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BMC Nursing Oct 2023Adequate and intensive nursing care was a key characteristic of recovery of the COVID-19 patients globally and in Uganda. However, there is limited literature on the...
INTRODUCTION
Adequate and intensive nursing care was a key characteristic of recovery of the COVID-19 patients globally and in Uganda. However, there is limited literature on the experiences of nurses who participated in the care of COVID-19 patients in Uganda, East Africa, and Africa at large, yet imperative in designing approaches to increase the efficiency of the health systems' response to future pandemics. To address this gap, this study aimed to explore the experiences of the nurses who managed COVID-19 patients at Mulago National Referral Hospital in Uganda.
METHODS
This was an exploratory qualitative study that used purposive sampling to identify 21 nurses who treated COVID-19 patients at Mulago National Referral Hospital in Uganda. Focus Group Discussions were used to collect data. Thematic Analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes.
RESULTS
Six themes were identified: 1) Motivation to work on COVID-19 patients, 2 ) Roles performed by nurses, 3) High workload and professional role strain, 4) Challenges with maintaining personal health and relationships, 5) Institutional and government support, 6) Acquired professional knowledge and skills to manage critical patients and epidemics. Most of the nurses faced work burnout, social isolation, stress, and psychological trauma. However, interprofessional collaboration, financial incentives, government recognition, and provision of personal protective equipment, were key motivators for the nurses. The majority reported to have gained new knowledge and skills in the management of pandemics and highly infectious diseases.
CONCLUSION
The nurses experienced negative scenarios like work burnout due to high workload, social isolation, and psychological stress. Therefore, there is a need for health systems to develop approaches and policies that support nurses' well-being. Nevertheless, key attributes like resilience, adaptability, and diligence to serve enabled them to persevere despite the hardships faced.
PubMed: 37789285
DOI: 10.1186/s12912-023-01503-6 -
BMC Health Services Research Dec 2023Maternal and neonatal health services are life-saving interventions for neonatal health outcomes. As Rwanda endeavors to accomplish sustainable development goals,...
BACKGROUND
Maternal and neonatal health services are life-saving interventions for neonatal health outcomes. As Rwanda endeavors to accomplish sustainable development goals, adequate ANC is essential to lessen of neonatal mortality. The utilization of ANC continues to be inadequate and high neonatal mortality rate persevere in Rwanda. Understanding the direct and indirect factors that affect newborn health outcomes is necessary for well-targeted interventions. However, few studies had been conducted in Rwanda to evaluate the importance of ANC in improving neonatal health. This study therefore assessed the association between ANC and neonatal outcomes.
METHODS
The Demographic and Health Surveys (DHS) are household surveys that are cross-sectional, nationally representative, and used to collect data on population, health, and nutrition. Data from the 2010,2015 and 2020 Rwanda Demographic and Health Surveys (RDHS) were used. The study involved 17,747 women between the ages of 15 and 49 who had a single live birth and at least one ANC visit in five years prior to each survey. Bivariate and multivariable logistic regression, a survey adjusted for clusters at multiple level, and the estimation of adjusted odds ratios (aOR) and 95% confidence intervals were used to evaluate the relationship between the outcome and independent variables.
RESULTS
Out of 17,747 women ;7638(42.91%) of the mothers had adequate ANC visits and low birth weight (LBW) was found among 833(4.63%) neonates. The birth of a LBW baby (aOR:4.64;95%CI:3.19,6.74) was directly related to increased odds of neonatal death. Mothers aged 20-34 years (aOR:0.40; 95%CI:0.20,0.81), a preceding birth interval of 24months or greater (aOR:0.41:95%CI:0.28,0.60), baby being female (aOR:0.72; 95%CI:0.54,0.96), having adequate ANC visits (aOR:0.64;95% CI:0.46,0.89) and the birth order of the newborn being ranked second or third (aOR:0.60; 95%CI:0.38,0.95) were negatively associated with neonatal death.
CONCLUSION
Health education programs targeting teen and primigravida mothers should be encouraged. Among the newborn survival interventions, addressing short birth intervals and the effective management of LBW cases should be explored. The findings confirm the fundamental importance of adequate ANC in the neonatal survival.
Topics: Infant, Newborn; Infant; Adolescent; Female; Pregnancy; Humans; Young Adult; Adult; Middle Aged; Male; Prenatal Care; Cross-Sectional Studies; Perinatal Death; Rwanda; Patient Acceptance of Health Care; Mothers; Infant Mortality; Family Characteristics; Health Surveys
PubMed: 38066497
DOI: 10.1186/s12913-023-10345-6 -
Critical Care Explorations Jan 2024Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk...
OBJECTIVES
Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based risk strata upon adjusting for illness severity, presence of severe acute kidney injury (acute kidney injury), and use of continuous renal replacement therapy (CRRT) in pediatric septic shock.
DESIGN
Ongoing multicenter prospective observational cohort.
SETTING
Thirteen PICUs in the United States (2003-2023).
PATIENTS
Six hundred and eighty-one children with septic shock.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Cumulative percent PFB between days 1 and 7 (days 1-7 %PFB) was determined. Primary outcome of interest was complicated course defined as death or persistence of greater than or equal to two organ dysfunctions by day 7. Pediatric Sepsis Biomarker Risk Model (PERSEVERE)-II biomarkers were used to assign mortality probability and categorize patients into high mortality ( = 91), intermediate mortality ( = 134), and low mortality ( = 456) risk strata. Cox proportional hazard regression models with adjustment for PERSEVERE-II mortality probability, presence of sepsis-associated acute kidney injury on day 3, and use of CRRT, demonstrated that time-dependent variable days 1-7%PFB was independently associated with an increased hazard of complicated course. Risk-stratified analyses revealed that each 10% increase in days 1-7 %PFB was associated with increased hazard of complicated course only among patients with high mortality risk strata (adjusted hazard ratio 1.24 (95% CI, 1.08-1.43), = 0.003). However, this association was not causally mediated by PERSEVERE-II biomarkers.
CONCLUSIONS
Our data demonstrate the influence of cumulative %PFB on the risk of complicated course in pediatric septic shock. Contrary to our previous report, this risk was largely driven by patients categorized as having a high mortality risk based on PERSEVERE-II biomarkers. Incorporation of such prognostic enrichment tools in randomized trials of restrictive fluid management or early initiation of de-escalation strategies may inform targeted application of such interventions among at-risk patients.
PubMed: 38234587
DOI: 10.1097/CCE.0000000000001027 -
Asian Nursing Research Feb 2024During the COVID-19 pandemic, nurses have faced many professional and ethical dilemmas and challenges along with bearing physical, mental, and emotional stress resulting...
PURPOSE
During the COVID-19 pandemic, nurses have faced many professional and ethical dilemmas and challenges along with bearing physical, mental, and emotional stress resulting from worrying about themselves or their family being infected and stigmatized. This stress can potentially lead to burnout and resignation. Professional resilience is crucial for nurses to cope with these adverse situations. This study aimed to investigate the process by which nurses adapt, change, and overcome challenges during the COVID-19 pandemic and ultimately demonstrate professional resilience.
METHODS
Descriptive phenomenology was applied. Semi-structured interviews were conducted with 11 nurses working in COVID-19 wards and intensive care units to collect data. Giorgi's phenomenological analysis method was employed.
RESULTS
Based on the interview responses, four major themes were identified: 1) balancing patient care, self-protection, and passing on experience; 2) providing timely pandemic team resources and social support; 3) nurses' perseverance amid social discourse and constrained lives; and 4) selfless dedication shaping nursing's pinnacle experiences.
CONCLUSIONS
In the face of a sudden pandemic, frontline nurses play a critical role in maintaining medical capacity. Consequently, they must balance their families, lives, and work while adapting to the impact of the pandemic and changing practices and procedures based on the development of the pandemic and policy demands. The study findings provide insights into the challenges and emotional experiences encountered by nurses during a sudden pandemic outbreak and can serve as a reference for developing strategies to help nurses overcome these challenges and enhance their professional resilience.
Topics: Humans; COVID-19; Pandemics; Resilience, Psychological; Patients; Disease Outbreaks; Qualitative Research; Nurses
PubMed: 38246233
DOI: 10.1016/j.anr.2024.01.003 -
The Oncologist May 2024Indolent non-Hodgkin's lymphomas (iNHL) are a heterogenous group of mostly incurable diseases with prolonged illness courses and prognostic uncertainty. Yet, studies...
BACKGROUND
Indolent non-Hodgkin's lymphomas (iNHL) are a heterogenous group of mostly incurable diseases with prolonged illness courses and prognostic uncertainty. Yet, studies evaluating coping and perception of prognosis are limited.
METHODS
We conducted a cross-sectional study of adults newly diagnosed with iNHL in the past 3 months at a single academic center. We assessed quality of life (QOL: Functional Assessment of Cancer Therapy-General), psychological symptoms (Hospital Anxiety and Depression Scale), coping (Brief-COPE), and perception of prognosis (Prognosis Awareness Impact Scale).
RESULTS
We enrolled 70.6% (48/68) of eligible patients. Patients had older age (mean = 66.9,sd = 10.5), were female (60.4%), predominantly identified as White (85.4%), and had at least received a college degree (75%). Chronic lymphocytic leukemia (39.6%) and follicular lymphoma (33.3%) were the most common diagnoses. Overall, 27.1% and 14.6% of patients reported clinically significant anxiety and PTSD symptoms, respectively. Patients highly utilized acceptance (56.2%), seeking emotional support (47.9%), and denial (47.9%) as coping strategies at diagnosis. While 66.7% of patients recalled their oncologist assessment of illness as incurable, only 35.4% reported that the illness is unlikely to be cured. Overall, 45.8% indicated that they were worried about prognosis and 31.2% reported perseverating on their prognosis. Higher emotional coping with prognosis was associated with fewer anxiety (B = -0.6, SE = 0.2, P < .001), depression (B = -0.3, SE = .1, P = .005), and PTSD (B = -1.3, SE = 0.4, P < .001) symptoms and better QOL (B = 1.7, SE = 0.4, P < .001).
DISCUSSION
Patients with iNHL report substantial psychological distress, a diversity of coping strategies, and complex cognitive understanding of their prognosis. Interventions, which address prognostic uncertainty and promote positive emotional coping with prognosis, may ameliorate psychological distress in this population.
Topics: Humans; Female; Male; Prognosis; Lymphoma, Non-Hodgkin; Adaptation, Psychological; Aged; Cross-Sectional Studies; Middle Aged; Quality of Life; Anxiety; Depression; Adult
PubMed: 37935593
DOI: 10.1093/oncolo/oyad295 -
Behavioral Sciences (Basel, Switzerland) Feb 2024The study of the relationship between key psychological attributes of learners and their engagement in second language (L2) learning helps to understand the critical...
The study of the relationship between key psychological attributes of learners and their engagement in second language (L2) learning helps to understand the critical personality mechanisms influencing language learning. The present study examined the L2 learning engagement from the perspectives of grit (i.e., consistent efforts and interests devoted to a long-term goal) and affect balance (a notion that takes into account both positive and negative emotions concurrently, assessing and evaluating which side holds more significance or influence). A cohort of English L2 learners ( = 394) participated in an online survey aimed at gauging their levels of grit, affect balance, and engagement in L2 learning. The results indicated that grit and affect balance were significantly correlated with behavioral engagement and affective engagement in L2 learning. However, among the two components of grit, namely consistency of interest, showed no significant relationship with L2 learning engagement, while perseverance of effort was significantly positively correlated with L2 learning engagement. Affect balance played a partially mediating and full mediating role between perseverance of effort and behavioral engagement as well as affective engagement respectively. These findings confirm the crucial role of perseverance of effort in second language learning and reveal the unique role of affect balance in their relationship.
PubMed: 38540487
DOI: 10.3390/bs14030184 -
BioRxiv : the Preprint Server For... Jul 2023To survive, animals must meet their biological needs while simultaneously avoiding danger. However, the neurobiological basis of appetitive and aversive survival...
UNLABELLED
To survive, animals must meet their biological needs while simultaneously avoiding danger. However, the neurobiological basis of appetitive and aversive survival behaviors has historically been studied using separate behavioral tasks. While recent studies in mice have quantified appetitive and aversive conditioned responses simultaneously (Heinz et al., 2017; Jikomes et al., 2016), these tasks required different behavioral responses to each stimulus. As many brain regions involved in survival behavior process stimuli of opposite valence, we developed a paradigm in which mice perform the same response (nosepoke) to distinct auditory cues to obtain a rewarding outcome (palatable food) or avoid an aversive outcome (mild footshoock). This design allows for both within- and between-subject comparisons as animals respond to appetitive and aversive cues. The central nucleus of the amygdala (CeA) is implicated in the regulation of responses to stimuli of either valence. Considering its role in threat processing (Haubensak et al., 2010; Wilensky et al., 2006) and regulation of incentive salience (Warlow and Berridge, 2021), it is important to examine the contribution of the CeA to mechanisms potentially underlying comorbid dysregulation of avoidance and reward (Bolton et al., 2009; Sinha, 2008). Using this paradigm, we tested the role of two molecularly defined CeA subtypes previously linked to consummatory and defensive behaviors. Significant strain differences in the acquisition and performance of the task were observed. Bidirectional chemogenetic manipulation of CeA somatostatin (SOM) neurons altered motivation for reward and perseveration of reward-seeking responses on avoidance trials. Manipulation of corticotropin-releasing factor neurons (CRF) had no significant effect on food reward consumption, motivation, or task performance. This paradigm will facilitate investigations into the neuronal mechanisms controlling motivated behavior across valences.
SIGNIFICANCE STATEMENT
It is unclear how different neuronal populations contribute to reward- and aversion-driven behaviors within a subject. To address this question, we developed a novel behavioral paradigm in which mice obtain food and avoid footshocks via the same operant response. We then use this paradigm to test how the central amygdala coordinates appetitive and aversive behavioral responses. By testing somatostatin-IRES-Cre and CRF-IRES-Cre transgenic lines, we found significant differences between strains on task acquisition and performance. Using chemogenetics, we demonstrate that CeA SOM+ neurons regulate motivation for reward, while manipulation of CeA CRF+ neurons had no effect on task performance. Future studies investigating the interaction between positive and negative motivation circuits should benefit from the use of this dual valence paradigm.
PubMed: 37461627
DOI: 10.1101/2023.07.07.547979 -
Journal of Applied Gerontology : the... Jul 2023Social prescribing is a non-clinical approach to addressing social, environmental, and economic factors affecting how people feel physical and/or emotionally. It...
Social prescribing is a non-clinical approach to addressing social, environmental, and economic factors affecting how people feel physical and/or emotionally. It involves connecting people to "community assets" (e.g., local groups, organizations, and charities) that can contribute to positive well-being. We sought to explain in what ways, for whom, and why the cultural sector can support social prescribing with older people. We conducted semi-structured interviews with 28 older people (aged 60+) and 25 cultural sector staff. The following nine concepts, developed from interview data, progressed the understanding of tailoring cultural offers, which came from our previous realist review- Through tailoring, we propose that older people might experience one or more of the following benefits from engaging with a cultural offer as part of social prescribing-being immersed, psychological holding, connecting, and transforming through self-growth.
Topics: Aged; Humans; Social Inclusion; Health Status
PubMed: 36724235
DOI: 10.1177/07334648231154043 -
Brain Sciences Dec 2023In recent years, there has been a growing interest in increasing motivational factors within the domain of psychology. Among these factors, Grit, Mindset, Self-Efficacy,...
In recent years, there has been a growing interest in increasing motivational factors within the domain of psychology. Among these factors, Grit, Mindset, Self-Efficacy, and Well-Being (Flourishing) have been suggested to play an important role in individuals' performance and Well-Being. Thus, cultivating these factors in the general population is important. Previous interventions have displayed substantial effects in certain areas. However, these interventions have primarily been Mindset oriented. This paper presents a novel intervention approach by also emphasizing the importance of brain development; the importance of stimuli for building a network in the brain; the importance of repetition for strengthening the network; and the importance of perseverance and deliberate practice for achievement. The purpose of the current study was to examine the effects of a 35-40 min online intervention to increase the beliefs of 'I CAN' for 38 university students in Norway. The mean age of the 38 participants was 22.55 (SD = 1.59) and they completed a pre-test assessment of the Grit-S Scale, Theories of Intelligence Scale (Mindset), General Self-Efficacy Scale, and Flourishing Scale (Well-Being). This was followed up by the novel intervention and finally a post-test of the scales eight weeks later. The results showed an increase in Grit, Self-Efficacy, and Well-Being. However, only Grit displayed a significant increase. We aimed at creating an intervention where the participants would "turn on the switch", meaning that they develop stronger beliefs. These promising results warrant a further development of the intervention, and studies with a larger group.
PubMed: 38248248
DOI: 10.3390/brainsci14010033 -
Healthcare (Basel, Switzerland) Jul 2023The electronic sharing of health information holds the potential to enhance communication and coordination among hospitals and providers, ultimately leading to improved...
The electronic sharing of health information holds the potential to enhance communication and coordination among hospitals and providers, ultimately leading to improved hospital performance. However, despite the benefits, hospitals often encounter significant challenges when it comes to sharing information with external parties. Our study aimed to identify the circumstances under which sharing information with external parties can result in changes in overall hospital costs, with a particular emphasis on various obstacles that hospitals may encounter, including lack of incentives or capabilities essential to facilitate effective information exchange. To achieve this goal, we obtain data from multiple sources, including the American Hospital Association (AHA) annual and IT surveys, the Center for Medicare and Medicaid Services (CMS) hospital compare dataset, and the Census Bureau's small-area income and poverty estimates. Consistent with previous research, we observed a significant reduction in hospital costs when information was shared internally but not externally. However, our findings also revealed that the sharing of health information can lead to cost savings for hospitals when they encounter challenges such as the absence of incentives and capabilities regardless of whether the information is shared internally or externally. The implication of our study is simple but strong: perseverance and effort yield positive outcomes. Only when hospitals push through challenges related to sharing information can they achieve the anticipated advantages of information sharing. Based on our results, we suggest that policymakers should strategically target hospitals and providers that face challenges in sharing health information rather than focusing on those without obstacles. This targeted approach can significantly increase policy efficiency, and we emphasize the need for policymakers to address the specific areas where hospitals and providers encounter difficulties. By doing so, they can effectively "scratch where it itches" and address the core issues hindering the successful exchange of health information.
PubMed: 37510464
DOI: 10.3390/healthcare11142023