Understanding the Impacts of the COVID-19 Pandemic on Small Businesses and Workers Using Quantitative and Qualitative Methods.

The COVID-19 pandemic has simultaneously exacerbated and elucidated inequities in resource distribution for small businesses across the United States in terms of worker health and the financial stability of both owners and employees. This disparity was further intensified by the constantly changing and sometimes opposing health and safety guidelines and recommendations to businesses from the local, state, and federal government agencies. To better understand how the pandemic has impacted small businesses, a cross-sectional survey was administered to owners, managers, and workers (n = 45) in the beauty and auto shop sectors from Southern Arizona. The survey identified barriers to safe operation that these businesses faced during the pandemic, illuminated worker concerns about COVID-19, and elicited perceptions of how workplaces have changed since the novel coronavirus outbreak of 2019. A combination of open-ended and close-ended questions explored how businesses adapted to the moving target of pandemic safety recommendations, as well as how the pandemic affected businesses and workers more generally. Almost all the beauty salons surveyed had to close their doors (22/25), either temporarily or permanently, due to COVID-19, while most of the auto repair shops were able to stay open (13/20). Beauty salons were more likely to implement exposure controls meant to limit transmission with customers and coworkers, such as wearing face masks and disallowing walk-ins, and were also more likely to be affected by pandemic-related issues, such as reduced client load and sourcing difficulties. Auto shops, designated by the state of Arizona to be 'essential' businesses, were less likely to have experienced financial precarity due to the pandemic. Content analysis of open-ended questions using the social-ecological model documented current and future worker concerns, namely financial hardships from lockdowns and the long-term viability of their business, unwillingness of employees to return to work, uncertainty regarding the progression of the pandemic, conflict over suitable health and safety protocols, and personal or family health and well-being (including anxiety and/or stress). Findings from the survey indicate that small businesses did not have clear guidance from policymakers during the pandemic and that the enacted regulations and guidelines focused on either health and safety or finances, but rarely both. Businesses often improvised and made potentially life-changing decisions with little to no support. This analysis can be used to inform future pandemic preparedness plans for small businesses that are cost-efficient, effective at reducing environmental exposures, and ultimately more likely to be implemented by the workers.

Efficacy of a language-concordant health coaching intervention for latinx with diabetes.

OBJECTIVE: To describe the effect of a language-concordant health coaching intervention for Spanish-speaking patients with limited English proficiency (LEP) and uncontrolled Type 2 Diabetes (T2D) on glycemic control, anxiety, depression, and diabetes self-efficacy. METHODS: 64 patients with T2D were randomly assigned to a control or intervention group. Outcomes were assessed by blood work and surveys pre and post intervention. RESULTS: The mean sample age was 47.8 years (SD=11.3) and 81% were female. HbA1c was not significantly different between groups at baseline. The intervention group's HbA1c was significantly lower at times 2 and 3 than in the control arm (p < .01 and p < .001). There were significant reductions in the intervention group's mean HbA1c levels from baseline 10.37 to midpoint 9.20, p < .001; and from baseline 10.42 to study end 8.14, p < .001. Depression and anxiety scores significantly decreased (p < .05 and p < .001), and diabetes self-efficacy significantly increased (p < .001). CONCLUSION: Health coaching led to statistically significant and clinically meaningful decreases in HbA1c, depression, and anxiety scores among LEP Latinx adults with uncontrolled T2D. PRACTICE IMPLICATIONS: Heath coaching can be conducted in primary care clinics by nurses or advanced practice nurses. The short-term intervention tested here could be adapted to the clinical setting.

Feasibility and Acceptability of a Language Concordant Health Coaching Intervention Delivered by Nurses for Latinx With Type 2 Diabetes.

BACKGROUND: Latinx immigrants have high rates of type 2 diabetes (T2D), exhibit out-of-range glycemic control, and have higher rates of diabetes-related complications than non-Latinx whites, with limited English proficiency (LEP) being a major barrier to care. AIMS: We tested the feasibility and acceptability of a language concordant (provider that is proficient in the patient's preferred language) health coaching intervention delivered by nurse and nurse practitioner students in a pilot study of Latinx immigrants with T2D and LEP. METHODS: A sample of 17 Latinx immigrants with T2D and LEP were split into intervention and control groups. The control group received basic diabetes care and written educational materials on diabetes self-management in Spanish. Individuals in the intervention group received the standard diabetes care offered by the clinic and six biweekly health coaching sessions (intervention) with a trained language concordant health coach. RESULTS: The language concordant health coaching intervention was both feasible (delivery) and acceptable (satisfactory) to Latinx immigrants with T2D and LEP and resulted in clinically meaningful differences in key diabetes-related outcomes. LINKING EVIDENCE TO ACTION: Our findings suggest that lack of language concordance between provider and patient has an important and meaningful impact on the ability of an LEP Latinx patient to receive, and perhaps act upon, adequate education for T2D management. Receiving biweekly coaching calls could have offered further emotional support for participants to discuss living with T2D, which may have helped to alleviate symptoms of depression and anxiety that individuals with T2D frequently endure.

Alternate Nostril Breathing to Reduce Stress: An Option for Pregnant Women Survivors of Intimate Partner Violence?

BACKGROUND: Stress resulting from intimate partner violence (IPV) on pregnant women causes and sustains poor health and contributes to poor pregnancy and birth outcomes. Appropriate interventions to reduce stress in this population of women are warranted. OBJECTIVE: To present a systematic review and the state of the science of evidence on alternate nostril breathing (ANB) as a holistic intervention for stress reduction for pregnant survivors of IPV, framed by complex adaptive systems theory and psychoneuroimmunology. DATA SOURCES: Eight databases and reference lists of potential articles. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials published between January 2013 and July 2019. PARTICIPANTS: Adults. INTERVENTION: ANB. STUDY APPRAISAL AND SYNTHESIS METHOD: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: ANB is effective in reducing stress, as measured by psychological and biological indicators. LIMITATIONS: Studies were limited in ethnic and gender diversity, most of the populations being Asian Indian and predominately male. CONCLUSIONS: Use of ANB as a safe and effective holistic intervention for stress reduction shows promise, but research in pregnant survivors of IPV is limited. IMPLICATIONS: Stress reduction benefits may be significant for pregnant survivors of IPV and their fetuses, with minimal risk.

Communicating and Coaching in Spanish for Chronic Care.

BACKGROUND: Language barriers affect millions of health care consumers each year in the United States. One in five U.S. residents over the age of 5 years speaks a language other than English. METHOD: A multidisciplinary team consisting of applied linguists and nurse educators developed a graduate elective for nursing students who demonstrated a minimum Spanish proficiency level. The course was organized around three core content components: management of type 2 diabetes, motivational interviewing competencies, and strategic communication in Spanish. Course activities included discourse analysis, simulated mini-conversations, and standardized patient simulations. RESULTS: A multidisciplinary team-teaching approach was ideal in assisting students to develop culturally sensitive clinical language skills. CONCLUSION: Language concordance is imperative to providing quality health care to non-English-speaking patients. Health care providers must be able to demonstrate empathy, an understanding of cultural dynamics, and the ability to provide care to non-English-speaking patients. [J Nurs Educ. 2021;60(1):34-37.].

Tangled pasts, healthier futures: Nursing strategies to improve American Indian/Alaska Native health equity.

American Indian/Alaska Native (AI/AN) populations in the United States continue to experience overall health inequity, despite significant improvement in health status for nearly all other racial-ethnic groups over the past 30 years. Nurses comprise the bulk of healthcare providers in the U.S. and are in an optimal position to improve AI/AN health by transforming both nursing education and practice. This potential is dependent, however, on nurses' ability to recognize the distinct historical and political conditions through which AI/AN health inequities have been produced and sustained. Nurse providers, educators, and leaders must in turn recognize how the sustained conditions of marginalization and expropriation that underpin current AI/AN health inequities continue to shape contemporary AI/AN health outcomes. This manuscript builds upon the extant literature of AI/AN historical health policy and utilizes decolonial theorizations of nursing and a cultural safety framework to propose a series of immediately actionable steps for nursing intervention into AI/AN health inequity. Ultimately, we suggest that it is crucial for nurses to collaborate with AI/AN individuals and communities across educational and clinical settings to further refine these approaches in alignment with the disciplinary obligation of promoting social justice within healthcare.