Health Inequities and Moral Distress Among Community Health Nurses During the COVID-19 Pandemic

     The core values of community health nursing practice are rooted in the social determinants of health, health equity and social justice.  Throughout the COVID-19 pandemic, community health nurses (CHNs) witnessed first-hand the impact on individuals in situations of marginalization. This research inquiry explored how health inequities among client populations contributed to experiences of MD among CHNs in Canada during the pandemic.      A total of 245 CHNs from across Canada participated in an online survey. Participants reported that during the pandemic individuals living in situations of marginalization were disproportionately impacted. CHNs were unable to provide the necessary health promotion interventions and experienced high levels of moral distress. The negative impact of the pandemic on individuals living in situations of marginalization illuminated the intersecting social and structural inequities that drive negative health outcomes and emphasized the need to adopt an equity focus for current and future pandemic planning, response, and recovery.  

Simulating a situation of homelessness: nursing students' perceptions of learning through virtual embodiment

Individuals experiencing homelessness encounter unique challenges in accessing and receiving care in our health systems[1,2,3,4]  Preparing emerging health professionals to respond to their complex health needs will require innovative educational approaches that promote person-centered care, and stimulate critical reflection and action towards the personal, interpersonal and structural factors that shape health care delivery.[5,6,7] This presentation reports on preliminary findings of phase 1 of a critical qualitative case study of nursing student’s perceptions of learning about the experience of homelessness, through a virtual reality educational experience.  The study design was informed by critical transformative learning theories and theories of embodiment.  Twenty nursing students were engaged in a virtual reality experience of 12 minutes, followed by a 1:1 debrief interview. The debrief interview used an adapted version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework to elicit students’ reflections on the experience. The interviews were audio recorded and transcribed verbatim. Data analysis involved a process of reading all of the transcripts for a sense of the whole, mindmapping each of the transcripts, identifying themes that permeated the data set, and coding data in Quirkos software. Six preliminary themes include: a) seeing the person through story, b) destabilizing assumptions and questioning stereotypes, c) embodied emotional awareness, d) challenges to care, e) recognizing vulnerability of people experiencing homelessness, and f) quality of the immersive experience in learning. The findings contribute to our knowledge about virtual reality simulation as an innovative approach to fostering learning about homelessness in health professions education. &nbsp

Kangaroo mother care diminishes pain from heel lance in very preterm neonates: A crossover trial

BACKGROUND: Skin-to-skin contact, or kangaroo mother care (KMC) has been shown to be efficacious in diminishing pain response to heel lance in full term and moderately preterm neonates. The purpose of this study was to determine if KMC would also be efficacious in very preterm neonates. METHODS: Preterm neonates (n = 61) between 28 0/7 and 31 6/7 weeks gestational age in three Level III NICU's in Canada comprised the sample. A single-blind randomized crossover design was employed. In the experimental condition, the infant was held in KMC for 15 minutes prior to and throughout heel lance procedure. In the control condition, the infant was in prone position swaddled in a blanket in the incubator. The primary outcome was the Premature Infant Pain Profile (PIPP), which is comprised of three facial actions, maximum heart rate, minimum oxygen saturation levels from baseline in 30-second blocks from heel lance. The secondary outcome was time to recover, defined as heart rate return to baseline. Continuous video, heart rate and oxygen saturation monitoring were recorded with event markers during the procedure and were subsequently analyzed. Repeated measures analysis-of-variance was employed to generate results. RESULTS: PIPP scores at 90 seconds post lance were significantly lower in the KMC condition (8.871 (95%CI 7.852-9.889) versus 10.677 (95%CI 9.563-11.792) p < .001) and non-significant mean differences ranging from 1.2 to1.8. favoring KMC condition at 30, 60 and 120 seconds. Time to recovery was significantly shorter, by a minute(123 seconds (95%CI 103-142) versus 193 seconds (95%CI 158-227). Facial actions were highly significantly lower across all points in time reaching a two-fold difference by 120 seconds post-lance and heart rate was significantly lower across the first 90 seconds in the KMC condition. CONCLUSION: Very preterm neonates appear to have endogenous mechanisms elicited through skin-to-skin maternal contact that decrease pain response, but not as powerfully as in older preterm neonates. The shorter recovery time in KMC is clinically important in helping maintain homeostasis. TRIAL REGISTRATION: (Current Controlled Trials) ISRCTN63551708

Marine epibiosis. II. Reduced fouling on Polysyncraton lacazei (Didemnidae, Tunicata) and proposal of an antifouling potential index

Polysyncraton lacazei is a colonial tunicate (family didemnidae) living in the NW-mediterranean rocky sublitoral. A thorough scanning of numerous colonies revealed that in spite of an apparently heavy local fouling pressure only one fouling species — a kamptozoan — is encountered with some regularity on Polysyncraton. We try to define the epibiotic situation of sessile marine organisms as composed of four epibiotic parameters: longevity or exposure time (A), epibiont load (E), colonizer pool (CP) and fouling-period (FP). Subsequently, these factors are combined to propose an “Antifouling Potential” index: AFP=(1−E/CP)×A/(FP+A). This index is intended to permit evaluating the relative antifouling defense potency to be expected in a given organism in a given epibiotic situation and to compare different cases of epibiosis and fouling