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Miner DC, Ailey SH, Thompson RA, Squires A, Adarlo A, Brown H. "We have met the enemy and it is us": Healthcare professionals as the barrier to health equity for people with intellectual and developmental disability. Res Nurs Health 2024; 47:269-273. [PMID: 38415432 DOI: 10.1002/nur.22376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Dianne C Miner
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
| | - Sarah H Ailey
- Rush University College of Nursing, Chicago, Illinois, USA
| | - Roy A Thompson
- Preparing Future Faculty for Inclusive Excellence Postdoctoral Fellow, Sinclair School of Nursing, University of Missouri, Kansas City, Missouri, USA
| | - Allison Squires
- NYU Rory Meyers College of Nursing, New York, New York, USA
- Department of General Internal Medicine, Grossman School of Medicine, New York City, New York, USA
- National Academy of Medicine, Washington, District of Columbia, USA
| | - Amyela Adarlo
- Loma Linda University, School of Nursing, Loma Linda, California, USA
- Gamma Alpha Chapter of Sigma Theta Tau International, Indianapolis, Indiana, USA
| | - Holly Brown
- Golisano Institute for Developmental Disability Nursing, Rochester, New York, USA
- Wegmans School of Nursing, St John Fisher University, Pittsford, New York, USA
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Lee SE, Seo JK, Squires A. Voice, silence, perceived impact, psychological safety, and burnout among nurses: A structural equation modeling analysis. Int J Nurs Stud 2024; 151:104669. [PMID: 38160639 DOI: 10.1016/j.ijnurstu.2023.104669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/14/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The organizational studies' literature suggests that employees' expressions of voice and silence may be distinct concepts with different predictors. Organizational researchers also argue that both employees' voice and silence are related to burnout; however, these relationships have not been adequately examined in the healthcare context. OBJECTIVE This study aimed to investigate the relationships among nurses' perceived impact, psychological safety, voice behaviors, and burnout using a theoretical model. Voice behaviors were conceptualized as voice and silence. DESIGN A cross-sectional, correlational study design was employed. SETTINGS Study data were collected in 34 general hospitals in South Korea. PARTICIPANTS A total of 1255 registered nurses providing direct care to patients were included in this study. METHODS Using a convenience sampling method, a web-based survey was conducted to obtain data. All variables were measured using standardized instruments. A structural equation modeling analysis was employed to test a hypothesized model positing that perceived impact and psychological safety have both direct and indirect effects on nurse burnout through voice and silence. The response rate was 72.8 %. RESULTS The findings supported the hypothesized model. Both perceived impact and psychological safety were positively related to expressions of voice, but both were negatively associated with silence. We also found that perceived impact was more strongly associated with voice than with silence, while psychological safety had a stronger impact on silence than on voice. Furthermore, voice reduced burnout, while silence increased it. Finally, perceived impact reduced burnout through voice (β = -0.10, 95 % confidence interval [-0.143, -0.059]) and silence (β = -0.04, 95 % confidence interval [-0.058, -0.014]), and psychological safety also decreased burnout through voice (β = -0.04, 95 % confidence interval [-0.057, -0.016]) and silence (β = -0.07, 95 % confidence interval [-0.101, -0.033]). Additional analyses revealed that prohibitive voice and silence significantly mediated the associations between psychological safety and burnout and perceived impact and burnout, but the mediating role of promotive voice was not statistically significant. CONCLUSIONS It is important to recognize that voice and silence are distinct concepts. Moreover, to reduce nurse burnout, nurse managers and hospital administrators should develop separate strategies for promoting nurses' perceived impact and psychological safety, as their influences on voice and silence differ. REGISTRATION Not applicable. TWEETABLE ABSTRACT Voice and silence both influence nurse burnout. Separate strategies should be applied to voice and silence, as they are different concepts.
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Affiliation(s)
- Seung Eun Lee
- College of Nursing, Yonsei University, Seoul, South Korea.
| | - Ja-Kyung Seo
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Malinowska-Lipień I, Put D, Maluchnik M, Gabryś T, Kózka M, Gajda K, Gniadek A, Brzostek T, Squires A. Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies. BMC Nurs 2024; 23:117. [PMID: 38360713 PMCID: PMC10870652 DOI: 10.1186/s12912-024-01762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates. AIM To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals. BACKGROUND An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates. MATERIAL AND METHODS The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses' satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models. RESULTS A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = - 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = - 0.50); the ward nurse is a good manager (r = - 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = - 0.41). CONCLUSIONS Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland.
| | - Dariusz Put
- Department of Computational Systems, Krakow University of Economics, Krakow, Poland
| | - Michał Maluchnik
- Department of Adult Neurology, Medical University of Gdansk and University Clinical Center, Gdansk, Poland
- Ministry of Health, Warsaw, Poland
| | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Krzysztof Gajda
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University- Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Thompson RA, Lewis KR, Curtis CA, Olanrewaju SA, Squires A. Making the invisible visible: The importance of applying a lens of intersectionality for researching internationally educated nurses. Nurs Outlook 2024; 72:102086. [PMID: 37984020 DOI: 10.1016/j.outlook.2023.102086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Roy A Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, MO.
| | - Kaleea R Lewis
- Department of Public Health, School of Health Professions, Columbia, MO; Department of Women's and Gender Studies, College of Arts and Science, University of Missouri, Columbia, MO
| | - Cedonnie A Curtis
- School of Nursing and Health Sciences, La Salle University, Philadelphia, PA
| | - Sherif A Olanrewaju
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, NY; Department of General Internal Medicine, Grossman School of Medicine, New York, NY
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Squires A, Gerchow L, Ma C, Liang E, Trachtenberg M, Miner S. A multi-language qualitative study of limited English proficiency patient experiences in the United States. PEC Innov 2023; 2:100177. [PMID: 37384163 PMCID: PMC10294089 DOI: 10.1016/j.pecinn.2023.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
Objective The purpose of this study was to understand the limited English proficiency patient experience with health care services in an urban setting in the United States. Methods Through a narrative analysis approach, 71 individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews between 2016 and 2018. Analyses used monolingual and multilingual open coding approaches to generate themes. Results Six themes illustrated patient experiences and identified sources of structural inequities perpetuating language barriers at the point of care. An important thread throughout all interviews was the sense that the language barrier with clinicians posed a threat to their safety when receiving healthcare, citing an acute awareness of additional risk for harm they might experience. Participants also consistently identified factors they felt would improve their sense of security that were specific to clinician interactions. Differences in experiences were specific to culture and heritage. Conclusions The findings highlight the ongoing challenges spoken language barriers pose across multiple points of care in the United States' health care system. Innovation The multi-language nature of this study and its methodological insights are innovative as most studies have focused on clinicians or patient experiences in a single language.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Lauren Gerchow
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Eva Liang
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America
| | - Melissa Trachtenberg
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, United States of America
| | - Sarah Miner
- Wegman's School of Nursing, St. John Fischer College, Rochester, NY, United States of America
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Squires A, Engel P, Ma C, Miner S, Feldman PH, McDonald MV, Jones S. Continuity of Care Versus Language Concordance as an Intervention to Reduce Hospital Readmissions From Home Health Care. Med Care 2023; 61:605-610. [PMID: 37561604 PMCID: PMC10421624 DOI: 10.1097/mlr.0000000000001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. OBJECTIVE The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. DESIGN A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. PARTICIPANTS The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. MEASURES The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. RESULTS When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). CONCLUSION In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.
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Affiliation(s)
| | | | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University
| | - Sarah Miner
- Wegman’s School of Nursing, New York University
| | | | | | - Simon Jones
- Director of Analytics, Center for Delivery Systems Science Department of Population Health, Grossman School of Medicine, New York University
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Topel M, Ejaz A, Squires A, Ferguson AL. Learned Reconstruction of Protein Folding Trajectories from Noisy Single-Molecule Time Series. J Chem Theory Comput 2023; 19:4654-4667. [PMID: 36701162 DOI: 10.1021/acs.jctc.2c00920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Single-molecule Förster resonance energy transfer (smFRET) is an experimental methodology to track the real-time dynamics of molecules using fluorescent probes to follow one or more intramolecular distances. These distances provide a low-dimensional representation of the full atomistic dynamics. Under mild technical conditions, Takens' Delay Embedding Theorem guarantees that the full three-dimensional atomistic dynamics of a system are diffeomorphic (i.e., related by a smooth and invertible transformation) to a time-delayed embedding of one or more scalar observables. Appealing to these theoretical guarantees, we employ manifold learning, artificial neural networks, and statistical mechanics to learn from molecular simulation training data the a priori unknown transformation between the atomic coordinates and delay-embedded intramolecular distances accessible to smFRET. This learned transformation may then be used to reconstruct atomistic coordinates from smFRET time series data. We term this approach Single-molecule TAkens Reconstruction (STAR). We have previously applied STAR to reconstruct molecular configurations of a C24H50 polymer chain and the mini-protein Chignolin with accuracies better than 0.2 nm from simulated smFRET data under noise free and high time resolution conditions. In the present work, we investigate the role of signal-to-noise ratio, data volume, and time resolution in simulated smFRET data to assess the performance of STAR under conditions more representative of experimental realities. We show that STAR can reconstruct the Chignolin and Villin mini-proteins to accuracies of 0.12 and 0.42 nm, respectively, and place bounds on these conditions for accurate reconstructions. These results demonstrate that it is possible to reconstruct dynamical trajectories of protein folding from time series in noisy, time binned, experimentally measurable observables and lay the foundations for the application of STAR to real experimental data.
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Affiliation(s)
- Maximilian Topel
- Department of Physics, University of Chicago, Chicago, Illinois 60637, United States
| | - Ayesha Ejaz
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, Illinois 60637, United States
| | - Allison Squires
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, Illinois 60637, United States
| | - Andrew L Ferguson
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, Illinois 60637, United States
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Skela-Savič B, Sermeus W, Dello S, Squires A, Bahun M, Lobe B. How nurses' job characteristics affect their self-assessed work environment in hospitals- Slovenian use of the practice environment scale of the nursing work index. BMC Nurs 2023; 22:100. [PMID: 37024874 PMCID: PMC10077322 DOI: 10.1186/s12912-023-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Nurses' work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses' work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI). METHODS The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee. RESULTS The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with 'Opportunities for advancement', 'Educational opportunities', 'Satisfaction with current job', 'Professional status', 'Study leave', and 'Level of education'. A three-factor solution of PES-NWI yielded eight distinct variables. CONCLUSIONS The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important. TRIAL REGISTRATION This is a non-intervention study - retrospectively registered.
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Affiliation(s)
- Brigita Skela-Savič
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, Jesenice, 4270, Slovenia.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, 3000, Belgium
| | - Simon Dello
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, 3000, Belgium
| | - Allison Squires
- Dept. of General Internal Medicine, Grossman School of Medicine, Meyers College of Nursing, New York University, New York, USA
| | - Mateja Bahun
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, Jesenice, 4270, Slovenia
| | - Bojana Lobe
- Faculty of Social Sciences, University of Ljubljana, Kardeljeva ploščad 5, Ljubljana, 1000, Slovenia
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Riser TJ, Thompson RA, Curtis C, Squires A, Mowinski Jennings B, Szanton SL. Freedom is not free: Examining health equity for racial and ethnic minoritized veterans. Res Nurs Health 2023; 46:181-185. [PMID: 36929135 PMCID: PMC10273202 DOI: 10.1002/nur.22304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Tiffany J Riser
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Roy A Thompson
- University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
| | | | - Allison Squires
- Rory Meyers College of Nursing, New York, New York, USA
- Grossman School of Medicine, New York University, New York, New York, USA
| | | | - Sarah L Szanton
- Patricia M. Davidson Professor for Health Equity and Social Justice, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins University, Baltimore, Maryland, USA
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Van Cleave J, Guerra A, Liang E, Squires A. Cultural Influences On Patients' Perception Of Pain. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Zisberg A, Lickiewicz J, Squires A. Improving care for older people: A special issue. Int J Nurs Stud 2023; 141:104475. [PMID: 36931177 DOI: 10.1016/j.ijnurstu.2023.104475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, the Center of Research & Study of Aging, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel 31905, Israel.
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University, Sw Anny 12 St., Krakow 31-008, Poland.
| | - Allison Squires
- Global Consortium of Nursing & Midwifery Studies, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America.
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12
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Foli KJ, Choflet A, Matthias-Anderson D, Mercer M, Thompson RA, Squires A. The power of the language we use: Stigmatization of individuals and fellow nurses with substance use issues. Res Nurs Health 2023; 46:3-8. [PMID: 36571705 DOI: 10.1002/nur.22295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Karen J Foli
- School of Nursing, Purdue University West Lafayette Campus, West Lafayette, Indiana, USA
| | - Amanda Choflet
- Bouvé College of Health Sciences School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | | | - Maile Mercer
- NYU Rory Meyers College of Nursing, New York City, New York, USA
| | - Roy A Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Allison Squires
- NYU Rory Meyers College of Nursing, New York City, New York, USA.,Department of General Internal Medicine, Grossman School of Medicine, New York City, New York, USA
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Finlayson CS, Rosa WE, Mathew S, Applebaum A, Squires A, Fu MR. Awareness of Disease Status Among Patients With Cancer: An Integrative Review. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00091. [PMID: 36728162 PMCID: PMC10349894 DOI: 10.1097/ncc.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND As the quality of cancer care improves, oncology patients face a rapidly increasing number of treatment options. Thus, it is vital that they are full and active partners in the treatment decision-making process. Awareness of disease status has been investigated in the literature; it has been inconsistently conceptualized and operationalized. OBJECTIVE The aim of this integrative review was to develop a conceptual definition and model of the awareness of disease status among patients with cancer. METHODS Whittemore and Knafl's integrative review methodology guided this article. We obtained data through a systematic search of 8 databases. Key terms utilized were awareness, perception, truth disclosure, diagnosis, prognosis, terminal illness, status, neoplasm, and metastasis. Dates through January 2020 were searched to capture all relevant articles. Sixty-nine articles met inclusion criteria. RESULTS The integrative review methodology guided the development of a conceptual definition and model. The concept of "awareness of disease status" was defined as the individual patient's understanding of being diagnosed and treated for cancer based on the multifactorial components of individual patient characteristics and contextually driven communication practices of healthcare providers. This understanding is dynamic and changes throughout the disease trajectory. CONCLUSION These findings will inform consistency in the literature. Such consistency may improve person-centered clinical communication, care planning practices, and, ultimately, cancer-related outcomes. IMPLICATIONS FOR PRACTICE With a greater understanding of the complexity of patients' awareness of disease status, nurses will be able to guide their patients to make informed decisions throughout their disease trajectory.
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Affiliation(s)
- Catherine S Finlayson
- Author Affiliations: Department of PhD in Nursing, Pace University Lienhard School of Nursing, Pleasantville (Dr Finlayson and Ms Mathew); and Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center (Drs Rosa and Applebaum); New York University Rory Meyers College of Nursing (Dr Squires), New York; and Rutgers, The State University of New Jersey School of Nursing, New Brunswick, New Jersey (Dr Fu)
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Soled KRS, Clark KD, Altman MR, Bosse JD, Thompson RA, Squires A, Sherman ADF. Changing language, changes lives: Learning the lexicon of LGBTQ+ health equity. Res Nurs Health 2022; 45:621-632. [PMID: 36321331 PMCID: PMC9704510 DOI: 10.1002/nur.22274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kodiak R. S. Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, New Hampshire, USA
| | - Molly R. Altman
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Jordon D. Bosse
- School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Roy A. Thompson
- Sinclair School of Nursing, University of Missouri, Colombia, Missouri, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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15
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Squires A, Thompson R, Sadarangani T, Amburg P, Sliwinski K, Curtis C, Wu B. International migration and its influence on health. Res Nurs Health 2022; 45:503-511. [DOI: 10.1002/nur.22262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing New York University New York New York USA
- Grossman School of Medicine New York University New York New York USA
| | - Roy Thompson
- Sinclair School of Nursing University of Missouri Columbia Missouri USA
| | - Tina Sadarangani
- Rory Meyers College of Nursing New York University New York New York USA
| | - Polina Amburg
- School of Nursing Monmouth University Long Branch New Jersey USA
| | - Kathy Sliwinski
- School of Nursing, Center for Health Outcomes and Policy Research University of Pennsylvania Philadelphia Pennsylvania USA
| | - Cedonnie Curtis
- School of Nursing La Salle University Philadelphia Pennsylvania USA
| | - Bei Wu
- P50 Center for Asian Health Promotion and Equity, Rory Meyers College of Nursing New York University New York New York USA
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Zisberg A, Lickiewicz J, Rogozinski A, Hahn S, Mabire C, Gentizon J, Malinowska-Lipień I, Bilgin H, Tulek Z, Pedersen MM, Andersen O, Mayer H, Schönfelder B, Gillis K, Gilmartin MJ, Squires A. Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study. Int J Nurs Stud 2022; 134:104283. [DOI: 10.1016/j.ijnurstu.2022.104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
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Amburg P, Thompson RA, Curtis CA, Squires A. Different countries and cultures, same language: How registered nurses and midwives can provide culturally humble care to Russian‐speaking immigrants. Res Nurs Health 2022; 45:405-409. [DOI: 10.1002/nur.22252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Polina Amburg
- Marjorie K. Unterberg School of Nursing and Health Studies Monmouth University West Long Branch New Jersey USA
| | | | - Cedonnie A. Curtis
- School of Nursing and Health Sciences La Salle University Philadelphia Pennsylvania USA
| | - Allison Squires
- Rory Meyers College of Nursing New York University New York New York USA
- Department of General Internal Medicine Grossman School of Medicine, New York University New York New York USA
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Squires A, Clark-Cutaia M, Henderson MD, Arneson G, Resnik P. "Should I stay or should I go?" Nurses' perspectives about working during the Covid-19 pandemic's first wave in the United States: A summative content analysis combined with topic modeling. Int J Nurs Stud 2022; 131:104256. [PMID: 35544991 PMCID: PMC9020864 DOI: 10.1016/j.ijnurstu.2022.104256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic had its first peak in the United States between April and July of 2020, with incidence and prevalence rates of the virus the greatest in the northeastern coast of the country. At the time of study implementation, there were few studies capturing the perspectives of nurses working the frontlines of the pandemic in any setting as research output in the United States focused largely on treating the disease. OBJECTIVE The purpose of this study was to capture the perspectives of nurses in the United States working the frontlines of the COVID-19 pandemic's first wave. We were specifically interested in examining the impact of the pandemic on nurses' roles, professional relationships, and the organizational cultures of their employers. DESIGN We conducted an online qualitative study with a pragmatic design to capture the perspectives of nurses working during the first wave of the United States COVID-19 pandemic. Through social networking recruitment, frontline nurses from across the country were invited to participate. Participants provided long form, text-based responses to four questions designed to capture their experiences. A combination of Latent Dirichlet Allocation--a natural language processing technique--along with traditional summative content analysis techniques were used to analyze the data. SETTING The United States during the COVID-19 pandemic's first wave between May and July of 2020. RESULTS A total of 318 nurses participated from 29 out of 50 states, with 242 fully completing all questions. Findings suggested that the place of work mattered significantly in terms of the frontline working experience. It influenced role changes, risk assumption, interprofessional teamwork experiences, and ultimately, likelihood to leave their jobs or the profession altogether. Organizational culture and its influence on pandemic response implementation was a critical feature of their experiences. CONCLUSIONS Findings suggest that organizational performance during the pandemic may be reflected in nursing workforce retention as the risk for workforce attrition appears high. It was also clear from the reports that nurses appear to have assumed higher occupational risks during the pandemic when compared to other providers. The 2020 data from this study also offered a number of signals about potential threats to the stability and sustainability of the US nursing workforce that are now manifesting. The findings underscore the importance of conducting health workforce research during a crisis in order to discern the signals of future problems or for long-term crisis response. TWEETABLE ABSTRACT Healthcare leaders made the difference for nurses during the pandemic. How many nurses leave their employer in the next year will tell you who was good, who wasn't.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th Floor, New York, NY 10010, United States of America,Corresponding author
| | - Maya Clark-Cutaia
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th Floor, New York, NY 10010, United States of America
| | - Marcus D. Henderson
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Gavin Arneson
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th Floor, New York, NY 10010, United States of America
| | - Philip Resnik
- Department of Linguistics and Institute for Advanced Computer Studies, University of Maryland, College Park, MD, United States of America
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Niles PM, Jun J, Lor M, Ma C, Sadarangani T, Thompson R, Squires A. Honoring Asian diversity by collecting Asian subpopulation data in health research. Res Nurs Health 2022; 45:265-269. [PMID: 35462441 PMCID: PMC9235292 DOI: 10.1002/nur.22229] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2023]
Affiliation(s)
- P. Mimi Niles
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Jin Jun
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Maichou Lor
- UW-Madison School of Nursing, Madison, Wisconsin, USA
| | - Chenjuan Ma
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Tina Sadarangani
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Roy Thompson
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Allison Squires
- Florence S. Downs PhD Program in Nursing Research & Theory Development, NYU Rory Meyers College of Nursing, New York, New York, USA
- NYU School of Medicine, 2019-2020 Distinguished Nurse Scholar in Residence, National Academy of Medicine, New York, New York, USA
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Gerchow L, Squires A. Dimensional Analysis of Shared Decision Making in Contraceptive Counseling. J Obstet Gynecol Neonatal Nurs 2022; 51:388-401. [PMID: 35605641 DOI: 10.1016/j.jogn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To conduct a dimensional analysis to identify conceptual gaps around shared decision making (SDM) in reproductive health care and to refine the conceptual definition of SDM as related to contraceptive counseling. DATA SOURCES We identified source data through systematic searches of the CINAHL and PubMed databases. STUDY SELECTION We included peer-reviewed research and nonresearch articles that addressed contraceptive counseling for pregnancy prevention in the United States. We did not consider date of publication as an inclusion criterion. We included 35 articles in the final review. DATA EXTRACTION Using dimensional analysis, we extracted data to clarify the definition of SDM as a socially constructed concept that varies by perspective and context. DATA SYNTHESIS Data synthesis enabled us to compare SDM from patient and provider perspectives and to identify four primary dimensions of SDM that varied by context: Patient Preferences, Relationship, Provider Bias, and Clinical Suitability. CONCLUSION The four dimensions we identified illustrate the complexity and depth of SDM in contraceptive counseling encounters and broaden the definition of SDM to more than an encounter in which decision making incorporates clinician expertise and patient participation. We identified several assumptions that indicate the need for improved understanding that SDM is not a universal concept across perspectives and contexts. Most researchers in the included articles addressed the Patient Preferences dimension. Fewer considered the patient-provider relationship, the effect of provider bias, and the effect of specific clinical circumstances on SDM. We propose a conceptual map and model that can be used to refine the concepts that inform SDM and guide providers and researchers. Future research is needed to address the remaining gaps.
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Thumm EB, Stimpfel AW, Squires A. Dimensions of being a Midwife and Midwifery Practice in the United States: A Qualitative Analysis. Int J Childbirth 2022. [DOI: 10.1891/ijc-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundMidwives are a vital component of addressing maternal mortality crisis in the United States (US); however, there is scant understanding of the elements of midwifery practice that affect patient outcomes and the stability of the midwifery workforce in the country. This study investigates US midwives’ perceptions of factors influencing their practice and willingness to stay in the profession.MethodsWe applied a pragmatic qualitative design using summative content analysis techniques to code 1,035 comments from a national sample of 2,887 certified nurse-midwives and certified midwives. Two coders identified categories and themes of midwives’ perceptions of their practice environments, which were confirmed by an independent auditor.ResultsEight themes emerged from the data: I love midwifery but…; feeling valued and respected…or not; workload; time and its consequences; the multilevel geography of midwifery practice; changes at odds with quality midwifery care; midwives withdrawing from practice to cope; and the ambiguity of “I just want to practice like a midwife”.ConclusionMidwives readily identified aspects of their practice environment that negatively impact quality of care and stability of the midwifery workforce, including not valuing midwives, high workload, regulatory restrictions, and moral distress; however, respondents expressed strong commitment to the profession of midwifery. The findings also demonstrated the lack of a universally accepted definition of midwifery care within respondents’ professional communities and among respondents. Initiatives to increase integration of midwifery into the U.S. perinatal health system will benefit from taking these findings into consideration.
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22
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Nava A, Estrada L, Gerchow L, Scott J, Thompson R, Squires A. Grouping people by language exacerbates health inequities-The case of Latinx/Hispanic populations in the US. Res Nurs Health 2022; 45:142-147. [PMID: 35247219 DOI: 10.1002/nur.22221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Adrianna Nava
- National Association of Hispanic Nurses, Lexington, Kentucky, USA
| | - Leah Estrada
- School of Nursing, Columbia University, New York City, New York, USA
| | - Lauren Gerchow
- Rory Meyers College of Nursing, Nursing New York University, New York City, New York, USA
| | - Joanie Scott
- School of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Roy Thompson
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York City, New York, USA.,Grossman School of Medicine, New York University, New York City, New York, USA
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Nigenda G, Zárate-Grajales RA, Aristizabal P, Squires A, Ostiguín-Meléndez RM, Salcedo RA, Leija C, Choperena D, Serván-Mori E. Labor Market Participation of Bachelor's Degree Prepared Nurses in Mexico: Lessons for Capacity Building. J Prof Nurs 2022; 39:109-116. [DOI: 10.1016/j.profnurs.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022]
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Thompson R, Curtis CA, Squires A. Using culturally sensitive language for race. Res Nurs Health 2022; 45:3-5. [PMID: 35064584 DOI: 10.1002/nur.22207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Roy Thompson
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Cedonnie A Curtis
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
| | - Allison Squires
- Florence S. Downs PhD Program in Nursing Research and Theory Development, Rory Meyers College of Nursing, New York University, New York, NY, USA.,Department of General Internal Medicine, Grossman School of Medicine, New York University, New York, NY, USA
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Ejaz A, Chu J, Joseph M, Coraor A, Schaffer O, Squires A. Classification of DNA-FRET based single-molecule spectroscopic labels in anti-Brownian electrokinetic (ABEL) trap. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Chu J, Ejaz A, Joseph M, Coraor A, Tsang N, Squires A. Engineering spectroscopic labels for multiplexed single-molecule detection. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Squires A, Wang Q, Dahlberg P, Moerner WE. A bottom-up perspective on photodynamics and photoprotection in light-harvesting complexes using anti-Brownian trapping. J Chem Phys 2022; 156:070901. [DOI: 10.1063/5.0079042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Quan Wang
- Genomics, Princeton University, United States of America
| | | | - W. E. Moerner
- Department of Chemistry, Stanford University, United States of America
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Hu M, Squires A, Wu B. Caregiver Support for Asian American Alzheimer’s Disease and Related Dementias Caregivers: A Conceptual Synthesis. Innov Aging 2021. [PMCID: PMC8681041 DOI: 10.1093/geroni/igab046.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Informal caregiver support has been defined as different types of interventions. However, it has not been well explained in the social context and not well discussed as an integrative concept for dementia caregivers who are Asian Americans. Therefore, the aim of this study was to conduct a dimensional analysis--a type of evidence synthesis--to explore caregiver support in the context of Asian American dementia caregivers. A synthesis of 40 articles produced four interrelated dimensions of caregiver support: Individual (language, information, psychological issue, and culture); Family (family member support, availability of extended family, and decision making); Community (bilingual and bicultural help, and religion and spiritual source); and Professional healthcare system (expectations from healthcare professionals and caregivers for caregiver interventions, communication concordance, initiative in seeking help, and trust). The findings provide guidance for future studies on this population in promoting caregiver’s health and developing caregiver interventions.
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Affiliation(s)
- Mengyao Hu
- New York University, New York, New York, United States
| | | | - Bei Wu
- New York University, New York, New York, United States
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29
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Malinowska-Lipień I, Micek A, Gabryś T, Kózka M, Gajda K, Gniadek A, Brzostek T, Squires A. Nurses and physicians attitudes towards factors related to hospitalized patient safety. PLoS One 2021; 16:e0260926. [PMID: 34874957 PMCID: PMC8651112 DOI: 10.1371/journal.pone.0260926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The attitudes of healthcare staff towards patients' safety, including awareness of the risk for adverse events, are significant elements of an organization's safety culture. AIM OF RESEARCH To evaluate nurses and physicians' attitudes towards factors influencing hospitalized patient safety. MATERIALS AND METHODS The research included 606 nurses and 527 physicians employed in surgical and medical wards in 21 Polish hospitals around the country. The Polish adaptation of the Safety Attitudes Questionnaire (SAQ) was used to evaluate the factors influencing attitudes towards patient safety. RESULTS Both nurses and physicians scored highest in stress recognition (SR) (71.6 and 80.86), while they evaluated working conditions (WC) the lowest (45.82 and 52,09). Nurses achieved statistically significantly lower scores compared to physicians in every aspect of the safety attitudes evaluation (p<0.05). The staff working in surgical wards obtained higher scores within stress recognition (SR) compared to the staff working in medical wards (78.12 vs. 73.72; p = 0.001). Overall, positive working conditions and effective teamwork can contribute to improving employees' attitudes towards patient safety. CONCLUSIONS The results help identify unit level vulnerabilities associated with staff attitudes toward patient safety. They underscore the importance of management strategies that account for staff coping with occupational stressors to improve patient safety.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Agnieszka Micek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Krzysztof Gajda
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
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Niles PM, Vedam S, Witkoski Stimpfel A, Squires A. Kairos care in a Chronos world: Midwifery care as model of resistance and accountability in public health settings. Birth 2021; 48:480-492. [PMID: 34137073 DOI: 10.1111/birt.12565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the United States (US), pregnancy-related mortality is 2-4 times higher for Black and Indigenous women irrespective of income and education. The integration of midwifery as a fundamental component of standard maternity services has been shown to improve health outcomes and service user satisfaction, including among underserved and minoritized groups. Nonetheless, there remains limited uptake of this model in the United States. In this study, we examine a series of interdependent factors that shape how midwifery care operates in historically disenfranchised communities within the Unites States. METHODS Using data collected from in-depth, semi-structured interviews, the purpose of this study was to examine the ways midwives recount, describe, and understand the relationships that drive their work in a publicly funded urban health care setting serving minoritized communities. Using a qualitative exploratory research design, guided by critical feminist theory, twenty full-scope midwives working in a large public health care network participated. Data were thematically analyzed using Braun & Clarke's inductive thematic analysis to interpret data and inductively identify patterns in participants' experiences. FINDINGS The overarching theme "Kairos care in a Chronos World" captures the process of providing health-promoting, individualized care in a system that centers measurement, efficiency, and pathology. Five subthemes support the central theme: (1) the politics of progress, (2) normalizing pathologies, (3) cherished connections, (4) protecting the experience, and (5) caring for the social body. Midwives used relationships to sustain their unique care model, despite the conflicting demands of dominant (and dominating) medical models. CONCLUSION This study offers important insight into how midwives use a Kairos approach to maternity care to enhance quality and safety. In order to realize equitable access to optimal outcomes, health systems seeking to provide robust services to historically disenfranchised communities should consider integration of relationship-based strategies, including midwifery care.
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Affiliation(s)
| | - Saraswathi Vedam
- Birth Place Lab, University of British Columbia, Vancouver, BC, Canada
| | | | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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31
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Wilkinson R, Garden E, Nanyonga RC, Squires A, Nakaggwa F, Schwartz JI, Heller DJ. Causes of medication non-adherence and the acceptability of support strategies for people with hypertension in Uganda: A qualitative study. Int J Nurs Stud 2021; 126:104143. [PMID: 34953374 DOI: 10.1016/j.ijnurstu.2021.104143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is the most common non-communicable disease in Uganda and its prevalence is predicted to grow substantially over the next several years. Rates of hypertension control remain suboptimal, however, due in part to poor medication adherence. There is a significant need to better understand the drivers of poor medication adherence for patients with non-communicable diseases and to implement appropriate interventions to improve adherence. OBJECTIVE The purpose of this study was two-fold. First, this study sought to understand what factors support or undermine patients' efforts to adhere to their hypertensive medications at baseline. Second, this study sought to explore the acceptability and feasibility of adherence interventions to both providers and patients. METHODS This study was conducted at a large, urban private hospital in Kampala, Uganda. We conducted key informant interviews with both providers and patients. We explored their beliefs about the causes of medication non-adherence while examining the acceptability of support strategies validated in similar contexts, such as: daily text reminders, educational materials on hypertension, monthly group meetings (i.e. "adherence clubs") led by patients or providers, one-on-one appointments with providers, and modified drug dispensing at the hospital pharmacy. STUDY DESIGN AND PARTICIPANTS Fifteen healthcare providers and forty-two patients were interviewed. All interviews were transcribed, and these transcripts were analyzed using the NVIVO software. We utilized a conventional content analysis approach informed by the Health Belief Model. RESULTS Of the proposed interventions, participants expressed particularly strong interest in adherence clubs and educational materials. Participants drew connections between these interventions and previously underexplored drivers of non-adherence, which included the lack of symptoms from untreated hypertension, fear of medication side effects, interest in traditional herbal medicine, and the importance of family and community support. CONCLUSIONS Both providers and patients at the facility recognized medication non-adherence as a major barrier to hypertension control and expressed interest in improving adherence through interventions that addressed context-specific barriers.
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Affiliation(s)
- Rachel Wilkinson
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Evan Garden
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Rose Clarke Nanyonga
- Clarke International University, Kawagga Close, off Kalungi Road, Muyenga Block 244, Plot 8244 Bukasa Kyadondo, P.O.Box 7782, Kampala Uganda
| | - Allison Squires
- NYU Rory Meyers College of Nursing, 433 1st Avenue New York, NY 10010 USA
| | - Florence Nakaggwa
- Clarke International University, Kawagga Close, off Kalungi Road, Muyenga Block 244, Plot 8244 Bukasa Kyadondo, P.O.Box 7782, Kampala Uganda
| | | | - David J Heller
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA.
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Malinowska-Lipień I, Micek A, Gabryś T, Kózka M, Gajda K, Gniadek A, Brzostek T, Fletcher J, Squires A. Impact of the Work Environment on Patients' Safety as Perceived by Nurses in Poland-A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:12057. [PMID: 34831812 PMCID: PMC8623184 DOI: 10.3390/ijerph182212057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
Numerous studies have found that organizational features connected with the work environment of nurses have a significant influence on patients' safety. The aim of this research was to capture nurses' opinions about patients' safety and discern relationships with work environment characteristics. This cross-sectional study surveyed 1825 nurses. The research used questionnaire consisting of four parts: (1) covered The Practice Environment Scale of the Nursing Work Index (PES-NWI); (2) assessed the quality of nursing care and care safety; (3) contained information on the most recent duty served by the nurses and (4) captured social and demographic data of participants. The research identified strong association between patient safety assessment and work environment of nurses in the aspect of employment adequacy, cooperation between nurses and doctors, support for nurses from the managing staff, the possibility to participate in the management as well as professional promotion of nurses employed in the hospital (p < 0.001). Nurses rated patient safety higher when responsible for a smaller number of patients. Work environment factors such as proper staffing, good cooperation with doctors, support from the management, as well as professional independence are significantly related to nurses' assessment of patients' safety.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-501 Krakow, Poland; (A.M.); (T.G.); (M.K.); (A.G.); (T.B.)
| | - Agnieszka Micek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-501 Krakow, Poland; (A.M.); (T.G.); (M.K.); (A.G.); (T.B.)
| | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-501 Krakow, Poland; (A.M.); (T.G.); (M.K.); (A.G.); (T.B.)
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-501 Krakow, Poland; (A.M.); (T.G.); (M.K.); (A.G.); (T.B.)
| | - Krzysztof Gajda
- Institute of Public Health, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-066 Krakow, Poland;
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-501 Krakow, Poland; (A.M.); (T.G.); (M.K.); (A.G.); (T.B.)
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Medical College, Jagiellonian University, 31-501 Krakow, Poland; (A.M.); (T.G.); (M.K.); (A.G.); (T.B.)
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY 10012, USA; (J.F.); (A.S.)
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, NY 10012, USA; (J.F.); (A.S.)
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Malinowska-Lipień I, Wadas T, Gabryś T, Kózka M, Gniadek A, Brzostek T, Squires A. Evaluating Polish nurses' working conditions and patient safety during the COVID-19 pandemic. Int Nurs Rev 2021; 69:239-248. [PMID: 34716590 PMCID: PMC8653238 DOI: 10.1111/inr.12724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023]
Abstract
Aim To study the relationship between Polish nurses' working conditions and their attitudes towards patient safety during the COVID‐19 pandemic. Background Facing the COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, healthcare worldwide has been reorganised. How these changes affected patient safety for hospitalised persons is not well understood. Introduction Difficult working conditions related to the outbreak of the COVID‐19 pandemic may affect the provision of safe and effective care by healthcare staff. Methods This observational research was performed on the group of 577 nurses working during the COVID‐19 pandemic in isolation infection wards (n = 201) and non‐infectious diseases wards (n = 376) in Polish hospitals. The evaluation of working conditions was performed with an author's questionnaire, while the evaluation of factors influencing attitudes towards safety of the hospitalised patients was performed using Safety Attitudes Questionnaire. The STROBE checklist was used to report this study. Results The procedures developed by management in advance for COVID‐19 patient treatment had a statistically significant influence on nurses' ‘evaluation of teamwork climate, safety climate, job satisfaction, perception of management and work conditions’. Providing management with the ability to perform a swab polymerase chain reaction SARS‐CoV‐2 test for hospital staff in the workplace, and psychological support from professionals and employers were statistically significant for higher ratings of ‘teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and work conditions’ by the Polish nurses. Hospital workload during the COVID‐19 pandemic was significantly correlated with lower evaluation of work conditions. Discussion Our study reinforces the existing literature on many fronts and demonstrates how even when operating under the COVID‐19 pandemic conditions, some factors remain critical for fostering a culture of patient safety. Reinforcing patient safety practices is a imperative under these conditions. Conclusions and implications for nursing Working conditions influence nurses' attitudes towards safety of the hospitalised patients. These are largely modifiable factors related to the workplace and include prior preparation of procedures, restrictions to extending daily work hours and psychological counselling for the staff.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland.,Małopolska District Chamber of Nurses and Midwives in Krakow, Kraków, Poland
| | - Tadeusz Wadas
- Małopolska District Chamber of Nurses and Midwives in Krakow, Kraków, Poland
| | - Teresa Gabryś
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Kózka
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Brzostek
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Affiliation(s)
- Allison Squires
- NYU Rory Meyers College of Nursing, New York City, New York, USA.,NYU School of Medicine, New York City, New York, USA
| | - Roy Thompson
- Duke University School of Nursing, Durham, North Carolina, USA
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Squires A, Ma C, Miner S, Feldman P, Jacobs EA, Jones SA. Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: A retrospective analysis. Int J Nurs Stud 2021; 125:104093. [PMID: 34710627 DOI: 10.1016/j.ijnurstu.2021.104093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. OBJECTIVE To determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge. DESIGN Retrospective cross-sectional study of hospital readmissions from an urban home health care agency's administrative records and the national electronic home health care record for the United States, captured between 2010 and 2015. SETTING New York City, New York, USA. PARTICIPANTS The dataset comprised 90,221 post-hospitalization patients and 6.5 million home health care visits. METHODS First, a Chi-square test was used to determine if there were significant differences in crude readmission rates based on language group. Inverse probability of treatment weighting was used to adjust for significant differences in known hospital readmission risk factors between to examine all-cause hospital readmission during a home health care stay. The final matched sample included 87,561 patients with a language preference of English, Spanish, Russian, Chinese, or Korean. English-speaking patients were considered the comparison group to the non-English speaking patients. A Marginal Structural Model was applied to estimate the impact of non-English language preference against English language preference on rehospitalization. The results of the marginal structural model were expressed as an odds ratio of likelihood of readmission to the hospital from home health care. RESULTS Home health patients with a non-English language preference had a higher hospital readmission risk than English-speaking patients. Crude readmission rate for the limited English proficiency patients was 20.4% (95% CI, 19.9-21.0%) overall compared to 18.5% (95% CI, 18.7-19.2%) for English speakers (p < 0.001). Being a non-English-speaking patient was associated with an odds ratio of 1.011 (95% CI, 1.004-1.018) in increased hospital readmission rates from home health care (p = 0.001). There were also statistically significant differences in readmission rate by language group (p < 0.001), with Korean speakers having the lowest rate and Spanish speakers having the highest, when compared to English speakers. CONCLUSIONS People with a non-English language preference have a higher readmission rate from home health care. Hospital and home healthcare agencies may need specialized care coordination services to reduce readmission risk for these patients. Tweetable abstract: A new US-based study finds that home care patients with language barriers are at higher risk for hospital readmission.
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Affiliation(s)
- Allison Squires
- Director, Florence S. Downs PhD Program, Rory Meyers College of Nursing, Research Associate Professor, Department of General Internal Medicine, Grossman School of Medicine, New York University, 433 First Avenue, 6th floor, New York, NY 10010, United States.
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, United States.
| | - Sarah Miner
- Wegman's School of Nursing, St. John Fischer College, Rochester, NY, United States.
| | - Penny Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10017, United States.
| | - Elizabeth A Jacobs
- Maine Medical Center Research Institute, MaineHealth, Scarborough, ME 04047, United States.
| | - Simon A Jones
- Department of Population Health, Division of General Internal Medicine, Grossman School of Medicine, New York University, New York, NY 10010, United States.
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Abstract
BACKGROUND Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality. OBJECTIVE The objective of this study was to examine the association between continuity of nursing care in HHC and rehospitalization among PWD. RESEARCH DESIGN This is a retrospective cohort study using multiple years (2010-2015) of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency. SUBJECTS This study included 23,886 PWD receiving HHC following a hospitalization. MEASURES Continuity of nursing care was calculated using the Bice and Boxerman method, which considered the number of total visits, nurses, and visits from each nurse during an HHC episode. The outcome was all-cause rehospitalization during HHC. Risk-adjusted logistic regression was used for analysis. RESULTS Approximately 24% of PWD were rehospitalized. The mean continuity of nursing care score was 0.56 (SD=0.33). Eight percent of PWD received each nursing visit from a different nurse (no continuity), and 26% received all visits from one nurse during an HHC episode (full continuity). Compared with those receiving high continuity of nursing care (third tertile), PWD receiving low (first tertile) or moderate (second tertile) continuity of nursing care had an adjusted odds ratio of 1.33 (95% confidence interval: 1.25-1.46) and 1.30 (95% confidence interval: 1.22-1.43), respectively, for being rehospitalized. CONCLUSIONS Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, 433 First Ave., New York, NY 10010
| | - Margaret V. McDonald
- Center for Home Care Policy & Research at the Visiting Nurse Service of New York, 107 E. 70 St. New York, NY 10021
| | - Penny H. Feldman
- Center for Home Care Policy & Research at the Visiting Nurse Service of New York, 107 E. 70 St. New York, NY 10021
| | - Sarah Miner
- St. John Fisher College Wegmans School of Nursing, 3690 East Ave. Rochester, NY 14618
| | - Simon Jones
- Department of Population Health, NYU School of Medicine, 227 East 30 St., New York, NY 10016
| | - Allison Squires
- New York University Rory Meyers College of Nursing, 433 First Ave., New York, NY 10010
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Germack H, Cary M, Gilmartin H, Girouard S, Jones TM, Martin BJ, Norful AA, Anusiewicz CV, Riman KA, Schlak AE, Squires A, Estrada LV, Gazarian P, Gerchow L, Ghazal LV, Henderson MD, Mitha S, Mpundu G, Nikpour J, Royster M, Thompson R, Stolldorf DP. Leading Policy and Practice Change During Unprecedented Times: The Nursing Health Services Research Response. J Nurs Regul 2021; 12:56-60. [PMID: 34513205 DOI: 10.1016/s2155-8256(21)00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Background: Disparities in breastfeeding patterns by race and ethnicity in the United States have been documented, and Latinx ethnicity is often associated with higher rates of breastfeeding initiation and longer breastfeeding duration compared to other U.S. racial and ethnic groups. Despite marked differences in infant feeding practices in Latinx countries of origin, U.S. breastfeeding data are routinely presented with Latinx as a single category. Objective: To analyze breastfeeding duration of New York City Latinx mothers by birth region. Methods: Using data from the 2016 New York City Work and Family Leave Survey (WAFLS) surveying residents who gave birth in 2014, we conducted a survival analysis of breastfeeding duration in a sample of Latinx-identifying mothers (n = 271), who reported having ever breastfed their child. Kaplan-Meier survival curves for time to breastfeeding cessation were created for four birth regions (United States, Caribbean, Mexico/Central America, and South America) and compared using the log-rank test. Adjusted hazard ratios (AHRs) were calculated using Cox regression. Results: Survival curves and median breastfeeding duration were significantly different between the four regions. AHR models found that non-Caribbean birthplace was significantly associated with a lower risk of early breastfeeding cessation. Being partnered at the time of childbirth and neonate hospitalization of 6 days or longer was associated with a greater risk of earlier breastfeeding cessation. Conclusion: The significant differences reinforce the need to separate breastfeeding findings by birth region in the Latinx population. Within-group differences are lost in combined analyses and reinforce conclusions that Latinx mothers have optimal breastfeeding behaviors.
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Affiliation(s)
- Lauren Gerchow
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Allison Squires
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Simon Jones
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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Abstract
Depression represents a growing health problem and African American women (AAW) disproportionally experience increased risk and broad disparities in health care. This integrative review examines what is known about the equity of depression care provided to AAW. PubMed, PsychINFO, and Web of Science were searched through April 2020 for studies in peer-reviewed journals from 2015 to 2020. Across the studies (n = 7), AAW received inequitable care across a depression care cascade including lower rates of screening, treatment initiation, and guideline-concordant care. Here we explore individual-, relational-, and structural-level factors related to these disparities and implications for research, practice, and education.
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Affiliation(s)
| | - Yzette Lanier
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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Cochran KL, Doo K, Squires A, Shah T, Rinne S, Mealer M. Addressing Burnout Syndrome From a Critical Care Specialty Organization Perspective. AACN Adv Crit Care 2021; 31:158-166. [PMID: 32525998 DOI: 10.4037/aacnacc2020579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Health care specialty organizations are an important resource for their membership; however, it is not clear how specialty societies should approach combating stress and burnout on an organizational scale. OBJECTIVE To understand the prevalence of burnout syndrome in American Thoracic Society members, identify specialty-specific risk factors, and generate strategies for health care societies to combat burnout. METHODS Cross-sectional, mixed-methods survey in a sample of 2018 American Thoracic Society International Conference attendees to assess levels of burnout syndrome, work satisfaction, and stress. RESULTS Of the 130 respondents, 69% reported high stress, 38% met burnout criteria, and 20% confirmed chaotic work environments. Significant associations included sex and stress level; clinical time and at-home electronic health record work; and US practice and at-home electronic health record work. There were no significant associations between burnout syndrome and the selected demographics. Participants indicated patient care as the most meaningful aspect of work, whereas the highest contributors to burnout were workload and electronic health record documentation. Importantly, most respondents were unaware of available resources for burnout. CONCLUSIONS Health care specialty societies have access to each level of the health system, creating an opportunity to monitor trends, disseminate resources, and influence the direction of efforts to reduce workplace stress and enhance clinician well-being.
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Affiliation(s)
- Kathryn L Cochran
- Kathryn L. Cochran is Senior Behavioral Health Program Coordinator, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Rm 1201G, Aurora, CO 80045
| | - Kathleen Doo
- Kathleen Doo is Medical Doctor, Division of Pulmonary and Critical Care Medicine, The Permanente Medical Group, Oakland, California
| | - Allison Squires
- Allison Squires is Associate Professor, NYU Rory Meyers College of Nursing, New York University, New York, New York
| | - Tina Shah
- Tina Shah is Medical Director of Practice Improvement, WellStar Health System, Atlanta, Georgia
| | - Seppo Rinne
- Seppo Rinne is Assistant Professor, Boston University Pulmonary Center, Boston, Massachusetts
| | - Meredith Mealer
- Meredith Mealer is Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
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Squires A, Murali KP, Greenberg SA, Herrmann LL, D'amico CO. A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program. Gerontologist 2021; 61:e75-e84. [PMID: 31681955 DOI: 10.1093/geront/gnz150] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment. RESEARCH DESIGN AND METHODS Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. After critical appraisal, 43 articles were included. RESULTS Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. Specialized older adult care, a key feature of NICHE programs, resulted in improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. NICHE program adoption and refinement focuses on the methods used to improve care, implementation and adoption of the NICHE program, and measuring its impact. DISCUSSION AND IMPLICATIONS The evidence about the NICHE program in caring for older adults is promising but more studies examining patient outcomes and the impact on health care professionals are needed.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York.,Division of General Internal Medicine, Langone School of Medicine, New York University, New York, New York
| | | | | | - Linda L Herrmann
- Hartford Institute for Geriatric Nursing, New York University, New York, New York
| | - Catherine O D'amico
- Nurses Improving Care for Healthsystem Elders Program (NICHE), Rory Meyers College of Nursing, New York, New York
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Gerchow L, Burka LR, Miner S, Squires A. Language barriers between nurses and patients: A scoping review. Patient Educ Couns 2021; 104:534-553. [PMID: 32994104 PMCID: PMC8011998 DOI: 10.1016/j.pec.2020.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/05/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Global migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers. METHODS A systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists. RESULTS 48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions. CONCLUSION Generally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload. PRACTICE IMPLICATIONS This review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.
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Affiliation(s)
- Lauren Gerchow
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA.
| | - Larissa R Burka
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA
| | - Sarah Miner
- St. John Fisher College Wegmans School of Nursing, 3690 East Ave, Rochester, NY, USA
| | - Allison Squires
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA
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Steeb DR, Brock TP, Dascanio SA, Drain PK, Squires A, Thumm M, Tittle R, Haines ST. Entrustable Professional Activities (EPAs) for Global Health. Acad Med 2021; 96:402-408. [PMID: 33239533 PMCID: PMC7899746 DOI: 10.1097/acm.0000000000003856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings. METHOD In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains. RESULTS Twenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability. CONCLUSIONS EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions.
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Affiliation(s)
- David R. Steeb
- D.R. Steeb is clinical assistant professor and director, Global Engagement, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-7802-5422
| | - Tina P. Brock
- T.P. Brock is professor of pharmacy education and practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0001-7455-4063
| | - Sarah A. Dascanio
- S.A. Dascanio is a global engagement fellow, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-8999-4539
| | - Paul K. Drain
- P.K. Drain is associate professor, Department of Global Health, Department of Medicine (infectious diseases), and Department of Epidemiology, and associate director, Tuberculosis Research and Training Center, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0003-3300-3817
| | - Allison Squires
- A. Squires is associate professor, New York University Rory Meyers College of Nursing, New York, New York, and she is currently the distinguished nurse scholar in residence, National Academy of Medicine; ORCID: https://orcid.org/0000-0002-5238-2122
| | - Melissa Thumm
- M. Thumm is an independent global health consultant and former senior technical advisor, Management Sciences for Health, Denver, Colorado
| | - Robin Tittle
- R. Tittle is assistant professor, Oregon Health and Science University, Portland, Oregon, and curriculum director, University of California, San Francisco, HEAL Initiative, Oakland, California
| | - Stuart T. Haines
- S.T. Haines is professor of pharmacy practice and director, Division of Pharmacy Professional Development, University of Mississippi School of Pharmacy, Oxford, Mississippi; ORCID: https://orcid.org/0000-0001-8217-1871
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Abstract
PURPOSE OF REVIEW The purpose of this review was to assess the prevalence of United States chronic kidney disease (CKD) health disparities, focusing on racial/ethnic groups, immigrants and refugees, sex or gender, and older adults. RECENT FINDINGS There are major racial/ethnic disparities in CKD, with possible contributions from the social determinants of health, socioeconomics, and racial discrimination. Racial/ethnic minority patients experience faster progression to end-stage kidney disease (ESKD) and higher mortality predialysis, however, once on dialysis, appear to live longer. Similarly, men are quicker to progress to ESKD than women, with potential biological, behavioral, and measurement error factors. There is a lack of substantial evidence for intersex, nonbinary, or transgender patients. There are also strikingly few studies about US immigrants or older adults with CKD despite the fact that they are at high risk for CKD due to a variety of factors. SUMMARY As providers and scientists, we must combat both conscious and unconscious biases, advocate for minority patient populations, and be inclusive and diverse in our treatment regimens and provision of care. We need to acknowledge that sufficient evidence exists to change treatment guidelines, and that more is required to support the diversity of our patient population.
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Affiliation(s)
| | - Eleanor Rivera
- Assistant Professor, University of Illinois Chicago College of Nursing, Chicago, Illinois
| | - Christin Iroegbu
- Doctoral Student, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Allison Squires
- Associate Professor, NYU Meyers College of Nursing, New York, New York, USA
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Wittleder S, Smith S, Wang B, Beasley JM, Orstad SL, Sweat V, Squires A, Wong L, Fang Y, Doebrich P, Gutnick D, Tenner C, Sherman SE, Jay M. Peer-Assisted Lifestyle (PAL) intervention: a protocol of a cluster-randomised controlled trial of a health-coaching intervention delivered by veteran peers to improve obesity treatment in primary care. BMJ Open 2021; 11:e043013. [PMID: 33637544 PMCID: PMC7919589 DOI: 10.1136/bmjopen-2020-043013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Among US veterans, more than 78% have a body mass index (BMI) in the overweight (≥25 kg/m2) or obese range (≥30 kg/m2). Clinical guidelines recommend multicomponent lifestyle programmes to promote modest, clinically significant body mass (BM) loss. Primary care providers (PCPs) often lack time to counsel and refer patients to intensive programmes (≥6 sessions over 3 months). Using peer coaches to deliver obesity counselling in primary care may increase patient motivation, promote behavioural change and address the specific needs of veterans. We describe the rationale and design of a cluster-randomised controlled trial to test the efficacy of the Peer-Assisted Lifestyle (PAL) intervention compared with enhanced usual care (EUC) to improve BM loss, clinical and behavioural outcomes (aim 1); identify BM-loss predictors (aim 2); and increase PCP counselling (aim 3). METHODS AND ANALYSIS We are recruiting 461 veterans aged 18-69 years with obesity or overweight with an obesity-associated condition under the care of a PCP at the Brooklyn campus of the Veterans Affairs NY Harbor Healthcare System. To deliver counselling, PAL uses in-person and telephone-based peer support, a tablet-delivered goal-setting tool and PCP training. Patients in the EUC arm receive non-tailored healthy living handouts. In-person data collection occurs at baseline, month 6 and month 12 for patients in both arms. Repeated measures modelling based on mixed models will compare mean BM loss (primary outcome) between study arms. ETHICS AND DISSEMINATION The protocol has been approved by the Institutional Review Board and the Research and Development Committee at the VA NY Harbor Health Systems (#01607). We will disseminate the results via peer-reviewed publications, conference presentations and meetings with stakeholders. TRIAL REGISTRATION NUMBER NCT03163264; Pre-results.
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Affiliation(s)
- Sandra Wittleder
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Shea Smith
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Binhuan Wang
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Jeannette M Beasley
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Stephanie L Orstad
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Victoria Sweat
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Laura Wong
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Yixin Fang
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Paula Doebrich
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Damara Gutnick
- Department of Epidemiology & Population Health, Department of Family & Social Medicine, Department of Psychiatry & Behavioral Sciences, The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Craig Tenner
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
- Veterans Affairs New York Harbor Healthcare System, Veterans Health Administration, New York City, New York, USA
| | - Scott E Sherman
- Veterans Affairs New York Harbor Healthcare System, Veterans Health Administration, New York City, New York, USA
- Department of Population Health, Department of Medicine, Department of Psychiatry, New York University School of Medicine, New York City, New York, USA
| | - Melanie Jay
- Veterans Affairs New York Harbor Healthcare System, Veterans Health Administration, New York City, New York, USA
- Department of Medicine, Department of Population Health, New York University School of Medicine, New York City, New York, USA
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Malinowska-Lipień I, Brzyski P, Gabryś T, Gniadek A, Kózka M, Kawalec P, Brzostek T, Squires A. Cultural adaptation of the Safety Attitudes Questionnaire - Short Form (SAQ-SF) in Poland. PLoS One 2021; 16:e0246340. [PMID: 33544732 PMCID: PMC7864443 DOI: 10.1371/journal.pone.0246340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background It is essential to provide safe healthcare in complex, difficult, and quickly changing conditions. The quality of healthcare services directly influences the safety of both the patients and staff. Understanding healthcare staff attitudes toward safety in the healthcare delivery context is foundational for building a culture of safety. Aim of the work To adapt, via a structured translation methodology, the Safety Attitudes Questionnaire–Short Form (SAQ-SF), which assesses how employees of the health care sector perceive the safety climate in their workplace, to the Polish context. Methods Using a content validation approach to structure the translation process, we tested and psychometrically analysed the translated SAQ-SF. The sample comprised 322 employees of a district hospital (second referral level, which ensures 24/7 emergency care services) in Poland. Results The reliability of the sub-scales of the Polish version of the SAQ-SF ranged from 0.66 to 0.95. The discriminatory power of particular SAQ items ranged between 0.02 and 0.90. For 6 out of the 8 scale dimensions, the questions with the highest factor loadings were those measuring the same dimensions of the safety climate, according to the original scale. Conclusions The Polish version of the SAQ-SF (SAQ-SF-PL) meets the criteria of psychometric and functional validation as well as demonstrates good reliability as a measure of patient safety culture in the Polish context. The SAQ-SF-PL is an instrument that enable a valid and reliable assessment of patient safety climate in the Polish healthcare facilities and identify opportunities for improvement. International comparisons will also become easier.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
- * E-mail:
| | | | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Paweł Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University–Medical College, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
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Stolldorf D, Germack HD, Harrison J, Riman K, Brom H, Cary M, Gilmartin H, Jones T, Norful A, Squires A. Health Equity Research in Nursing and Midwifery: Time to Expand Our Work. J Nurs Regul 2020; 11:51-61. [PMID: 32834909 PMCID: PMC7363434 DOI: 10.1016/s2155-8256(20)30110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Squires A, Miner S, Greenberg SA, Adams J, Kalet A, Cortes T. Graduate level health professions education: how do previous work experiences influence perspectives about interprofessional collaboration? J Interprof Care 2020; 35:193-199. [PMID: 32506976 DOI: 10.1080/13561820.2020.1732888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants' previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, New York, NY, USA.,Division of General Internal Medicine, School of Medicine, New York University, New York, NY, USA
| | - Sarah Miner
- Wegman's School of Nursing, St. John Fischer University, Rochester, NY, USA
| | - Sherry A Greenberg
- Rory Meyers College of Nursing, New York University, New York, NY, USA.,Hartford Institute for Geriatric Nursing at Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Jennifer Adams
- Division of General Internal Medicine, School of Medicine, New York University, New York, NY, USA
| | - Adina Kalet
- Division of General Internal Medicine, School of Medicine, New York University, New York, NY, USA
| | - Tara Cortes
- Rory Meyers College of Nursing, New York University, New York, NY, USA.,Hartford Institute for Geriatric Nursing at Rory Meyers College of Nursing, New York University, New York, NY, USA
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Lynch HM, Green AS, Clarke Nanyonga R, Gadikota-Klumpers DD, Squires A, Schwartz JI, Heller DJ. Exploring patient experiences with and attitudes towards hypertension at a private hospital in Uganda: a qualitative study. Int J Equity Health 2019; 18:206. [PMID: 31888767 PMCID: PMC6937689 DOI: 10.1186/s12939-019-1109-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Hypertension is the leading risk factor for mortality worldwide and is more common in sub-Saharan Africa than any other region. Work to date confirms that a lack of human and material resources for healthcare access contributes to this gap. The ways in which patients’ knowledge and attitudes toward hypertension determine their engagement with and adherence to available care, however, remains unclear. Methods We conducted an exploratory, qualitative descriptive study to assess awareness, knowledge, and attitudes towards hypertension and its management at a large private hospital in Kampala. We interviewed 64 participants (29 with hypertension and 34 without, 1 excluded) in English. General thematic analysis using the Integrated Conceptual Health Literacy Model was used to iteratively generate themes and categories. Results We identified three main themes: Timing of Hypertension Diagnosis, Aiming for Health Literacy, and the Influence of Knowledge on Behavior. Most participants with hypertension learned of their condition incidentally, speaking to the lack of awareness of hypertension as an asymptomatic condition. Drove nearly all participants to desire more information. However, many struggled to translate knowledge into self-management behaviors due to incomplete information and conflicting desires of participants regarding lifestyle and treatment. Conclusions Internal patient factors had a substantial impact on adherence, calling attention to the need for educational interventions. Systemic barriers such as cost still existed even for those with insurance and need to be recognized by treating providers.
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Affiliation(s)
- Hayley M Lynch
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA
| | - Aliza S Green
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA
| | | | - Darinka D Gadikota-Klumpers
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA
| | | | - Jeremy I Schwartz
- Section of General Internal Medicine, Yale School of Medicine, New Haven, USA
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, New York, NY, 10029, USA.
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Aristizabal P, Nigenda G, Squires A, Rosales Y. Regulation of nursing in Mexico: actors, processes and outcomes. Cien Saude Colet 2019; 25:233-242. [PMID: 31859871 DOI: 10.1590/1413-81232020251.28462019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022] Open
Abstract
This paper aims to analyze the regulatory structure of nursing in Mexico through its legislation and perspectives of participant stakeholders. A case study was undertaken using qualitative and quantitative data sources, as well as from the review of official documents. The analysis included data from the sources according to the four realms proposed by the Moran & Wood (1993) model. The more advanced realm was the market entry since the state regulates entry through a license of practice. The regulation of competition is weak, showing very reduced areas of autonomous practice. The labor market is offering a wide variety of entry options with clear signs of deterioration. The dominant payment mechanism is salary, showing a structure that incorporates a component that does not impact on pensions at the end of the labor cycle. The regulation of nursing is a component of its professionalization, and as such, it is understood as a multidimensional consolidating process, particularly realms related to the regulation of competition, market structure, and payment mechanisms, in which nursing representatives should play a more active role in the future.
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Affiliation(s)
- Patricia Aristizabal
- Facultad de Estudios Superiores Iztacala. Universidad Nacional Autónoma de México. Av. De los Barrios 1, Hab. Los Reyes Iztacala, Barrio de los Arboles / Barrio de los Héroes. 54090 Tlalnepantla de Baz Edo. México México.
| | - Gustavo Nigenda
- Escuela Nacional de Enfermería y Obstetricia. Universidad Nacional Autónoma de México. Ciudad de México México
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