Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome-Related Mortality.

Importance: It is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US. Objective: To study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US. Design, Setting, and Participants: This cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024. Exposures: A total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM2.5) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate. Main Outcomes and Measures: The primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied. Results: Data from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] ß = 6.78 [2.78-11.56]) and PM2.5 concentrations (median [IQR] ß = 5.52 [-11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] ß = -0.002 [-0.003 to -0.001]), rurality (median [IQR] ß = -0.32 [-0.67 to 0.02]), high school completion rate (median [IQR] ß = -1.89 [-4.54 to 0.10]), racial and ethnic minority rate (median [IQR] ß = -0.66 [-1.85 to 0.89]), and primary health care access rate (median [IQR] ß = -0.18 [-0.35 to 0.07]). Conclusions and Relevance: In this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.

Older persons' perceptions and experiences of community palliative care: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to critically appraise and synthesize qualitative evidence of older persons' perceptions and experiences of community palliative care. INTRODUCTION: Palliative care focuses on the relief of symptoms and suffering at the end of life and is needed by approximately 56.8 million people globally each year. An increase in aging populations coupled with the desire to die at home highlights the growing demand for community palliative care. This review provides an understanding of the unique experiences and perceptions of older adults receiving community palliative care. INCLUSION CRITERIA: This review appraised qualitative studies examining the perceptions and experiences of older adults (65 years or older) receiving community palliative care. Eligible research designs included, but were not limited to, ethnography, grounded theory, and phenomenology. METHODS: A search of the literature across CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid SP), Web of Science Core Collection, and Scopus databases was undertaken in July 2021 and updated November 1, 2022. Included studies were published in English between 2000 and 2022. The search for unpublished studies included ProQuest Dissertations and Theses. Study selection, quality appraisal, and data extraction were performed by 2 independent reviewers. Findings from the included studies were pooled using the JBI meta-aggregation method. RESULTS: Nine qualitative studies involving 98 participants were included in this review. A total of 100 findings were extracted and grouped into 14 categories. Four synthesized findings evolved from these categories: i) Older persons receiving palliative care in the community recognize that their life is changed and come to terms with their situation, redefining what is normal, appreciating life lived, and celebrating the life they still have by living one day at a time; ii) Older persons receiving palliative care in the community experience isolation and loneliness exacerbated by their detachment and withdrawal from and by others; iii) Older persons receiving palliative care in the community face major challenges managing prevailing symptoms, medication management difficulties, and costs of medical care and equipment; and iv) Older persons want to receive palliative care and to die at home; however, this requires both informal and formal supports, including continuity of care, good communication, and positive relationships with health care providers. CONCLUSIONS: Experiences and perceptions of community palliative care vary among older adults. These are influenced by the individual's expectations and needs, available services, and cost. Older adults' input into decision-making about their care is fundamental to their needs being met and is contingent on effective communication between the patient, family, and staff across services. Policy that advocates for trained palliative care staff to provide care is necessary to optimize care outcomes, while collaboration between staff and services is critical to enabling holistic care, managing symptoms, and providing compassionate care and support.

Reevaluating the Cardiac Risk of Noncardiac Surgery Using the National Surgical Quality Improvement Program.

BACKGROUND: As surgical techniques evolve and patient outcomes improve over time, a renewed analysis of the cardiac risk of noncardiac surgeries is needed. The goal of this study was to investigate and categorize the cardiac risk of elective noncardiac surgeries. METHODS: This was a cohort study of surgical data and outcomes from the 2018 National Surgical Quality Improvement Program Participant Use Data File; 807,413 cases were analyzed after excluding non-elective, emergent, and cardiac surgeries. Postoperative major adverse cardiac events (MACE) were defined as 30-day all-cause mortality, myocardial infarction, or cardiac arrest. According to their 95% confidence intervals (CI) for postoperative MACE, surgeries were categorized as low risk (95% CI <1%), intermediate risk (95% CI above and below 1%), or elevated risk (95% CI ≥1%). Multivariable logistic regression analyses were performed to determine differences in the odds for postoperative MACE for the intermediate- and elevated-risk categories relative to the low-risk category while controlling for several risk factors of prognostic importance. RESULTS: Postoperative MACE occurred in 4047/807,413 cases (0.50%), including in 1708/667,735 (0.26%) of the low-risk category, in 516/53,499 (0.96%) of the intermediate-risk category, and in 1823/86,179 (2.12%) of the elevated-risk category. The elevated-risk category accounted for 10.7% of total procedures and 45.1% of total postoperative MACE. Compared with the low-risk category, the multivariable adjusted risk of postoperative MACE was increased in the intermediate-risk category (adjusted odds ratio 2.35; 95% CI, 2.12-2.62) and the elevated-risk category (adjusted odds ratio 3.15; 95% CI, 2.92-3.39). CONCLUSION: Categorization of noncardiac surgeries according to cardiac risk may help to identify populations who are most likely to benefit from preoperative cardiac evaluation when indicated.

Older persons' perceptions and experiences of community palliative care: a systematic review of qualitative evidence protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify and synthesize the best available qualitative evidence on how older persons perceive and experience community palliative care.The specific question is: What are older persons' perceptions and experiences of community palliative care?

Measuring final-year nursing students' satisfaction with the viva assessment.

This paper reports a study conducted to develop and test the psychometric properties of a brief 5-item Satisfaction with the Oral Viva Assessment Scale. The viva has been increasingly used to gauge students' learning, beyond the traditional written assessments. This assessment approach may pose additional challenges to various student groups. Using a prospective, correlational design, this study surveyed 275 final year nursing students about their satisfaction with the viva as an assessment approach. The survey was administered to those who attended a revision session in an undergraduate high dependency unit. Descriptive and inferential statistical analyses, as well as exploratory and confirmatory factor analyses of the scale were computed. Exploratory factor analysis yielded a one-component structure that explained 51% of the total variance, which was supported by confirmatory factor analysis (standardised factor loadings: 0.54-0.73). Internal consistency as computed by a Cronbach's alpha was 0.8. The results also revealed that those who obtained higher grades in their viva performance (OR: 2.78, 95% CI: 1.58-4.90) and English-speaking only students (OR: 1.87, 95% CI: 1.07-3.27) were more satisfied with the viva assessment. These findings support the validity and reliability of this scale, and can be used to assess students' satisfaction with the viva.

Barriers to breast and cervical cancer screening for women with physical disability: A review.

This review critically examined the barriers to breast and cervical cancer screening services for women with physical disability and discussed ways forward to change practice. When compared to the rest of the community, women with disability were less likely to use preventive health screening services for multiple reasons. Moreover, women with disability live longer than in previous years, and as age is linked to an increased risk of developing cancer, it is imperative that the barriers to screening for these women become a focus of discussion. We designed an integrative literature review to investigate this. Multiple databases were systematically searched for literature published between 2001 and 2013. Search terms used were a combination (AND/OR) of key terms. After excluding duplicates and articles not meeting the eligibility criteria, twenty-five articles were systematically and critically reviewed. Sociodemographic factors were associated with less access to preventive health screening for women with disability. The literature reviewed indicated that this was complicated further by three prominent barriers: health insurance, health care workers, and physical barriers. Sociodemographic, health insurance, health workers, and physical barriers impair access for disabled women to breast and cervical cancer screening, which are vital measures in the timely detection of breast and cervical cancers and preventable morbidity and mortality. Measures are needed to address these limiting factors for women with disability so that they can be active participants in health care, rather than being marginalized because of their disability.

The experience of sessional teachers in nursing: A qualitative study.

BACKGROUND: Worldwide, there is a growing reliance on sessional teachers in universities. This trend is reflected in an undergraduate nursing program in a large Australian metropolitan university where a significant proportion of contact hours is staffed by sessional teachers, yet little is known about what type of support is needed for sessional teachers to optimise their capacity to contribute to the academic program. OBJECTIVES: To describe the experiences of sessional teachers in a Bachelor of Nursing program in an Australian university. DESIGN: This is an exploratory qualitative study; fifteen sessional teachers were interviewed using semi-structured questions to explore their experiences of teaching. SETTING: This study was conducted in a large metropolitan school of nursing located on three sites. PARTICIPANTS: A purposive sample of 15 sessional teachers was interviewed for this study. METHODS: Semi-structured interviews were conducted face to face. Thematic analysis was used to identify major themes in the interview data and collaborative analysis was undertaken to ensure rigour. RESULTS: Findings revealed that sessional teachers enjoyed teaching, were committed to their role and viewed their clinical currency as a valuable asset for teaching. However, participants also spoke about wanting a sense of belonging to the School, with most feeling they were "outsiders". Areas identified for improvement included system and process issues, micro teaching and assessment skills, classroom management and timely access to resources. CONCLUSION: There is a need to improve sessional teachers' sense of belonging and to provide an inclusive structure and culture to optimise their capacity to contribute to the academic program.

Barriers to breast cancer screening in Australia: experiences of women with physical disabilities.

AIMS AND OBJECTIVES: To explore the experiences of breast cancer screening for women with physical disabilities. BACKGROUND: Despite women with disabilities having the same or greater risk of having breast cancer than women without disabilities, they are less likely to uptake breast cancer screening services. DESIGN: Qualitative descriptive study. METHODS: Twelve women with physical disabilities were recruited for the purpose of this study. Data were collected via semi-structured face to face or telephone interviews. Interviews were transcribed and data were analysed thematically. RESULTS: Overwhelmingly, participants conveyed that their breast screening experiences were negative. The following four themes describe the experiences of breast cancer screening for women with physical disabilities: feeling I'm not in control; being ignored and not listened to; being helpless, alone and afraid and; experiencing pain, torture and humiliation. CONCLUSIONS: Women with physical disabilities experience substantial barriers to breast cancer screening. This research highlights that the attitudes and poor communication skills of health professionals served as a deterrent to future screening for participants. RELEVANCE TO CLINICAL PRACTICE: By exploring experiences of women with physical disabilities of breast cancer screening, nurses and other health-care professionals can use this to develop and implement optimal approaches, such as collaborative models of care which empower women with disabilities.

Using patterns of knowing in nursing as a possible framework for nursing care of homeless families with children.

In developed countries such as Australia, the United Kingdom and the United States of America, homeless families are amongst the fastest growing subpopulations of the homeless. This paper seeks to explore the major issues involved in the health and nursing care of such families, and proposes that the patterns of knowing in nursing offer a pertinent, guiding framework for nurses to understand the phenomenon and to optimize holistic nursing care for homeless families with children.

The discursive field of Web-based health research: implications for nursing research in cyberspace.

Web-based health research is a relatively new phenomenon. Its definition and conceptualization differs markedly as it is deployed within and across a complex array of discourses, with serious implications for nursing research and knowledge development. Web-based health research offers nurse researchers unique and abundant opportunities to provide leadership in the development and conduct of diverse modes of online health research. To appropriately avail themselves of such opportunities, however, nurse researchers must first address the significant ontological, epistemological, methodological, ethical, legal, and professional issues and concerns that nursing research in cyberspace raises.

Ensnaring webs and nets: ethical issues in Internet-based research.

The Internet is a relatively new medium for research that few nurse researchers have embraced. While it offers countless opportunities for nursing research, it also is prey to many perils. In the crucible of cyberspace, the very nature of not only the research process, but also that of the participant researcher relationship is transmuted. This paper critically examines the major and often unique ethical issues of online research, and argues these must be adequately addressed if online nursing research is to effectively protect participants and researchers from harm, and optimally meet the profession's and society's best interests.