A Precautionary Tale: Individual Decision Making in the Time of COVID-19.

Precaution taking is an important part of managing COVID-19 and has been since the start of the pandemic. Guided by the Health Belief Model, two studies conducted during the beginning of the COVID-19 pandemic aimed to identify possible individual difference predictors of precautionary actions. Study 1 was an online, cross-sectional study using 763 adults aged 20-79 years old. Study 2, a 30-day daily diary study, examined daily precautions in 261 persons over the age of 55 years old. Study 1 and Study 2 indicated that COVID-19 knowledge predicted precautionary behaviors. Multilevel models from Study 2 indicated that daily increases in in-person interactions and leaving home were associated with decreases in precautions, but increases in disruption to routine were associated with increases in precautions. In both studies, including concurrent and lagged models in Study 2, significant interactions between information seeking and perceived risk suggested higher information seeking was related to higher precautions for those who consider themselves low risk. Findings highlight the burden of daily precautions and potentially modifiable factors of engagement in precautions.

Pediatric Chemotherapy Infusions in Outpatient Examination Rooms: A Novel Patient Care Approach.

Background: Many health care organizations offer pediatric infusions in outpatient infusion centers or, as in our organization, in a hospital-based outpatient Pediatric Infusion Therapy Center (PITC). When restrictions related to the COVID-19 pandemic decreased our PITC appointment capacity by 40%, other patient and family satisfaction issues were exacerbated. We implemented a new approach to pediatric infusions with the aim of improving patient and family satisfaction and reducing the amount of time in an appointment itinerary without negatively affecting patient safety. Methods: Our team used a phased approach to pilot the administration of short chemotherapy infusions in the same outpatient clinic examination rooms where consultation and routine office visits were conducted. Patients saw their specialist for an examination and, if clinically indicated, their infusion was administered in the same room. Appointment itineraries were then completed. The team tracked efficiency, satisfaction, and safety metrics related to the new process. Results: All efficiency metrics improved. No harm came to the 49 unique patients who received a total of 184 infusions. Patient appointment itineraries were shortened by an average of 1.03 hr. Satisfaction survey responses indicated a clear preference (93%) for the new process. Discussion: The novel approach of offering short infusions in outpatient clinic examination rooms provides an opportunity to ease capacity constraints and further increase patient and family satisfaction. This method may be especially helpful for health care organizations when external influences (e.g., lack of physical space, challenging patient volumes, and pandemics) necessitate a change.

A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ).

Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members' beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.

Age, education, and political involvement differences in daily election-related stress.

Stress in daily life is rather common, but elections can present unique challenges. Evaluating the impact of individual characteristics, behaviors, and political beliefs on stress processes is imperative to understanding how elections influence psychological well-being. Exploring how these individual and behavioral characteristics interacted to predict exposure to election-related stressors, we hypothesized that age, education, and past socio-political involvement would be associated with exposure to election-related stressors. In the 2018 U.S. Midterm Election Stress Coping and Prevention Every Day (ESCAPED) study, 140 participants in the United States and territories aged 19-86 were recruited through Amazon's Mechanical Turk for a 30-day daily diary study. Collectively, participants completed a total of 1196 reports between October 15, 2018 and November 13, 2018. The midterm election was November 6, 2018. Each day, participants reported on past political participation, election stress anticipation, and exposure to election-related stressors. Confirming our hypothesis, on days when people were more politically active and on days when stress anticipation increased, exposure to election-related stressors increased. Age differences in exposure depended on political activity in the last 24 h, with older adults exhibiting a steeper increase in exposure following political activity, especially if they were highly educated. However, higher education was protective against election-related stressors among younger adults even with increases in political activity. Individuals' experiences, characteristics, and daily decisions influence the likelihood of exposure to election-related stressors. Additionally, for younger adults, education may function as a protective factor when they engage in political activities.

Mechanisms of organisational learning in hospitals: An instrument development study.

AIM: To develop a valid, reliable research instrument to measure mechanisms associated with organisational learning in hospitals. BACKGROUND: A valid, reliable instrument for measuring mechanisms of organisational learning would enable nurse leaders and researchers to improve health care through facilitation and study of organisational learning. METHODS: The Organizational Learning in Hospitals model was used as a framework to develop the Organizational Learning Instrument-Mechanisms. Cognitive interviews and expert reviews were used to refine and evaluate item-level and scale-level content validity. The instrument was distributed by email to a random sample of nurses working in inpatient hospitals in Utah (n = 1253). Confirmatory factor analysis was used to assess construct validity, and coefficient alpha was used to assess internal reliability. RESULTS: Item-level content validity scores were .88 to 1.0, and scale-level content validity was .98 (maximum score = 1.0). Standardized factor loadings were .539-.956, with model fit statistics as follows: comparative fit index (CFI) = .975, Tucker-Lewis index (TLI) = .973 and root mean square error of approximation (RMSEA) = .059. Coefficient alpha scores were .77-.95 for the instrument's five factors. CONCLUSIONS: Initial testing indicates the Organizational Learning Instrument-Mechanisms has adequate levels of reliability, content validity and construct validity. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital leaders and researchers may begin using this instrument to improve and study the mechanisms of organisational learning in hospital units.

Experiencing and Forecasting COVID-19 Daily Stress on Mental Health Reactivity Across Age and Race.

OBJECTIVES: This study systematically evaluates age and race differences in mental health symptoms as they unfold microlongitudinally during the coronavirus disease 2019 (COVID-19) pandemic with a focus on within-person reactivity to forecasting and experiencing COVID-19 stress. METHOD: A daily diary approach was used to examine predictors of daily anxiety and depressive symptoms among 526 adults (White [54%] and Black American [46%]) aged 21-79. A total of 3,605 online diaries were collected for 21 consecutive days between October and November, 2020. In addition to mental health symptoms, participants reported forecasted (next 24 h) stress as well as experienced (past 24 h) stress related to COVID-19. RESULTS: Patterns of reactivity to forecasted and experienced COVID-19 stress depended on age and race. White older adults displayed greater reactivity to COVID-19-related stress than White younger adults, but the effects of COVID-19-related stress were consistently detrimental for the daily anxiety of Black Americans, regardless of age. For Black Americans, age was less negatively associated with depressive symptoms than for White Americans. Increases in experienced COVID-19 stress were also more strongly associated with increases in depressive symptoms for Black Americans relative to White participants. DISCUSSION: This study moves beyond cross-sectional, descriptive work within the context of the COVID-19 pandemic and emphasizes the dynamic nature of within-person reactivity patterns that differ by age and race. Although White older adults experienced an increase in daily anxiety when forecasting COVID-19 stress, the co-occurring pandemic of systemic racism may be more powerful than age-related vulnerabilities for Black adults.

Creating a Work Environment Conducive to Organizational Learning.

Through organizational learning, health care teams can consistently provide excellent patient care in a complex and changing environment. Nurse managers, educators, and other leaders can facilitate organizational learning within their teams by promoting certain contextual factors in the clinical work environment. This article provides an overview of contextual factors associated with organizational learning, includes practice-based examples of these factors, and offers evidence-based recommendations for creating a learning-focused work environment. [J Contin Educ Nurs. 2021;52(6):281-285.].

BFF: Bayesian, Fiducial, and Frequentist Analysis of Cognitive Engagement among Cognitively Impaired Older Adults.

Engagement in cognitively demanding activities is beneficial to preserving cognitive health. Our goal was to demonstrate the utility of frequentist, Bayesian, and fiducial statistical methods for evaluating the robustness of effects in identifying factors that contribute to cognitive engagement for older adults experiencing cognitive decline. We collected a total of 504 observations across two longitudinal waves of data from 28 cognitively impaired older adults. Participants' systolic blood pressure responsivity, an index of cognitive engagement, was continuously sampled during cognitive testing. Participants reported on physical and mental health challenges and provided hair samples to assess chronic stress at each wave. Using the three statistical paradigms, we compared results from six model testing levels and longitudinal changes in health and stress predicting changes in cognitive engagement. Findings were mostly consistent across the three paradigms, providing additional confidence in determining effects. We extend selective engagement theory to cognitive impairment, noting that health challenges and stress appear to be important moderators. Further, we emphasize the utility of the Bayesian and fiducial paradigms for use with relatively small sample sizes because they are not based on asymptotic distributions. In particular, the fiducial paradigm is a useful tool because it provides more information than p values without the need to specify prior distributions, which may unduly influence the results based on a small sample. We provide the R code used to develop and implement all models.

Age Differences in Risk and Resilience Factors in COVID-19-Related Stress.

OBJECTIVES: Older adults are at higher risk for death and infirmity from COVID-19 than younger and middle-aged adults. The current study examines COVID-19-specific anxiety and proactive coping as potential risk and resilience factors that may be differentially important for younger and older adults in understanding stress experienced due to the COVID-19 pandemic. METHODS: Five hundred and fifteen adults aged 20-79 years in the United States reported on their anxiety about developing COVID-19, proactive coping, and stress related to COVID-19 in an online survey. RESULTS: Although there were no age differences in stress levels, anxiety about developing COVID-19 was associated with more COVID-19 stress for older adults relative to younger adults, but proactive coping was associated with less COVID-19 stress for older adults relative to younger adults. DISCUSSION: Our results suggest that anxiety might function as a risk factor, whereas proactive coping may function as a resilience factor for older adults' COVID-19 stress. We encourage future context-dependent investigations into mental health among older adults during this pandemic and beyond.

Family and Community Approaches to Intimate Partner Violence: Restorative Programs in the United States.

Now is the time to rethink reliance on legal intervention to end intimate partner violence (IPV). Arrest, incarceration, and family separation have fallen disproportionately on people who are Black or Brown, impoverished, or immigrant, lesbian, gay, bisexual, transgender and queer (LGBTQ). Restorative approaches bring together the persons harmed, persons causing harm, their family or community networks, or combinations of these stakeholders. Based on a U.S. national study, this article examines: What influences programs to adopt a restorative approach to ending IPV? How do programs safeguard their original vision for social change? What principles guide the programs in carrying out their work in safe and productive ways?

Mental Health Challenges of United States Healthcare Professionals During COVID-19.

As COVID-19 continues to impact global society, healthcare professionals (HCPs) are at risk for a number of negative well-being outcomes due to their role as care providers. The objective of this study was to better understand the current psychological impact of COVID-19 on HCPs in the United States This study used an online survey tool to collect demographic data and measures of well-being of adults age 18 and older living in the United States between March 20, 2020 and May 14, 2020. Measures included anxiety and stress related to COVID-19, depressive symptoms, current general anxiety, health questions, tiredness, control beliefs, proactive coping, and past and future appraisals of COVID-related stress. The sample included 90 HCPs and 90 age-matched controls (M age = 34.72 years, SD = 9.84, range = 23 - 67) from 35 states of the United States. A multivariate analysis of variance was performed, using education as a covariate, to identify group differences in the mental and physical health measures. HCPs reported higher levels of depressive symptoms, past and future appraisal of COVID-related stress, concern about their health, tiredness, current general anxiety, and constraint, in addition to lower levels of proactive coping compared to those who were not HCPs (p < 0.001, η2 = 0.28). Within the context of this pandemic, HCPs were at increased risk for a number of negative well-being outcomes. Potential targets, such as adaptive coping training, for intervention are discussed.

Capecitabine and temozolomide: design, implementation, and preliminary outcomes from a pilot project to ensure safe prescribing of oral chemotherapy.

Without adequate safety measures, oral chemotherapy can lead to undetected dosing errors. The Mayo Clinic launched a project to ensure that all capecitabine and temozolomide prescriptions receive an independent double check.