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AnteayerJournal of Nursing Scholarship

Functioning of structurally diverse families living with adolescents and children with chronic disease: A metasynthesis

Abstract

Purpose

The diagnosis of children and adolescents with a chronic disease may affect the entire family system. When families have diverse structures, additional tensions can be present and affect the balance of family functioning. This metasynthesis aims to analyze and synthesize qualitative evidence on the functioning of structurally diverse families who live with adolescents and children with chronic disease.

Design

Qualitative metasynthesis.

Methods

Systematic searches up to 2021 were performed in PubMed, CINAHL, PsycINFO, SCOPUS, LILACS, and Web of Science and supplemented by manual search strategies. It followed guidelines from the statement in the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A quality appraisal of each study was undertaken using the Critical Appraisal Skills Programme. Data synthesis was conducted according to the thematic synthesis approach.

Findings

Of a total of 6538 references identified, 9 studies were included in the metasynthesis. The thematic synthesis enabled the construction of three analytical themes: “Family structural changes and weakened co-parenting”; “Family rearrangements and the challenges faced by families”; and “Committed to healthy family functioning for the child's well-being: Searching for family homeostasis”.

Conclusions

The themes showed that the causes of the rupture in the family unit interfere in family functioning, making it ineffective. In most families, family functioning is centered on the mothers. Faced with the need to care for children and adolescents and to control chronic disease, structurally diverse families need to adjust their family functioning and search for family homeostasis.

Clinical Relevance

The results of this review can support nurses to target their care toward these families and formulate effective interventions that promote, strengthen, or maintain the healthy functioning of these families.

Puerto Rican healthcare workers' perspectives on the impact of COVID‐19 pandemic on their role, patient care, and mental health

Abstract

Purpose

To explore the personal and work-related stressors of healthcare workers in Puerto Rico and the organizational support they received during the pandemic.

Design and Methods

We used a qualitative descriptive design and from April – November, 2021, conducted semi-structured individual interviews with Puerto Rican frontline healthcare workers (n = 12) and supervisors (n = 5).

Findings

Thematic analysis revealed five major themes: (a) Organizations' response to COVID-19; (b) increased complexity of patients; (c) intensified work and psychological demand for nurses; (d) overwhelmed and overworked; and (e) recommendations for healthcare leadership. Participants explained that their organizations' responses to COVID-19 were insufficient for  meeting the demands and acuity of the patients. Closure of outpatient services contributed to people presenting to hospitals with exacerbated chronic conditions – especially the elderly. With COVID-19 precautions prohibiting family visitation, nurses became responsible for total care, including emotional support of patients. In addition, the shortage of staff contributed to nurses assuming greater workloads, feeling overwhelmed and overworked, and healthcare worker resignations. Given their experiences, healthcare workers recommended that healthcare leadership show more appreciation for staff, demonstrate empathy, include frontline workers in decision-making, and provide mental health resources for staff.

Conclusions

This study with Puerto Rican frontline workers and supervisors uncovers the multiple stressors experienced during the COVID-19 pandemic. Our findings underscore the need for prioritizing the well-being of healthcare workers, preparing healthcare leadership on how to support staff, and mandating nurse-to-patient ratios.

Clinical Relevance

Healthcare workers explained the barriers they experienced for providing quality care to their patients. They also presented recommendations for healthcare leadership to facilitate supporting frontline workers, which ultimately contributes to optimal patient care.

Effectiveness of breast cancer screening interventions in improving screening rates and preventive activities in Muslim refugee and immigrant women: A systematic review and meta‐analysis

Abstract

Purpose

To systematically assess the effectiveness of breast cancer (BC) interventions in improving breast self-examination (BSE), clinical breast examination (CBE), mammogram screening rates, and preventive activities in Muslim refugee and immigrant women.

Design

Guided by the Health Belief Model, a mixed method systematic review and meta-analysis was performed using a sequential design.

Methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), the Critical Appraisal Skill Program Checklists, and the Joanna Briggs Institute (JBI) methodology for systematic review and meta-analysis. A systematic search of English-language peer-reviewed articles was undertaken in multiple health and social sciences databases from January 1, 2015, to March 31, 2022. Randomized clinical trials and quasi-experimental studies focused on the uptake of BSE, CBE, and mammograms were selected.

Results

Fourteen articles were included in the review. Most of the studies relied on quasi-experimental designs and were carried out in the United States of America. The qualitative analysis of BC screening interventions generated three themes: (1) education, (2) access-focused, and (3) cultural and faith-based. The meta-analysis included three randomized control trials and two quasi-experimental studies. The meta-analysis demonstrates the effectiveness of community-led cultural and faith-based interventions in facilitating the completion of CBE and mammography screening. Education on BC and patient navigator interventions are more effectively used in conjunction than standalone interventions, yet community-based cultural and faith-based interventions are the most effective.

Conclusion

This systematic and meta-analysis review provides evidence on the effectiveness of access-focused and cultural and faith-based interventions in improving BC screening in Muslim refugee and immigrant women. Future research should focus on designing and measuring the effectiveness of cultural and faith-based interventions to increase Muslim refugee and immigrant women's BC screening knowledge and practices.

Clinical Relevance

This systematic and meta-analysis review demonstrates the need to explore Muslim refugee and immigrant women's cultural contexts for developing culturally sensitive BC screening interventions. Knowledge and practice of BC and religiosity intersect with financial, geographic, and linguistic barriers to decrease participation in screening and preventive activities in Muslim refugee and immigrant women.

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Psychological distress, social support, and family satisfaction among family members of non‐COVID‐19 critical care patients: A cross‐sectional study

Abstract

Purpose

This study aims to explore the associations among psychological distress, perceived social support, and family satisfaction among family members of non-COVID-19 intensive care unit (ICU) patients during the COVID-19 pandemic.

Design

A cross-sectional study.

Methods

Family members of patients with at least 48 h in the ICU and without a COVID-19 diagnosis were screened between January and March 2021. For enrolled ICU family members, five questionnaires for perceived stress (Perceived Stress Scale), anxiety symptoms (General Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), perceived social support (Medical Outcomes Study Social Support Survey), and family satisfaction (Family Satisfaction with Care in the Intensive Care Unit-24) were administered by phone either in English or Spanish language. Sociodemographic and patient clinical data were also collected. Data were analyzed using descriptive statistics, Pearson's correlations, Mann–Whitney U, and Fisher's exact tests.

Findings

Of 87 eligible ICU family members, 63 were enrolled (72.4%); 27% of the sample presented with clinically significant symptoms of anxiety, 25.4% with depression, and 76.2% had a high perception of social support. ICU family members with low/fair perceived social support reported statistically significantly higher perceived stress and lower family satisfaction. Perceived stress was negatively correlated with family satisfaction. Clinically significant symptoms of anxiety and depression were not statistically associated with family satisfaction or perceived social support.

Conclusions

While ICU admission-related stress may undermine family satisfaction, perceived social support may be positively associated with the way that ICU family members of non-COVID-19 patients evaluate the quality of care in the ICU. Knowing the factors that influence family satisfaction in the ICU may assist stakeholders and policy developers to improve family-centered care in the hospital setting.

Clinical Relevance

Early screening for psychological distress and social support levels during admission should be included in updates of visiting and communication policies in the ICU. Prompt identification of family members at risk of a poor ICU experience may enhance efforts to support them, particularly in acute care settings where differentiated approaches to COVID-19 and non-COVID-19 ICU family members are established.

Experiences with the implementation of remote monitoring in patients with COVID‐19: A qualitative study with patients and healthcare professionals

Abstract

Introduction

This study investigated how patients with COVID-19, telemonitoring (TM) teams, general practitioners (GPs) and primary care nurses in Belgium experienced remote patient monitoring (RPM) in 12 healthcare organizations, in relation to the patients' illness, health, and care needs, perceived quality of care, patient and health system outcomes, and implementation challenges.

Design

A qualitative research approach was adopted, including focus group discussions and semi-structured interviews.

Methods

Four different groups of participants were interviewed, that is, patients (n = 17), TM teams (n = 27), GPs (n = 16), and primary care nurses (n = 12). An interview guide was drafted based on a literature review. Interviews were transcribed verbatim, and NVivo was used for managing and analyzing the data. The QUAGOL method was used to guide the data analysis process and was adapted for the purpose of a thematic content analysis.

Results

All participants agreed that RPM-reassured patients. The overall perceived value of RPM for individual patients depended on how well the intervention matched with their needs. Patients who did not have the necessary language (Dutch/French speaking) and digital skills, who did not have the right equipment (smartphone or tablet), or who missed the necessary infrastructure (no internet coverage in their region) were often excluded. Remote patient monitoring also reassured healthcare professionals as it gave them information on a disease they had little knowledge about. Professionals involved in RPM experienced a high workload. All TM teams agreed that quality of data was a key factor to ensure an adequate follow-up, but they differed in what they found important. The logistic management of RPM was a challenge because of the contagious character of COVID-19, and the need for an effective information flow between the hospital team and primary care providers. Participants missed clarification about who was accountable for the care for patients in the projects. Primary care nurses and GPs missed access to RPM data. All agreed that the funding they received was not sufficient to cover all the costs associated with RPM.

Conclusion

Healthcare professionals and patients perceive RPM as valuable and believe that the concept will have its place in the Belgium health system. However, current RPM practice is challenged by many barriers, and the sustainability of RPM implementation is low.

Clinical relevance

Remote patient monitoring (RPM) was perceived as a valuable intervention for patients with COVID-19, but there were important concerns about unequal access to care. While the technology for RPM is available, the sustainability of implementation is low because of concerns with data quality, challenging logistics within projects, lack of data integration and communication, and a lack of an overarching guiding framework.

A meta‐ethnography of developing and living with post‐burn scars

Abstract

Introduction

Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars.

Design

A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis.

Results

Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self.

Conclusion

Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes.

Clinical relevance

Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID‐19: A scoping review

Abstract

Objective

Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic.

Methods

This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings.

Findings

Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively.

Conclusion

The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics.

Clinical Relevance

EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Effectiveness of a nurse‐led mHealth app to prevent excessive gestational weight gain among overweight and obese women: A randomized controlled trial

Abstract

Objective

To explore the effectiveness of a nurse-led mobile health (mHealth) intervention to prevent excessive gestational weight gain (GWG) in overweight and obese women.

Methods

A randomized controlled trial with an experimental study design. Ninety-two pregnant women with body mass index (BMI) ≥5 kg/m2 at less than 17 weeks gestation were recruited from two prenatal clinics in northern Taiwan from January to June 2020. The experimental group used the MyHealthyWeight (MHW) app and a wearable activity tracker (WAT), and the controls received standard antenatal treatments with no mHealth-based elements. Two hospital follow-up visits were scheduled at 24–26 weeks in the second trimester and 34–36 weeks in the third trimester. A generalized estimating equation (GEE) was used to examine the trajectories and the effectiveness of mHealth on GWG.

Results

No difference in GWG was found between the intervention and control groups at baseline (p > 0.05). The GWG trajectory in the entire cohort of women with obesity exhibited a quadratic pattern (ß = 1.8, 95% confidence interval [CI] = 1.27–2.32), and intervention participants' weekly GWG was gained significantly lower than their controls in the second trimester (p < 0.05). Throughout the pregnancy, the mHealth intervention group had a significantly lower proportion of individuals who exceeded their GWG in both total (21.6% vs. 32.6%) and weekly weight gain (first trimester = 58.7% vs. 65.2%; second trimester = 45% vs. 67.4%; third trimester = 48.6% vs. 55.1%). In particular, among obese women in the third trimester, those in the intervention group gained less gestational weight than their controls. The adjusted body weight difference was 5.44 kg (p = 0.023), signifying the total GWG difference (3.30 vs. 8.74 kg) between the means of the two groups. The GEE model indicated that obese women who were aged 35 years, had prepregnancy exercise habits, perceived self-efficacy of diet, and more physical activity tended to have low GWG (p < 0.05).

Conclusions

The nurse-led mHealth-based intervention shows promising results in significantly preventing excessive GWG among high-BMI women. More effectiveness was found among the obese subgroup.

Clinical relevance

The mHealth-based intervention would be successfully implemented by nurses to help high-BMI women maintain their optimal body weight and promote healthy behavioral changes, particularly in diet and physical activity during pregnancy.

Healthcare needs and assets of gender diverse older adults: A systematic integrative review

Abstract

Introduction

Gender diverse older adults often endure health disparities, encounter discrimination in healthcare settings, and experience lack of access to healthcare. However, members of this population also have assets that help to mitigate these healthcare challenges. A systematic integrative review was performed to synthesize recent studies of the healthcare needs and assets of gender diverse older adults living in the United States.

Methods

A search of PubMed, CINAHL, Web of Science, PsycINFO, and Google Scholar was conducted. Findings from selected studies were organized by theme and subtheme.

Results

Thirty-five articles met inclusion criteria. Seven themes were identified: (1) Inclusivity and acceptance, (2) Antidiscrimination protections, (3) Community, (4) Care of mind, body, and spirit, (5) End of life preparations, (6) Financial security, and (7) Intersectionality. These themes were further divided into 20 healthcare needs and 9 healthcare assets.

Conclusion

The findings call for increased training for healthcare providers to provide safe, gender-inclusive care environments; policy to combat discrimination across all healthcare settings; supportive community resources and healthcare advocacy; empowerment of gender diverse older adults through acknowledgment of their healthcare assets; and more research to discern the role of intersectionality in the applicability of the identified themes to gender diverse older adults of various sociodemographic backgrounds.

Clinical relevance

This review benefits clinicians by suggesting practice changes to address healthcare needs of gender diverse older adults while describing healthcare assets of this population for integration into health promotion initiatives.

Professional grief among nurses in Spanish public health centers after caring for COVID‐19 patients

Abstract

Aims and objectives

The aim of the present study is to investigate the professional grief suffered by nurses in various medical units, after coping with the COVID-19 pandemic for the last 18 months.

Background

Addressing and acknowledging the reality of professional grief is of fundamental importance to nurses' mental health, as this condition has both professional and personal consequences.

Design

A qualitative, content analysis approach was taken.

Methods

Based on 25 interviews with nursing professionals working in different health centers units were performed. The following sampling schemes were used: first, convenience sampling, then nominated sampling, and finally theoretical sampling.

Results

From our analysis of the data obtained, three main themes were identified: the impact on nurses of COVID-19 outcomes; the symptoms of professional grief; and cognitive reactions. These core elements interacted with 12 subtopics, including symptoms of grief and the cognitive impact produced.

Conclusions

A large proportion of the nurses consulted in this study have suffered and suffered professional grief and report many related symptoms. In response to the present pandemic and any future occurrence, the question of professional grief needs to be addressed.

Relevance to clinical practice

To help them cope better with this type of situation, nurses should receive appropriate training. Moreover, healthcare institutions should be made aware of the problem and be encouraged to offer assistance to address the impact produced on nurses by the deaths of their patients.

Clinical relevance

This study shows the impact of professional grief on nurses in the context of the COVID-19 pandemic. Nurses are affected personally by the deaths of patients and by alterations to their working conditions. In many cases, this grief remains unresolved and its various symptoms persist.

Issue Information

Journal of Nursing Scholarship, Volume 54, Issue 5, Page 529-532, September 2022.

Job satisfaction among small rural hospital nurses: A cross‐sectional study

Abstract

Purpose

To explore the relationships between job satisfaction, community satisfaction, practice environment, burnout, and intention to leave of nurses working in Australian small rural hospitals.

Design

A national cross-sectional survey of 383 nurses from Australian rural public hospitals of less than 99 beds during 2018.

Methods

Job satisfaction was measured on a four-point Likert scale. Factors associated with community satisfaction, practice environment, burnout and intention to leave were analyzed using multiple linear regression to explore the predictors of job satisfaction.

Findings

Overall job satisfaction was positive, with most nurses moderately (n = 146, 38.1%) or very satisfied (n = 107, 27.9%) with their current job. Emotional exhaustion, nurse manager ability, leadership and support of nurses were the most significant predictors of job satisfaction.

Conclusion

This study provides new insight into the factors impacting the job satisfaction of nurses working in rural hospitals. The knowledge gained is important to inform strategies to retain nurses in rural areas and, in turn, ensure rural communities have access to quality health care.

Clinical relevance

The impact of nurses' job satisfaction on burnout, patient safety, and intention to leave is well recognized; however, there is limited understanding of job satisfaction in a rural hospital context. This study provides an understanding of the factors that impact job satisfaction of nurses working in small rural hospitals and highlights the importance of improving the practice environment to reduce the high attrition rates of this workforce.

Effects of technology‐assisted interventions for people with dementia: A systematic review and meta‐analysis

Abstract

Purpose

The use of technology-assisted interventions in dementia care contributes to increased communication, reduced burden on the caregivers, improved health outcomes, and improved expense management. Technology-assisted interventions can be provided remotely to monitor, improve, and enable home care, benefiting the health of both patients and caregivers. Despite increasing use, the effectiveness of technology-assisted interventions for dementia care remains uncertain, with studies reporting inconclusive findings subject to interpretation. Therefore, the current study investigated the available evidence to explore the efficacy of technology-assisted interventions for people with dementia.

Design

Systematic review and meta-analysis.

Methods

The study was preregistered with the PROSPERO international prospective register of systematic reviews using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided protocol. The primary search was conducted in eight databases from database inception to January 29, 2022. Using a random-effects model, the standardized mean differences (SMDs) with 95% confidence intervals (CIs) were synthesized to obtain pooled effect sizes (using Stata 16.0). The updated Cochrane Risk of Bias 2 tool (RoB-2) was used to evaluate the methodological quality of the studies.

Findings

A pooled analysis of 12 trials, including 584 people with dementia, showed more improvement associated with technology-assisted interventions compared with standard care, including in the domains of cognitive function (SMD = 0.39; 95% CI: 0.14 to 0.64; p < 0.001) and depression (SMD = −0.75; 95% CI: −1.33 to −0.17; p = 0.01). However, no significant effects were observed for activities of daily living (ADL) or quality of life.

Conclusion

Technology-assisted interventions appear to improve cognitive function and reduce depression in people with dementia compared with standard care.

Clinical relevance

This study may be used to demonstrate that interventions incorporating many modalities or technologies can be used to enhance dementia care, which may improve favorable outcomes when using technology-assisted interventions to remotely initiate appropriate activities for people with dementia. Because technology allows for simultaneous communication and access to shared multimedia, it removes environmental constraints and allows treatment to be administered remotely.

Which factors are associated with cannabis use among adolescents in Andalusia? An application of the I‐Change model

Abstract

Background

Cannabis use is increasing among Andalusian adolescents, causing health, social and financial problems. School nurses visit schools and provide health promotion to adolescents in Andalusia. In order to better tailor health promotion programs, it is important to understand the sociodemographic and motivational factors related to cannabis use in Andalusian adolescents.

Design/Methods

In this cross-sectional study, 369 students (aged 15–18 years) from secondary schools in Andalusia were involved. An anonymous questionnaire based on the I-Change Model was self-administered during school hours. Cannabis users were compared with non-cannabis users regarding sociodemographic and motivational factors. Contingency tables, mean comparison tests, and logistic regression analyses were conducted.

Results

The prevalence of cannabis use in the last year was 21.6%. Non-cannabis users had a few positive beliefs toward cannabis use (e.g. the ability to relax or medical benefits), as well as users. Users recognized some disadvantages of cannabis use but played down their importance and mentioned more advantages. Moreover, social influence, especially from peers, plays a critical role in cannabis use. Specific social situations and moods seemed to be special risk factors for cannabis use, such as being at a celebration or feeling good. Results of regression analysis showed that cannabis use is mainly associated with age, low family function, low family affluence, high pocket money, perceiving few disadvantages of cannabis use, much social modeling of cannabis use, social norm and pressure favoring cannabis, low self-efficacy to resist using cannabis and positive intentions to use cannabis.

Conclusions

Based on our results, prevention programmes lead by nurses can be tailored to the factors important to prevent cannabis use, focusing on outlining the disadvantages of cannabis use, alternatives for using cannabis when feeling good, increasing salience of healthy social influences and reinforcing self-efficacy to resist temptations to use cannabis are recommended.

Clinical Relevance

Nurses need to know the sociodemographic factors and motivations associated with the use of cannabis in adolescents in order to establish effective preventive interventions at school.

Helping the crisis in peer review

Journal of Nursing Scholarship, Volume 54, Issue 5, Page 533-534, September 2022.

Impact of advance care planning and end‐of‐life conversations on patients with cancer: An integrative review of literature

Abstract

Purpose

The purpose was to review published articles to examine the impact of advance care planning (ACP) and end-of-life (EOL) conversations on patients with cancer, and aimed to compare the findings for congruency with the goals of ACP.

Design and Method

The study was guided by Whittemore and Knafl's integrative review methodology. Articles published between 2015 to 2020 were identified through electronic databases. The search included: Cumulative Index for Nursing Allied Health Literature (CINAHL), PubMed, MEDLINE-Ovid, and MEDLINE full text, and using the MeSH terms. Two hundred and five (205) articles were identified and screened for eligibility, and 15 articles were appraised.

Findings

The fifteen (15) articles that met the inclusion criteria included five (5) qualitative, eight (8) quantitative, and two (2) mixed methods. The review analysis revealed six themes emerged in three categories: cancer patients' experience with advance care planning (1) patients' prognostic awareness, (2) decision making; cancer patients' perceived outcomes with advance care planning (3) patient-provider relationship, (4) concordance in care based on goals, and cancer patients' propositions related to advance care planning, (5) timings of advance care planning discussions, and (6) support during ACP and/or EOL conversations.

Conclusion

ACP and EOL conversations play a critical role in cancer patients' awareness of their disease and prognosis and help them in making end-of-life care decisions.

Clinical relevance

There exists a need for earlier ACP and EOL conversations with cancer patients with emotional support during these conversations.

Advocacy and policy in action: Developing a financial and healthcare safety net for nurses

Abstract

Introduction

The COVID-19 pandemic has opened a dialogue regarding advocacy and policy changes that need to occur at the federal, state, and local levels to ensure provisions for the financial and healthcare well-being of nurses. Often nurses struggle as the “breadwinners” in their families caring for multiple generations, thus leading them to live paycheck to paycheck.

Design

A review of current and proposed policy changes. The pandemic demonstrated clearly through governmental executive orders that laws and regulations could be changed more rapidly than the traditional routes, illustrating an ability to enact change in nursing practice. At the federal level, provisions are not made to ensure that nurses who risk their lives during pandemic times are adequately compensated monetarily and through extended healthcare benefits, often provided for police, fire, and other emergency personnel.

Results/Conclusions

Suggestions for new policy and advocacy agendas are proposed based on the gap in coverage noted during and after this pandemic.

Clinical Relevance

COVID-19 has brought to the forefront gaps in the financial and healthcare safety nets for nurses in the United States. Opportunities exist to inform via advocacy and policy reform at the federal, state, and local governmental agencies regarding the need for extended financial and healthcare provisions for nurses.

Residential substance use treatment outcomes for pregnant and postpartum women: Distinct patterns for women enrolled before versus during the COVID‐19 pandemic

Abstract

Introduction

Substance use among pregnant and postpartum women (PPW) is a serious public health concern. The COVID-19 pandemic has exacerbated substance use among the general population including pregnant women, and disrupted operations for substance use treatment centers. Little is known about the outcomes of substance use treatment for PPW before and during the COVID-19 pandemic.

Method

Data from a longitudinal program evaluation were analyzed to examine outcomes among 136 PPW participating in a residential SUD treatment program, and to explore differences in treatment outcomes for women who enrolled in services before versus during the COVID-19 pandemic. Analyses were used to test the significance of change from treatment intake to 6-month post-intake on assessments of substance use, mental health symptoms, and functioning collected to evaluate the Healthy Families Program (HFP), a comprehensive program for PPW located within a gender-specific SUD treatment facility in the United States.

Results

Results indicated that from treatment intake to follow-up assessment, clients self-reported statistically significant improvements in family functioning and daily functioning as well as reduced days of substance use. Notably, the rate of treatment intakes declined during the COVID-19 pandemic. In separate analyses by subgroup, mental health indicators showed improvements only for clients engaged in treatment before the COVID-19 pandemic and not for clients served during the COVID-19 pandemic, but substance use decreased significantly for both pre-pandemic and pandemic enrollees.

Conclusion

Specialized treatment considerations and implications for PPW are discussed, including a need for added emphasis on co-occurring mental health symptoms and family system stress during a pandemic, and the role of nurses in identifying and addressing these concerns. Additionally, potential relapse prevention efforts during COVID-19 for PPW with substance use disorders are examined.

Clinical Relevance

The present research continues to highlight the importance of specialized treatment programming for PPW with SUDs as well as the potential need for additional recovery support mechanisms to be utilized during the COVID-19 pandemic.

Association of breastfeeding with undernutrition among children under 5 years of age in developing countries: A systematic review and meta‐analysis

Abstract

Objective

This meta-analysis was conducted to examine the association between breastfeeding and undernutrition among children under 5 years of age in developing countries.

Study design

Systematic review and meta-analysis.

Methods

A comprehensive literature search was conducted of datasets from Embase, CINHAL, PubMed, Cochrane Library, and Indonesian databases to include eligible studies. Comprehensive Meta-Analysis 3.0 statistical software was used to perform data entry and data analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted from each study or were calculated based on the reported number of cases and controls in each study. Random-effects models or fixed-effects models were used to demonstrate overall risk estimates. A moderator analysis was conducted to examine possible moderators explaining the heterogeneity across studies.

Findings

In total, 33 studies were included which examined the association of breastfeeding with undernutrition. A random-effects model showed that breastfeeding had inverse correlations with overall undernutrition (OR = 0.82, 95% CI = 0.68, 0.99) and the stunting type of undernutrition (OR = 0.73, 95% CI = 0.55, 0.95). A moderator analysis showed that studies which included exclusive breastfeeding and unclear birth weights had low risks of overall undernutrition (p < 0.05). Moreover, studies which included exclusive breastfeeding and adopted a case–control study design exhibited a low risk of the stunting type of undernutrition (p < 0.05).

Conclusions

Providing breastfeeding or exclusive breastfeeding can benefit children under 5 years of age in developing countries reduce overall undernutrition and the stunting type of undernutrition.

Clinical relevance

Healthcare professionals should develop and implement suitable strategies to increase awareness regarding the importance of breastfeeding and enhance breastfeeding and exclusive breastfeeding adherence.

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