Background: Continuous glucose monitors (CGMs) are associated with improved HgA1C and quality of life but have historically been less accessible to underserved populations. The 2022 changes to California Medicaid switched CGM coverage from Durable Medical Equipment to expanded pharmacy benefits which increased CGM access for Medi-Cal beneficiaries with Type 2 Diabetes (T2DM). These reimbursement changes necessitate opportunities to support CGM use among the Latinx population, which is significantly impacted by T2DM and remains disproportionately underserved and understudied. Objectives: To evaluate the effectiveness of a CGM educational intervention on diabetes empowerment, CGM adherence, diabetes distress, glucose monitoring satisfaction, and blood glucose regulation for Latinx adults with T2DM who have been prescribed a CGM. Methods: Participants for this pilot study were recruited at a Federally Qualified Health Center in Southern California from a primary interprofessional research study focused on patient outcomes of CGM use within underserved populations. Inclusion criteria included Spanish-speaking Latinx adults (18 years and older) diagnosed with T2DM who were prescribed a CGM. Ten participants agreed to attend a Spanish-speaking, in-person educational intervention with enhanced telephonic follow-up. The Diabetes Empowerment Scale Short Form (DES-SF) measured diabetes empowerment and was administered pre-intervention, immediately post-intervention, and six weeks post-intervention. CGM adherence and blood glucose regulation were measured by the CGM device and collected pre-intervention and six weeks post-intervention. Glucose-monitoring satisfaction scores and diabetes distress scores were administered pre-intervention and six weeks post-intervention.

Results: Statistical significance was observed post-intervention in glucose monitoring satisfaction and CGM adherence. CGM adherence increased by 80%, and blood glucose control results varied one month after the intervention. Improvements were also demonstrated in diabetes distress and diabetes empowerment, although not statistically significant. The need for language-concordant health education and interventions focused on supporting Latinx adults with T2DM should continue to be explored. Conclusion: An educational intervention on CGMs, problem-solving barriers to CGM use, and diabetes empowerment in Latinx adults with T2DM provides preliminary data on the potential for improving CGM adherence, diabetes empowerment, and glucose monitoring satisfaction while decreasing diabetes distress. Further research on a larger sample is necessary.

Background: A 282-bed community-based hospital in Southern California with a newly established palliative care program has experienced low rates of medical orders for palliative care consultations. Many intensive care unit (ICU) patients have elevated mortality risk and nearly 20% of all patients in the United States die in an ICU. New palliative care programs experience underutilization of services and consultations occur late in the course of patients’ hospitalization when the full benefits of palliative care cannot be realized. Various studies have explored introduction of screening tools to help identify patients who could benefit from palliative care services. Objectives: This DNP project examined incorporating a mortality screening tool to determine if mortality risk upon patient admission to the ICU impacts the number and timing of medical orders for palliative care consultations. The project also explored ICU nurses’ knowledge and attitude regarding palliative care and nurses’ self-efficacy of using the SOFA screening and discussing results in ICU multidisciplainary rounds after taking a palliative care learning module. Methods: A pilot project was initiated that included nurses completing a Sequential Organ Failure Assessment (SOFA) score upon patient admission to the ICU and discussion of findings during ICU rounding. The number and timing of palliative care consultation orders were collected for 7-weeks prior to the intervention and for 7-weeks post intervention. ICU nurses took a 51-minute online educational session on the goals and benefits of palliative care and the use of SOFA and completed a demographic questionnaire and a brief survey regarding their attitudes and knowledge about palliative care. Results: Twenty-one nurses took the educational module and had improved attitude about palliative care and gained self-efficacy in performing a SOFA assessment and discussing results in ICU rounds. In the pre-intervention period, there were a total of 199 patient admissions and 224 in the post intervention period. Incorporation of a mortality screening tool did not increase the number of palliative care consultation orders but did improve the timeliness of orders. In the pre-intervention period, the mean medical order for a palliative care consultation was placed 12.8 days after ICU admission and post-intervention, this was reduced to 5.5 days. A random sample of patients received SOFA scoring, 43 patients in the pre-intervention period with average SOFA score of 6, and 54 patients in the post intervention period with average SOFA score of 3.8. Conclusion: Palliative care is often underutilized or employed late in the course of hospitalization resulting in decrease in potential benefits of the service. Incorporation of a mortality screening tool could help clinicians identify patients who have the highest risk of death during the period of hospitalization and shorten the time for patients to receive palliative care consultation. Nurses were competent in using a mortality screening tool and leading discussions of mortality risk in multidisciplinary rounds advocating for palliative care consultation for patients. Mortality screening upon admission to ICU empowered nurses to advocate for high-risk patients. Research on whether improving the timeliness of palliative care can help improve patient care, reduce costs of care and reduce burnout in ICU clinicians (by transitioning patients to more appropriate levels of care) is needed.

Background: Patients hospitalized with life-threatening conditions are exposed to constant psychological stressors that can lead to anxiety and poor patient outcomes. Mindfulness stress reduction interventions have been shown to decrease stress and anxiety with sustained effect. Objectives: This project aims to evaluate the feasibility and effect of a brief mindfulness intervention (MBI) on stress, anxiety, and resilience in advanced heart failure patients, hospitalized awaiting transplant. Methods: A one group, pretest-posttest design over a 4-week period in a single center’s cardiac care units was used. The intervention included a one-on-one mindfulness educational session and a 12-minute audio guided iPad application for daily self-practice. Variables measured at baseline, and every 2 weeks post intervention included stress (The Perceived Stress Scale [PSS)]), anxiety (the Generalized Anxiety Disorder [GAD-7]) and resilience (the Brief Resilience Scale [BRS]), with patient demographics and self-reported mindfulness performance collected. Statistical analysis included descriptive statistics, repeated measures ANOVA with Friedman tests verification, Bonferroni post hoc tests and Wilcoxon matched pairs tests applied. Results: Statistically significant differences were found from baseline to 2 and 4 weeks after intervention in reduced stress (p=.001) and anxiety (p=.001) and increased resilience (p=.001). The greatest change was seen at 2 weeks post intervention and was maintained at 4 weeks. Additionally, feasibility and acceptability of the MBI were evident from the patient experience survey data and focused interview responses. Conclusion: A brief mindfulness intervention holds promise in improving stress, anxiety and resilience for advanced heart failure patients awaiting transplant. Nurses could help to alleviate symptoms of distress through education on use of a mindfulness app in the daily patient care plan. Further study in a larger sample is warranted.

Objective. Healthcare’s efforts to prevent adverse events include initiatives to encourage adverse event reporting so it becomes possible to explore causes and prevent recurrence. However, the current climate of significant underreporting of adverse events by healthcare providers curtails the opportunity to explore preventable medical errors, improve system care delivery processes, and achieve better patient outcomes. The purpose of this study was to investigate the relationship between structural and psychological empowerment elements and nurses’ reporting of adverse events including near-misses, event has no potential to harm the patient and event could harm the patient but does not. This study also examined nurses’ identification of different types of adverse events, their intention to report each type, and whether their professional characteristics (education level, work role, staff position, specialty nursing certification, and professional society membership) are related to nurses’ adverse event reporting. Methods. A cross-sectional survey study among nurses in a large academic, tertiary and quaternary referral medical system in the Southwest region of the United States of America. Kanter’s described elements of organizational empowerment (opportunity, information, support, resources, formal power and informal power), measured by the Condition of Work Effectiveness Questionnaire (CWEQ-II) were compared to adverse event reporting. Spreitzer’s Psychological Empowerment Instrument (PEQ), a 12-item scale with three items for each of the four dimensions (meaning, competence, self-determination and impact) was used to compare psychological empowerment to nurses’ reporting of adverse events. Specific questions from the Hospital Survey of Patient Safety Culture (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ) were used to measure nurses’ reporting of adverse events. The variables analyzed from the HSOPSC survey included: 1) the overall number of events reported by participants in the past 12 months, and 2) three questions measuring nurses’ perception of how frequently (never/rarely, sometimes, most of the time, and always) three types of events (near-missed, event with no potential for harm, and event that could harm the patient but does not) are reported on their units. Results. Study findings indicate no statistically significant association between the number of incidents that participants reported and any of the CWEQ-II and PEQ subscales. All CWEQ-II outcomes with the exception of access to opportunity showed an overall significant difference between categories of frequencies of the three types of adverse event reported (near-missed incident, events with no potential harm, and events with potential harm but did not). Among the four elements of psychological empowerment measured with the PEQ, “impact” consistently shows a significant difference in nurses’ perception of how frequently the three types of adverse events are reported. When provided clinical scenarios with five levels of harm (omission, near miss, no harm, reversible harm, and irreversible harm), participants indicated they would report the event when they were in “strong agreement” with their determination that the scenario was viewed as an adverse event. Nurses’ professional characteristics, level of education, work role, level of nursing practice and certification status play a role in nurses’ reporting of adverse events. Implications and Conclusion. Organizational and nursing leaders should construct a supportive environment that fosters adverse event reporting among nurses. Nurse leaders should cultivate a work environment that improves nurses’ empowerment and autonomy, such as shared-governance, which could promote creating evidence-based strategies for delivering safe patient care. Nurse educators can provide a curriculum that emphasizes quality improvement to build a foundation of knowledge and skills needed to implement quality improvement methodologies. Unit directors can encourage nurses to participate in process improvement projects to champion the drive for better patient outcomes. Nursing professional education should emphasize that errors of omission and near-missed events are indeed adverse events and should be reported as opportunities for system improvement. Our findings provide a glance into the needed elements, tailored to special professional characteristics to be taken into consideration when constructing such programs.

Background: Critical care nurses faced unprecedented challenges during the pandemic, exacerbating stress, burnout, and moral distress. Despite the significant implications of moral distress, few effective interventions exist. Shifting the focus from mitigating moral distress to strengthening moral resilience may help to address this gap and provides an opportunity to shape future research. Mindfulness practices have been shown to reduce distress and burnout, improve well-being and resilience, and may provide a useful tool in mitigating the negative effects of moral distress. Objectives: To determine the efficacy and feasibility of a brief mindfulness-based self-care program on critical care nurses’ resilience and well-being during the COVID-19 pandemic. Methods: A single-group pretest-posttest design was utilized. From an adult critical care unit in an academic hospital, a convenience sample of nurses working during the pandemic were enrolled. The four-week intervention was offered through a free online application. Participants were asked to complete five assigned guided practices per week at a location and time convenient to them. Pre-and-postintervention surveys were available through Qualtrics and utilized the 10-item Connor-Davidson Resilience Scale, Rushton Moral Resilience Scale, and Nurse Well-Being Index to evaluate outcome measures. Practice frequency was automatically tracked by the application. Demographic data and feasibility measures were included. Statistical analysis included descriptive statistics, Wilcoxon signed rank tests, nonparametric permutation tests, and nonparametric bootstrap analyses; a regression analysis evaluated relationships between variables. Results: Thirty nurses completed pretest data, and twenty-three participated in practices and the postintervention survey. Significant changes in resilience, moral resilience and well-being scores were noted. There was no significant correlation between practice frequency and changes in outcome measures. A positive correlation was found between resilience and moral resilience. Resilience measures were negatively correlated with at-risk well-being scores. Participant responses lent support to the acceptability and feasibility of the intervention. Conclusion: Participation in a brief, online MBSC intervention appeared beneficial in fostering resilience, moral resilience, and well-being in a sample of critical care nurses during the COVID-19 pandemic. Future studies are warranted. Interventions that offer room for personal and collective growth may be an important next step, particularly as we look forward.

Many patients diagnosed with kidney failure and referred for kidney transplant do not proceed towards medical evaluation for transplant and are considered “Lost to Follow-Up.” The reasons patients do not pursue kidney transplant are not well understood by providers and kidney transplant centers. To expand and deepen understanding about the “Lost to Follow-Up” population, this study sought to explore the lived experiences of patients who are referred for renal transplant but do not initiate or complete transplant evaluation. The goal was to listen to their stories about living with life-threatening kidney disease, their perspectives about the referral process, and their considerations about renal failure treatments.Using the Narrative Inquiry method of qualitative research, the PI conducted semi-structured phone interviews with ten patients labeled “Lost to Follow-Up” by their kidney transplant center. Interviews were digitally recorded and immediately transcribed for analysis. Multi-level coding was performed and the themes that emerged included a metanarrative entitled “The Struggling Self” and four themes that appear to describe the “Lost to Follow-up” patient designation. The themes reveal that participants (1) wanted meaningful information, (2) experienced both internal and external barriers as they put off the kidney transplant referral, (3) needed improved provider communication, and (4) needed help to shoulder the burden of renal failure and subsequent treatment. The study findings revealed that patients do not see themselves as “Lost to Follow-Up” but rather as “nowhere”, “prisoners”, “trapped”, “stuck”, “scarred”, “on-hold”, “not worth it”, “wrecked”, “complicated”, “home alone” and “pretty happy”. The study findings reveal opportunities for provider actions that align with the four thematic categories including (1) increase upstream screening and early, meaningful patient education and engagement regarding kidney health; (2) enhance provider communication training; (3) perform ongoing patient assessment for internal and external barriers to follow-up and (4) align care with patient goals and consider the utilization of conservative care as a treatment option in kidney disease.

Background: Significant burnout is well documented in nurses. Hematology nurses are exposed to conditions positively correlated with vulnerability to burnout yet have not been studied. Resilience levels are inversely related with reported burnout. Cultivation of resilience is possible, and potentially reduces burnout. Mindfulness-based interventions (MBIs) have been identified throughout the literature as viable and feasible mechanisms to mitigate burnout and increase resilience in nurses.

Objectives: The purpose of this DNP scholarly project was to determine the feasibility and efficacy of an abbreviated, four-week MBI in reducing burnout and increasing resilience in hematology registered nurses working at a National Cancer Institute (NCI) designated cancer center.

Methods: A pre-post intervention project design was utilized. A convenience sample of 40 registered nurses were enrolled. All nurses working inpatient and outpatient within hematology were eligible. Enrollment was self-selection. Demographic data were collected at the onset of the project. An online mindfulness intervention was introduced during a 30-minute, online session. Participants were then asked to practice guided mindfulness daily for four weeks. Participants were asked to complete the Maslach’s Burnout Inventory and the Connor-Davidson Resilience Scale via REDcap at baseline and at the end of the four-week intervention. Frequency of practice was reported. Although not intended, all components of the intervention and analysis occurred during the COVID-19 pandemic crisis.

Results: All components of the study were completed by 20 nurses. The Wilcoxon and two-tailed Spearman testing were used for analysis. Resilience increased post intervention (z=2.49; p=.01; Change in M 28.1 to 30.65). No significant changes were noted in the three burnout dimensions. Positive correlation between frequency of mindfulness practice and increased resilience (.480) was found.

Conclusion: Practice of a four-week, online mindfulness intervention proved beneficial in increasing resilience in a small sample of hematology nurses in an NCI designated cancer center. In addition to the stressors inherent to hematology nursing, this sample of nurses coincidentally faced the demands of a pandemic. Future studies of mindfulness and its impact on resilience and burnout are necessary to fully explore potential benefits in this population; focus on responses during health emergencies is also critical.

Afghan refugee women who have been resettling in the US since the 1980’s are now aging and may face multiple layers of disadvantage, experience increased burden of disease, and face challenges to equitable access to preventive health screening. While research with refugee women’s health prioritizes the assessment and treatment of communicable diseases, there is a paucity of research which seeks to understand social and cultural factors influencing preventive health behaviors beyond their initial resettlement. This study used focused ethnography methodology to explore women’s perceptions of influences on health, mammography, and colonoscopy screening among a sample of Afghan women over the age of 50. Fourteen women participated in open-ended, semi-structured interviews. Interviews with their family members (n = 5) and key informants (n = 8) from the Afghan community provided richer descriptions of women’s context and social influences.

The findings of this research are presented in three manuscripts. The first manuscript is an integrative review of published literature of Afghan and other Muslim refugee women’s preventive cancer screening behaviors in high-income countries of resettlement. This study found multi-level influences on women’s screening behaviors and lower rates of mammography, colonoscopy and Pap smear use among refugee women compared to rates among the general host country's population. Findings also establish that resettled refugees from Muslim majority countries are understudied and underrepresented in health promotion interventions. The second manuscript is a qualitative study of Afghan women’s perceptions about health and sociocultural influences on health-related behaviors. Afghan women reported holistic health beliefs as well as family-centered and religion-informed motivation for healthy behaviors. This study offers new insights on Afghan women’s health concerns and health experiences as they continue to age in the US. The third manuscript is a qualitative study exploring sociocultural factors on women’s perceptions of breast and colorectal cancer and screening. Screening behaviors were influenced by culturally-informed beliefs about cancer, poor and inadequate communication with providers and the need for support from family and community in navigating the US health system. This study offers new insights into patient empowerment factors for Afghan women to obtain screening repeatedly, including religious coping and family support. Future screening and health promotion interventions should incorporate women’s cultural explanatory models of illness and religious and family-centered approaches.

Background: There are approximately 50,000 children worldwide living in an “unresponsive wakefulness state/vegetative state” (UWS/VS). Technological advancements continue to extend life expectancy for people with life-threatening health conditions that would not have survived otherwise.Purpose/Aims: To understand the experiences of parents Whose Disabled Child is in a UWS/VS and residing in a skilled nursing facility (SNF). Specific aims include: (1) describing the impact on parents’ well-being, (2) exploring unique parental experiences during their child’s first year of residency at a SNF, (3) identifying key influences on parents’ decision-making and coping, and (4) examining factors that influence parental engagement with their child and social networks. iii Methods: This qualitative study utilizes narrative inquiry using a semi-structured interview guide and inductively analyzed the data to identify themes and codes that best inform the research question. Results: After eligibility screening, nine singles and five couples participated in interviews. Line by line coding was performed on all interview transcripts with reliability checked by two senior qualitative researchers. Four primary themes with 2-3 sub-themes organically emerged from the participants’ narratives to form a coherent and interconnected storyline that depicted a very subtle chronology of events and experiences. The four main themes include: (1) Enduring the Unexpected, (2) Navigating the Unknown, (3) Prioritizing Values in Decision-Making, and (4) Changing Relationships. Implications: Nursing research on this topic is limited and yet nurses play a key role in providing family-centered care and support for this vulnerable population. A deeper understanding of parent caregiving for these fragile children could be a valuable resource for healthcare professionals. Potential future interventions and suggestions to improve parental and family support were identified in the areas of emotional, social, and decision-making through the trajectory of the child’s chronic illness.

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