Description of a student success program to increase support, coping, and self-efficacy among under-represented minority nursing students in the wake of the dual pandemics of COVID-19 and racial violence.

BACKGROUND: Increasing the size and diversity of the nursing workforce is an important priority. Here, we describe a student success program to increase students' perceived support, coping, and self-efficacy for completing the nursing program among underrepresented racial/ethnic minority students in nursing education following the dual pandemics of COVID-19 and racial injustice. METHODS: In collaboration with the Urban Health Program at the University of Illinois Chicago, we conducted a 15-week online student success pilot program with a volunteer sample of upper-level undergraduate nursing students. The curriculum for the program included topics centered on traditional student success topics and psychological, emotional, and contextual issues associated with student success. The sessions were conducted weekly throughout the Spring and Fall semesters of 2021, lasting 90-min. Quality improvement evaluations included weekly process variables and a post-test assessment. RESULTS: Participants (N = 35) were primarily female and Hispanic. The program was acceptable, with participants very satisfied with the weekly sessions (83 %). Post-evaluations revealed self-reported improvements in peer support (69 %), confidence in reaching educational goals (94 %), handling microaggressions (77 %), coping with adversity (80 %), stress levels (63 %), and thoughts about leaving the program (86 %). CONCLUSIONS: This student success program shows promise for improving general and minority-specific factors associated with student success. Additional development and evaluation are needed to determine the program's benefits for a larger group of nursing students.

Strategies to address structural and institutional barriers to success among students of color in nursing programs.

The COVID-19 pandemic and the significant disparities experienced by Black, Indigenous, and people of color (BIPOC) in infections, hospitalizations, and deaths associated with the Coronavirus have underscored the imperative to increase the size and diversity of the healthcare workforce, including nursing. Academically focused pipeline development programs have led to some advances in minority recruitment and retention; however, emerging research highlights the importance of extra-academic factors that reduce the sense of belonging and persistence among underrepresented and minority students. The purpose of this manuscript is to describe the diversity, equity, and inclusion goals and activities of a college of nursing located in a minority-serving institution. Here, we emphasize the description of a range of activities aimed at meeting our diversity goals. Further, we highlight the actions initiated in response to emergent "extra-academic" student needs over the past year related to the COVID-19 pandemic and police brutality. The strategies described have implications for improving diversity, equity, and inclusion among higher education institutions in nursing.

Experience of African American Surrogate Decision Makers of Patients With Dementia.

Dementia cases are expected to grow for African Americans and surrogate decision makers (SDMs) will have a significant role at the end of life (EOL). This qualitative exploratory case study used Cognitive Task Analysis and an integrated conceptual framework to understand the EOL decision experience of African American SDMs for patients with advanced dementia. Using a holistic multiple-case design, 8 African American SDMs were interviewed about their experiences with the decision-making process, including role acceptance, role enactment, and emotional outcomes of decision making. Thirteen themes germane to understanding the EOL decision experience of African American SDMs were identified. Findings suggest African American SDMs often lack sufficient knowledge of disease prognosis and intervention options to make informed treatment choices at EOL. In particular, African Americans extend the caregiver role to SDM for patients with dementia at EOL without being fully aware of the role and decision-making responsibilities. Surrogates lacked a general understanding of EOL options resulting in underutilization of hospice and palliative care and subsequent regret, and few interventions exist to improve the uptake of EOL care services. There is a need to develop culturally appropriate role preparation, education, and decision support to improve EOL treatment decisions and emotional adjustment of surrogates of patients with advanced dementia, which should be rendered early and throughout the illness trajectory.

Advance Care Planning for African American Caregivers of Relatives With Dementias: Cluster Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: African-American family caregivers may have insufficient knowledge to make informed end-of-life (EOL) decisions for relatives with dementias. Advance Care Treatment Plan (ACT-Plan) is a community-based education intervention to enhance knowledge of dementia and associated EOL medical treatments, self-efficacy, intentions, and behavior (written EOL care plan). This study evaluated efficacy of the intervention compared to attention control. RESEARCH DESIGN AND METHODS: In a theoretically based, 2-group, cluster randomized controlled trial, 4 similar Midwestern urban megachurches were randomized to experimental or control conditions. Each church recruited African-American caregivers, enrolling concurrent waves of 5 to 9 participants in 4 weekly 1-hour sessions (358 total: ACT-Plan n = 173, control n = 185). Dementia, cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and tube feeding (TF) treatments were discussed in ACT-Plan classes. Participants completed assessments before the initial class, after the final class (week 4), and at week 20. Repeated measures models were used to test the intervention effect on changes in outcomes across time, adjusting for covariates as needed. RESULTS: Knowledge of CPR, MV, TF, and self-efficacy to make EOL treatment decisions increased significantly more in the ACT-Plan group at weeks 4 and 20. Knowledge of dementia also increased more in the ACT-Plan group at both points, reaching statistical significance only at week 20. Intentions to make EOL treatment decisions and actually an advance care plan were similar between treatment arms. DISCUSSION AND IMPLICATIONS: Findings demonstrate promise for ACT-Plan to increase informed EOL treatment decisions for African American caregivers of individuals with dementias.

End-of-Life Interventions for African Americans With Serious Illness: A Scoping Review.

Older African Americans (AAs) with serious illness experience disparities in advance care planning, access to palliative care and hospice, and decision-making at end of life. While culturally specific drivers of care outcomes have been identified, little has been done to standardize integration and application of targeted elements of end-of-life (EOL) interventions for AA populations. A scoping review was conducted to describe and evaluate the benefit of culturally targeted EOL interventions for AAs. A computerized search of empirical and gray literature was completed. Twelve full-text articles, 1 brief report, and 1 abstract describing a total of 14 EOL interventions for AAs with a range of serious illness were reviewed. Interventions were described relative to culturally targeted adaptations and resulting cognitive, emotional, and behavioral outcomes. Most interventions were theory-based and used psychoeducational approaches and interactive discussion and interviews. Significant improvements in psychological and behavioral outcomes were reported including knowledge and self-efficacy (n = 8); self-reported anxiety, depression, and/or well-being (n = 5); and advance care plan completion (n = 3). Few culturally tailored randomized controlled trials (n = 9) have been conducted. Preliminary results show promise for interventions using cultural adaptations. Culturally targeted intervention approaches are feasible to address EOL outcomes for AA patients and families experiencing serious illness.

The use of strategies from the social sciences to inform pipeline development programs for under-represented minority faculty and students in the health sciences.

Representation of under-represented minority (URM) faculty in the health sciences disciplines is persistently low relative to both national and student population demographics. Although some progress has been made through nationally funded pipeline development programs, demographic disparities in the various health sciences disciplines remain. As such the development of innovative interventions to help URM faculty and students overcome barriers to advancement remains a national priority. To date, the majority of pipeline development programs have focused on academic readiness, mentorship, and professional development. However, insights from the social sciences literature related to "extra-academic" (e.g., racism) barriers to URM persistence in higher education suggest the limitations of efforts exclusively focused on cognitively mediated endpoints. The purpose of this article is to synthesize findings from the social sciences literature that can inform the enhancement of URM pipeline development programs. Specifically, we highlight research related to the social, emotional, and contextual correlates of URM success in higher education including reducing social isolation, increasing engagement with research, bolstering persistence, enhancing mentoring models, and creating institutional change. Supporting URM's success in the health sciences has implications for the development of a workforce with the capacity to understand and intervene on the drivers of health inequalities.

Trust Building Recruitment Strategies for Researchers Conducting Studies in African American (AA) Churches: Lessons Learned.

BACKGROUND: An initial and vital important step in recruiting participants for church-based hospice and palliative care research is the establishment of trust and credibility within the church community. Mistrust of medical research is an extremely important barrier hindering recruitment in African American (AA) communities. A church-based EOL dementia education project is currently being conducted at four large urban AA churches. Church leaders voiced mistrust concerns of previous researchers who conducted investigations in their faith-based institutions. We explored strategies to ameliorate the mistrust concerns. Specific aim: To identify trust-rebuilding elements for researchers following others who violated trust of AA church leaders. METHODS: Face-to-face, in-depth interviews were conducted from a convenient sample of four established AA church leaders. Interviews were held in the informants' churches to promote candor and comfort in revealing sensitive information about trust /mistrust. Content analysis framework was used to analyze the data. Elements identified from the analysis were then used to create themes. RESULTS: Multidimensional overarching themes emerged from the analysis included: Experience with researchers (positive and extremely negative), violation of trust and trust building strategies. CONCLUSIONS: Findings suggest that researchers who wish to conduct successful studies in the AA religious institutions must implement trust rebuilding strategies that include mutual respect, collaboration and partnership building. If general moral practices continue to be violated, threat to future hospice and palliative care research within the institutions may prevail. Thus, potential benefits are thwarted for the church members, AA community, and advancement of EOL care scholarship.