Recent ucsd_nursing_oapdeposits items

Racism and the well-being of nurses of color: A scoping review

Tue, 15 Jul 2025 00:00:00 +0000

BACKGROUND: Structural disparities in the United States (U.S.) healthcare system negatively impact care access and quality for racial and ethnic minorities. The predominantly White nursing workforce does not reflect the nation's diverse population. Enhancing workforce diversity is crucial to addressing these issues. PURPOSE: This scoping review investigates associations between experiences of racism and the well-being of racial/ethnic minority nurses in the U.S., identifying existing evidence and literature gaps. METHODS: Utilizing Joanna Briggs' Scoping Review Methodology and PRISMA-ScR standards, we screened eight databases; 31 studies met our inclusion criteria. DISCUSSION: Racism is consistently associated with worse psychological and/or physical outcomes among nurses of color across methodologically inconsistent studies. Future research should expand upon the nascent, methodologically inconsistent research reviewed herein to identify and eliminate sources of racism in...

Suicidal Thoughts and Behaviors Among Health Care Trainees, Staff and Faculty at an Academic Medical Center

Thu, 13 Feb 2025 00:00:00 +0000

Background/Objectives: Health care workers are at greater risk for death by suicide compared to the general population and are less likely to seek assistance. More information about correlates of suicidality and treatment-seeking behavior are needed to reduce risk. Methods: The American Foundation for Suicide Prevention developed an Interactive Screening Program to identify and engage at-risk staff and trainees in health care settings. The study reports on the prevalence and demographic and clinical predictors of current suicidal thoughts, behaviors and mental health treatment at a single site (n = 5898) from 2009 to 2024. Results: The study found that 18.2% of respondents reported current suicidal thoughts and behaviors. These were more common among respondents who were younger, male, and who identified as a race/ethnicity other than non-Hispanic White. Suicidal thoughts and behaviors were more likely among those with higher PHQ-8 scores (OR...

Learning from Health Care Counselors' Perspectives on Health Care Worker Distress: A Qualitative Analysis.

Sat, 31 Aug 2024 00:00:00 +0000

Background: Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and faculty. Since its inception in 2009, the program has been staffed by 4 licensed counseling professionals who have worked both before and since the COVID-19 pandemic. Methods: Qualitative data obtained from semi-structured, 1-hour interviews and a follow-up 1-hour focus group with 4 HEAR counselors was analyzed using reflexive thematic analysis. Results:...

Palliative care interventions in intensive care unit patients – a systematic review protocol

Mon, 8 Jul 2024 00:00:00 +0000

BackgroundEven though data suggest that palliative care (PC) improves patient quality of life, caregiver burden, cost, and intensive care unit (ICU) length of stay, integration of PC in the ICU is far from being universally accepted. Poor understanding of what PC provides is one of the barriers to the widespread implementation of their services in ICU. Evidence suggests that the availability of specialist PC is lacking in most European countries and provided differently depending on geographical location. The aim of this systematic review is to compare the numbers and types of PC interventions and gauge their impact on stakeholder outcomes and ICU resource utilisation.MethodsWe will undertake a systematic review of the published peer-reviewed journal articles; our search will be carried out MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO. The search strategy will include variations in the term ‘palliative care’ and ‘intensive care’. All studies with patient populations undergoing...

Feasibility and acceptability of family administration of delirium detection tools in the intensive care unit: a patient-oriented pilot study

Mon, 8 Jul 2024 00:00:00 +0000

BACKGROUND: Family-administered delirium detection tools may serve as valuable diagnostic adjuncts because family caregivers may be better able than providers to detect changes in patient cognition and behaviour from pre-illness levels of functioning. The aim of this pilot study was to assess the feasibility and acceptability of family-administered tools to detect delirium in critically ill patients. METHODS: In this single-centre pilot tool validation study conducted in August and September 2017, eligible family caregivers used the Family Confusion Assessment Method (FAM-CAM) and the Sour Seven questionnaire to detect delirium during the patient's intensive care unit (ICU) stay. We calculated descriptive statistics for all study variables. Patients and family caregivers were involved as research partners throughout the study. A patient-orient research approach was taken, engaging patients and family caregivers as full partners. RESULTS: Of 141 patients admitted to the ICU, 75...

Development and Validation of an ICU Delirium Playbook for Provider Education

Sat, 2 Sep 2023 00:00:00 +0000

Although delirium detection and prevention practices are recommended in critical care guidelines, there remains a persistent lack of effective delirium education for ICU providers. To address this knowledge-practice gap, we developed an "ICU Delirium Playbook" to educate providers on delirium detection (using the Confusion Assessment Method for the ICU) and prevention. DESIGN: Building on our previous ICU Delirium Video Series, our interdisciplinary team developed a corresponding quiz to form a digital "ICU Delirium Playbook." Playbook content validity was evaluated by delirium experts, and face validity by an ICU nurse focus group. Additionally, focus group participants completed the quiz before and after video viewing. Remaining focus group concerns were evaluated in semi-structured follow-up interviews. SETTING: Online validation survey, virtual focus group, and virtual interviews. SUBJECTS: The validation group included six delirium experts in the fields of critical care,...

American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide

Tue, 18 Jul 2023 00:00:00 +0000

Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses' risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses' health and well-being...

Using Photographs to Bring Dignity to Patients and Help Clinicians Find Meaning and Joy in Work

Thu, 13 Jul 2023 00:00:00 +0000

Background: The importance of dignity in health care is well described, yet limited interventions exist to improve dignity, particularly patient-driven interventions. Objectives: To test the hypothesis that patient-selected photographs at the bedside would impact patients' sense of dignity and clinicians' sense of meaningful work, stimulate conversation between patients and clinicians, and serve as a visual and patient-driven complement to the Patient Dignity Question (PDQ). Methods: Patients admitted to three units at an academic medical center displayed photographs above their head of bed and were interviewed for this study. We used thematic content analysis to compare themes extracted from patient interviews, the PDQ, and clinician surveys. Results: Eight themes emerged from patient interviews (n = 19): conveying goals, joy, capturing the patient's spirit, faith and spirituality, sense of belonging, physical appearance...

Associations between caregiver-detected delirium and symptoms of depression and anxiety in family caregivers of critically ill patients: a cross-sectional study

Wed, 12 Jul 2023 00:00:00 +0000

BackgroundWitnessing delirium can be distressing for family caregivers (i.e., relatives or friends) of critically ill patients. This study aimed to evaluate associations between caregiver-detected delirium in critically ill patients and depression and anxiety symptoms in their family caregivers.MethodsConsecutive adult patient-caregiver dyads were enrolled from a 28-bed medical-surgical intensive care unit. Patient delirium was screened for daily by family caregivers using the Sour Seven instrument. Family caregivers completed the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) instruments daily to assess their own depression and anxiety symptoms. Response feature analysis was used to handle repeated measures. Descriptive statistics and regression analyses were completed.ResultsOne hundred forty-seven patient-caregiver dyads were enrolled. Clinically significant symptoms of depression and anxiety occurred in 27% and 35% of family caregivers, respectively....

Effectiveness of an intensive care unit family education intervention on delirium knowledge: a pre-test post-test quasi-experimental study

Wed, 12 Jul 2023 00:00:00 +0000

PurposeTo create, validate, and refine an intensive care unit (ICU) delirium education intervention to prepare family members to partner with the ICU care team to detect delirium symptoms and prevent and manage delirium using nonpharmacological strategies.MethodsIn this pre-test post-test quasi-experimental study, consecutive eligible family members of critically ill patients admitted to an ICU completed an ICU Family Education Delirium intervention in two parts: 1) six-minute video on ICU delirium (risk factors, prevention/management, symptoms, communication with the ICU care team), and 2) two case vignettes to practice detecting delirium using family-administered delirium detection questionnaires (Family Confusion Assessment Method [FAM-CAM] and Sour Seven). Family members’ delirium knowledge was measured before, immediately after, and two weeks following the intervention using the Caregiver ICU Delirium Knowledge Questionnaire (CIDKQ).ResultsOf 99 family members recruited over...

The association of delirium severity with patient and health system outcomes in hospitalised patients: a systematic review

Wed, 12 Jul 2023 00:00:00 +0000

BACKGROUND: delirium is an acute state of confusion that affects >20% of hospitalised patients. Recent literature indicates that more severe delirium may lead to worse patient outcomes and health system outcomes, such as increased mortality, cognitive impairment and length of stay (LOS). METHODS: using systematic review methodology, we summarised associations between delirium severity and patient or health system outcomes in hospitalised adults. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus databases with no restrictions, from inception to 25 October 2018. We included original observational research conducted in hospitalised adults that reported on associations between delirium severity and patient or health system outcomes. Quality of included articles was assessed using the Newcastle-Ottawa Scale. The level of evidence was quantified based on the consistency of findings and quality of studies reporting on each outcome. RESULTS: we included 20 articles evaluating...

A study protocol for a randomized controlled trial of family-partnered delirium prevention, detection, and management in critically ill adults: the ACTIVATE study

Wed, 12 Jul 2023 00:00:00 +0000

BackgroundDelirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Family members are also at risk of long-term complications, including depression and anxiety. Family members are frequently at the bedside and want to be engaged; they know the patient best and may notice subtle changes prior to the care team. By engaging family members in delirium care, we may be able to improve both patient and family outcomes by identifying delirium sooner and capacitating family members in care.MethodsThe primary aim of this study is to determine the effect of family-administered delirium prevention, detection, and management in critically ill patients on family member symptoms of depression and anxiety, compared to usual care. One-hundred and ninety-eight patient-family dyads will be recruited from four medical-surgical ICUs in Calgary, Canada. Dyads will be randomized 1:1 to the intervention or control group....

A scoping review of the literature addressing psychological well-being of racial and ethnic minority nurses during the COVID-19 pandemic

Mon, 10 Jul 2023 00:00:00 +0000

BACKGROUND: The COVID-19 pandemic has affected the well-being of nursing professionals, especially long-term and acute care nurses, many of whom are nurses of color. PURPOSE: We examine the evidence and gaps in the literature addressing psychological well-being of racial/ethnic minority RNs in the United States during COVID-19. METHODS: We searched eight databases during March 2022 and used Joanna Briggs' Scoping Review Methodology and PRISMA-ScR reporting standards. DISCUSSION: Seven studies met inclusion criteria. Two exclusively examined nurses; five reported findings from heterogeneous samples of health care workers. No significant racial/ethnic differences in well-being were reported among health care workers. Among nurses, if a difference existed, White nurses reported decreased psychological well-being relative to ethnic and racial minority nurses. Two studies report modest racial/ethnic differences in nurses' psychological well-being. CONCLUSION: Significant gaps in the...

Longitudinal analysis of suicides among pharmacists during 2003-2018

Fri, 30 Jun 2023 00:00:00 +0000

BACKGROUND: Suicide is one of the leading causes of death worldwide, and estimates of suicide among health professionals are higher than the general population. High rates of suicide among physicians and nurses have been described previously, but there is a lack of data for suicides completed by pharmacists. OBJECTIVE: The purpose of this study was to quantify the incidence, means, and characteristics of pharmacist suicides in the United States. METHODS: Data were obtained from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) for the years 2003-2018. The dataset contained all suicides, coded by occupation, reported by medical examiners and law enforcement from 39 states and Washington DC and Puerto Rico. Suicide characteristics were compared between pharmacists and nonpharmacists. Age-adjusted rates were calculated for 2004, 2009, and 2014. RESULTS: During 2003-2018, the NVDRS contained 316 pharmacist suicides compared with...

The future of family-centred care in intensive care

Tue, 27 Jun 2023 00:00:00 +0000

The future of family-centred care in intensive care

Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study

Thu, 15 Jun 2023 00:00:00 +0000

PurposeWhile studies report on perceptions of family participation in delirium prevention, little is known about the use of family-administered delirium detection tools in the care of critically ill patients. This study sought the perspectives of patients, their family members, and healthcare providers on the use of family-administered delirium detection tools to detect delirium in critically ill patients and barriers and facilitators to using family-administered delirium detection tools in patient care.MethodsIn this qualitative study, critical care providers (five physicians, six registered nurses) and participants from the Family ICU Delirium Detection Study (seven past patients and family members) took part in four focus groups at one hospital in Calgary, Alberta.ResultsKey themes identified following thematic analysis from 18 participants included: 1) perceptions of acceptability of family-administered delirium detection (e.g., family feels valued, intensive care unit (ICU)...

Nurse suicide in the United States: Analysis of the Center for Disease Control 2014 National Violent Death Reporting System dataset

Fri, 2 Jun 2023 00:00:00 +0000

OBJECTIVE: This study explored nurse suicide in the United States. METHODS: Characteristics were compared between occupations using 2014 National Violent Death Reporting System data. RESULTS: Female nurse suicides were significantly higher (11.97/100,000) than in the female population (7.58/100,000) (p < 0.001); similarly male nurses (39.8/100,000) compared to the male population (28.2/100,000) (p < 0.001). Benzodiazepines and opioids were the most commonly used substances used in clinician suicide. CONCLUSION: These results suggest a public health imperative for future research and development of effective preventative strategies for nurses; a largely understudied population.

The other COVID‐19 survivors: Timing, duration, and health impact of post‐acute sequelae of SARS‐CoV‐2 infection

Wed, 29 Mar 2023 00:00:00 +0000

AIMS AND OBJECTIVES: To determine the frequency, timing, and duration of post-acute sequelae of SARS-CoV-2 infection (PASC) and their impact on health and function. BACKGROUND: Post-acute sequelae of SARS-CoV-2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised. DESIGN: Descriptive cross-sectional survey (n = 5163) was conducted from online COVID-19 survivor support groups who reported symptoms for more than 21 days following SARS-CoV-2 infection. METHODS: Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom-specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies...

Novel Pedagogical Training for Nursing Doctoral Students in Support of Remote Learning

Wed, 18 Jan 2023 00:00:00 +0000

BACKGROUND: The need for faculty to educate prospective nurses is urgent: without sufficient nursing faculty, schools regularly reject qualified applicants, despite an increasing need for nurses. At the same time, many graduate-prepared nurses lack preparation in teaching and pedagogical frameworks. PROBLEM: Literature on how PhD programs in nursing prepare graduates for teaching indicates that there is typically more emphasis on research than pedagogical learning. APPROACH: With the shift to remote learning under the COVID-19 pandemic, the University of California Irvine created a Graduate Fellows program to provide support to faculty while offering graduate students education in pedagogy and remote learning. OUTCOMES: Fellows were satisfied and reported increased understanding of challenges in teaching and increasing comfort with nurse faculty roles. CONCLUSIONS: The collaborative efforts of fellows and faculty provided important resources at a critical time, and insights gained...

A novel conceptual model of trauma‐informed care for patients with post‐acute sequelae of SARS‐CoV‐2 illness (PASC)

Sun, 30 Oct 2022 00:00:00 +0000

AIM: This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC). DESIGN: This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes. DATA SOURCES: PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors. IMPLICATIONS FOR NURSING: The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care...

A distinct symptom pattern emerges for COVID-19 long-haul: a nationwide study

Tue, 18 Oct 2022 00:00:00 +0000

Long-haul COVID-19, also called post-acute sequelae of SARS-CoV-2 (PASC), is a new illness caused by SARS-CoV-2 infection and characterized by the persistence of symptoms. The purpose of this cross-sectional study was to identify a distinct and significant temporal pattern of PASC symptoms (symptom type and onset) among a nationwide sample of PASC survivors (n = 5652). The sample was randomly sorted into two independent samples for exploratory (EFA) and confirmatory factor analyses (CFA). Five factors emerged from the EFA: (1) cold and flu-like symptoms, (2) change in smell and/or taste, (3) dyspnea and chest pain, (4) cognitive and visual problems, and (5) cardiac symptoms. The CFA had excellent model fit (x2 = 513.721, df = 207, p < 0.01, TLI = 0.952, CFI = 0.964, RMSEA = 0.024). These findings demonstrate a novel symptom pattern for PASC. These findings can enable nurses in the identification of at-risk patients and facilitate early, systematic symptom management...

COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler Looking for Clarity in the Haze of the Pandemic

Tue, 18 Oct 2022 00:00:00 +0000

Post-acute sequelae of SARS-CoV-2 (PASC) is defined as persistent symptoms after apparent recovery from acute COVID-19 infection, also known as COVID-19 long-haul. We performed a retrospective review of electronic health records (EHR) from the University of California COvid Research Data Set (UC CORDS), a de-identified EHR of PCR-confirmed SARS-CoV-2-positive patients in California. The purposes were to (1) describe the prevalence of PASC, (2) describe COVID-19 symptoms and symptom clusters, and (3) identify risk factors for PASC. Data were subjected to non-negative matrix factorization to identify symptom clusters, and a predictive model of PASC was developed. PASC prevalence was 11% (277/2,153), and of these patients, 66% (183/277) were considered asymptomatic at days 0-30. Five PASC symptom clusters emerged and specific symptoms at days 0-30 were associated with PASC. Women were more likely than men to develop PASC, with all age groups and ethnicities represented. PASC is a...

Antihistamines for Postacute Sequelae of SARS-CoV-2 Infection

Fri, 3 Jun 2022 00:00:00 +0000

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

Exploring Distress Caused by Blame for a Negative Patient Outcome

Mon, 7 Dec 2015 00:00:00 +0000

OBJECTIVE:

The aim of this study was to explore blame-related distress (B-RD).

BACKGROUND:

No research exists describing the incidence and characteristics of consequences of blame.

METHODS:

Survey research was used to explore the incidence, characteristics, and consequences of the distress caused by blame in the workplace.

RESULTS:

B-RD is prevalent among intensive care and oncology staff. Participants reported an organizational impact to B-RD in terms of staff morale, turnover, and employee health. Management, physicians, and peers were the most frequently cited source of blame.

CONCLUSIONS:

A proposed model is described to relate blame to other similar constructs