Burnout and psychological distress among Hispanic nurses across Illinois and New York hospitals: Implications for structural and person-centered solutions.

BACKGROUND: Despite high levels of burnout and psychological distress among nurses, few studies have evaluated these outcomes among Hispanic nurses. PURPOSE: To evaluate the differences in job-related and psychological well-being outcomes for Hispanic and non-Hispanic White nurses and the association of nurse work environments. METHODS: Cross-sectional analysis of the 2021 RN4CAST-New York-Illinois nurse survey. Multilevel logistic regression models examined the association between nurse ethnicity and job-related outcomes and psychological well-being. DISCUSSION: Our sample included 798 (10.7%) Hispanic and 6,642 (89.3%) non-Hispanic White nurses in 249 hospitals. In unadjusted models, Hispanic ethnicity was associated with higher odds of burnout (odds ratio (OR) 1.21, 95% confidence interval (CI): 1.03-1.42), which diminished when considering the work environment (OR 1.16, 95% CI: 1.01-1.35) and nurse characteristics (i.e., age) (OR 1.01, 95% CI: 0.83-1.21). CONCLUSION: Equity-driven solutions to support the well-being of Hispanic nurses should consider a focus on the needs of young Hispanic nurses and include increased support in work environments.

Factors associated with the COVID-19 booster vaccine intentions of young adults in the United States.

Young adults experience high coronavirus disease 2019 (COVID-19) incidence yet have the lowest vaccination and booster rates among adults. Understanding the factors influencing their intentions regarding boosters is essential for crafting effective public health strategies. We examined the psychosocial factors (attitudes, norms, perceived behavioral control) associated with their intentions to receive a COVID-19 booster. This cross-sectional study included 292 young adults aged 18-25 residing in Philadelphia who completed an online survey from September 2021 and February 2022 (mean age 21.98, standard deviation 2.25; 51% racial/ethnic minorities). The survey included measures of attitudes, norms, and perceived behavioral control related to COVID-19 vaccination. We employed structural equation modeling analysis to examine the intention of young adults to receive the COVID-19 booster and their vaccine-related attitudes, norms, and perceived behavioral control. Covariates included race/ethnicity and gender. Subjective norms were significantly associated with the intention to receive a COVID-19 booster (standardized ß̂ = 0.685, p = .018). Attitudes and perceived behavioral control showed no significant association with intention. Subgroup analyses based on race/ethnicity revealed that attitudes (standardized ß̂ = 0.488, p = .004) and subjective norms (standardized ß̂ = 0.451, p = .050) were predictors among young adults from racial and ethnic minority backgrounds, while only subjective norms (standardized ß̂ = 1.104, p = .002) were significant for non-Hispanic White young adults. Public health efforts should prioritize engaging healthcare providers and peer groups in order to influence subjective norms and promote collective responsibility and acceptance for vaccination. Tailored interventions and diverse communication strategies targeting specific subgroups of young adults may be useful to ensure comprehensive and effective vaccination initiatives.

Psychosocial correlates of parents' willingness to vaccinate their children against COVID-19.

BACKGROUND: Public health guidance recommended that children who are 6 months or older be vaccinated against COVID-19 in June of 2022. In the U.S., 56% of children under 17 had not received the COVID-19 vaccination in 2023. We examine parents' willingness to vaccinate their children against COVID-19 using the theory of planned behavior in order to design effective strategies to promote vaccine uptake. METHODS: The Philadelphia Community Engagement Alliance is part of an NIH community-engaged consortium focused on addressing COVID-19 disparities across the U.S. We surveyed 1,008 Philadelphia parents (mean age 36.86, SD 6.55; 42.3% racial/ethnic minorities) between September 2021 and February 2022, a period when guidance for child vaccination was anticipated. Structural Equation Modeling analysis examined associations between parental willingness and vaccine-related attitudes, norms, and perceived control. Covariates included parents' COVID-19 vaccination status, race/ethnicity, gender, and survey completion post-CDC pediatric COVID-19 vaccination guidelines. Subgroup analyses by race/ethnicity and gender were conducted. RESULTS: Our model demonstrated good fit (χ2 = 907.37, df = 419, p<0.001; comparative fit index [CFI] = 0.951; non-normed fit index [NNFI] = 0.946; root mean square error of approximation [RMSEA] = 0.034 with 95% CI = 0.030-0.038). Attitudes ([Formula: see text] = 0.447, p<0.001) and subjective norms ([Formula: see text] = 0.309, p = 0.002) were predictors of intention. Racial/ethnic minority parents exhibited weaker vaccination intentions ([Formula: see text] = -0.053, p = 0.028) than non-Hispanic White parents. CONCLUSIONS: Parents' attitudes and norms influence their vaccination intentions. Despite the survey predating widespread child vaccine availability, findings are pertinent given the need to increase and sustain pediatric vaccinations against COVID-19. Interventions promoting positive vaccine attitudes and prosocial norms are warranted. Tailored interventions and diverse communication strategies for parental subgroups may be useful to ensure comprehensive and effective vaccination initiatives.

Engaging Trusted Messengers to Increase COVID-19 Pediatric Vaccine Uptake in Philadelphia: Lessons from the VaxUpPhillyFamilies program.

INTRODUCTION: Communities of color had higher rates of Coronavirus (COVID-19) infection and lower rates of COVID-19 vaccination during the pandemic. Parental concern about the safety and necessity of pediatric COVID-19 vaccines contribute to low childhood vaccination. Enlisting parents and caregivers as trusted messengers is an evidence-based approach to mitigate this challenge. VaxUpPhillyFamilies was formed to engage parents and caregivers as vaccine ambassadors to increase vaccination rates in children of color. This study aimed to understand the key benefits, challenges, and lessons learned from the VaxUpPhillyFamilies program. METHODS: Three online debriefing sessions with ambassadors were conducted between September 7 and October 24, 2022, to share best practices, address challenges, receive emerging vaccine information, and provide support. Thematic analysis was utilized to develop broad themes and subthemes. RESULTS: Four themes with corresponding subthemes were identified: 1) Motivations to Become an Ambassador: a) improving the health of the community and b) personal satisfaction; 2) Defining Success: a) community interactions and b) influencing opinions; 3) Best Approaches: a) being mentally prepared with facts, b) addressing community health needs beyond COVID-19, c) demonstrating empathy, d) "meeting them where they're at" by motivational interviewing, and e) building trust and connection; 4) Challenges: a) changes in vaccine guidelines, b) vaccine misinformation, c) varied perceptions of severity of COVID-19 illness and benefits of the vaccine, d) breakdown of communication from trusted sources, and e) structural barriers to engagement. CONCLUSION: Parents and caregivers were a resource for delivering evidence-based messaging about COVID-19 and other health challenges. To effectively equip parents and caregivers as public health ambassadors, it is critical to offer training in engagement strategies, to identify and combat misinformation, and to provide support in navigating challenges. VaxUpPhillyFamilies program is a model for future public health campaigns.

A Reflection on Claire Fagin.

Honoring the life and work of this visionary leader.

Trust in federal COVID-19 vaccine oversight and parents' willingness to vaccinate their children against COVID-19: a cross-sectional study.

BACKGROUND: Over half of the youth population in the United States, aged 6 months to 17 years, have not received the Coronavirus Disease 2019 (COVID-19) vaccine. Given parents' central role in vaccinating their children, we examined associations between parents' trust of the federal oversight of COVID-19 vaccine safety and their willingness to vaccinate their children against COVID-19. METHODS: This cross-sectional study included 975 parents of minor children residing in Philadelphia who completed the online survey between September 2021 and February 2022. Trust was measured using a four-point Likert scale ranging from 'do not trust' to 'fully trust' for two variables: (1) trust in federal oversight of COVID-19 vaccine safety for children and (2) trust in federal oversight of COVID-19 vaccine safety for the general public. A multiple logistic regression evaluated associations between trust and parents' willingness to vaccinate their children, which was measured on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree.' The analysis was adjusted for race/ethnicity, age, sexual orientation, gender, education, insurance, and parents' vaccination status. RESULTS: Analyses included 975 parents whose children had not previously been vaccinated against COVID-19 (mean age 36.79, standard deviation 6.4; 42.1% racial/ethnic minorities; 93.2% heterosexual; and 73.7% with a college degree). Greater trust regarding federal oversight of COVID-19 vaccine safety for children [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.13-2.04] and for the public (aOR = 1.58, 95% CI: 1.17-2.14) were each associated with increased willingness to have their child vaccinated against COVID-19. Unvaccinated parents had decreased willingness compared to parents who had received at least one dose of the vaccine (aOR = 0.14, 95% CI: 0.04-0.41). College-graduate parents exhibited increased willingness compared to those without a college degree (aOR = 2.07, 95% CI: 1.52-2.81). Non-heterosexual parents showed increased willingness compared to heterosexual parents (aOR = 2.30, 95% CI: 1.20-4.76). CONCLUSIONS: Trust in federal COVID-19 vaccine oversight was associated with parental willingness to vaccinate their children against COVID-19 among parents whose children have not yet been vaccinated. Identifying and addressing causes of mistrust are crucial next steps to promote child vaccination. Intervention efforts to address trust gaps should remain a public health priority.

Assessing and Improving Data Integrity in Web-Based Surveys: Comparison of Fraud Detection Systems in a COVID-19 Study.

BACKGROUND: Web-based surveys increase access to study participation and improve opportunities to reach diverse populations. However, web-based surveys are vulnerable to data quality threats, including fraudulent entries from automated bots and duplicative submissions. Widely used proprietary tools to identify fraud offer little transparency about the methods used, effectiveness, or representativeness of resulting data sets. Robust, reproducible, and context-specific methods of accurately detecting fraudulent responses are needed to ensure integrity and maximize the value of web-based survey research. OBJECTIVE: This study aims to describe a multilayered fraud detection system implemented in a large web-based survey about COVID-19 attitudes, beliefs, and behaviors; examine the agreement between this fraud detection system and a proprietary fraud detection system; and compare the resulting study samples from each of the 2 fraud detection methods. METHODS: The PhillyCEAL Common Survey is a cross-sectional web-based survey that remotely enrolled residents ages 13 years and older to assess how the COVID-19 pandemic impacted individuals, neighborhoods, and communities in Philadelphia, Pennsylvania. Two fraud detection methods are described and compared: (1) a multilayer fraud detection strategy developed by the research team that combined automated validation of response data and real-time verification of study entries by study personnel and (2) the proprietary fraud detection system used by the Qualtrics (Qualtrics) survey platform. Descriptive statistics were computed for the full sample and for responses classified as valid by 2 different fraud detection methods, and classification tables were created to assess agreement between the methods. The impact of fraud detection methods on the distribution of vaccine confidence by racial or ethnic group was assessed. RESULTS: Of 7950 completed surveys, our multilayer fraud detection system identified 3228 (40.60%) cases as valid, while the Qualtrics fraud detection system identified 4389 (55.21%) cases as valid. The 2 methods showed only "fair" or "minimal" agreement in their classifications (κ=0.25; 95% CI 0.23-0.27). The choice of fraud detection method impacted the distribution of vaccine confidence by racial or ethnic group. CONCLUSIONS: The selection of a fraud detection method can affect the study's sample composition. The findings of this study, while not conclusive, suggest that a multilayered approach to fraud detection that includes conservative use of automated fraud detection and integration of human review of entries tailored to the study's specific context and its participants may be warranted for future survey research.

Dismantling structural racism in nursing research.

Dismantling structural racism in nursing research is key to achieving health equity for populations that experience disproportionate burden of health disparities. Several nursing organizations have advocated for the nursing profession to address structural racism in the discipline and the Future of Nursing 2020 to 2030: Charting a Path to Achieve Health Equity specifically calls for research that addresses equity and social justice. Bold calls to conduct research to address structural racism notwithstanding, what remains less clear are the strategies needed. We propose key considerations for the design of research to address structural racism and offer examples from behavioral and biobehavioral research designed to dismantle structural racism.

Creating an innovation infrastructure in academic nursing.

As interest in nurse-led health and health care innovation grows, we must prepare nurses with the skills, knowledge, and experiences necessary to lead in these areas. In this article we describe how schools of nursing can integrate innovation in their mission, describe actionable steps to position nurses as leaders in this space, and provide a case study example of how to infuse innovation into a school of nursing. CLINICAL RELEVANCE: In order for nurses to lead in health and healthcare innovation, schools of nursing and nursing programs must think strategically about the knowledge and skills the next generation of nurses will need and then support those innovation needs at all levels of research, education, and practice.

Innovations in Ph.D. education to prepare nurse scientists for the future.

The University of Pennsylvania sponsored a PhD summit in October 2019 to bring together faculty and leaders in PhD education as well as professional associations in nursing to discuss the state of PhD education. Participants were divided into groups and asked to address specific questions. This paper presents the discussion points and recommendations from the group focusing on innovation in PhD education. Innovations such as team mentoring models, design thinking courses, and structures that support students to progress from BSN through PhD programs are discussed. Recommendations include a need to intentionally structure faculty development earlier in their professorial careers, develop team models of advisement and longitudinal follow-up of alumni graduates form Ph.D. programs to examine the effectiveness of innovations.

From vision to action: Next steps in designing PhD programs of the future.

Declines in PhD enrollment, funding and support for PhD students, and the quality and quantity of the nursing research pipeline has fueled the concern about providing high-quality education in research-focused nursing doctoral programs. To address the challenges and opportunities facing research focused PhD education, the University of Pennsylvania School of Nursing convened an invitational summit, Re-Envisioning Research-Focused PhD Programs of the Future, of research-intensive institutions. Both as a dissemination strategy and as an effort to engage perspectives from other Schools with PhD programs, we presented a summary of the Penn Summit discussion at the AACN Doctoral Education Conference (AACN Doctoral Conference). Focused discussions at both events further identified opportunities for research focused PhD programs, including recruiting undergraduate students, establishing research-focused partnerships, creating clear evaluation methods. AACN Doctoral conference participants also discussed the need to discuss and identify competencies, common subject areas, and financial resources for PhD students and graduates. This synthesis of discussions, considerations, and challenges affecting research-focused doctoral programs of nursing serve as a basis and catalyst for further discussion and action to ensure PhD research focused programs are preparing successful nurse scientists of the future.

Invitational summit: Re-envisioning research focused PHD programs of the future.

Ten years ago, in response to the growing discussions, a seminal report, The Research-Focused Doctoral Program in Nursing -Pathways to Excellence was endorsed by AACN members. A re-envisioning of PhD programs is urgently needed to ensure the advancement of nursing science and to situate research focused nursing PhD graduates for success - in academia and beyond. To address these issues, the University of Pennsylvania School of Nursing held a summit in October 2019, Re-envisioning Research Focused PhD Programs of the Future, with stakeholders from 41 educational, governmental, professional and philanthropic institutions. Results from a pre-summit poll shaped the Summit agenda, which consisted of panels and roundtables. Prior to and throughout the Summit, attendees identified and discussed challenges facing research intensive nursing PhD programs, emerging innovations within programs, and suggested changes to re-envision the future training of nurse scientists. These changes include better preparing PhD program graduates to bridge the research and practice divide, redesign funding and support for accelerated PhD students, and to reconceptualize outcome measures and evaluations of graduates. A synthesis of roundtable discussions will be used to frame other manuscripts in this issue as well as to prepare a roadmap for next steps.