Telehealth resources and utilization interest among women who sell sex: An explanatory sequential mixed methods study.

Objective: Among a sample of women who sell sex (WSS), we examined unmet health needs, resources for telehealth, utilization interest, and attributes associated with interest in using telehealth. Study design: Explanatory sequential mixed methods. Methods: WSS (N = 52) completed a fixed choice survey and focus group (N = 6, 26 individuals) from drop-in centers serving WSS. Chi-square/t-tests and results from the survey data informed the semi-structured focus group interview guide. Thematic analysis of focus group data was conducted to identify themes. Results: Over half (58 %) of participants expressed interest in using telehealth; however, some lack the necessary resources for use. While 60 % of participants own mobile phones and 46 % have access to a computer, only 35 % have a secure, private space for telehealth appointments. Interest in telehealth was higher among participants who self-identified as having high risk for HIV compared to low risk for HIV (79 % versus 46 %, p = 0.024), and among those considering PrEP for HIV prevention versus not considering PrEP (68 % versus 32 %, p = 0.046). Focus group participants preferred face-to-face encounters for complex medical concerns but expressed interest in telehealth for improved access to healthcare providers for routine care and mental health. Conclusion: Incorporating telehealth into community organizations could be one strategy to address health inequities experienced by WSS. Access to resources, including technology and safe spaces may be well-accepted if offered at trusted community organizations. Such accessibility addresses a gap in care for WSS and paves the way for new avenues for HIV prevention, mental health support, and research related to unmet health needs among WSS.

Understanding the 'Dancing Nurses of TikTok'.

Judgment by nursing leaders is the wrong response.

Sprinting in a Marathon: Nursing Staff and Nurse Leaders Make Meaning of Practicing in COVID-19 Devoted Units Pre-Vaccine.

Objective: To describe the lived experience of nursing staff and nurse leaders working in COVID-19 devoted units (intensive care or medical unit) prior to vaccine availability. Research Design: Qualitative phenomenological design with a focus group approach. Methods: The study team recruited a convenience sample of nursing staff (nurses, and nursing assistants/nurse technicians) and nurse leaders (managers, assistant nurse managers, clinical nurse specialists, and nurse educators) at an academic medical center in the midwestern United States. Focus groups and individual interviews were conducted to encourage participants to describe their (1) experiences as nursing professionals, (2) coping strategies, and (3) perspectives about supportive resources. Moral distress was measured with the moral distress thermometer and qualitative data were analyzed with Giorgi-style phenomenology. Results: We conducted 10 in-person focus groups and five one-on-one interviews (n = 44). Seven themes emerged: (1) the reality of COVID-19: we are sprinting in a marathon; (2) acute/critical care nurse leaders experience unique burdens; (3) acute/critical care staff nurses experience unique burdens; (4) meaning of our lived experience; (5) what helped us during the pandemic; (6) what hurt us during the pandemic; and (7) we are not okay. Participants reported a moderate level of moral distress (M = 5.26 SD = 2.31). They emphasized that peer support was preferred over other types of support offered by the healthcare organization. Participants expressed positive feedback about the focus group experience and commented that group processing validated their experiences and helped them "feel heard." Conclusion: These findings affirm the need for trauma-informed care and grief support for nurses, interventions that increase meaning in work, and efforts to enhance primary palliative communication skills. Study findings can inform efforts to tailor existing interventions and develop new, more comprehensive resources to meet the psychosocial needs of nursing staff and nurse leaders practicing during a pandemic.

Reducing Nonemergent Visits to the Emergency Department in a Veterans Affairs Multistate System.

STUDY OBJECTIVE: The purpose of this quality improvement study was to reduce nonemergent visits to the emergency department attendance within a multistate Veterans Health Affairs network. METHODS: Telephone triage protocols were developed and implemented for registered nurse staff to triage selected calls to a same-day telephonic or video virtual visit with a provider (physician or nurse practitioner). Calls, registered nurse triage dispositions, and provider visit dispositions were tracked for 3 months. RESULTS: There were 1606 calls referred by registered nurses for provider visits. Of these, 192 were initially triaged as emergency department dispositions. Of these, 57.3% of calls that would have been referred to the emergency department were resolved via the virtual visit. Thirty-eight percent fewer calls were referred to the emergency department following licensed independent provider visit compared to the registered nurse triage. CONCLUSION: Telephone triage services augmented by virtual provider visits may reduce emergency department disposition rates, resulting in fewer nonemergent patient presentations to the emergency department and reducing unnecessary emergency department overcrowding. Reducing nonemergent attendance to emergency departments can improve outcomes for patients with emergent dispositions.

Work-Related Burnout, Compassion Fatigue, and Nurse Intention to Leave the Profession During COVID-19.

The purpose of this mixed-method study was to understand the relationships between work-related burnout (WRB), compassion fatigue (CF), and intention to leave the nursing profession. The Job Demands-Resources model was used to predict intention to leave as a function of WRB, CF, and caring for COVID-19 patients in a sample of 1299 US nurses. Greater WRB and CF scores were associated with intention to leave the profession. Contrary to prior research, working with COVID-19 patients was associated with greater intention to stay in nursing. Personal finances may represent the rationale for nurses to choose to stay nurses despite burnout.

COVID-19 Vaccine Acceptance or Refusal Among US Nurses: A Descriptive Cross-Sectional Study.

INTRODUCTION: Nurse turnover has accelerated during the COVID-19 pandemic. Nurse refusal of mandated vaccines contributes to understaffing and affects patient health outcomes. The purposes of this study were to describe (1) nurse reasons for COVID-19 vaccine decisions and (2) the relationship between vaccine status and nurse characteristics. METHODS: This cross-sectional descriptive study employed a survey of US nurses who worked in nursing during the COVID-19 pandemic. The survey included a free-text question about COVID-19 vaccine uptake rationale, self-reported vaccine acceptance/refusal, and demographic data. RESULTS: Of the 1682 participants, 11.2% refused the COVID-19 vaccine. Higher education level was correlated with greater vaccine acceptance rates (P < 0.001). Themes for vaccine rationale included safeguarding well-being, trust in the science, coercion to vaccinate, perceived immunity, and concern about preexisting health conditions. CONCLUSIONS: The risks of COVID-19 vaccine mandates may be greater than the potential benefits given the potential for compounding workforce attrition during a nursing staffing crisis. Further research is needed to outline the relationships between vaccine education, advocacy, and vaccine uptake among nurses.

Impact of COVID-19 on Intensive Care Unit Nurse Duty of Care and Professional Roles: A Qualitative Content Analysis.

Background: Nurse duty of care, the balance between nursing occupational obligations to provide care, the personal costs for providing such care, and the reward for providing care, has been significantly altered by the COVID-19 pandemic. ICU nurses are increasingly burdened with higher personal costs to fulfill their jobs, but little additional reward for continuing to provide care. Objectives: The purpose of this study was to examine the impact of the COVID-19 pandemic on the duty of care balance among ICU nurses who manage COVID-19 patients. Design: This was a descriptive qualitative study using semi-structured interviews. Methods: Nurses were recruited for a parent study on ICU nursing during COVID-19; this is a secondary analysis of the interviews that took place during the parent study. Content analysis was utilized to identify themes from interview transcripts. Results: Thirteen nurses participated in interviews. Nurses reported betrayal at perceived breeches in their duty of care agreement by their employers, the general public, and national health authorities. They described alterations to previous standards of care such as significantly increased workloads, worsening understaffing, and changes to patient care expectations that were implemented for reasons other than betterment of patient care. Nurses reported they felt a moral obligation to provide care, however they experienced disempowerment and burnout that affected them both in and out of the workplace. Conclusion: The COVID-19 pandemic has affected several aspects of the duty of care balance, resulting in a duty of care balance that is inequitable to nurses. Imbalance in the effort, risks, and rewards for nursing professionals may contribute to nurse burnout. Relevance to Clinical Practice: This research highlights the need for healthcare administrators to consider resource allocation, nurse appreciation, and commensurate compensation for professional nurses.