Latinas are one of the largest and fastest growing minority groups in the United States (U.S.) and are at risk for poor health outcomes due to stress. However, little is known about the buffering effects of social support on stress and health in Latinas. In this cross-sectional study, we applied a structural equation modeling (SEM) approach to examine stress, social support and health outcomes in urban Latinas who participated in a community survey. We conducted iterative development of conceptual and analytic models through exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and SEM. Four hypotheses were tested with SEM: 1) Higher levels of stress are associated with worse health outcomes; 2) Lower levels of social support are associated with worse health outcomes; 3) Being older or having lower levels of education is associated with worse health outcomes; and 4) Social support moderates the relationship between stress and health outcomes. The study sample comprised 2,035 Latinas who were predominantly immigrants from the Dominican Republic, had a mean age of 50; the majority reported low levels of chronic stress, lower than national average psychological distress scores, and rated their health as good or better. Levels of online social support were low – about 20%. The EFA rendered a three-factor solution with strong factor loadings: chronic stress, online social support, and health. The CFA models had adequate model fit indices. The hypotheses were not supported in the SEM. This is the first study to apply EFA and SEM approaches to develop and evaluate measurements of stress, social support, and health in a large sample of Latinas. Consequently, this research provides an important foundation for further examination of these constructs. This is an essential prerequisite to development of culturally appropriate social support interventions including those that are online for the rapidly growing U.S. Latina population.

Background: Although nurses provide the majority of healthcare, Africa also has the fewest healthcare workers in the world, including the least number of nurses and midwives in any WHO region. Concurrently, the majority of healthcare research is generated within the United States and Europe, creating evidence for practice that is potentially not applicable in African countries with limited resources and vastly different healthcare problems. Limited information is available regarding what determines which topics are studied in nursing, and even less is known regarding what predicts research trends in African countries. To maximize the use of the limited supply of nurse scientists available, it is important to understand what influences trends in nursing and midwifery research and whether these trends are correlated with what experts consider to be research priorities in a given geographical location and healthcare field. Objective: To address these gaps in the literature and to assist nurse scientists in southern and eastern African countries in directing their research toward those topics with the most critical needs, the aims of this study were to identify 1) what research is currently being conducted, 2) which topics local experts consider to be priorities and furthermore, 3) what influences trends in nursing research. The background and theoretical framework as well as an overview of the dissertation are presented in Chapter 1. Methods: This was accomplished through 1) an environmental scan (including a scoping and a grey literature review in Chapter 2) 2) a Delphi survey of clinical nurse research experts in southeastern African countries (Chapter 3), and 3) a statistical analysis of factors associated with current research topics (Chapter 4). Results: The results of the environmental scan suggest that overall, there is limited clinical nursing and midwifery research and it is less likely to be published in indexed literature. The Delphi survey suggested that critical research priorities in southern and eastern African countries include midwifery and maternal mortality and infectious disease and infection control. Although clinical nurse and midwifery research experts in the region are sensitive to the needs of the region, topics that they rank as critical priorities (such as midwifery and infectious disease) are under-researched. Publication in the grey literature (rather than an indexed source) appears to be associated with whether a topic has major funding, affiliations of the first author (such as international affiliations, or affiliation with a nursing school with a global research focus), and the education level of the first author. Conclusions (Chapter 5): Clinical nursing and midwifery researchers in southern and eastern African countries are generating research that is critical for developing and supporting evidence-based practice but may have difficulty publishing in indexed sources reducing the dissemination and impact of this research. Strategies to assist junior nurse scientists with broader dissemination of their work could include establishing a network of clinical nursing and midwifery researchers in the area for mentoring and resource sharing. Moreover, policy makers and funders from outside the region should consider expert opinion when developing health care policy and funding mechanisms for research to assist with the dissemination of research, reduce waste in research, and to ensure improvement of patient outcomes through relevant, translational research.

Preterm birth occurs in 12% of US births and Latinas have preterm rates close to national levels. Becoming a mother in the neonatal intensive care unit (NICU) is considered an altered transition experience impacted by psychosocial and cultural factors. Providing mother’s own milk (MoM) to a preterm is challenging due to immaturity and or illness. Despite being the fastest growing, largest minority culture in the US, few studies focus on the experience of Latina mothers in the NICU. The purpose of this mixed methods study was to examine mothers’ experience of becoming a mother in NICU and factors that influence infant feeding decisions in the first month of life and to determine what distinguishes this experience for Latina mothers. Research on breastfeeding in NICU has focused primarily on white, married, middle class women. Despite the benefits of human milk, only one third of all NICUs in the US report routine use of human milk. A convenience sample of 30 mothers with infants ranging from 23 to 35 completed weeks gestational age participated in this study. Data analyses were conducted using NVIVO software for qualitative data and SPSS statistical software version 22 for the quantitative data. There were two primary research questions asked in this study. The first was central to the larger qualitative piece of this work and focused on becoming a mother and providing MoM in the NICU. The second was quantitative in nature and explored the relationship between infant feeding attitudes and key processes with regard to MoM provision outcomes as modified by culture. This mixed methods study is set in a major northeastern perinatal regional center. The dominant qualitative portion used a semi – structured interview guide developed from the main theoretical concepts of becoming a mother (BAM) and the current literature on parenting in the NICU and providing mother’s own milk. The supplementary exploratory descriptive quantitative strand used six standardized measurement tools to explore the relationships between selected psychosocial and cultural factors (maternal moods, decisional conflict, coping strategies, neonatal stressors, infant feeding attitudes and behaviors and psychological acculturation) and continuation of MoM. Data analysis consisted of directed content analysis to describe major themes for the qualitative portion and descriptive statistics and non-parametric tests to identify relationships and group differences. Multivariate analysis using binary logistic regression to describe the strongest relationships was conducted. The data were integrated and discussed for this sample of women. Qualitative results indicated that Latina mothers did fit into the framework described by Hurst and colleagues that proposed that BAM was interrupted with mothers having a paradoxical experience which included negotiations about pumping and the feeling that pumping created a wedge instead of a connection between them and their infants. Cultural themes that emerged included generational differences with Latina mothers less likely to have social support for breastfeeding and to feel uncertain about their decision and transitioning to their maternal role in the NICU. Cultural values, such as familismo, respeto and fatalism, provided a nuanced response to the experience of BAM in the NICU perceived by mothers, leading to an increased sense of uncertainty. Latina mothers described being in a state of parental liminality related to a sense of powerlessness and uncertainty, a theme that was not identified in the original BAM nor previous framework for providing milk in the NICU. Quantitative exploratory analyses revealed that there was a significant difference between Latina and non-Latina groups with Latina mothers demonstrating higher levels of self – efficacy about ability to successfully produce MoM for their infants. For this sample of Latina women, anxiety made a statistically significant contribution indicating that mothers who were anxious were 1.35 times less likely to continue to provide MoM. Decision uncertainty approached significance and mothers who were uncertain about decision to provide breast milk feeds were 1.14 times less likely to continue to provide MoM in the first month of neonatal life in the NICU. It is essential for healthcare providers to be aware that mothers who are anxious, experience decisional uncertainty, perceive alterations in their maternal role, and express a high degree of stress related to the overall NICU environment may be at risk for discontinuing to provide MoM for their premature infants. More research is needed to explore culturally relevant intervention methods aimed at decreasing maternal stress and anxiety and addressing decisional conflict with mothers of premature infants in the NICU.

<p> Experts in the study of ergonomics and human performance factors have described the &lsquo;collective mindfulness&rsquo; of nurses as a critical element to the attainment of highly reliable safety within patient care delivery. Little research exists related to the construct of mindfulness and its impact on safe nursing practice and situation awareness by the nurse. </p><p> A mixed method, descriptive correlational study of 102 senior-level nursing students at two baccalaureate nursing programs was used to examine the relationship between dispositional mindfulness, situation awareness (SA) and the clinical competence of senior-level nursing students engaged in a simulated patient care experience. Results of this study indicate that human cognitive factors negatively impacted the participants&rsquo; ability to focus attention, switch attention, and achieve SA necessary for quality and safe nursing care. </p><p> Quantitative analysis of study data revealed that self-reported dispositional levels of mindfulness did not correlate to the latent variable of clinical competence (<i>r</i> =0.099, <i>n</i> = 102, <i> p</i> = .320, 2-tailed) or SA (<i>r</i> = 0.091, <i>n </i> = 102, <i>p</i> = 0.363, 2-tailed); however, a weak correlation between the mindfulness facet of observing and the clinical competency of communication (<i>r</i> = .0.193, <i>p</i> = 0.053) was identified. Analysis of the relationship between SA and clinical competency revealed that overall higher levels of assessed SA were found to have a moderately strong, positive relationship with overall clinical competency scores (<i> n</i> =102, <i>r</i> = .301, <i>p</i> = .002, 2-tailed). The level of overall situation awareness demonstrated a positive correlation to three of the four competency related sub-scales: assessment (<i>r </i> = 0.212, <i>p</i> = 0.032), communication (<i>r </i> = 0.340, <i>p</i> = 0.000), and clinical judgment (<i> r</i> = 0.388, <i>p</i> = 0.000). The qualitative findings identified two areas in which nursing students described lacking mindfulness in their clinical practice: focused attention (acting with awareness, observing) and effective communication skills (describing). </p><p> These findings provide implications to nurse educators regarding the impact of mindfulness and situation awareness on the clinical outcomes of students. The findings further suggest the inclusion of teaching/learning strategies within the curriculum to develop both mindfulness and situation awareness as non-technical skills needed for safe practice.</p><p>

Aim The overarching aims of this study were to explore what second hand clothing sellers understand about their occupational health risks and how they might minimise and prevent these risks and secondly to explore if this understanding influences to their preventive health behaviours. Background Previous work I noticed that the sellers were exposed to health risks from working processes such as dust from clothes, UV exposure and heavy lifting without using personal protective equipment such as mask, hat and sunglasses, although these health risks can be protected against by cheap materials and preventive health behaviours to deal with the health risks are not complicated. In the light of the problems as outlined earlier, it is necessary to investigate why these workers are exposed to health threats from a working environment without sufficient protection. It is vital to understand the threats by exploring the understandings of the workers of work exposures, their beliefs, and examine how such understandings may have a role in directions for any preventive health behaviours. Theoretical framework Health Belief Model (HBM) focusing on health beliefs including preventive health behaviour was adopted as a theoretical framework to guide the assimilation of existing evidence and to frame the qualitative ethnographic study. Methodology and methods Ethnographic research methods, underpinned by an interpretative paradigm, were applied to obtain rich, culturally embedded information. Participant observation along with note-taking and photographs as well as ethnographic interviews were contemporaneously conducted over a six months period in Yala province, a district located in the southern border province of Thailand. Ethnographic data analysis based on the principle of HBM theory was utilised to analyse in-depth data from interview transcripts and sets this against a backdrop of detailed observation. Result The most significant findings of the present study are as follows: · Cues to action which produce information and knowledge are the most important component influencing the other components of HBM according to findings from this market context. · It seems that personal indirect experience is highly impactful for behaviour change and is most important for health promotion strategy for second-hand clothing sellers. · Perceived barriers (especially discomfort for using personal protective equipment) was the most important component affecting negative working behaviours of second-hand clothing sellers. · Limitations to access to information and context specific knowledge of second-hand clothing sellers is considered the most influential cause underpinning the occurrence of inadequate health beliefs and observations of negative work behaviour of second-hand clothing sellers. · While the findings may not be surprising, they do add to further insight about the application of the HBM to this unregulated work context, and furthermore provide indicative directions for informing health promotion strategy that is tailored to the context of the market. Conclusion Promotion of knowledge and theoretically informed discussion of beliefs including self-efficacy are considered as indications for health promotion strategy for the sellers.

Suicide is a national and global concern. Men continue to die by suicide at higher rates compared to women. The burden of grief associated with loss of a partner to suicide may go unreported by survivors. This study aimed to explore the coping experiences of survivors following the suicide of their intimate partners. The research question was: How do bereaved survivors make sense of their coping experiences following intimate partner suicide? Interpretative Phenomenological Analysis (IPA) enables inquiry into individuals’ perceptions of their everyday lived experience particularly in the context of a past significant experience such as being bereaved by suicide. IPA as a methodology was also well situated within my epistemological position as an interpretative constructivist and the theoretical frameworks of phenomenology, hermeneutics and ideography that underpin its approach. Eight women bereaved by intimate partner suicide took part in the study. Data were collected using semi-structured in-depth interviews. Participants were interviewed once as this data collection method provided rich first-hand accounts of each participant’s lived experience. Five super-ordinate themes were identified. (1) Manageability identified how participants reacted to their suicide related grief and support. (2) Attaching meaning involved rumination, ascribed purpose to survival, and changing relationships with others. (3) Relating to others highlighted participants’ need for humanistic processes during interactions, identifying with other survivors, and develop compassion for others. (4) Changed perceptions of self became evident both as a person and in considering new possibilities in life. (5) A new philosophy of life reflected a changed sense of what is important, establishing new priorities, and living in the ‘here and now’. Coping was complex, differed amongst participants, and went beyond the parameters often specified in the bereavement literature. Complex elements associated with managing life, ascribed meaning, relationships with others and a changed ‘self’ were unique findings. While negative or harmful coping strategies were discussed, participants also highlighted their resilience and clearly articulated what was helpful and what hindered their coping. The findings contributed to the development of the Intimate Partner Suicide Bereavement Coping Model (IPSBCM) to help shape supportive practices and models of care to support survivors at different stages of their suicide-related grief.

Research regarding pregnancy and women living with HIV does exist, however, in-depth qualitative research about the decision making process concerning around pregnancy and the pregnancy journey for women living with HIV is absent from both the international and Thai literature. This qualitative research study employs the constructivist grounded theory method to understand and generate a model of the pregnancy decision making process and continue with their pregnancy in Thai women living with HIV. Data collection was done in antenatal clinics (ANCs), at two provincial hospitals located in the Northeast of Thailand. In-depth semi-structured interviews were conducted with 15 HIV positive pregnant women. Data analysis involved open coding, making-memos and using the constant comparative method to develop a grounded theory substantive model of HIV pregnancy decision making. The substantive model consists of 6 categories; 1) concealing HIV positive status from husband; 2) desire to have a child; 3) becoming pregnant; 4) keeping or terminating pregnancy; 5) accepting a decision; and 6) adapting to a decision. This research finds that the main concerns women living with HIV in deciding to have a child are balancing fear, concealing HIV status and the information that they have in each decision making step. Based on the research findings, a unique process of decision making has been found among these women that related to personal and Thai social beliefs. This study recommends that health care providers need to pay more attention to counselling women living with HIV and couples by giving sufficient contraceptive information to prevent unplanned and unwanted pregnancy, to support and guide the women who want and plan for pregnancy in advance of this happening and helping women to deal with HIV disclosure issues related to morality and the rights of couples. Moreover, respect and support must be accorded to HIV positive women about their right to have a child if they choose to do so.

Thesis (M.S.)--Boston University

The purpose of this study was to determine whether or not Winslow's typology of definitions of client advocacy in nursing accurately and comprehensively represented the manner in which registered nurses defined the role. The author also hoped to explore contextual factors influencing the lack of consensus among nurses of the client advocacy role.;A survey questionnaire was developed and submitted to a random sample of nurses registered to practice in the state of Virginia. The sample population was asked for a definition of and a clinical situation describing client advocacy. A Likert scale was used to determine the degree of agreement of the sample population with Winslow's typology as well as clincial practice situations developed by the author.;Survey data revealed Winslow's typology of definitions represent the manner in which a substantial number of respondents defined client advocacy. Demographic and professional data of the sample population was obtained and analyzed. There was no substantial relationship between these variables and the opinions of client advocacy definitions.;The relationship to two factors, the development of the code of ethics and the nurse-physician relationship, were examined. All versions of the code of ethics contain elements of client advocacy behaviors. The lack of consensus among nurses of the client advocate role is related to male-female role conflicts and the desire of the nursing profession to attain full-fledged professional status.;Further investigation is indicated to determine if the current lack of consensus among nurses of the client advocate role, is an indication of the process of role change the profession must experience to realize the acceptance of any one definition of the client advocate role.

No description available.