Publications by authors named "Patricia M Davidson"

477 Publications

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

AACN Adv Crit Care 2021 Sep;32(3):341-345

Patricia M. Davidson is Vice-Chancellor, University of Wollongong, Wollongong NSW, Australia.

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http://dx.doi.org/10.4037/aacnacc2021862DOI Listing
September 2021

Nursing Leadership for 21st Century.

Rev Lat Am Enfermagem 2021 Aug 30;29:e3472. Epub 2021 Aug 30.

University of Sydney, Susan Wakil School of Nursing, Sydney, NSW, Australia.

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http://dx.doi.org/10.1590/1518-8345.0000.3472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432511PMC
August 2021

The Edmonton Symptom Assessment Scale in Heart Failure: A Systematic Review.

J Cardiovasc Nurs 2021 Aug 16. Epub 2021 Aug 16.

Reiko Asano, PhD, RN Postdoctoral Fellow, Georgetown University School of Nursing & Health Studies, Washington, DC. Kelley M. Anderson, PhD, FNP Associate Professor, Georgetown University School of Nursing & Health Studies, Washington, DC. Binu Koirala, PhD, MGS, RN Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. Martha Abshire, PhD, RN Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. Cheryl Dennison Himmelfarb, PhD, RN, FAAN Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland. Patricia M. Davidson, PhD, MEd, RN, FAAN Johns Hopkins University School of Nursing, Baltimore, Maryland.

Background: Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety.

Purpose: The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes.

Methods: The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms "heart failure," "CHF," "cardiac failure," "heart decompensation," "myocardial failure," "Edmonton Symptom Assessment Scale". Hand searching of articles was also undertaken.

Results: The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an assessment of symptom burden and (2) evaluating the impact of symptom burden on quality of life and functional status.

Conclusion: This review highlighted the Edmonton Symptom Assessment Scale as a predictive instrument to identify symptom burden, symptom clusters, and symptom changes for patients living with heart failure. The clinical use of the Edmonton Symptom Assessment Scale may identify treatment priorities, promote self-management, inform the treatment plan, and advance effective therapeutic adjustments. The symptom burden in heart failure is high, and improving the symptom experience is an important focus of future healthcare interventions. The Edmonton Symptom Assessment Scale has utility in heart failure management due to psychometric properties and ease of administration.

Clinical Implications: The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden.
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http://dx.doi.org/10.1097/JCN.0000000000000835DOI Listing
August 2021

Compelling Voices of Diversity, Equity, and Inclusion in Prelicensure Nursing Students: Application of the Cultural Humility Framework.

Nurse Educ 2021 Sep-Oct 01;46(5):E90-E94

Author Affiliations: Assistant Professor (Drs Wright, Baptiste, Abshire, Hansen, and Wright), Research Program Assistant (Ms Booth), Registered Nurse (Ms Alvarez), Director of Student Services (Ms Barrett), DNP/PhD Candidate (Ms Jenkins), Associate Director, Campus Operations (Ms Scarborough), Former Dean and Professor (Dr Davidson), and Associate Dean for Diversity, Equity, and Inclusion (Dr Ramsey), Johns Hopkins School of Nursing, Baltimore, Maryland; and PhD Student (Ms Addison), University of Pennsylvania School of Nursing, Philadelphia.

Background: Diversity, equity, and inclusion are increasingly recognized as core values for guiding nursing education, practice, and research. The conceptual framework of cultural humility has been adapted in a variety of health care settings, fostering a culture of diversity, equity, and inclusion through openness, supportive interaction, self-awareness, self-reflection, and critique.

Problem: Nurse educators have the opportunity, but may find it challenging, to teach students about the changing landscape of health care and the populations we serve.

Approach: This article describes the integration of the cultural humility framework into nursing curricula to teach principles of diversity, equity, and inclusivity. We provide a practical example of a diversity panel, with student and panelist reflections, exploring the intersectionality of experiences in health care and integration of personal accounts and perspectives.

Conclusion: Dialogue about diversity, equity, and inclusion is essential for preparing future nurses to deliver culturally competent care and promote health equity.
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http://dx.doi.org/10.1097/NNE.0000000000001094DOI Listing
August 2021

Corrigendum to "Nursing research on intimate partner violence in China: A scoping review" [The Lancet Regional Health - Western Pacific 2 (2020) 100017].

Lancet Reg Health West Pac 2021 Jan 8;6:100067. Epub 2020 Dec 8.

School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, USA.

[This corrects the article DOI: 10.1016/j.lanwpc.2020.100017.].
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http://dx.doi.org/10.1016/j.lanwpc.2020.100067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315312PMC
January 2021

A Multi-Site Thailand Heart Failure Snapshot Study.

Heart Lung Circ 2021 Aug 5. Epub 2021 Aug 5.

The Johns Hopkins University School of Nursing, Baltimore, MD, USA.

Background: The prevalence of heart failure (HF) is increasing in many low-income and middle-income countries, but the limited availability of data on patient profiles and clinical outcomes, particularly at a community level, challenges health service planning.

Methods: The Thai HF Snapshot Study was a multi-site, observational study conducted in Thailand between June 2017 to June 2019. It aimed to document demographic, clinical and sociodemographic characteristics, and to compare clinical outcomes by the level of the hospital.

Results: A total of 512 participants were recruited across Thailand: mean age was 64.9±15.3 years and 286 were female (55.9%). The most frequently identified admitting diagnosis was ischaemic heart disease (45.1%). Most patients (70.3%) were classified as New York Heart Association class II at discharge. Patients in university hospitals were frailer (3.2 vs 2.9; p=0.015), had more depressive symptoms (8.1 vs 5.7; p<0.001), and had lower functional status (66.2 vs 73.3; p<0.001) than those in tertiary care.

Conclusion: Although HF patients admitted to university hospitals had access to advanced technology and health care specialists, clinical outcomes likely affected patient acuity. Interventions are urgently needed to ensure improved HF management considering the social determinants of health in Thailand.
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http://dx.doi.org/10.1016/j.hlc.2021.07.010DOI Listing
August 2021

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide.

J Pain Symptom Manage 2021 Jul 28. Epub 2021 Jul 28.

International Children's Palliative Care Network; Makerere University, Kampala, Uganda.. Electronic address:

Context: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal.

Objectives: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services.

Methods: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce.

Results: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships.

Conclusion: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

Key Message: Achieving universal palliative care access is a global social justice priority. Nurses are critical to strategically realizing this vision. Health system leaders, interdisciplinary partners, and policy makers must support nurses to practice to the full extent of their education and licensure to provide high-quality palliative care services for populations worldwide.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.07.014DOI Listing
July 2021

Nursing research on intimate partner violence in China: A scoping review.

Lancet Reg Health West Pac 2020 Sep 7;2:100017. Epub 2020 Sep 7.

School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, USA.

Intimate partner violence (IPV) is a serious public health issue, and nurses have the potential to screen, navigate to interventions, and provide support, but responses to IPV differ greatly in mainland China, Hong Kong, Macao, and Taiwan. We conducted a scoping review to examine the nursing literature on IPV in the above four regions in China. We conducted a comprehensive search of 11 Chinese and English databases from database inception to January 31, 2020, for eligible papers including empirical studies, reviews, reports, and expert opinion articles. We hand searched references lists and other studies published by the first and corresponding authors of included articles. Two reviewers independently screened articles and extracted data, and three reviewers cross-checked the extracted results. We also conducted quality appraisal for applicable empirical studies. A total of 58 Chinese-language and 63 English-language articles were included, 58 from Taiwan, 44 from Hong Kong, 13 from mainland China, and six from institutions outside China, but none from Macao. The quantitative and qualitative studies described the prevalence and complex nature of IPV, comparable to non-nursing and international studies. Nurse-led advocacy and Qigong (traditional Chinese mind-body health practice) interventions showed promise for improving mental health in women in Hong Kong. There was a low level of knowledge and preparedness to respond to IPV among Chinese nurses, especially in mainland China. Mixed methods studies in Hong Kong and Taiwan as complex designs were generally well-conducted. Nursing case reports from Taiwan uniquely supplemented the evidence base. In Hong Kong and Taiwan, varying designs were used to study various facets of IPV, targeting victims, nurses and other key stakeholders. In mainland China and Macao, IPV research was limited in quantity, quality, and diversity. As more research in the area of IPV is needed, factors influencing nursing research on IPV also merit investigation, while taking into consideration socio-economic-political-cultural factors.
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http://dx.doi.org/10.1016/j.lanwpc.2020.100017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315422PMC
September 2020

A qualitative study exploring the career mindset of a group of early career academic nurses as they deployed 'Habits of Mind' to sustain their career journey.

Nurse Educ Pract 2021 Aug 14;55:103149. Epub 2021 Jul 14.

Vice-Chancellor and Principal, The Vice-Chancellor's Unit, Building 36, University of Wollongong, Australia. Electronic address:

Aim: This study aimed to explore the qualities that sustain a career mindset in a group of early career academics in one Australian university.

Background: Building an academic career is a lengthy, convoluted and complex journey requiring a mindset prepared to make informed and timely decisions. Success is predicated to a large extent on the ability of persons to process information effectively before actions are taken. Employing 'Habits of Mind' supports growth in intelligent behaviours through acquiring a composite of skills, attitudes, cues and past experiences that maximises appropriate choice of one pattern of thinking over another. A level of skill is required to employ 'Habits of Mind', suggesting that reflection and evaluation of experiences are critical to the process. In this, the third phase of a four-phase sequential study, the career mindset of a group of early career academic nurses were studied during 2019. A cluster of 'Habits of Mind' emerged as having value for an academic career mindset, allowing the individuals to meet challenges of negotiating a career terrain and deepening their learning about those situations. Time and energy could therefore be appropriated to engage with the academic global community in new and career challenging health related research.

Design: A qualitative descriptive approach.

Methods: The study applied the epistemology and constructivist thinking of John Dewey and the self-directed learning theories of Mezirow and Knowles. Set in a large metropolitan university in Sydney, Australia. A purposive sample of nine early career academic nurses were interviewed using semi-structured, one-to-one audio-taped interviews. Data were analysed thematically using Braun and Clarke (2006) six phase process.

Results: Findings revealed that deployment of the cluster of the five distinctive themes or 'Habits of Mind': Rely on self; take responsible risks; think with colleagues; keep an open mind and possess curiosity into the novice nurses' mindset, expedited self-directed learning processes, resulting in sharpening of their learning power to enable a more productive career journey.

Conclusions: It is argued that 'Habits of Minds' can provide a valuable learning framework when directing a career mindset and, that inclusion by providers of leadership, career or mentorship programs can sustain an academic environment where a culture of learning can flourish and where ECANs are equipped with attributes and behaviours necessary to address global demands.
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http://dx.doi.org/10.1016/j.nepr.2021.103149DOI Listing
August 2021

Workforce management and patient outcomes in the intensive care unit during the COVID-19 pandemic and beyond: a discursive paper.

J Clin Nurs 2021 Jun 28. Epub 2021 Jun 28.

Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, New South Wales, Australia.

Aims: To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.

Background: In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.

Design: Discursive paper.

Findings: Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.

Conclusion: COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.

Relevance To Clinical Practice: Objective measures commonly fail to capture the complexity of the critical care nurses' role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.
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http://dx.doi.org/10.1111/jocn.15916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447459PMC
June 2021

A picture is worth a thousand words: exploring the roles of caregivers and the home environment of ventricular assist device patients.

Eur J Cardiovasc Nurs 2021 Jun 14. Epub 2021 Jun 14.

Johns Hopkins University School of Nursing, 525 N Wolfe St., Baltimore, MD 21205, USA.

Aims: Caregivers of persons living with ventricular assist devices (VADs) are integrally involved in both medical and non-medical care. We sought to understand tasks caregivers perform after surgical recovery, ways the home is adapted for those tasks, and presence of home safety hazards.

Methods And Results: We conducted semi-structured interviews with persons living with a VAD and their caregivers. Pictures were taken of areas in the home where: (i) caregiving activities occurred, (ii) VAD or medical supplies were kept, and (iii) home adaptations were made for VAD care. Pictures were described in written detail and analysed. A qualitative descriptive approach was used for analysis. The sample consisted of 10 dyads, with mostly spousal relationships (60%) between male patients (60%) and female caregivers (80%). Three themes were identified: (i) Evolution of Caregiving and Support: Patients gain independence, but caregivers are still needed, (ii) Adapting the Home Environment: Changes are focused on functional needs, and (iii) Hidden Dangers: Illumination of safety concerns by photographs. Assistance with bathing, driveline care, and medication management were common caregiving tasks. Most home adaptations occurred in the bathroom and bedroom including sleeping recliners, shower chairs, removable shower heads, and hanging hooks to hold VAD equipment. Safety hazards included minimal space for safe ambulation, infection risk, and home-made adaptations to the environment.

Conclusions: These findings describe key home caregiving tasks, home adaptations, and safety concerns that require further education and support. Utilizing pictures may be a feasible method for assessing VAD teaching, caregiving needs, and identifying potential risks.
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http://dx.doi.org/10.1093/eurjcn/zvab043DOI Listing
June 2021

Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study.

BMC Geriatr 2021 06 7;21(1):350. Epub 2021 Jun 7.

Johns Hopkins University School of Nursing, MD, Baltimore, USA.

Background: Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other.

Methods: We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates.

Results: Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates.

Conclusions: Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults' daily activities.
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http://dx.doi.org/10.1186/s12877-021-02305-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185919PMC
June 2021

Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene.

J Nurs Scholarsh 2021 Sep 31;53(5):552-560. Epub 2021 May 31.

Dean and Linda Koch Lorimer Professor of Nursing, Yale University School of Nursing, Orange, CT, USA.

Purpose: To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide.

Design: Discussion paper.

Methods: Literature review.

Findings: Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems.

Conclusions: Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels.

Clinical Relevance: Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.
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http://dx.doi.org/10.1111/jnu.12672DOI Listing
September 2021

Frailty as a Predictor of Postoperative Outcomes in Invasive Cardiac Surgery: A Systematic Review of Literature.

J Cardiovasc Nurs 2021 May 19. Epub 2021 May 19.

Anna Peeler, RN Johns Hopkins School of Nursing, Baltimore, Maryland. Chandler Moser, RN Johns Hopkins School of Nursing, Baltimore, Maryland. Kelly T. Gleason, PhD, RN Johns Hopkins School of Nursing, Baltimore, Maryland. Patricia M. Davidson, PhD, MEd, RN Johns Hopkins School of Nursing, Baltimore, Maryland.

Objectives: Frailty is a syndrome characterized by increased vulnerability and reduced ability to maintain homeostasis after stressful events that results in an increased risk for poor outcomes. Frailty screening could potentially be valuable in cardiac surgery risk assessment. The purpose of this review is to evaluate the current literature linking multicomponent frailty assessment and invasive cardiac surgery outcomes.

Methods: We searched PubMed, EMBASE, and CINAHL; 1887 articles met the search criteria, and each was independently reviewed by 2 reviewers.

Results: The 19 eligible studies assessed 52 291 subjects using 17 different frailty measurements. The most commonly used instruments were the Fried Frailty Phenotype and the Clinical Frailty Scale. Between 9% and 61% of participants were found to be frail in each study. All 19 studies included mortality as an outcome, 12 included surgical complications, 12 included hospital length of stay, 3 included quality of life, and 2 included functional status. Nine found statistically significant differences in survival between frail and nonfrail patients, 6 of 12 found that frail patients had a longer length of stay, 4 of 12 found that frail patients were more likely to experience major complications, and 2 of 2 found that frail patients were more likely to have a decrease in functional status.

Conclusion: Although some studies lacked power, the majority confirmed that frail patients are more likely to experience poor outcomes. Further research is needed to determine which frailty measure provides the best predictive validity and to identify interventions to mitigate the risks that major cardiac surgery poses to frail patients.
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http://dx.doi.org/10.1097/JCN.0000000000000821DOI Listing
May 2021

Bibliotherapy for improving caregiving appraisal of informal caregivers of people with dementia: A pilot randomized controlled trial.

Res Nurs Health 2021 08 18;44(4):692-703. Epub 2021 May 18.

School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.

Caregiving appraisal is a key driver to moderating caregiving outcomes. The caregiving appraisal of informal caregivers of people with dementia requires increased attention. This study aimed to explore the feasibility and acceptability of an evidence-based bibliotherapy protocol, and test the efficacy on improving caregiving appraisal. A two-arm pilot randomized controlled trial was adopted. Sixty informal caregivers were randomized to either the intervention group, receiving eight weekly professional-guided bibliotherapy sessions in addition to usual care; or the usual care group. The professional-guided bibliotherapy sessions were weekly sessions in which caregivers self-read the designated chapter and then received telephone coaching. Caregiving appraisal, coping, psychological well-being, positive aspects of caregiving, knowledge of dementia, and attitude toward dementia were assessed both at baseline and immediately after the intervention. Assessors were blinded to group allocation. Individual interviews among 10 participants from the intervention group were conducted to explorecaregivers' acceptance of the intervention. Descriptive statistics, χ test, Mann-Whitney U test, independent t test, generalized estimating equation, and content analysis were used for data analysis. This study pioneered the use of bibliotherapy among informal caregivers of people with dementia. The participant recruitment rate was 69.8%. The attrition rate of the intervention group was 20%. Bibliotherapy had a significant time-by-group interaction effect on caregiving appraisal (p < 0.001), coping (p = 0.003), positive aspects of caregiving (p = 0.001), knowledge of dementia (p = 0.017), and attitude toward dementia (p < 0.001). The effect on psychological well-being, however, was only significant on the personal growth subscale (p = 0.025). The acceptability was also confirmed. No adverse event was documented.
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http://dx.doi.org/10.1002/nur.22143DOI Listing
August 2021

Patient safety: the value of the nurse.

Lancet 2021 05 11;397(10288):1861-1863. Epub 2021 May 11.

Vice-Chancellor's Unit, University of Wollongong, Wollongong, NSW, Australia.

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http://dx.doi.org/10.1016/S0140-6736(21)00981-8DOI Listing
May 2021

International survey for assessing COVID-19's impact on fear and health: study protocol.

BMJ Open 2021 05 11;11(5):e048720. Epub 2021 May 11.

School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong.

Introduction: COVID-19, caused by the SARS-CoV-2, has been one of the most highly contagious and rapidly spreading virus outbreak. The pandemic not only has catastrophic impacts on physical health and economy around the world, but also the psychological well-being of individuals, communities and society. The psychological and social impacts of the COVID-19 pandemic internationally have not been well described. There is a lack of international study assessing health-related impacts of the COVID-19 pandemic, especially on the degree to which individuals are fearful of the pandemic. Therefore, this study aims to (1) assess the health-related impact of the COVID-19 pandemic in community-dwelling individuals around the world; (2) determine the extent various communities are fearful of COVID-19 and (3) identify perceived needs of the population to prepare for potential future pandemics.

Methods And Analysis: This global study involves 30 countries. For each country, we target at least 500 subjects aged 18 years or above. The questionnaires will be available online and in local languages. The questionnaires include assessment of the health impacts of COVID-19, perceived importance of future preparation for the pandemic, fear, lifestyles, sociodemographics, COVID-19-related knowledge, e-health literacy, out-of-control scale and the Patient Health Questionnaire-4. Descriptive statistics will be used to describe participants' characteristics, perceptions on the health-related impacts of COVID-19, fear, anxiety and depression, lifestyles, COVID-19 knowledge, e-health literacy and other measures. Univariable and multivariable regression models will be used to assess the associations of covariates on the outcomes.

Ethics And Dissemination: The study has been reviewed and approved by the local ethics committees in participating countries, where local ethics approval is needed. The results will be actively disseminated. This study aims to map an international perspective and comparison for future preparation in a pandemic.
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http://dx.doi.org/10.1136/bmjopen-2021-048720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117470PMC
May 2021

Attitudes and practices towards palliative care in chronic heart failure: a survey of cardiovascular nurses and physicians.

Contemp Nurse 2021 Feb-Apr;57(1-2):113-127. Epub 2021 May 28.

School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.

Background: Heart failure is a chronic condition with various implications for individuals and families. Although the importance of implementing palliative care is recommended in best practice guidelines, implementation strategies are less clear.

Aims: This study sought to; (1) determine Australian and New Zealand cardiovascular nurses and physicians' end of life care attitudes and specialist palliative care referral in heart failure and; (2) determine self-reported delivery of supportive care and attitudes towards service names.

Methods: An electronic survey was emailed to members of four peak bodies and professional networks. Participants were also recruited through social media. Paper-based versions of the survey were completed by attendees of the 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, August 2018.

Findings: There were 113 completed responses included in the analyses. Participants were nurses ( = 75), physicians ( = 32) and allied health professionals ( = 4). Most (67%) reported they were comfortable with providing end of life care; however, fewer respondents agreed they received support for their dying patients and one-third experienced a sense of failure when heart failure progressed. Most (84-100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name 'supportive care' than to 'palliative care'.

Conclusion: Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name 'supportive care' and further research focusing on primary palliative team-based approach is required to improve palliative care access.

Impact Statement: Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.
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http://dx.doi.org/10.1080/10376178.2021.1928522DOI Listing
May 2021

Medication Adherence Interventions for Cardiovascular Disease in Low- and Middle-Income Countries: A Systematic Review.

Patient Prefer Adherence 2021 29;15:885-897. Epub 2021 Apr 29.

Johns Hopkins University School of Nursing, Baltimore, MD, USA.

Purpose: The burden of cardiovascular diseases (CVD) is high in low- and middle-income countries (LMICs). Medications are integral to the management and control of CVD; however, suboptimal adherence impacts health outcomes. This systematic review aims to critically examine interventions targeted at improving medication adherence among persons with CVD in LMICs.

Methods: In this systematic review, we searched online databases PubMed, Embase, and CINAHL for studies that evaluated a medication adherence intervention for CVD, reported adherence as an outcome measure, were conducted in LMICs and reported the strategy or tool used to measure adherence. We included articles published in English, available in full text, peer-reviewed, and published between 2010 and 2020.

Results: We included 45 articles in this review. The majority of the studies implemented counseling and educational interventions led by nurses, pharmacists, or community health workers. Many of the studies delivered medication-taking reminders in the form of phone calls, text messages, short message services (SMS), and in-phone calendars. Multi-component interventions were more effective than unifocal interventions. Interventions involving technology, such as mobile phone calls, electronic pillboxes, and interactive phone SMS reminders, were more effective than generic reminders. The outcomes reported in the studies varied based on the complexity and combination of strategies. When interventions were implemented at both the patient level, such as reminders, and at the provider level, such as team-based care, the effect on medication adherence was larger.

Conclusion: In LMICs, medication adherence interventions among persons with CVD included a combination of patient education, reminders, fixed-dose combination therapy and team-based care approach were generally more effective than singular interventions. Among patients who had CVD, the medication adherence interventions were found to be moderately effective. Future studies focusing on improving medication adherence in LMICs should consider non-physician-led interventions and appropriately adapt the interventions to the local context.
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http://dx.doi.org/10.2147/PPA.S296280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092634PMC
April 2021

Global digital social learning as a strategy to promote engagement in the era of COVID-19.

J Clin Nurs 2021 Aug 26;30(15-16):2366-2372. Epub 2021 Apr 26.

Department of Pharmaceutical & Health Economics, School of Pharmacy, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA.

Aims And Objectives: To assess formative and summative milestones in a digital course and the reach to low- and middle-income countries of a Massive Open Online Course focussing on supporting nurses dealing with an emerging pandemic.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ravaged the globe and increased the need for timely and accurate information from reliable sources. Access to reliable and accurate information, as well as support, is important in achieving health systems strengthening. Using a Massive Open Online Course format, an educational resource aimed at large-scale interactive participation via the Internet, and participants were engaged in a course focussing on nursing in a time of crisis and involved using social learning principles.

Design: Observational descriptive study.

Method: Routinely collected data were collated during the period of 18 May-18 July 2020 focused on both formative and summative milestones in the course. Data were separated and classified by income in accordance with the publicly accessible 2020 World Bank Open Dataset.

Results: During the 2-month period of observation (18 May-18 July 2020), 10,130 individuals from 156 countries enrolled in the course. More than 51% of participants were Active Learners. Thirty per cent completed over 90% of the course content by the end. There was widespread distribution of learners in low- and middle-income countries across Asia, Africa and Latin America.

Conclusion: The COVID-19 pandemic has underscored the importance of reliable and valid information sources. The use of Massive Open Online Course format can facilitate dissemination.

Relevance To Clinical Practice: In the context of a dynamic global pandemic, leveraging digital resources to allow access to reliable information and resources is important. Incentivising participation through recognition of learning is important. Engaging in a social learning platform also has the power for reflection, promotion of resilience and capacity for health systems strengthening.
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http://dx.doi.org/10.1111/jocn.15776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242900PMC
August 2021

Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study.

Geriatr Nurs 2021 May-Jun;42(3):740-747. Epub 2021 Apr 16.

Johns Hopkins University School of Nursing, Baltimore, 21205, MD, USA. Electronic address:

The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.
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http://dx.doi.org/10.1016/j.gerinurse.2021.03.013DOI Listing
April 2021

Improving hypertension knowledge, medication adherence, and blood pressure control: A feasibility study.

J Clin Nurs 2021 Oct 19;30(19-20):2960-2967. Epub 2021 Apr 19.

Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.

Aims And Objectives: To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension.

Background: Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension.

Design: Pre-test and post-test feasibility study.

Methods: A convenience sample of forty-four participants who identified as Haitian immigrants was enrolled in this evidence-based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill-Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes.

Results: Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six-week follow-up period.

Conclusion: The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in-depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities.

Relevance To Clinical Practice: Advanced practice nurses are uniquely qualified to implement evidence-based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence-based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.
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http://dx.doi.org/10.1111/jocn.15803DOI Listing
October 2021

Time for a reset and recalibration: Healthcare in the post COVID era.

Int J Nurs Sci 2021 Apr 20;8(2):143-144. Epub 2021 Mar 20.

Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.

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http://dx.doi.org/10.1016/j.ijnss.2021.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979640PMC
April 2021

Ensuring COVID-related innovation is sustained.

J Adv Nurs 2021 Jun 26;77(6):e4-e6. Epub 2021 Mar 26.

Johns Hopkins University School of Nursing, Baltimore, MD, USA.

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http://dx.doi.org/10.1111/jan.14837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251018PMC
June 2021

Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: How Do We Expand Capacity in the COVID-19 Era?

Heart Lung Circ 2021 May 3;30(5):623-625. Epub 2021 Mar 3.

Johns Hopkins School of Nursing, Baltimore, MD, USA. Electronic address: https://twitter.com/nursingdean.

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http://dx.doi.org/10.1016/j.hlc.2021.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927577PMC
May 2021

A single educational intervention on heart failure self-care: Extended follow-up from a multisite randomized controlled trial.

Eur J Cardiovasc Nurs 2021 03;20(3):212–219

Johns Hopkins School of Nursing, USA.

Background: Heart failure outcomes remain poor, and little is known about the causes and predictors of these outcomes in Lebanon.

Aim: The purpose of this article is to report the causes and predictors of the 6- and 12-month readmission and mortality of previously recruited patients to the Family focused Approach to iMprove Heart Failure care In LebanonQualitY intervention (FAMILY) study.

Methods: A multi-site block randomized controlled trial in three tertiary medical centers in Beirut. Initially, participants were randomized to either the control or the intervention group. The latter group, with their family caregivers, received heart failure self-care resources and an educational intervention on self-care and symptom management during their index admission. Participants from the FAMILY study were followed up with through phone calls for readmission and mortality at 6 and 12 months following their hospital discharge.

Results: A total of 218 (85%) patients were followed up with for this evaluation. There was a significant difference between the intervention group and the control group in terms of mortality at 6 months (n=18 (16%) versus n=36 (33%); p<0.05) and 12 months (n=29 (26%) versus n=45 (42%); p<0.05) post the index discharge. Mortality at 6 and 12 months was associated with aging, lower body mass index scores and readmission at 30 days post the index admission. Results of a logistic regression for mortality at 6 months showed hypertensive etiology of heart failure and 30-day readmission to be the only significant predictors.

Conclusion: A single session intervention was associated with lower mortality, even after an extended period of time, possibly mediated by other variables. Future studies should be powered for such outcomes while also addressing the cultural needs and literacy levels of the patients using multi-session trials and more frequent follow-ups.
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http://dx.doi.org/10.1177/1474515120941645DOI Listing
March 2021

Using a Twitter Chat as an Alternative to Traditional Classroom Discussion.

Nurse Educ 2021 Sep-Oct 01;46(5):316

By Samuel Byiringiro, MS, RN, Katie Nelson, MSN, RN, Alvine Akumbom, MS, RN, Patricia M. Davidson, PhD, RN, FAAN, Mengchi Li, BSN, RN, Chandler H. Moser, BSN, RN, Jennifer Lee, BSN, RN, Sydnee Logan, Oluwabunmi Ogungbe, MPH, RN, Mona Shattell, PhD, RN, FAAN, Johns Hopkins University School of Nursing, Baltimore, MD,

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http://dx.doi.org/10.1097/NNE.0000000000000989DOI Listing
February 2021

"Talking Around It": A Qualitative Study Exploring Dyadic Congruence in Managing the Uncertainty of Living With a Ventricular Assist Device.

J Cardiovasc Nurs 2021 May-Jun 01;36(3):229-237

Background: Vital components of communicating goals of care and preferences include eliciting the patient and caregiver's definition of quality of life, understanding meaningful activities and relationships, and exploring wishes for care at the end of life. Although current literature suggests framing conversations regarding end of life through the lens of meaning and quality of life, there is limited literature exploring dyadic congruence surrounding these important constructs among patients with ventricular assist devices (VADs) and their caregivers.

Objectives: The purpose of this study was to explore congruence of VAD patient and caregiver perspectives regarding end of life, definitions of quality of life, and meaning in life while managing the uncertainty of living with a VAD.

Methods: We used thematic analysis to analyze semistructured qualitative interviews of 10 patient-caregiver dyads 3 to 12 months after VAD implantation.

Results: Three major themes were identified: (1) differing trajectories of uncertainty and worry, (2) a spectrum of end-of-life perspectives, and (3) enjoying everyday moments and independence. Overall, patients and caregivers had differing perspectives regarding uncertainty and end of life. Within-dyad congruence was most evident as dyads discussed definitions of meaning or quality of life.

Conclusions: Dyadic perspectives on end of life, meaning in life, and quality of life can inform how palliative care and VAD teams approach conversations about planning for the end of life. Findings from this study can inform future shared decision-making interventions for patients living with VADs and their caregivers.
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http://dx.doi.org/10.1097/JCN.0000000000000784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035157PMC
January 2022

A review of inpatient nursing workload measures.

J Clin Nurs 2021 Jul 15;30(13-14):1799-1809. Epub 2021 Feb 15.

Johns Hopkins University School of Nursing, Baltimore, MD, USA.

Background: Fiscal constraints, an ageing populations and the increasing burden of chronic conditions are stressing health systems internationally. Nurses are the linchpin of effective healthcare delivery and their success is dependent on adequate staffing models, which must align knowledge, skills and competencies with workload.

Objectives: To compare measures of nursing workload in adult inpatient settings.

Design, Data Sources And Review Method: A review of published studies characterising nursing workload measures was undertaken. Databases-PubMed and CINHAL-were used to identify published studies. A description of the psychometric properties of each measure and its use in an inpatient setting was required for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide and report the review.

Results: Of the 1,422 studies identified, 15 met the inclusion criteria. Nursing workload was measured in the intermediate care unit (n = 6), overall hospital (n = 7), emergency department (n = 1) and burn unit (n = 1) settings and also by mailed survey (n = 1). Eleven different workload measures were identified. The National Aeronautics and Space Administration Task Load Index (n = 3), Therapeutic Intervention Scoring System (n = 3) and Nursing Activities Score (n = 2) were the most common nursing workload measures identified with reported psychometric properties.

Conclusion: Researchers, clinicians and hospital administrators should carefully identify and assess the psychometric properties of nursing workload measures before using these in routine practice.

Relevance To Clinical Practice: Gaining a consensus on effective nursing workload measures is a crucial step in designing appropriate staffing models and policies, improving nurse productivity and well-being, as well as enhancing patient health outcomes in inpatient settings.
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http://dx.doi.org/10.1111/jocn.15676DOI Listing
July 2021

A 10-year evaluation of projects in a doctor of nursing practice programme.

J Clin Nurs 2020 Nov 19;29(21-22):4090-4103. Epub 2020 Aug 19.

Johns Hopkins School of Nursing, Baltimore, MD, USA.

Aims And Objectives: The role of professional doctorates is receiving increased attention internationally. As part of building the rigour and scholarship of these programmes, we assessed projects undertaken as part of a doctor of nursing practice (DNP) programme at Johns Hopkins University. Recommendations for programme development in professional doctorates are provided.

Background: Past research has described the methodologic limitations and dissemination of DNP projects. However, few studies have provided recommendations for strengthening these projects and alternative strategies for achieving scale in larger student cohorts.

Design: A descriptive study reported in accordance with STROBE guidelines.

Methods: From 2009-2018, 191 final DNP project reports were obtained from the DNP programme administrator. Essential project characteristics from the papers were extracted, including use of theoretical framework, design, setting, sample and dissemination through publication. To determine whether the results of the projects had been published, the title and student's name were searched in Google Scholar and Google.

Results: Of the 191 projects, 83% focused on adults and 61% were conducted in the hospital setting. Sample sizes ranged from 7 to 24,702. Eighty per cent of the projects employed a pretest/post-test design, including both single and independent groups. The projects spanned six overarching themes, including process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment. Twenty-one per cent of the project findings were published in scholarly journals.

Conclusions: Conducting a critical review of DNP projects has been useful in refining a strategy shifting from incremental to transformative changes in advanced practice.

Relevance To Clinical Practice: Programme evaluation is critical in order to sufficiently prepare nurses in advanced nursing practice to influence healthcare outcomes at the individual or population level.
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http://dx.doi.org/10.1111/jocn.15435DOI Listing
November 2020
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