A mixed methods study of moral distress among frontline nurses during the COVID-19 pandemic.

OBJECTIVE: The study's purpose was to develop an understanding of factors affecting moral distress among nurses during the COVID-19 pandemic. METHOD: California-licensed, registered nurses who cared for COVID-19 patients for at least 3 months were recruited for an explanatory concurrent mixed methods study. Data are derived from the first of two surveys administered 3 months apart, including open-ended questions. RESULTS: Variables with significant bivariate correlations were included as simultaneous predictors in a linear regression model predicting moral distress. The overall model was significant, explaining a substantial portion of the variance in moral distress, but results showed only organizational support and institutional betrayal uniquely predicted moral distress. Three qualitative themes were identified: Ethical Violations in Care, Institutional Betrayal, and Traumatic Strain. The impacts of organizational support and institutional betrayal on nurses' moral distress are important findings in both datasets. CONCLUSIONS: Findings provide insights into how nurses' experiences affected their feelings about work. Participants indicated feeling disregarded by management and institutional structures, indicating potential means of slowing the rates at which nurses plan to leave bedside practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A novel conceptual model of trauma-informed care for patients with post-acute sequelae of SARS-CoV-2 illness (PASC).

AIM: This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC). DESIGN: This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes. DATA SOURCES: PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors. IMPLICATIONS FOR NURSING: The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care approach to PASC patients can enhance nurses' ability to remediate and ameliorate both the traumatic burden of and the symptoms and experience of the illness. CONCLUSION: Applying a trauma-informed perspective to care of PASC patients can help to reduce the overall burden of this complex condition. Owing to the fundamentally holistic perspective of the nursing profession, nurses are best positioned to implement care that addresses multiple facets of the PASC experience. IMPACT: The proposed model specifically addresses the myriad ways in which PASC may affect physical as well as mental and psychosocial dimensions of health. The model particularly seeks to suggest means of supporting patients who have already experienced a life-threatening illness and are now coping with its long-term impact. Since the scope of this impact is not yet defined, trauma-informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.

Between Healthcare Practitioners and Clergy: Evangelicals and COVID-19 Vaccine Hesitancy.

Evangelical Christians are among the most hesitant to get the COVID-19 vaccine. This study examined the extent to which COVID-19 vaccination uptake among Evangelicals is explained by demographic characteristics, Health Belief Model constructs, and faith-based support factors. Survey research firm Qualtrics recruited 531 U.S. adults and conducted a survey to explore predictors of COVID-19 vaccine uptake among people who self-identified as Evangelicals in September 2021. A logistic regression showed that those reporting high perceived benefits of the COVID-19 vaccine were more likely to be vaccinated, while those reporting high perceived barriers were less likely to be vaccinated. Those whose healthcare provider asked them about the vaccine were more likely to be vaccinated than those whose healthcare provider did not ask. Finally, while those who reported information seeking from religious leaders were less likely to be vaccinated, those who reported more faith-based support for vaccination were more likely to be vaccinated. In addition to beliefs about benefits and barriers to vaccination, the role of healthcare providers and clergy were important factors influencing vaccination status. Intervention efforts that capitalize on partnerships between health providers and clergy in supportive congregations may be able to reach undecided Evangelicals.

Application of trauma-informed care principles in academic nursing settings during the COVID-19 pandemic.

The persistence of the COVID-19 pandemic has led to a multitude of changes in the ways nursing education, research, and practice are carried out. In addition to the demands of shifting to remote education as well as finding alternatives to direct patient care learning, nursing faculty and students are directly confronting morbidity and mortality among classmates, colleagues, friends, and family members. These experiences unquestionably meet criteria for traumatic experience, and this must be accounted for in nursing education as they can have detrimental effects on learning, teaching, and well-being. The current generation of nursing students and faculty will necessarily carry the traumatic experiences of this chaotic time into workplace, classroom, and community settings. Understanding how to manage this trauma appropriately not only supports individuals through this experience but provides increased opportunity and capacity for the provision of trauma-informed care (TIC) to patients and colleagues going forward. This paper describes some of the ways COVID-19-related trauma may affect nursing faculty and students; and proposes application of TIC principles to research, education, and practice environments to enhance well-being and overall functioning in the profession.

Antihistamines for Postacute Sequelae of SARS-CoV-2 Infection.

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

Novel Pedagogical Training for Nursing Doctoral Students in Support of Remote Learning: A Win-Win Situation.

BACKGROUND: The need for faculty to educate prospective nurses is urgent: without sufficient nursing faculty, schools regularly reject qualified applicants, despite an increasing need for nurses. At the same time, many graduate-prepared nurses lack preparation in teaching and pedagogical frameworks. PROBLEM: Literature on how PhD programs in nursing prepare graduates for teaching indicates that there is typically more emphasis on research than pedagogical learning. APPROACH: With the shift to remote learning under the COVID-19 pandemic, the University of California Irvine created a Graduate Fellows program to provide support to faculty while offering graduate students education in pedagogy and remote learning. OUTCOMES: Fellows were satisfied and reported increased understanding of challenges in teaching and increasing comfort with nurse faculty roles. CONCLUSIONS: The collaborative efforts of fellows and faculty provided important resources at a critical time, and insights gained can inform similar projects in nursing faculty development.

U.S. public support for COVID-19 vaccine donation to low- and middle-income countries during the COVID-19 pandemic.

As COVID-19 vaccines become available to the public, there will be a massive worldwide distribution effort. Vaccine distribution has historically been unequal primarily due to the inability of nations with developing economies to purchase enough vaccine to fully vaccinate their populations. Inequitable access to COVID-19 vaccines will not just cause humanitarian suffering, it will likely also be associated with increased economic suffering worldwide. This study focuses on the U.S. population and its beliefs about future COVID-19 vaccine donation by the U.S. to low- and middle-income countries. This study carried out a survey among 788 U.S. adults. Variables include demographics, COVID-19 vaccine priority status, COVID-19 vaccine donation beliefs, and Social Dominance Orientation. Analyses showed that older respondents were both less likely to endorse higher levels of COVID-19 vaccine donations and were more likely to want to wait until all in the U.S. who want the vaccine have received it; those who identified as Democrats were more likely to endorse higher levels of future COVID-19 vaccine donation than Republicans; and those scoring higher on SDO were both less likely to endorse higher levels of COVID-19 vaccine donations as well as more likely to want to wait until all in the U.S. who want the vaccine have received it. Policymakers, as well as healthcare providers and public health communication professionals, should give consideration to those messages most likely to engender support for global prevention efforts with each audience segment.

Willingness to get the COVID-19 vaccine with and without emergency use authorization.

BACKGROUND: This study assessed psychosocial predictors of U.S. adults' willingness to get a future COVID-19 vaccine and whether these predictors differ under an emergency use authorization (EUA) release of the vaccine. METHODS: A survey of 788 U.S. adults was conducted to explore the relationships between demographics and psychosocial predictors of intent to get a future COVID-19 vaccine as well as willingness to get such a vaccine under EUA. RESULTS: Significant predictors of COVID-19 vaccine uptake intentions were education, having insurance, scoring high on subjective norms, a positive attitude toward the vaccine, as well as high perceived susceptibility to COVID-19, high perceived benefits of the vaccine, scoring low on barriers to the vaccine, and scoring high on self-efficacy. Predictors of willingness to take a COVID-19 vaccine under EUA were age, race/ethnicity, positive subjective norms, high perceived behavioral control, positive attitudes toward the vaccine, as well as high perceived susceptibility to COVID-19, high perceived benefits of the vaccine, low barriers to the vaccine, and scoring high on self-efficacy for getting the vaccine. Concerns about rushed vaccine development appear to reduce vaccine uptake intent, as well as willingness to get the vaccine under EUA. CONCLUSIONS: COVID-19 vaccine-related messages should both address concerns about the vaccine and its development and reinforce benefits of the vaccine (both factors significant in both models). Vaccine efforts may need to go beyond just communications campaigns correcting misinformation about a COVID-19 vaccine to also focus on re-establishing public trust in government agencies.