Review.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults (OAs) may require care in long-term care (LTC), assisted living, and home health settings. Healthcare workers' (HCWs, e.g., registered nurses, social workers, certified nursing assistants, home health aides) perceptions and attitudes could influence care, health disparities, and outcomes. The aim of this integrative review was to discover what is known about HCWs' perceptions toward LGBTQ+ OAs. Searched databases included PsycINFO, PubMed, CINAHL, and Web of Science. Quality review assessment was conducted separately by two reviewers; Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A total of 370 studies were identified; 10 studies were included in the review. Five studies were quantitative, four were qualitative, and one was a mixed methods study. Major themes included preparedness/training, responsibility of disclosure, and clinical practice. HCW's perceptions may be associated with discriminatory care and health disparities in the LGBTQ+ OA population.

Experiences With Suicide Loss: A Qualitative Study.

To better understand suicide loss survivors' experiences and barriers to accessing support and mental health care, 28 (21 women and 7 men) suicide loss survivors were interviewed. Using qualitative analysis of 28 in-depth, semi-structured phone interviews data, three categories emerged: Life before Suicide, Life after Suicide, and Meaning of Life. This deeper understanding of suicide loss survivors along with inclusion of experiences of male and rural participants' suicide loss, fill previously identified research gaps. Our findings suggest importance in providing emotional support and mental health resources to those with suicide intent or experiences with suicide loss. Most importantly, the recognition of suicide loss survivors extends beyond the immediate family and includes cousins, friends, and work associates. Recognition of extended suicide loss survivors' bereavement will provide additional opportunities for healthcare providers to effectively intervene with this vulnerable population.

Recruiting bereaved family and friends left behind after a suicide loss to participate in research.

BACKGROUND: Although understanding bereavement experiences following a suicide is necessary for development of better interventions to support and provide mental health care services for friends and family members, recruiting suicide loss survivors (friends and family members left behind following a suicide) to participate in research presents challenges. Expanding recruitment to include previously underrepresented male and rural participants can further complicate recruitment. PURPOSE: In this paper, the author describes the methods used for recruiting suicide loss survivors (the friends and family members left behind following loss of a loved one to suicide) to participate in this qualitative research study. CONCLUSION: Facebook, Twitter, and Instagram were useful social media platforms used to recruit 28 participants for telephone interviews. Participants in this study reported an interest in research in hopes they could help others with suicide bereavement.

Advance care planning at life milestones.

Much progress has been made in advance care planning (ACP), especially related to end of life and palliative care. These advances have moved thinking about ACP from a checklist approach to an upstream recognition that ACP is an iterative process that should begin early in adulthood and be revisited with each milestone or life-changing event. It is recognized that there are many stages and milestones in adult life that contribute to changing loci of responsibility and life goals. These changes impact how individuals view their lives, the complexity of health care, and the myriad of health conditions they may encounter. ACP discussions should routinely be started and reexamined at the time of key life events like starting a career or a marriage and not delayed until hospitalization, the occurrence of a serious accident, or the development of a catastrophic illness.

Intimate Partner Violence Stories of Appalachian Women.

The purpose of this study was to explore past intimate partner violence as it occurred in Appalachian women residing in rural and non-urbanized areas. The methodology was qualitative description. Twelve former intimate partner violence female victims shared their experiences through the socioculturally appropriate tradition of story-telling. The meta-theme, Turning Points, reflecting the perceived non-linearity of intimate partner violence was supported by three themes: (1) The Process of Abuse: (2) Learn from my Story; Don't Let it be Your Story; and (3) Does Where I Live Make a Difference? All participants experienced patterns of abuse that cycled in frequency and severity, similar injuries and health problems, fear, helplessness, and, at times, hopelessness. Application of knowledge gained through naturalistic methods can advance our understanding of intimate partner violence as it occurs in vulnerable populations and the depth and breadth of sociocultural influences which may affect the public health threat of this type of violence.

Graphic Novela: Mexican American Families' Use of Community Services for Older Adults.

Knowledge gaps exist about how to help Mexican American (MA) families seek assistance when their capacity to assist older family members is challenged. MA families may resist confronting unpleasant but real situations with the older adult, for example, the need to access long term support services (LTSS), because of cultural and structural barriers. The purpose was to describe stakeholders' reactions to a culturally focused graphic novela created in partnership with a community advisory council. Qualitative description with content analysis of a focus group's reactions to the graphic novela was used. Results included positive reactions as well as suggestions for improvement and dissemination. Graphic novelas can be an effective medium for modeling conversations about older adults' needing additional care, and demonstrating how to identify and access available LTSS or other services. Included is a description of the researchers' process of partnering with diverse stakeholders, which is essential for creating new solutions.

"My problems aren't their fault": Mexican American women managing diabetes while caring for grandchildren.

Diabetes affects many aspects of family life for the Mexican American (MA) population. Caregiving grandmothers, the traditional family nurturers, are often simultaneously managing their type 2 diabetes (T2DM). The purpose of this qualitative descriptive study was to describe the perceptions of MA grandmothers managing T2DM while caring for a grandchild. Eight participants were interviewed. Participants consistently reported feeling a personal responsibility for their T2DM self-management as well as for the health and wellbeing of their families, including their grandchildren. Regardless of associated caregiving stress, grandchildren were described as the main source of positive motivation for T2DM self-management.

A Guide for Intentional Home Telehealth Assessment: Patient and Caregiver Perceptions.

Telehealth can provide expanded access to healthcare. The Comprehensive Patient Assessment for Using Telehealth at Home is a comprehensive approach for an intentional remote patient meeting that provides a high-quality patient encounter when using technology. In this study, we describe the perspectives of seriously ill older adults and their caregivers on the usability of the Comprehensive Patient Assessment for Using Telehealth at Home using technology to meet remotely and assess patients in their own homes. This study used qualitative description with semistructured interviews to explore participants' user experience of the telehealth visit using the Comprehensive Patient Assessment for Using Telehealth at Home. The overarching theme of participants' experiences with the Comprehensive Patient Assessment for Using Telehealth at Home intervention was of a continuum of acceptance of technology use. Participants felt that a combination of in-person and telehealth visits was ideal, and telehealth visits were appropriate for routine visits. In-person assessments would be necessary if the communication was not adequately received through remote technology. Other themes were satisfaction and detractors, usability of the technology, privacy and confidentiality, and timing of the telehealth visit. Telehealth presents new opportunities for patients to engage and connect with providers, allowing them to seek care in the comfort of their own home. In some circumstances, telehealth is appropriate but is not a permanent replacement for in-person visits.

"I put diabetes on the shelf": African-American Women's Perceptions of Risk for Diabetes Complications.

The purpose of this study was to describe the perceptions of African American (AA) women with Type 2 diabetes mellitus (T2DM) about developing diabetes mellitus (DM) complications and explore how their perceived risk influenced DM self-management. Ten (N = 10) AA women participated in the qualitative description study through semi-structured interviews. Thematic analysis informed by the Health Belief Model and Risk Perception Conceptual Model revealed the perceived probability of DM complications by AA women with T2DM and how they made judgments regarding the seriousness, extent, or severity of complications. Those with high levels of DM knowledge perceived themselves at high risk of developing DM complications and those with low DM knowledge perceived themselves at low risk of DM complications. Risk perceptions and health literacy also influenced DM self-management behaviors.

Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis.

Problem identification: Loneliness is common after cancer, contributing to poor outcomes. Interventions to modify loneliness are needed. This systematic review describes the current literature regarding loneliness interventions in cancer survivors.Literature search: Databases including: Ovid/MEDLINE; The Cochrane Central Register of Controlled Trials (CENTRAL); Elsevier/Embase; Clarivate/Web of Science (Core Collection), EBSCO/PsycINFO, EBSCO/CINAHL were used to perform a systematic review of literature using PRISMA guidelines. Second, risk of bias, meta-analysis and a narrative synthesis approach was completed to synthesize findings from multiple studies.Data evaluation/synthesis: Six thousand five hundred three studies were initially evaluated; eight studies met inclusion criteria. Findings indicate a paucity of interventions, generally of lower quality. Interventions were feasible and acceptable; those interventions with cultural modifications were more likely to demonstrate effectiveness.Conclusions: There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted.Implications for psychosocial oncology: Current studies suggest the psychosocial symptom of loneliness is modifiable among adult cancer survivors. Few interventions have been tested and shown to be effectiveness in cancer survivors in the U.S. and none have been tailored for older adult survivors, by patient gender/sex and few for specific race/ethnic groups. Results from this systematic review: a narrative synthesis and meta-analysis can inform future interventions targeting loneliness in this growing, yet vulnerable, adult cancer survivor population.

Health Care Professionals' Experiences as Family Caregivers During Intra-Hospital Transitions.

Family caregivers are often perceived as inexperienced family members assuming caregiving duties. However, health care professionals may also find themselves in an informal caregiving role as older adult relatives or friends are hospitalized and experience intra-hospital transitions. The purpose of the current study was to describe the experiences of health care professionals assuming the role of informal caregiver during intra-hospital transitions. As part of a larger study, a separate analysis of six semi-structured interviews from family caregivers with health care backgrounds was considered. Health care professionals as family caregivers (HCP-FCs) reported they sought inclusion in the care provided, they had unique insider perspectives, and experienced role struggle between health care professional and new informal caregiver. Moreover, HCP-FCs reported increased role struggle during interactions with colleagues and fellow health care professionals. Understanding of the role of HCP-FCs during transitions in care is necessary to develop interventions supportive of patient- and family-centered care. [Journal of Gerontological Nursing, 47(2), 31-36.].

The Lived Experience of Persons With Malignant Pleural Mesothelioma in the United States.

BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an emerging picture of the individual MPM experience, the United States is underrepresented in this literature. With the United States contributing more deaths from MPM than any other country, findings from this study will enhance a global body of literature on the lived experience of this devastating cancer. OBJECTIVE: The aims of this descriptive phenomenological research study were to explore the lived experience of MPM in the United States and identify unmet patient needs. INTERVENTIONS/METHODS: This was a descriptive phenomenology study employing semi-structured individual interviews with persons with MPM. RESULTS: A total of 7 persons with MPM from a large northeastern US medical center participated. Three major themes about the MPM lived experience emerged: (1) uncertainty/worry about the future, (2) value in relationships, and (3) adapting to a new norm. CONCLUSIONS: Findings from this study are consistent with other MPM research, noting a high symptom burden, lifestyle changes, and feelings of uncertainty about the future. However, participants also expressed feelings of hope and optimism. Particularly salient to the MPM experience was the role of communication with the healthcare team as well as other persons with MPM. IMPLICATIONS FOR PRACTICE: Timely, coordinated, and personalized care as well as skilled communication should be the cornerstone of care for persons with MPM. Supportive care strategies that address uncertainty, the high symptom burden, feelings of isolation, and existential concerns are also integral to quality care.

Social Determinants of Health and Health Care Delivery: African American Women's T2DM Self-Management.

African American (AA) women have high prevalence of Type 2 diabetes mellitus (T2DM) and complications. No studies have been conducted about how social determinants of health and health care delivery affect their T2DM self-management. The purpose was to describe how social determinants of health and healthcare delivery may influence AA women's T2DM self-management using qualitative descriptive methodology (N = 10). Ten participants were interviewed. Participants' geographical location, education, level of income, health literacy, and systemic racism, that is, healthcare delivery services, for example, inadequate healthcare services, providers' assumptions about the patient's knowledge of diabetes, providers' attitudes toward patients, and stigma related to diabetes as a disease were identified. Understanding the role of social determinants of health and the health care delivery system in influencing T2DM self-management is a powerful tool for providers and practitioners for improving practice and health care policies to decrease health disparities and improve health outcomes among AA women with T2DM.

Race and Gender-Based Perceptions of Older Adults: Will the Youth Lead the Way?

BACKGROUND: Older individuals encounter the greatest racial/gender biases. It is unknown whether younger generations, who often lead culture shifts, have racial and gender biases against older populations. METHODS: Using Amazon's Mechanical Turk's crowdsourcing, we identified how an individual's race and gender are associated with perceptions of individuals aged mid-60s. Participants were asked to rate photograph appearances on Likert Scale (1-10). Interactions between participant and photograph race and gender were assessed with mixed effects models. Delta represents rating differences (positive value higher rating for Whites or women, negative value higher rating for African-Americans or men). RESULTS: Among 1563 participants (mean 35 years ± 12), both non-Hispanic White (WP) and all Other race/ethnicity (OP) participants perceived African-American photos as more trustworthy [Delta WP -0.60(95%CI-0.83, - 0.37); Delta OP - 0.51(- 0.74,-0.28), interaction p = 0.06], more attractive [Delta non-Hispanic White participants - 0.63(- 0.97, - 0.29); Delta Other race/ethnicity participants - 0.40 (- 0.74, - 0.28), interaction p < 0.001], healthier [Delta WP -0.31(- 0.53, - 0.08); Delta OP -0.24(- 0.45, -0.03), interaction p = 1.00], and less threatening than White photos [Delta WP 0.79(0.36,1.22); Delta OP 0.60(0.17,1.03), interaction p < 0.001]. Compared with OP, WP perceived African-American photos more favorably for intelligence (interaction p < 0.001). Both genders perceived photos of women as more trustworthy [Delta Women Participants (WmP) 0.50(0.27,0.73); Delta Men Participants(MnP) 0.31(0.08,0.54); interaction p < 0.001] and men as more threatening [Delta WmP -0.84(-1.27, -0.41), Delta MnP - 0.77(- 1.20, - 0.34), interaction p = 0.93]. Compared with MnP, WmP perceived photos of women as happier and more attractive than men (interaction p < 0.001). Compared with WmP, MnP perceived men as healthier than women (interaction p < 0.001). CONCLUSIONS: Among a young generation, older African-Americans were perceived more favorably than Whites. Gender perceptions followed gender norms. This suggests a decline in implicit bias against older minorities, but gender biases persist. Future work should investigate whether similar patterns are observed in healthcare.

Role of the Infusion Nurse: Caring for the Family/Lay Caregiver of Older Adults.

Approximately 43 500 000 family caregivers provide unpaid care to an adult or child. Most caregivers provide care to older adults, most often parents. Caregivers are often ill-prepared to assist their loved ones, creating or increasing caregiving burden and/or risk of compassion fatigue, potentially leading to critical "caregiving tipping points." Identifying families who are experiencing increased burden or risk of compassion fatigue is a skill that nurses, including infusion nurses, who have unique entrée into the caregiving situation, should develop. The purpose of this article is to describe "impending" tipping points before they occur and to offer solutions for how nurses can help caregiving families identify them and access additional supportive services.

Association of Gender and Race With Allocation of Advanced Heart Failure Therapies.

Importance: Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women. Objective: To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies. Design, Setting, and Participants: In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests. Exposure: Randomization to clinical vignettes. Main Outcomes and Measures: Thematic differences in allocation of advanced therapies by patient race and gender. Results: Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients. Conclusions and Relevance: This national study of health care professionals randomized to clinical vignettes that varied only by gender and race found evidence of gender and race bias in the decision-making process for offering advanced therapies for heart failure, particularly for African American women patients, who were judged more harshly by appearance and adequacy of social support. There was no associated between patient gender and race and final recommendations for allocation of advanced therapies. However, it is possible that bias may contribute to delayed allocation and ultimately inequity in the allocation of advanced therapies in a clinical setting.

Compassion Fatigue Among RNs Working in Skilled Nursing Facilities.

Nurses employed in skilled nursing facilities (SNFs) are at risk for developing compassion fatigue. Compassion fatigue negatively impacts patient outcomes and is associated with decreased quality of care. Some nurses leave the profession due to compassion fatigue. There are no published studies in the United States focused on compassion fatigue among SNF nurses. The purpose of this interpretive phenomenological study was to identify the shared meanings of compassion fatigue among RNs caring for residents in SNFs. Shared meanings among participants were identified as: (1) I feel conflicted, which causes my compassion fatigue; (2) I feel physical and emotional manifestations of compassion fatigue; (3) Compassion fatigue is infused in every aspect of my life; and (4) We are trying to cope with compassion fatigue. Of paramount importance was the desire to make a difference in the lives of residents. Three participants sought employment outside the SNF setting due to compassion fatigue. Further research and education are needed to improve knowledge, policy, and practice. [Research in Gerontological Nursing, 13(6), 320-328.].

Gender Differences in End-of-Life Care in Older Mexican American Adults.

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults' gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.

Early for Everyone: Reconceptualizing Palliative Care in the Neonatal Intensive Care Unit.

BACKGROUND: Palliative care (PC) in the neonatal intensive care unit (NICU) is often provided exclusively to infants expected to die. Standards of care support providing PC early after diagnosis with any condition likely to impact quality of life. PURPOSE: To determine the state of early PC practice across populations to derive elements of early PC applicable to neonates and their families and demonstrate their application in practice. SEARCH STRATEGY: Multiple literature searches were conducted from 2016 to 2019. Common keywords used were: palliative care; early PC; end of life, neonate; NICU; perinatal PC; pediatric PC; family-centered care; advanced care planning; palliative care consultant; and shared decision-making. FINDINGS: Early PC is an emerging practice in adult, pediatric, and perinatal populations that has been shown to be helpful for and recommended by families. Three key elements of early PC in the NICU are shared decision-making, care planning, and coping with distress. A hypothetical case of a 24-week infant is presented to illustrate how findings may be applied. Evidence supports expansion of neonatal PC to include infants and families without terminal diagnoses and initiation earlier in care. IMPLICATIONS FOR PRACTICE: Involving parents more fully in care planning activities and decision-making and providing structured support for them to cope with distress despite their child's prognosis are essential to early PC. IMPLICATIONS FOR RESEARCH: As early PC is incorporated into practice, strategies should be evaluated for feasibility and efficacy to improve parental and neonatal outcomes. Researchers should consider engaging NICU parent stakeholders in leading early PC program development and research.

Does Race Influence Decision Making for Advanced Heart Failure Therapies?

Background Race influences medical decision making, but its impact on advanced heart failure therapy allocation is unknown. We sought to determine whether patient race influences allocation of advanced heart failure therapies. Methods and Results Members of a national heart failure organization were randomized to clinical vignettes that varied by patient race (black or white man) and were blinded to study objectives. Participants (N=422) completed Likert scale surveys rating factors for advanced therapy allocation and think-aloud interviews (n=44). Survey results were analyzed by least absolute shrinkage and selection operator and multivariable regression to identify factors influencing advanced therapy allocation, including interactions with vignette race and participant demographics. Interviews were analyzed using grounded theory. Surveys revealed no differences in overall racial ratings for advanced therapies. Least absolute shrinkage and selection operator regression selected no interactions between vignette race and clinical factors as important in allocation. However, interactions between participants aged ≥40 years and black vignette negatively influenced heart transplant allocation modestly (-0.58; 95% CI, -1.15 to -0.0002), with adherence and social history the most influential factors. Interviews revealed sequential decision making: forming overall impression, identifying urgency, evaluating prior care appropriateness, anticipating challenges, and evaluating trust while making recommendations. Race influenced each step: avoiding discussing race, believing photographs may contribute to racial bias, believing the black man was sicker compared with the white man, developing greater concern for trust and adherence with the black man, and ultimately offering the white man transplantation and the black man ventricular assist device implantation. Conclusions Black race modestly influenced decision making for heart transplant, particularly during conversations. Because advanced therapy selection meetings are conversations rather than surveys, allocation may be vulnerable to racial bias.