Nursing Research最新文献

Background: Despite experiencing an increased incidence in stroke, minority groups have the lowest reported knowledge of stroke signs and symptoms and are less likely to receive time-sensitive interventions. There is a need to explore the relationship between social determinants of health and stroke awareness and severity within at-risk communities.

Objectives: The aim of this study was to explore relationships between social determinants of health and stroke awareness and severity in an underserved area located in a city borough in Northeastern United States.

Methods: We used an exploratory descriptive retrospective design and existing data. Data from 1,162 patients discharged with a principal diagnosis of stroke (ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage) were analyzed to explore the relationship between social determinants of health (age, sex, race, ethnicity, payer status, zip code) and stroke awareness and severity.

Results: Age group, race, and hospital arrival method were all significant indicators of time to arrival at the hospital. When holding all other factors in the model constant, being 65 years of age or older was associated with a decrease in time to reach the hospital compared to those under 65 years of age. Those who traveled by private transport had longer discovery to arrival times when holding all other factors constant, as compared to those who arrived by emergency medical services. Compared to persons who were White, persons who were Black or Asian saw increased times to hospital arrival.

Discussion: This study found that social determinants of health including age, race, sex, and insurance type significantly influenced stroke awareness and/or severity. These study findings can be used by stroke program leadership and community nurses to direct community-centered stroke awareness outreach.

Background: Despite expanding investigations of chronic physiological stress as measured by hair cortisol concentration among adults, there is little research examining chronic physiological stress among early childhood educators. Despite the "calling" of the career, these educators are at a unique increased risk for chronic stress due to earning stagnant, unlivable wages as compared to their K-12 educator colleagues and often being primary care providers to children and families experiencing intergenerational trauma. Because physiological stress may be linked to chronic disease later in life and may present differently than psychological stress, it is important to understand the feasibility of measuring chronic physiological stress, as commonly measured with hair cortisol, in this essential and unique population.

Objectives: The aim of the study was to examine the feasibility of collecting hair to measure cortisol concentration as an estimate of chronic physiological stress among early childhood educators by understanding variations in their participation.

Methods: Analyses of hair sampling participation of center-based educators by sociodemographic characteristics occurred across two pilot studies: one longitudinal ( n = 67) conducted during the COVID-19 pandemic (2021) and one cross-sectional ( n = 31) occurring postpandemic (2024). Educators were asked to provide hair samples for cortisol analysis to measure physiological stress and complete surveys on reasons for nonparticipation and their sociodemographic characteristics, including age, race, ethnicity, gender, and highest level of education.

Results: Educators' sociodemographic characteristics generally reflected nationally representative samples. Across the studies, 75.3% of educators participated in initial hair sampling. Collectively, the most common reason for nonparticipation was related to hairstyle or hair characteristics. Educators who were Black/African American or had less than a bachelor's degree in education were least likely to participate in hair sampling.

Discussion: Collecting hair for cortisol as a measure of physiological stress among early childhood educators is feasible. However, researchers may want to consider alternative measures of chronic physiological stress to promote equitable research practices among educators who are Black/African American or who have lower than a bachelor's degree in education. Given the importance of chronic physiological stress for health, avenues for future research are discussed.

Background: The cost of cancer treatment is higher for breast cancer than any other cancer diagnosis, leaving women with metastatic breast cancer (MBC) vulnerable to challenges given the extended length of cancer treatment, including financial, physical, and psychological burdens.

Objective: The purpose of this study was to examine the lived experiences of women diagnosed with MBC in the realm of financial concerns and unmet support needs specific to their cancer treatment.

Methods: This qualitative, phenomenological study included individual interviews that were audio-recorded and transcribed verbatim. Applied thematic analysis was completed using Atlas.ti. Interrater reliability using Cohen's kappa was established at 0.80. Participants were recruited from a National Cancer Institute-designated cancer center in the United States.

Results: Sixteen participants were interviewed. A majority were White, non-Hispanic, married, unemployed, and had obtained at least a bachelor's degree level of education. Nearly 19% of participants reported a gross household income of below $50,000. The mean age of participants was 55.6 years. Two major themes were identified, with each having three corresponding subthemes, including: 1) financial toxicities (cost of cancer treatments and medications, limitations of health insurance, and effect on employment); and 2) unmet support needs (managing usual responsibilities, emotional support, community and organizational support).

Discussion: The results highlight the financial and psychosocial needs of women with MBC. Treatment costs take a huge financial toll on patients and their families, including insured women with higher household incomes. Participants expressed a desire for specific MBC resources and support.

Background: Population aging has increased the need for solutions that help older adults live independently in their own homes, where medication management is a major challenge.

Objectives: In this systematic review, we assessed the effects of medication dispensers among home-dwelling older adults on outcomes within the five domains of the Quintuple Aim framework: user experiences, health and well-being outcomes, health service utilization and costs, care professional experiences, and equity.

Methods: We identified relevant studies by searching databases (Scopus, CENTRAL, PubMed, Web of Science, CINAHL, PsycINFO, and Cochrane Reviews) from January 2017 to April 2022 with a predefined search strategy and two-person abstract and full-text screening. Two authors extracted the most relevant data and assessed quality for each included study. We assessed the evidence using a four-level quality rating measure: strong, moderate, limited, or no evidence.

Results: We included five original studies and three systematic reviews, which provided information on 20 additional original studies. Data were extracted from these 25 original studies. We found significant results in 16 of them, mostly pointing to the beneficial effects of dispenser devices. Significant results for health and well-being outcomes were found in 13 out of 21 studies in which these were assessed, for service utilization in two out of five studies, for costs in two out of three studies, and for patient/carer experiences in one out of five studies. No study evaluated professional experiences or equity outcomes. Overall, strong evidence of a beneficial effect of dispenser devices in any outcome is lacking, but they can improve health outcomes (moderate evidence of beneficial effects of using dispenser devices on systolic and diastolic blood pressure, and hemoglobin A1c levels). For other outcome domains, there is no or only limited evidence for beneficial effects of dispenser devices.

Discussion: We found that the use of dispenser devices by home-dwelling older adults can improve clinical health outcomes and may reduce health service utilization and costs. More high-quality research is needed to get a better insight into their effects on service utilization and costs. Future studies should also examine the effects on care professionals' experiences and equity.

Background: In hospitals that serve disproportionately patients of Black race, here termed Black-serving hospitals (BSH), nurse staffing is worse, mortality rates are higher, and nursing-sensitive indicators may be worse than in other hospitals, but this evidence has not been compiled.

Objective: The study objective was to examine whether nursing-sensitive indicators, which measure changes in patient health status directly affected by nursing care, differ in hospitals where Black patients predominantly access their care, as compared to other hospitals.

Methods: To fulfill the objective, a cross-sectional design using publicly available 2019 to 2022 Hospital Compare, 2019 Medicare Provider Analysis and Review (MEDPAR), and case mix index (CMI) file databases were used. Four nursing-sensitive indicators were evaluated: pressure ulcer, postoperative sepsis, perioperative pulmonary embolus/deep vein thrombosis, and death rate among surgical inpatients with serious treatable complications ("failure to rescue") in hospitals classified into high, medium, and low BSHs according to the percentage of patients of Black race in the MEDPAR data. Mean outcome differences across BSH categories were assessed through analyses of variance and regression models, which controlled for hospital CMI.

Results: The 3,101 hospitals were predominantly urban nonteaching hospitals in metropolitan areas. Although 12% of hospitals had Magnet designation, BSHs were disproportionately Magnet (14%). The outcome rates were 0.59 for pressure ulcers, 3.38 for perioperative pulmonary embolus/deep vein thrombosis, 143.58 for failure to rescue, and 4.12 for sepsis. Rates were significantly higher for pressure ulcers, perioperative pulmonary embolus/deep vein thrombosis, and sepsis in high BSHs. The mean failure to rescue rate was similar across low-to-high BSHs and did not show significant differences. These results were unchanged in models adjusting for CMI.

Discussion: The evidence suggests that several nursing-sensitive indicators are worse in high BSHs. Research linking nursing-sensitive indicators to nursing resources such as staffing is needed to explicate the mechanism underlying these findings. Poorer nursing-sensitive indicators in combination with poorer nurse staffing in high BSHs presents a priority for policy and management intervention.

Background: In clinical settings, counseling patients on physical activity starts by assessing patients' current physical activity levels. Self-report measures of PA are generally easy to administer; however, they may be too long to be convenient and are known to correlate poorly with objective measures of physical activity.

Objective: To assess the concurrent validity of a self-report three-question physical activity vital sign with objective Fitbit step counts and the distance walked during a 6-min walk test.

Methods: This pilot study tested a best practice advisory embedded in the Epic electronic health record, which was designed to prompt providers in a preventive cardiology clinic to counsel patients reporting low levels of physical activity. Patients were invited to participate in the remote patient monitoring phase to assess the change in their physical activity by wearing a Fitbit for 12 weeks and completing a 6-min walk test at baseline and 12 weeks. This analysis used the cross-sectional data collected in this phase. Pearson correlations were conducted between self-reported physical activity, Fitbit step counts, and the distance walked during the 6-min walk-a measure associated with current physical activity levels. Kappa coefficients were calculated to assess agreement between self-reported physical activity and step counts.

Results: Participants who enrolled in the Fitbit monitoring were approximately 50% female, with the majority identified as White non-Hispanic adults. Their most common cardiovascular risk factor was hypertension. The self-reported physical activity vital signs were significantly associated with step counts at baseline and 12 weeks but were not associated with the distance during the 6-min walk test. However, the distance walked was significantly associated with step counts at baseline and 12 weeks. The Kappa results demonstrate a poor level of agreement between two categories (meeting or not meeting current physical activity guidelines) of self-report physical activity vitals and the objective Fitbit step counts.

Discussion: There were moderate correlations between the self-reported physical activity vital signs and the Fitbit step counts, but there was lack of agreement when they were categorized. Further validation of this physical activity vital sign is warranted.

Background: Females with autism often receive late diagnoses-especially those with average or above-average intellectual abilities-highlighting the need to explore the unique experiences of this population for better health care support.

Objective: To explore the experiences and perceptions of females who received a late diagnosis on the autism spectrum in terms of coping and managing their diagnosis.

Methods: A descriptive qualitative study was conducted from December 2022 to March 2023 using semistructured interviews with 14 late-diagnosed autistic female subjects. Purposive and snowball sampling were employed, and thematic analysis of the interview data was performed using ATLAS.ti v.9 software. Findings were reported following standards for reporting qualitative research guidelines.

Results: Two main themes emerged: (a) getting a diagnosis: fitting into the norm, and (b) navigating the distinct significance for autistic females. The findings indicated that masking strategies contribute to delayed diagnoses, and social and health care stigma surrounding autism in females was evident. Areas for improving access to resources and support programs were identified.

Discussion: The results show that masking and camouflaging are predominant strategies among autistic females, contributing to delayed diagnoses and exposing them to additional risks. Enhancing resources and training for health care professionals is necessary to address the specific needs of this population.

Background: Depressive symptoms, anxiety, and inadequate social support are predictors of health-related quality of life (HRQoL) in persons with heart failure, but the prediction of HRQoL is multifaceted, and mechanisms underlying association are unknown. Self-care maintenance may moderate associations among these predictors, which is essential to better heart failure outcomes.

Objectives: To determine whether self-care maintenance moderates the direct and indirect effects of social support on HRQoL through psychological status (i.e., depressive symptoms and anxiety) in persons with heart failure.

Methods: We conducted a secondary analysis using cross-sectional data collected from 167 participants. Participants completed Patient Health Questionnaire-9, Brief Symptom Inventory, Multidimensional Scale of Perceived Social Support, Self-Care of Heart Failure Index version 6.2, and Minnesota Living with Heart Failure Questionnaire for depressive symptoms, anxiety, social support, self-care maintenance, and HRQoL, respectively. PROCESS macro was used for the analysis.

Results: Self-care maintenance did not moderate the direct effect of social support on HRQoL. However, self-care maintenance moderated the indirect effect of social support on HRQoL through depressive symptoms and anxiety. The beneficial effect of social support on depressive symptoms and anxiety varied with self-care maintenance, suggesting a dose-response moderation effect.

Discussion: Findings suggest that an increment in social support reduces depressive symptoms and anxiety, which further improves HRQoL. This relationship was more profound when the self-care maintenance was at a higher level. Our study emphasizes the need to focus on improving HRQoL by promoting positive social support that can decrease depressive symptoms and anxiety in persons with heart failure-particularly in those with low or moderate levels of self-care maintenance.

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.

Background: Few researchers have examined the organizational features of high-performing and low-performing hospitals for COVID-19 mortality during the pandemic, and how differences in hospital performance contributed to mortality disparities among socially vulnerable patients hospitalized with COVID-19.

Objectives: Our objectives were (a) to identify high- and low-performing hospitals on COVID-19 inpatient mortality and describe their distinguishing organizational characteristics, including nursing resources, and (b) to assess whether patients admitted to high-performing hospitals differed by social vulnerability level.

Methods: This analysis used linked nurse survey, hospital, and claims data for 73,792 hospitalized older adults diagnosed with COVID-19 across 96 New York and Illinois hospitals between January 1, 2020, and December 31, 2020. A robust benchmarking approach was used to identify high- and low-performing hospitals on 30-day inpatient mortality. We computed the cumulative proportion of admissions for patients in the highest and lowest social vulnerability index quartiles to the hospitals ranked by performance.

Results: The average mortality rate in the high-performing hospitals was 16.2% compared to 31.5% in the low-performing hospitals. Compared to low-performing hospitals, high-performing hospitals had more favorable nurse work environments and lower patient-to-nurse ratios. About half the patients in the lowest social vulnerability quartile (least vulnerable) were admitted to hospitals in the top-performing tertile of hospitals compared to 38% of patients in the highest social vulnerability quartile (most vulnerable).

Discussion: Nursing resources were a central feature of a high-performing hospital for COVID-19 mortality during the early stages of the pandemic. Patients diagnosed with COVID-19 who were admitted from the most socially vulnerable communities were less likely to be admitted to high-performing hospitals. Increasing nursing resources-particularly in hospitals that serve socially vulnerable communities-could be a key strategy for preparing for future public health emergencies and addressing health disparities.