Parental vaccine hesitancy and concerns regarding the COVID-19 virus.

PURPOSE: This study assessed parental vaccine hesitancy in a metropolitan area of the United States. The study aimed to determine what characteristics and contributing factors influenced parental vaccine hesitancy and concerns regarding COVID-19. DESIGN AND METHODS: An online survey was used to recruit 93 parents to answer demographic and vaccine hesitancy information. Vaccine hesitancy was measured using the Parent Attitudes about Childhood Vaccines survey. The study was conducted between June 2020 and September 2020 during the COVID-19 pandemic. RESULTS: The rate of vaccine hesitancy was 15%. One hundred percent of vaccine hesitant parents were mothers, at least 30 years of age, married, and had completed at least some college. When characteristics of vaccine hesitant parents were compared to non-hesitant parents, the hesitant parents reported having more children, with 93% reporting two or more children compared to only 74% of non-hesitant parents (p = 0.046). Fifty percent of hesitant parents reported no concerns regarding COVID-19 compared to only 20% of non-hesitant parents (p = 0.006), and significantly less hesitant parents reported willingness to have their children receive a safe, effective COVID-19 vaccine if it were available compared to non-hesitant parents (p < 0.001). CONCLUSIONS: Our findings indicate that older mothers with two or more children are more likely to be vaccine hesitant and this hesitancy extends to the current COVID-19 pandemic. PRACTICE IMPLICATIONS: Healthcare providers can use the results of this study to identify parents at risk for vaccine hesitancy and initiate individualized education to promote on-time childhood vaccination.

Assessment of Oncology Provider Knowledge and Cardiovascular Screening Practices: A Call for Heightened Screening.

Cardiac risk factors are known to compound the development of cardiotoxicities (CTx) in patients exposed to anthracycline (ANT) chemotherapy agents. National oncology and cardiology organizations have published recommendations for cardiovascular risk stratification and screening cancer patients following exposure to ANTs. The frequency with which oncology providers are integrating these principles into practice is unknown. This knowledge-based quality improvement (QI) project was designed to heighten oncology provider competencies such that screening frequency of cancer patients for CTx in the post-ANT setting aligns more closely with national guidelines for care. A web-based educational intervention, cardiac screening tool, and evidence-based literature were shared with 20 oncology providers over the course of 5 months. Retrospective chart reviews and pre- and post-project surveys were performed to assess competencies and practice trends. Qualitative and quantitative data were analyzed to illustrate whether the interventions improved knowledge and changed practice. Findings revealed an increase in the number of provider-perceived percentage of high cardiac risk patients and the number of patients screened, knowledge did not improve, and the frequency by which oncology providers ordered echocardiograms increased minimally. Factors such as organizational system changes, time constraints, and change fatigue limited effective and consistent implementation of the project interventions. The trajectory of cancer survivorship is affected by cardiovascular disease. Cardiac screening of cancer patients is a critical component of cancer care that has the potential to positively impact economic and health outcomes of this susceptible population.

Pharmacological Labor-Stimulating Agents and Neonatal Outcomes.

This study examined the physiological and feeding outcomes of term neonates in relation to if they were delivered with pharmacological labor-stimulating agents or not. A retrospective chart review was conducted at a regional hospital. Infant and mother charts were selected from a 6-week timeframe. Descriptive and inferential statistics were used to analyze the 296 charts that were included. There were no statistically significant differences in physiological and feeding parameters of term neonates in relation to pharmacological labor-stimulating agents. The only significant difference found was that deliveries, which received no labor-stimulating agents, had higher rates of meconium staining.

Postpartum depression: perceptions of a diverse sample of low-income women.

Postpartum depression (PPD) continues to significantly impact women and their families during the perinatal period. Consequences of untreated PPD in the mother may lead to impaired mother-infant bonding, recurring psychiatric illness, and fewer positive parenting behaviors. North Carolina participates in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey and has the second highest self-reported rate of postpartum depressive symptoms at 19.0%. The full study used both quantitative and qualitative methods. The qualitative approach, an interpretive Heideggerian perspective, elicited the postpartum clients' perceptions of risk factors, how those perceptions affected the pregnancy experience, and how self-efficacy played a role in their perceived ability to make healthy choices. The sample was comprised of 60 pregnant women between the ages of 18 and 40. Four themes were found: (1) Feeling joy and apprehension at once, (2) Depression is something you think about (3) Rearranging your thinking, and (4) Garnering support. The women in this study believed that support was an indispensable tool in dealing with feelings of sadness and depression. Critical aspects of becoming involved in their pregnancy included changing their expectations and knowing how to detect and seek help when depressive symptoms occurred.

Relationship between knowledge, attitudes, and self-efficacy of nurses in the management of pediatric pain.

Pain management is a very important aspect of nursing care of the pediatric patient. A nurse's knowledge and attitude can affect his or her ability to adequately provide pediatric pain management. This study examined the level of knowledge of pediatric pain management, the attitudes of nurses, and the level of self-efficacy of pediatric nurses in acute care. In addition, the relationship between the years of experience and the levels of knowledge, attitudes, and self-efficacy were examined. A cross-sectional, correlational design was used in a convenience, non-probability sample of 25 pediatric nurses. Nurses volunteering to participate in the study were asked to complete two instruments: Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS-Shriners Revision) (Manworren, 2000, 2001) and Nurses' Self-Efficacy in Managing Children's Pain (Chiang, Chen, & Huang, 2006). There was no statistically significant relationship between knowledge and self-efficacy (r = 0.039, p = 0.853) or knowledge and years of nursing experience (r = 0.050, p = 0.822). There was a statistically significant relationship between the level of knowledge and the years of pediatric experience (r = 0.404, p = 0.05) and knowledge and the membership in a professional nursing organization (t = 4.050, p = 0.004). Years of pediatric nursing experience correlated with significantly higher knowledge levels, as did a membership in a professional nursing organization. Further, education may benefit pediatric nurses in regard to their management of pediatric pain. Research is needed to examine the effects of self-efficacy on pediatric pain management and how it relates to the level of knowledge.

Postpartum depression among White, African American, and Hispanic low-income mothers in rural southeastern North Carolina.

The purpose of this study was to assess factors impacting postpartum depression (PPD) among the 61 White, African American, and Hispanic low-income Medicaid recipients who enrolled in a prenatal program at a local health department in rural Southeastern North Carolina. The findings indicate that mothers who experienced mood changes, such as depression and anxiety, before or during pregnancy reported an increased level of PPD (p = 0.035). Nearly a third of the mothers displayed either minor (17.3%) or major (15.4%) depressive symptoms. Community health nurses working with this population need to be increasingly aware of the underlying causes and prevalence of PPD among low income mothers for early screening and intervention.

Impact of a feeding log on breastfeeding duration and exclusivity.

Even with the gradual upward trends in breastfeeding initiation and duration, breastfeeding rates at 6 months continue to lag well behind the 50% target set for any breastfeeding and the 25% target set for exclusive breastfeeding by the Healthy People 2010 initiatives. Overall evidence is limited in identifying effective interventions that promote breastfeeding duration and more research needs to be focused on specific nursing strategies and their effect on breastfeeding outcomes. The aim of this study was to test the efficacy of a daily feeding log, guided by Bandura's social cognitive learning theory, on breastfeeding duration and exclusivity in primiparous mothers. The study used a randomized, controlled, two-group experimental design with a sample of 86 primiparous mothers. The experimental group completed a daily breastfeeding log for a minimum of 3 weeks and breastfeeding outcomes were examined over 6 months. The breastfeeding outcome variable was analyzed using survival analysis and Cox proportional hazards regression procedures. Subjects in the experimental group did not breastfeed significantly longer than the control group, however, a larger proportion of subjects in the experimental group reported full breastfeeding at 6 months as compared with subjects in the control group. Additional predictor variables were WIC enrollment, planned duration of breastfeeding, feeding frequency and feeding length at 1 week. The findings from the study suggest that the breastfeeding log may be a valuable tool in self-regulating breastfeeding and promoting a longer duration of full breastfeeding, but its acceptability may be impacted by socio-demographic variables.

Camp BONES: a partnership initiative to engage underrepresented adolescents in a career in nursing at the baccalaureate level.

The nursing profession is confronted with significant challenges related to the ever-increasing shortage and lack of diversity in the workforce. To address these challenges, a program for underrepresented middle school students was developed collaboratively between local school districts, academia, and health care partners. The program, Camp BONES, included a 2-week summer camp and follow-up weekend and summer camp experiences for students. Experiences were provided to explore critical thinking skills in the simulated laboratories at the university, as well as at clinical practice areas in nursing. The program was guided by the Theory of Planned Behavior and self-efficacy theory. Early evaluation of the program revealed positive accolades and students' increasing interest in pursuing nursing as a career. Collaborative programs between academia and practice areas, such as Camp BONES, provide important opportunities for middle school students to explore and engage in the nursing profession during the formative years.

Redesign of a weight-based heparin protocol for improved outcomes in a community hospital.

Heparin has long been used to minimize complications of a variety of disorders and reaching a therapeutic level within 24 hours has been shown to improve patient outcomes. However, the dosing of heparin to reach a therapeutic level has been controversial. At our institution a weight based heparin nomogram was in place, however an initial data analysis revealed a large percent of the initial aPTT levels were above therapeutic range. This article will describe the performance improvement process and the overall goal to decrease the percentage of patients exceeding the initial therapeutic aPTT levels without compromising daily therapeutic aPTT levels.