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To generate an in-depth understanding of the perceptions and experiences of individuals with youth-onset type 2 diabetes (T2D) to inform knowledge translation initiatives and clinical care.
Interpretive descriptive qualitative study.
Individuals were eligible to participate if they received a T2D diagnosis on or before 18 years of age, resided in Manitoba, and were between 10 and 25 years of age at the time of data collection. Twenty-two individuals (13 females, 7 males, 2 prefer not to indicate gender; mean age = 19.3 years) participated in 22 semi-structured interviews (mean length: 29:01 min) remotely using Zoom video conferencing software or by telephone. Data were analysed using inductive thematic analysis.
Four themes were generated: (1) Low public knowledge, misconceptions, and stigma impact youth experiences including those of diagnosis, disclosure, treatment, and supports; (2) shared familial experiences impacts perception of the future; (3) mental and emotional wellness is critically important but requires more attention; and (4) T2D carries unanticipated positive and negative impacts for youth.
Findings illustrate the complex interrelationships between public and personal conceptions of T2D, stigma, and T2D navigation, emphasising the centrality of emotional and mental well-being to participants' T2D experiences and management. This representation of experiences and perceptions of youth onset T2D offers direction for holistic and youth-centred research and care and highlights areas where further mental health and educational resources would be beneficial.
The knowledge translation resource being developed from this study involves input from patient and public partners.
Gender-based violence is a worldwide health and social problem with negative short- and long-term health impacts. Sexual and gender minority people experience more gender-based violence and significant barriers to support. These populations are often not included in, or are actively excluded from, gender-based violence research, and sexual orientation and gender are generally poorly measured and reported. One recommendation put forth to improve the evidence base with regard to sexual and gender diversity is higher standards of research and reporting by academic journals. Given the leading role of nurse researchers in this area of women's health, this is a topic of particular importance for nursing research and education.
We examined the sexual and gender diversity-related guidance provided by academic violence journals to authors, editors and peer-reviewers.
We conducted a descriptive document analysis. Two researchers independently searched for, and coded, guidance related to sexual and gender diversity from 16 websites of academic journals focused on violence research.
While most journals included some mention of diversity or inclusion, only about half provided in-depth guidance for authors, editors and/or peer-reviewers. Guidance related to gender was more common than guidance for sexual diversity. The journals gave varied prominence to diversity-related guidance, and it was often difficult to locate.
To reflect the spectrum of lived experiences of gender and sexuality, publishers must actively direct authors, editors and reviewers to include, measure and report these experiences. This has not yet been fully achieved in the important area of gender-based violence research, and is of direct concern to nurse researchers who contribute significantly to this body of knowledge.
This study explored perceptions of older adults racialised as Black on structural resilience across the life course.
A qualitative descriptive study.
Using purposive sampling, we recruited 15 Black adults aged 50 and older residing in Baltimore, Maryland, including individuals possessing historical or current knowledge of the community. Semi-structured interviews were conducted to elicit participants' experiences with structural resources during childhood, adulthood and late adulthood. Interviews were audio-recorded, transcribed verbatim and analysed using content analysis.
Of the 15 participants, three identified as male (20.0%) and 12 as female (80.0%), with an average age of 70.9 ± 8.2 years. The analysis identified nine categories of structural resilience, confirming its multifaceted and dynamic nature. Common categories present across all life stages included: Built environment, civic engagement, food and housing, healthcare, and social capital and cohesion. Life stage–specific categories included child and family services, educational supports, and workforce development supports during childhood and adulthood, and financial support during adulthood and late adulthood.
These categories were interdependent and spanned across life stages, illustrating the dynamic, cumulative and relational qualities of structural resilience. Furthermore, structural resources were identified as key to safeguarding, empowering and restorative responses to adversity.
These findings contribute to the development of a nuanced, life course–informed framework of structural resilience and highlight the need for ecological strategies that address structural forces shaping health and well-being, particularly among older adults racialised as Black.
This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
To map existing sexual and gender minority (SGM) health research in Ireland, identify gaps in literature and outline priorities for future research and healthcare. SGM is an umbrella term that includes people who identify as lesbian, gay, bisexual, transgender, queer or intersex and is sometimes abbreviated as LGBTQI+.
A scoping review of peer-reviewed studies published between 2014 and 2024.
The review followed Joanna Briggs Institute (JBI) guidelines and PRISMA-ScR framework for scoping reviews. Articles were identified through systematic database searches and screened independently by reviewers.
PubMed, PsycINFO, CINAHL and Embase were searched for articles published between January 2014 and April 2024. Sixty studies met inclusion criteria.
The review highlighted a disproportionate focus on gay, bisexual and other men who have sex with men (gbMSM), particularly regarding HIV and sexual health. Mental health research revealed high levels of anxiety, depression and suicidality, largely attributed to minority stress and systemic discrimination. Transgender health studies documented barriers to accessing gender-affirming care and mental health services. Few studies explored experiences of sexual minority women, older SGM individuals or intersex people. Intersectional perspectives on race, disability and socio-economic status were notably absent.
SGM health research in Ireland reflects significant progress in documenting disparities in mental and sexual health. However, there is a lack of representation for some groups. There is also limited attention to intersectionality. Systematic gaps in sexual orientation and gender identity (SOGI) data impede targeted policymaking and service delivery.
Findings underscore the need for inclusive, culturally competent healthcare services, better integration of SGM health topics into nursing education, and community-centred interventions. Addressing structural barriers and improving provider competence can enhance equitable healthcare access for SGM populations.
This review addresses the fragmented state of SGM health research in Ireland, highlighting gaps in representation and systemic issues.
Authorship includes individuals from various sexual and gender minority communities.
To explore mental health help-seeking behaviours among East Asian American dementia caregivers and construct a theory grounded in their behaviour patterns.
Qualitative using constructivist grounded theory design.
We recruited 20 East Asian American dementia caregivers between August 2023 and March 2024 using purposive sampling. We conducted one-on-one interviews and analysed the data using constructivist grounded theory coding.
We constructed a theory including six concepts and 22 categories. While ‘providing care’, caregivers manage caregiving tasks and personal life, experiencing caregiving challenges. ‘Individual capacity’ is a key to perceiving caregiving situations and ‘considering seeking support’. Various factors can affect ‘using support’. Different types of support can be used separately or in combination. When receiving adequate support, caregivers can ‘gain benefits from support’. These benefits, alongside individual capacities, can shape caregivers' ‘outlook on the present and the future’.
This study explains the mental health help-seeking process within East Asian culture, broadening perspectives on diverse populations and highlighting insights into culturally tailored services.
This study offers clinicians and communities insights into the mental health help-seeking process among East Asian American dementia caregivers and highlights strategies to encourage their use of mental health services.
This theory incorporates aspects of East Asian culture, addressing a research gap in studies of Asian Americans. It may enhance understanding of culturally tailored approaches and facilitate future funding for research and services, considering cultural diversity.
The Standards for Reporting Qualitative Research.
No Patient or Public Contribution.
Signs of clinical deterioration may appear differently in children with dark-coloured skin. How to assess children in this cohort is currently poorly defined.
To explore available information on the assessment of clinical deterioration in children with dark-coloured skin and identify research deficits.
A scoping review following Arksey and O'Malley and PRISMA-ScR frameworks. Five online databases, grey literature and reference lists of eligible documents were searched. Source titles, abstracts and full texts were screened. Included documents were assessed for level of evidence according to the Joanna Briggs Institute. Data were charted on a pre-defined data collection tool and analysed through descriptive and content analysis.
Out of 2382 documents screened, 37 were included. Document types included 16 quantitative studies, 14 opinion papers, five reviews and two reports. Most sources (21) were low-level evidence. Sixty-six unique terms were used to describe dark-coloured skin. Eighteen documents reported use of a skin classification system, including race/ethnicity, established colour scales, cosmetic references and observer opinion. Twelve focused on newborn hyperbilirubinaemia. Considerations for assessing jaundice, pallor, cyanosis, pulse oximetry, petechiae and signs of shock were reported. Techniques to improve assessment included optimising the environment, identifying baseline skin colour, and involving families and patients in assessment. No documents reported on assessment of mottling or capillary refill time for children with dark-coloured skin.
Assessment of clinical deterioration for children with dark-coloured skin is highly relevant to health professional practice. There is an overall deficit in high-quality research. Specific information gaps in assessment are considerations for mottling, capillary refill time, APGAR scoring, and clinical implications of device overestimation of bilirubin and oxygen saturations in children with dark-coloured skin. Health professionals are encouraged to use devices cautiously. Greater accuracy and objectivity are necessary to fill these gaps and support effective detection of signs of clinical deterioration.
To review current evidence on the implementation and impact of virtual nursing care in long-term aged care.
An integrative rapid literature review.
Medline, CINAHL, Web of Science, Embase, Ageline and Scopus.
The review included studies involving virtual care interventions provided by nurses (or by a multidisciplinary team including nurses) to older people in residential aged care that reported health outcomes or stakeholder experiences. Consistent with PRISMA guidelines, databases were systematically searched in July and August 2024, focusing on literature published since 2014. Studies were screened in Covidence by three team members, with conflicts resolved by additional reviewers. Studies not involving nurses or not set in aged care were excluded.
The search identified 13 studies, which included quantitative, qualitative and mixed-method approaches, conducted in both Australian and international settings, as well as in rural and metropolitan locations. Nurses were often involved as part of an existing virtual care programme, typically located in a hospital setting. The training and credentials of nurses delivering VN varied in terms of specialisation and advanced practice. The model of care in general was ad hoc, though in some cases there were regular, scheduled VN consultations. The time requirements for onsite staff and nurses were not well articulated in any of the studies, and information on the funding models used was also lacking.
There is some evidence that VN interventions in aged care may improve communication, enhance person-centred care and reduce emergency department presentations and hospitalisations.
Rigorous, ongoing evaluation of VN interventions is required to ensure their appropriate application in residential aged care.
Nurse leaders at every level are needed to help organizations achieve strategic goals and deliver safe patient care. Nurse leaders can find fulfillment in their roles; however, they are often prone to poor work-life balance due to the complexity and demands of their jobs. Professional well-being, consisting of an individual's overall health and the perception of good work-related quality of life, is at risk for being compromised in these nurses. Research exploring variables associated with psychosocial well-being in nurse leaders is limited.
To describe variables related to psychological well-being in nurse leaders, explore associations among these variables, and identify potential demographic and psychosocial predictors of resilience and burnout.
Participants were a convenience sample of nurse leaders from two hospitals located in the southwestern United States. We used a prospective observational design to describe the incidence of and relationships between self-compassion, satisfaction with life, resilience, perceived stress, and burnout. We then sought to identify predictors of disengagement and exhaustion (subscales of burnout) and resilience.
Participants (n = 105) were mostly female (82.7%) and white (57.7%), while one-third were charge nurses. Most reported normal to high levels of satisfaction with life (86%), self-compassion (90%), and resilience (93.3%) and 72.4% reported high stress levels. Moderately high levels of disengagement (46.4%) and exhaustion (59.1%) were also present. Higher self-compassion levels predicted higher levels of resilience. Lower satisfaction with life and self-compassion together predicted high disengagement scores, while lower self-compassion scores predicted high exhaustion scores.
When disengagement, exhaustion, and perceived stress are elevated, nurse leaders are at risk for low professional well-being and may be more prone to resignation ideation or turnover. Evidence-based interventions designed specifically for nurse leaders promoting professional well-being and emphasizing self-compassion skills are needed along with high-quality research on program outcomes.
Background
Federally Qualified Health Centers (FQHC) provide services to individuals facing systemic barriers to health equity and are disproportionately affected by adverse social determinants of health. To better align healthcare services with the needs of those individuals experiencing health inequities, it is essential to screen for and document problematic social contributors to health in electronic health records, which health systems have been mandated to document by 2026.
Objectives
The aims of this study were to 1) determine the prevalence of documented social contributors to health Z-codes among patients receiving care through Colorado nurse-led FQHCs across urban, rural, and frontier settings; and 2) estimate healthcare utilization and expenditures associated with the presence of documented social contributors to health Z-codes compared to a matched sample of patients without that Z-code documentation.
Methods
We conducted a secondary analysis of the Colorado All Payers Claim Database. Social contributor of health ICD-10 Z-codes, reflecting problematic social structural circumstances as defined by Healthy People 2030, were extracted from patients receiving care in FQHCs. Social contributor of health-related charges were computed using propensity matching to compare individuals with and without documented social contributors of health.
Results
Documentation of social contributors of health Z-codes was notably low. Housing instability was the most common Z-code documented. Chronic pulmonary disease, diabetes, and heart disease were the most prevalent comorbidities among those with identified social contributors of health. The majority of patients with social contributors of health Z-codes were insured through Medicaid and lived in rural areas. Persons with documented social contributors of health had significantly higher predicted annual medical expenditures compared to those without documentation.
Discussion
The low prevalence of social contributors of health coding aligns with previous studies and represents a missed opportunity to provide targeted interventions for populations experiencing adverse social contributors. These findings underscore the need for strategizing and implementing plans to identify and code social contributors of health, especially in facilities serving those experiencing health inequities. Improved documentation of social contributors to health can facilitate data-driven resource allocation and tailored interventions to address adverse social determinants and promote health equity. Commentary on: Kaldal, MH, Voldbjerg, SL, Gronkjaer, M, et al. Newly graduated nurses' commitment to the nursing profession and their workplace during their first year of employment: A focused ethnography. J Adv Nurs 2023:00:1-14.
Implications for practice and research Hospitals should have a structured support system for newly registered nurses (NRNs) to facilitate a positive and successful transition into professional practising nursing careers. A further qualitative research study exploring the nature of support NRNs require to facilitate a successful and committed nursing career.
The commitment of newly registered nurses (NRNs) mostly depends on their work environment and the support they receive from their first employment.
Commentary on: Wu CY, Iskander C, Wang C, et al. Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc. 2023; 71:3059–70.
Unless contraindicated, dipeptidyl peptidase 4 inhibitors (DPP-4i) should be used as first-line choice in older adults with type 2 diabetes in preference to sulfonylurea due to increased risk of dementia. Prospective studies are needed to ascertain if the use of sulfonylurea by older adult patients causes higher risk of developing dementia.
Diabetes is already known as a risk factor for developing dementia. Multiple factors contribute to this association: presence of microvascular and macrovascular complications, chronic inflammation, hyperglycaemia, hypoglycaemia and hyperinsulinemia.
Older adult patients often present with multimorbidities, polypharmacy, malnutrition, sarcopenia, longer duration of diabetes and renal and hepatic dysfunction. Furthermore, low education level, high blood pressure, dyslipidemia, obstructive...
Commentary on: Gilbert R, Lillekroken D. Caring to the end: an empirical application of Swanson’s caring theory to end-of-life care. ANS Adv Nurs Sci. 2023 Oct 13. doi: 10.1097/ANS.0000000000000515. Epub ahead of print.
Implications for practice and research Nursing theories, like Swanson’s caring theory, can bring visibility to the knowledge and skill harnessed by nurses when caring for dying patients and their families. Further research should explore how nurses’ relational practice is influenced by sociopolitical as well as interpersonal contexts.
‘Caring’ is a critical concept in nursing discourse and many theories about care in nursing have been developed and applied to a variety of settings. One example is Swanson’s caring theory, an empirically derived middle-range nursing theory that situates caring as a relational way of attending to others to whom we have a sense of commitment and responsibility, through the five specific...
Commentary on: Feeling like I’m failing a test, parents’ and adolescents’ opinions of diabetes clinic appointments.
Implications for practice and research Developing communication skills is essential for healthcare professionals to enhance practice and avoid alienating adolescent patients. Further research should be completed with patients who disengage from the clinic to understand how to best improve services and health outcomes.
Diabetes is a long-term health condition that requires continuous high-intensity self-management to prevent complications. This can be challenging for teenagers striving for independence and developing a sense of self. Maintaining engagement with adolescents with diabetes has favourable outcomes. Coyne et al
Commentary on: Pomeroy ML, Cudjoe TKM, Cuellar AE, et al. Association of social isolation with hospitalization and nursing home entry among community-dwelling older adults. JAMA Int Med. 2023; 183(9): 955–62. https://doi.org/10.1001/jamainternmed.2023.3064
Social isolation is a significant risk factor for nursing home placement for older adults, and public health interventions to improve social connections are urgently needed. Future research should address interventions across the lifespan and for those more vulnerable to isolation and loneliness, testing practical ways to improve social connectiveness.
The quality of our lives is the quality of our relationships. As we approach a challenging time of the year for loneliness and isolation, what do we know about social isolation and healthcare utilisation in older adults? Almost a quarter of community-dwelling older adults experience social isolation.
Nurse leaders are at a higher risk for burnout post-pandemic. Resilience skills training incorporating mind–body awareness and self-compassion practices significantly improved stress, self-compassion, and mindfulness in medical professionals by the end of the training.
This study aimed to assess if a 6-h resiliency training delivered to nurse leaders would improve measures related to well-being, for example, stress, burnout, life satisfaction, self-compassion, resilience, and mindfulness by the end of the course, and if any improvements would be sustained over time.
We prospectively examined the effects of a 6-h resiliency training on well-being outcomes in nurse leaders in a longitudinal study during Spring 2022 through Fall 2022. Experienced resiliency teachers trained 46 nurse leaders. Participants took pre-, post-, and 2-months-post online surveys measuring well-being-related variables. Only 48% (n = 22) completed the entire course and surveys at all three times.
Nurse leaders were mostly female (n = 38, 83%) and white (n = 27, 59%) with an average age of 44.72 [SD = 9.5] years. Median years of experience were 15.5 [3.5–47]. One-way repeated measures ANOVA demonstrated a significant effect across time on stress (p = 0.02), self-compassion (p = 0.02), mindfulness (p = 0.04), and the exhaustion subscale of burnout (p = 0.008) but the significant changes occurred by the 2-month follow-up. Resilience, life satisfaction, and disengagement scores did not significantly change.
Baseline stress and burnout scores were high in 43.5%–63% of the nurse leaders, indicating a need for continued support of nurse leaders to reduce stress and burnout. Post resiliency training, scores in perceived stress and exhaustion decreased significantly over time, demonstrating the efficacy of this 6-h program to improve key variables related to well-being in nurse leaders. While baseline self-compassion scores were already high in nurse leaders, statistically significant improvements in self-compassion and mindfulness, but not resilience, occurred 2 months after this resiliency training program. Significant changes in key variables related to well-being occurred 2 months post training, indicating the need for further exposure and time with practices taught in the course. Nurse leaders need support to break away from work tasks to participate in psychoeducational trainings and interventions to improve well-being. We need further applied research on how to improve well-being in clinicians from a systems and environmental perspective.
To investigate the barriers experienced by intensive care nurses and registered nurses and to provide optimal nursing for adult patients with a temporary tracheostomy in intensive care and general wards.
Tracheostomy is widely used in intensive care units, around 20% of intensive care unit patients undergo tracheostomy insertions and expect high quality of care. Caring for patients with a tracheostomy is complex and challenging task. An investigation of barriers to care for adult patients with a temporary tracheostomy in a hospital setting is essential to ensure that these patients receive the highest quality of care and to identify areas for improvement.
This paper applied secondary analysis to data from two qualitative studies, including narrative interviews and maximum variation sampling.
Secondary analysis of primary qualitative datasets is appropriate when the analysis extends rather than exceeds the primary. The analysis was based on interview data collected from six intensive care nurses and six registered nurses from two university teaching hospitals in Norway. The interviews were audio-recorded and transcribed. The data was analysed using the qualitative analysis suggested by Graneheim and Lundman. This study adhered to the consolidated criteria for reporting in a qualitative research (COREQ) checklist.
Four main themes were identified as barriers to care for adult patients with a temporary tracheostomy in the hospital: encountering ambivalence, inadequate staffing levels, lack of patient continuity of care and lack of systematic follow-up.
Understanding barriers to care is crucial for hospitals and healthcare organisations to develop targeted interventions and educational programs to address these barriers and improve the care provided to adult patients with tracheostomies in hospital settings.
The population is rapidly growing, significantly impacting healthcare settings such as hospitals and long-term care. Falls are a major concern, being a leading cause of hospitalisations and injuries especially among adults aged 60 and above. Despite extensive research on falls prevention and risk factors, there is limited study on effective post-fall management strategies, making it crucial to review and develop interventions to improve care and safety for older adults in healthcare settings.
To explore the interventions implemented for post-fall management for residents and patients within healthcare settings, including hospitals and long-term care facilities.
A scoping literature review.
We used the Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). Eligible articles included hospital and long-term care post-fall management interventions. Data were manually extracted by two independent reviewers using the AACTT (Actor, Action, Context, Target and Time) Framework to detail intervention characteristics and guide the data charting process, allowing for thematic analysis and narrative synthesis of key findings.
Medline, CINAHL, PsychINFO and Scopus were searched from inception until 30th September 2024.
Eighteen articles were included. Over half the studies (55.5%) focused on post-fall interventions in LTCFs, testing assessment tools (50%), structured protocols (27.7%), huddles (11.1%) or multifactorial approaches (11.1%), with varied effectiveness. While assessment tools and huddles showed mixed results, structured protocols showed encouraging results with reduced unnecessary hospital transfers and hospitalisations.
This scoping review identified a variety of interventions used after falls in healthcare settings. However, there is inconclusive evidence about the effectiveness of interventions to reduce hospitalisation and injuries. This review identified areas for research that may help to inform post-fall management, including the need for further research into various interventions (e.g., standardised toolkit) to enhance care immediately following a fall.
No Patient or Public Contribution.
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