Unsafe Environment Research Articles

Unveiling the obstacles encountered by women doctors in the Pakistani healthcare system: A qualitative investigation.

In Pakistan, women outnumber men in medical colleges with 80 percent enrollment, yet many fail to practice medicine following graduation. Pakistan Medical Council (PMC) states 50 percent of graduated women doctors either did not practice or left employment in a short period. Thus, the non-servicing women doctors are assumed as the one of the major causes for the overall doctors' shortage in the country. Addressing this enduring matter, this study aims to explore and understand the factors that discourage women doctors from practicing medicine in Pakistani hospitals. The study employed qualitative exploratory inquiry with an interpretive paradigm to attain a deeper understanding of the problem. 59-semi structured interviews were conducted by non-working women doctors across the entirety of Pakistan. The narratives were then analyzed by thematic analysis using ATLAS.ti 22. The findings have resulted in the three major themes, i.e., workplace challenges, socio-cultural obstructions, and familial restrictions that possibly obstruct women from practicing medicine in hospitals. The findings suggested that accepting traditional cultural values, including entrenched gender roles in society, deters women from practicing medicine. The prevailing patriarchal societal system includes stereotypes against working women; early marriages hinder women from practicing medicine. The prevailing societal system upholds the influence of in-laws and a husband for women doctor professional employment. As a result, severe work-life conflict was reported where most women doctors ended up in their profession in the middle of struggling between socially rooted gender roles as homemakers and their professional careers-furthermore, the study found various workplace issues that posit an additional burden on already struggling women doctors. Issues include poor recruitment and selection process, transfer constraints, excessive workload with inadequate salary, harassment, gender discrimination, unsafe work environment, and little support from the administration highly contribute to the shortage of women doctors in Pakistan.

Student nurses' experiences of discrimination and racism on work placements: What can higher education institutions do?

BackgroundThere is persistent interpersonal, institutional and structural racism within the health sector and higher education. Such anti-Black and anti-Brown racisms are experienced by nursing students, nursing apprentices and fully qualified nurses. This discrimination intersects with other characteristics, namely gender and student status, which can make the nursing profession an unsafe environment for many. ObjectivesTo understand student nurses' experiences of racism and intersecting oppressions, at university and on work placement. DesignA qualitative descriptive study with individual interviews and focus groups. SettingsA widening participation higher education institution in London, UK. ParticipantsTwenty-four student nurses and nurse apprentices studying on an adult nursing programme. MethodsStudents were recruited through purposive sampling. In-depth data relating to student nurses' perspectives and experiences were gathered through two focus groups and three individual interviews conducted by student nurse peers. Interviews were transcribed verbatim and open coding was used to analyse transcripts using comparison and thematic analysis. ResultsThree key themes arose: safety and support in the university space; hierarchical treatment in work placements due to intersecting race and ‘student’ identities, and; direct racism by patients and staff in work placements. ConclusionsStudent nurses expressed their vulnerability to discrimination and racism whilst on placement in the National Health Service. More opportunities within university curricula are needed for student nurses to learn about, reflect on, and gain support for managing experiences of discrimination in the health system.

Causes, Precautions and Management of Risk Factors Associated with Sports Injuries

Sports injuries are considered a global health problem that needs a special focus on public health to minimize the risk factors of sports injuries [1]. Sports Injuries refer to injuries commonly occurring during sports or exercise, but they are not only confined to sports. It can also appear in our routine life events. Suppose a factory worker can get tennis elbow injuries, and Painter gets shoulder injuries. Likewise, gardeners develop tendinitis even though they may not participate in sports [2]. The common sports injuries are sprains, strains, swollen muscles, shin splints, rotator cuff injuries, knee injuries, fractures, and dislocations. Based on nature, we can divide it into two types, i.e. intrinsic injuries and extrinsic injuries. Intrinsic injuries are those injuries which take place inside the body, while those injuries that take place outside the body are called outside injuries. Sports Injuries can occur in any part of the body, such as bones, joints, muscles, tendons, ligaments and cartilage [3]. Sports injuries may be categorized as chronic or acute sports injuries. Chronic or overuse injuries develop in sports where an athlete needs long-term repetitive motion, like long-distance running, cycling and swimming [4]. Chronic sports injuries include arthritis, tendonitis, tennis elbow, repetitive strain injury (RSI) and runner's knee [5]. Likewise, acute sports injuries consist of those injuries which happen suddenly. Wrist fractures. Ankle sprains. Shoulder dislocations are the best examples of acute sports injuries [5, 6]. In other words, those injuries which take place suddenly and need a short period of recovery are term as acute sports injuries, such as strain, sprain, dislocation and muscle aches etc. Similarly, those injuries that develop gradually and need more time for recovery are called chronic injuries [7]. Poor training, anatomical problems, muscle weakness, tendons, exercising ligaments, and unsafe environments are all causative factors of sports injuries [8]. In association with factors, sports injuries are usually instigated by overuse, direct impact, or the application of force greater than the body part can structurally withstand [9]. The main causes of injuries during sports are; lack of proper training, overtraining, long-term playing the same sports, playing on hard surfaces, and improper shoes and sports kits [2]. As a serious health concern, learning about preventive measures is important for athletes, coaches, and managers [10]. Preventive measures of sports injuries include; physical fitness, awareness about skills and techniques, and warm and cool down [11-13]. Due to injuries, a sportsman completely loses their performance. In addition, as a result of injuries, a sportsman feels soreness, swelling, muscular weakness, fatigue and pain. Along with physical problems, many psychological issues, such as fear, tension, lack of focus, and poor self-confidence, are also linked with sports injuries [14-18]. Different first aid techniques can help manage the severe effects of sports injuries, such as injury prevention, injury identification and treatment, and injury rehabilitation [19, 20]. Likewise, developing a fitness plan comprised of cardiovascular, strength and flexibility exercises, warm-up and cool down, staying hydrated, using proper equipment, etc. also used to manage sports injuries [21, 22]. There are five basic steps for preventing sports injuries among children. These preventive measures include wearing protective gear, i.e. helmets, protective pads, and other gear, warm up and cooling down, knowing the rules of the game, watch out for others and don't play when injured [22].

Perspectives and Experiences Regarding the Impacts of Emergency Department Overcrowding: A Rapid Qualitative Review


 This review used a rapid best-fit framework analysis approach to synthesize 9 included studies exploring how people who engage with emergency department (ED) services experience and understand the impacts of ED overcrowding, access block, and boarding on quality of care, patient safety, and the well-being of health care professional learners and staff working in the ED. None of the included studies were conducted in Canada.
 The included studies detailed how people who engage with ED services understand the ED as a location that is appropriate for providing short-term treatment to people requiring critical or emergent care, but inappropriate for providing care to patients for extended lengths of time. Study participants described experiencing ED overcrowding, boarding, and access block as transforming the ED into an unsafe environment where the risk of avoidable patient harm increased due to the accelerated depletion of available equipment, space, and human resources. They observed that this unsafe environment led to patients experiencing delayed, missed, and inappropriate care, resulting in potential or actual physical harm, threats to their human rights and dignity, exposures to secondary suffering, reduced satisfaction, and worsening emotional and psychological states.
 Participants reported that ED overcrowding, access block, and boarding had, for the most part, negative impacts on health care professional learners and staff working in the ED. Some ED staff reported that these phenomena led them to experience increased exposure to violence and physical harm, emotional and moral distress, dimensions of burnout, and/or missed learning opportunities for health care professional learners. Some ED staff reported experiences of camaraderie and collaboration necessarily forged as a coping mechanism to manage adversity in the context of overcrowding. Amid the challenges experienced within their practice setting, some experienced staff also perceived overcrowding as providing opportunities to exercise and expand their existing knowledge and skills.
 Considering these findings, decision-makers seeking to address the adverse impacts of ED overcrowding, access block, and boarding on quality of care and patient safety may explore facilitating the integration of routine preventive care into ED processes; enhancing communication within the ED; optimizing available equipment and space; giving patients information before and during their stay to manage their expectations; and enhancing staff’s access to education and resources necessary to better address the needs of patients who frequently experience extended stays in the ED and require specialized care beyond that which ED staff typically have the training and experience to provide. They may prioritize interventions that alleviate, rather than add to, the workload of ED staff. Additionally, they may assess and explore working conditions in the ED with a lens of promoting the well-being and retention of ED staff. By drawing on the findings of this review, they may, for example, consider exploring how to incentivize senior staff to remain in their positions, enhance learning opportunities for health care professional learners, and promote interprofessional collaboration. They may also consider investigating and addressing systemic factors contributing to overcrowding, access block, and the recruiting and retaining of health care providers in their jurisdictions.
 Decision-makers may also further explore how proposed interventions might address or exacerbate ethical and equity issues raised by ED overcrowding, including: the fair and equitable allocation of scarce resources; harms and forgone benefits to patients, health care providers, and other hospital staff; and inequitable access to and experience of ED care by patients, including impacts on patients’ dignity, relationships with care providers, and trust in EDs or health care systems. They may consider providing targeted support to groups identified as disproportionately at risk of harm in overcrowded EDs, including but not limited to: those requiring extended lengths of stay, those with limited agency to self-advocate or gain appropriate attention and care, those who are unable to perform activities of daily living, or those experiencing mental health emergencies. They also may consider that the included studies provided limited or no insight into the perspectives of people belonging to equity-deserving groups with a history of harm and lack of agency in the ED, including but not limited to: Indigenous people, Black people, and other people of colour; people with disabilities; people experiencing houselessness; those experiencing language barriers without access to a professional interpreter; and members of the 2SLGBTQ+ community. More research is needed to understand how these and other equity-deserving groups experience overcrowding, access block, and boarding as impacting their quality of care and safety.

Case analysis of long-term negative psychological responses to psychedelics

Recent controversies have arisen regarding claims of uncritical positive regard and hype surrounding psychedelic drugs and their therapeutic potential. Criticisms have included that study designs and reporting styles bias positive over negative outcomes. The present study was motivated by a desire to address this alleged bias by intentionally focusing exclusively on negative outcomes, defined as self-perceived ‘negative’ psychological responses lasting for at least 72 h after psychedelic use. A strong justification for this selective focus was that it might improve our ability to capture otherwise missed cases of negative response, enabling us to validate their existence and better examine their nature, as well as possible causes, which could inspire risk-mitigation strategies. Via advertisements posted on social media, individuals were recruited who reported experiencing negative psychological responses to psychedelics (defined as classic psychedelics plus MDMA) lasting for greater than 72 h since using. Volunteers were directed to an online questionnaire requiring quantitative and qualitative input. A key second phase of this study involved reviewing all of the submitted cases, identifying the most severe—e.g., where new psychiatric diagnoses were made or pre-existing symptoms made worse post psychedelic-use—and inviting these individuals to participate in a semi-structured interview with two members of our research team, during which participant experiences and backgrounds were examined in greater depth. Based on the content of these interviews, a brief summary of each case was compiled, and an explorative thematic analysis was used to identify salient and consistent themes and infer common causes. 32 individuals fully completed an onboarding questionnaire (56% male, 53% < age 25); 37.5% of completers had a psychiatric diagnosis that emerged after their psychedelic experience, and anxiety symptoms arose or worsened in 87%. Twenty of the seemingly severer cases were invited to be interviewed; of these, 15 accepted an in-depth interview that lasted on average 60 min. This sample was 40% male, mean age = 31 ± 7. Five of the 15 (i.e., 33%) reported receiving new psychiatric diagnoses after psychedelic-use and all fifteen reported the occurrence or worsening of psychiatric symptoms post use, with a predominance of anxiety symptoms (93%). Distilling the content of the interviews suggested the following potential causal factors: unsafe or complex environments during or surrounding the experience, unpleasant acute experiences (classic psychedelics), prior psychological vulnerabilities, high- or unknown drug quantities and young age. The current exploratory findings corroborate the reality of mental health iatrogenesis via psychedelic-use but due to design limitations and sample size, cannot be used to infer on its prevalence. Based on interview reports, we can infer a common, albeit multifaceted, causal mechanism, namely the combining of a pro-plasticity drug—that was often ‘over-dosed’—with adverse contextual conditions and/or special psychological vulnerability—either by young age or significant psychiatric history. Results should be interpreted with caution due to the small sample size and selective sample and study focus.

Psychological Safety for Mental Health in Elite Sport: A Theoretically Informed Model

Elite sports contexts are highly pressurised and frequently enforce a win-at-all-costs approach. This narrow focus on performance outcomes can potentially contribute in negative ways to the mental health of those within these environments. In this Current Opinion paper, we propose a model that outlines how key elements contributing to psychologically safe or unsafe environments may contribute to better or worse mental health outcomes, respectively. In an environment in which individuals feel safe to show their authentic selves rather than ‘wear a mask’, different experiences of mental health are likely to be normalised, help-seeking behaviour increased, and thus, mental health outcomes enhanced. We outline how sports teams and organisations can contribute to this through the creation of appropriate policies and procedures, in addition to leaders modelling and reinforcing positive cultural norms. It is intended that the theoretical model can inform stakeholders in elite sport as well as future research directions.

The Correlation Of Unsafe Action And Unsafe Condition On Work Accident Among Nurses At Dr Tadjuddin Chalid Hospital Makassar

Nurses working in hospital settings face a heightened susceptibility to work-related accidents, which primarily stem from two underlying factors: unsafe behaviour and hazardous conditions. Work accident data at Dr Tadjuddin Chalid, there are 12 reported cases of work accidents in 2021. The objective of this study was to establish the correlation between unsafe actions, unsafe conditions, and the frequency of work accidents among nurses at Dr Tadjuddin Chalid Makassar Hospital. The research methodology employed for this investigation was observational, adopting a cross-sectional approach. The targeted population encompassed 205 individuals, with a final sample size of 136 nurses being involved in this research endeavour. The sample is taken using a simple random sampling method. Respondent data collection using a questionnaire. Data analysis used the chi-square test to see the relationship between independent variables, namely unsafe actions (perceptions, work experience, work stress, work shifts and supervision) and unsafe conditions (work environment, tools/materials and dangerous unsafe environment) with the occurrence of work accidents. The findings indicated a notable correlation between unsafe behaviour and work accidents (p-value = 0.001), alongside a significant relationship between unsafe conditions and work accidents (p-value = 0.007). In summation, it can be concluded that both unsafe behaviour and unsafe conditions are connected to the incidence of work accidents at Dr. Tadjuddin Chalid Makassar Hospital. It is recommended that the hospital emphasizes enhancing the work environment's conditions and elevating the quality of training and supervision. These measures are essential for mitigating the prevalence of work accidents among nurses.

Self-Powered Robotic Sensor for Remote and Real-Time Monitoring of Heavy Metal Ions

In the recent years, heavy metal pollution has tremendously increased worldwide due to natural as well as anthropogenic reasons. Heavy metals accumulate in the human body through drinking water and food, ultimately causing irreversible damage to the body. For most of the heavy metals, the World Health Organization (WHO) has set permissible limits from 0.003-3 ppm in drinking water, above which it is contaminated. In addition, chemical threats remain a major global concern for sampling and sensing factors in unsafe environments. Therefore, robotic hand-based chemical sensing platforms that can monitor hazardous pollutants in the real environment are essential. Although robotic hand-based chemical sensors show great potential to substantially prevent humans from chemical threats in the environment, applications are often limited by the requirement of high-power consumption. In this study, we have fabricated a self-powered triboelectric nanosensor, which is integrated with a robot platform with wireless transmission capability, to detect heavy metal ions in the environment through a rapid onsite detection mechanism. In this regard, a copper electrode modified by an ion selective membrane (ISM) is used as a solid triboelectric material and is integrated with a robotic hand. Since the ionophore selectively binds to the corresponding ions, the solid-liquid TENS could detect Cr6+, Pb2+, and As3+ ions at a wide range of concentrations by the periodic contact and separate motion of the sensor probe to lead (Pb2+), arsenic (As3+) and chromium (Cr6+) solutions. This realization of direct integration of self-powered sensors with robotics provides low-cost and automated chemical sensing mechanisms. It can be applied to various environments for on-site detection of hazardous analytes and security. Finally, a real time remote monitoring system allows the presentation of the environmental monitoring data on mobile devices and enables remote real-time monitoring of the hazardous pollutants.

FACTORS ASSOCIATED WITH DEPRESSION, ANXIETY, AND STRESS AMONG FOOD INDUSTRY WORKERS: A SYSTEMATIC REVIEW

In 2021, food industry workers represented approximately one-tenth of the total labour force in Malaysia. There was an estimated 15% of working-age adults who experienced a mental disorder worldwide in 2019. To make the situation worse, service workers in food retail and food services face tremendous stress and mental health consequences during the COVID-19 pandemic. Various study found that worsening mental health and psychological distress have been accelerated substantially by the pandemic. An unsafe or unhealthy working environment can undermine mental health, as poor mental health can interfere with a person’s ability to work if left unsupported. This systematic review aimed to evaluate findings related to factors associated with depression, anxiety, and stress among food industry workers. Articles related to these factors were collected electronically from two different databases (EBSCOHOST and Scopus). An independent reviewers screened the titles and abstracts of the collected articles from each database, and then stored them in Google Sheet based on the inclusion and exclusion criteria. Next, the included articles were critically appraised to assess the quality of the studies using the Mixed Methods Appraisal Tool (MMAT). Out of the 292 articles identified, four were included in the final review. Sociodemographic characteristics, as well as biological, psychological, and occupational factors were found to be associated with common mental issues among food industry workers. By identifying the risk factors, specific interventions can be implemented by the employers and other relevant parties to prevent, promote, protect, and support the mental health well-being of food industry workers. These findings may be utilised to improve the implementation of key interventions directed to prevent, promote, protect, and support the mental health of food industry workers. Consequently, an enabling environment can be created to address mental health at work, as outlined by the World Health Organization (WHO). Employers may adapt or revamp their work environment to minimise exposure to psychological risks among their workers, which could prevent workers from experiencing adverse mental health conditions. Workers should also be equipped with awareness and skills, as well as opportunities to recognise and act early on mental health issues in order to promote and protect their mental health. Moreover, workers with pre-existing or ongoing mental health conditions should receive support to access job opportunities, or continue working, and thrive at work, since good mental health status at work can improve an individual’s performance and productivity.

Reframing morning report: Cognitive simulation in a safe space.

Various purposes for morning report (MR), in addition to education, have been cited in the literature. Learners can find traditional MR challenging secondary to a perceived lack of psychological safety, the sense that they are being evaluated. Despite the recognition of unsafe learning environments, there is a paucity of literature on how to promote psychological safety in the MR setting. Our aim was to create an MR format utilizing scientifically proven teaching strategies to enhance its educational value. The creation of a safe learning environment was at the forefront of this initiative. Using Kern's six steps of curriculum development, we describe one institution's experience in reframing the morning report experience. We conducted a pilot trial of the new MR with 35 paediatric residents beginning in July 2020 and followed the resident experience over 2years. The primary outcome was attitudinal data as measured via a Likert scale. We found that by the second-year post-curricular implementation, greater than 50% of residents were less hesitant to participate in conference, increased their practice of retrieval and perceived feeling more prepared for examinations as the curriculum progressed. We believe the use of proven teaching strategies based in the cognitive psychology of learning can enhance the quality of education. Furthermore, we believe that central to the success of learning is the perception that the classroom is a safe space to be wrong. This model can serve as a steppingstone for institutions that look to improve their MR series.

Prevalence and determinants of school bullying in Qatar: a cross-sectional study

BackgroundSchool bullying is a wide-spread phenomenon that manifests in various forms. It has both short-term and long-term devastating consequences on physical, mental and social wellbeing. The Middle East and North Africa (MENA) region, including Qatar, has a relatively high prevalence of school bullying. This research aims at identifying the prevalence of bullying, particularly unsafe environments were bullying takes place, and its attributes at schools in Qatar.MethodsIn a cross-sectional study, 980 students from 10 schools in Qatar completed an anonymous self-completion standardized questionnaire to assess the different aspects of bullying from school students’ point of view.ResultsThe prevalence of bullying victimization and perpetration was found to be 41.0% and 31.7% among school students in Qatar, respectively. Classroom (67.5%) and hallways (64.8%) were the most frequently indicated environments of bullying whereas library was the least indicated one (28.3%). Verbal bullying was the most used type of bullying by students. Overall, students in Qatar believe that bullying is considerably a significant issue at their schools, yet schools are safe place for them to be in. Gender, age, ethnicity, school grade and years living in Qatar showed significant differences among the students.ConclusionSchool bullying is a serious, yet a manageable global problem. Our findings re-demonstrated the alarming high prevalence of school bullying in Qatar, highlighted student related and school related factors which have implications for future multidimensional action and research and recommended measures to foster safety at school.

The Challenges Accosted by Educators in the Application of Disciplinary Procedures in Secondary Schools

The aim of this study was to investigate educator’s perceptions of how learners’ rights to safety affect disciplinary procedures in secondary schools in the Umbumbulu Circuit of KwaZulu-Natal. The paper adopted a qualitative approach, where semi-structured interviews were used to collect data from 10 purposively selected educators. The thematic analysis technique was employed to analyse the data. The main findings of the study indicated that educators had their own perceptions of how learners’ rights to safety affect the way they attend to disciplinary issues when a learner has transgressed. The educators’ perceptions of learners’ rights to safety affect disciplinary procedures for many reasons, including poor understanding of relevant education laws and policies. The results also showed that teachers think that the legislation guiding teaching and learning, as well as disciplinary procedures, are marred with contradictions, which make discipline management not only difficult, but also exposes both the learners and the educators to unsafe environments. The study also indicated that the teachers are sensitive to learners’ rights to safety, resulting in restricted attention to learners who are guilty of an offence in the school. In light of these findings, it was recommended that there should be mandatory continuous in-service workshops for the educators, on how learner discipline can be maintained.

Development of a Safety Heavy-Duty Vehicle Model Considering Unsafe Acts, Unsafe Conditions and Near-Miss Events Using Structural Equation Model

The World Health Organization has revealed that Thailand ranks first in Asia with regard to the region’s road traffic death rate. Due to the growth in the domestic economy and demands in logistics, traffic congestion regularly occurs and brings higher risks to transportation, resulting in a constant increase in the accident rate involving heavy-duty vehicles (HDVs), with a tendency to escalate in the future. To prevent its occurrence and solve the problem, this research aims to present a “Safety HDV Model” based on four dimensions, namely, driver behaviors, unsafe roadway environment, types of vehicles and near-miss events, which are all considered as causes of accidents. In this study, the researchers use the Delphi method to obtain a consensus from experts in logistics and safety from both public and private organizations, and then they define indicators and assess the complex dimensions. Based on the consensus, the researchers find 4 dimensions, 15 factors and 55 indicators with a high level of consensus at the Kendall’s coefficient of concordance (W) of 0.402 and P less than 0.001 to be relevant to safety in logistics. To estimate the influences among dimensions, the researchers apply a structural equation model and find that both absolute fit indices and incremental fit indices demonstrate good fit, with a CMIN/DF of 1.90, RMSEA of 0.048, GFI of 0.95, AGFI of 0.92 and RMR of 0.032 for the absolute fit indices and NFI of 0.97, CFI of 0.98, TLI of 0.98 and IFI of 0.98 for the incremental fit indices. As the model is consistent with data and variables, it is considered to be valid to be adopted by responsible authorities to improve unsafe roadway environments and behaviors of HDV drivers. As the data in the model can be altered by location, the model can be utilized as a tool in strategic planning and management to prevent accidents in each area of the country in the future.

Considerations of Left Ventricular Assist Device Therapy in the United States’ Prison System

Left ventricular assist device therapy for advanced heart failure is contraindicated if a patient lives in an unsafe environment and recent guidelines declare that “legal history is pertinent for determining personal constraints or financial responsibilities due to parole requirements, pending charges, and possible imprisonment,” implying that incarceration would be a contraindication. International guidelines and precedent in the United States establish that medical care for incarcerated persons should match access in the community. We present a case example and practical considerations for advanced heart failure programs faced with the challenge of partnering with patients with heart failure who may be incarcerated and their correctional health systems in the care of their chronic condition. We encourage the heart failure community to not let incarceration be a contraindication to left ventricular assist device therapy.

Influences on Long-Term Physical Activity in African American Women: A Scoping Review.

African American women experience a disparity of preventable long-term illness than non-Hispanic White, non-Hispanic Asian, and Hispanic women. Participation in routine physical activity (PA) is recommended to prevent and manage long-term illness, yet African American women are the least physically active. There is a paucity of literature addressing long-term PA in this population; therefore, a scoping review of the literature was conducted to assess what is known about physically active African American women who successfully participate in regular forms of long-term PA. The Socioecological Model was used to organize a synthesis of factors influencing PA at the individual, social, environmental, and political levels. A search of 7 electronic databases and reference lists produced 7 studies published in English between 2000 and 2022. Participants shared perspectives of influences at multiple levels. At the individual level, modeling PA behaviors was noted as a means for changing the cultural perspective of PA; future interventions that engage physically active African American women as advocates and promoters of PA may be useful. Social level influences were the most impactful and served as a channel for belonging and attachment while performing PA; culturally appropriate interventions may include supporting a sense of belonging. At the environmental level, financial constraints and unsafe environments for subgroups influenced the ability to perform PA; future research might consider interventions based on demographics and their impact on participants' ability to perform PA. No influences were mentioned by participants at the political level.

Reframing care while enduring the traumatic nature of witnessing disrupted family-patient-nurses' relationships during COVID-19.

To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States. A phenomenological philosophical approach following the van Manen analysis method. Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country. The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons. The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time. Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.

HIV-Response Intergenerational Participation Intervention Among Black Men in Ontario, Canada: Protocol for a Pilot Intervention Study.

Black men and their communities are more affected by HIV. Although they constitute less than 5% of the Ontarian population, they accounted for 26% of new HIV diagnoses in 2015, nearly half of which (48.6%) were attributed to heterosexual contact. HIV stigma and discrimination reinforce African, Caribbean, and Black men's HIV vulnerability by creating unsafe environments that deter them from testing and disclosure, resulting in isolation, depression, delayed diagnosis and linkage to treatment and care, and poor health outcomes. In response to these challenges, intergenerational strategies were identified from previous community-based participatory studies as best practices to reduce HIV vulnerabilities and promote resilience among heterosexual Black men and communities. The proposed intervention is premised on this recommendation of intergenerational intervention. The overarching objective is to engage heterosexual Black men and communities in cocreating a community centered, culturally safe intergenerational intervention to reduce HIV vulnerabilities and related health disparities. We will engage 12 diverse community stakeholders in Ontario, inclusive of heterosexual Black men, in 8 weekly sessions to evaluate existing evidence of effective HIV health literacy interventions, identify essential and relevant aspects, and work collaboratively to co-design the HIV-Response Intergenerational Participation (HIP) intervention for use with Black men and communities. Next, we will recruit 24 self-identified heterosexual Black men aged 18-29, 29-49, and ≥50 years. We will pilot and evaluate the HIP intervention with 24 heterosexual Black men from these 3 age groups (split as 2 events: a total of 12 participants in person in Toronto and 12 participants on the web in Windsor, London, and Ottawa). We will use the data obtained along with questionnaires from validated scales and focus groups to evaluate the effectiveness of HIP. The data will include HIV knowledge, perceived stigma toward people living with HIV, acceptance and uptake of HIV testing, preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and condom use. We will also collect data related to perceptions about system-level factors such as discrimination, socially misconstrued masculine identity, etc. Quantitative analysis will essentially be a univariate descriptive analysis. We will use thematic analysis to highlight the results of the focus group discussions. Finally, we will disseminate the evaluation results and engage researchers, leaders, Black men, and communities to expand the project team and scale up the intervention in Ontario and across Canada. Implementation commences by May 2023, and by September 2023, we should have produced, among others, an evidence-informed HIP intervention that can be adapted for use by heterosexual Black men and communities beyond Ontario. The pilot intervention will strengthen critical health literacy and build resilience against HIV through intergenerational dialogue among heterosexual Black men of all ages. PRR1-10.2196/48829.

“When I came to Canada, I almost forgot myself: Where I am, who I am”: A qualitative exploration of how im/migration shapes young women's experiences of pregnancy, motherhood, and marriage

For young women, im/migration can impact education, employment, and family dynamics in ways that shape the courses of their lives and health. The purpose of this study is to deepen understandings of how im/migration shapes young women's experiences of pregnancy, motherhood, and marriage. Guided by intersectionality theory and the structural and social determinants of health, we analyzed qualitative interviews conducted with young im/migrants ages 15-30, who identify as women, and who had experiences of pregnancy, motherhood, and/or marriage (N ​= ​34). Participants were interviewed as part of the IRIS study in British Columbia, Canada between May 2019 to February 2021. Young im/migrant women described how im/migration shaped experiences of pregnancy, motherhood, and marriage by way of health, social, legal, and economic drivers. These included being ineligible for health insurance and unable to prevent pregnancy and experiencing workplace discrimination in form of reduced hours and no maternity benefits. Demanding caregiving roles and unsafe home environments were also described as being exacerbated by unaffordable childcare in destination settings and unequal gender roles and power dynamics after im/migration. Our findings suggest structural changes necessary to improve young im/migrant women's health. We recommend that health systems decouple im/migration status from health insurance; that governments provide all people with accessible childcare and maternity benefits; and that governments fund community-based efforts towards dismantling structures of patriarchy.

Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants

BackgroundSudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. Local problemA multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. MethodsA comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. InterventionsInterventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. ResultsDocumented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. ConclusionsA multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

Beyond A Vision for The Future: Tangible Steps To Engage Diverse Participants in Inclusive Field Experiences.

Recent strides toward improving diversity, equity, and inclusion (DEI) in field biology present a unique opportunity for transdisciplinary exploration of the impacts and state of a topic that has remained hereto largely underexplored and under-discussed in the academic setting. Within current literature, themes of racial and gender inequity, power imbalances, unsafe environments, and underdeveloped infrastructure and resources are widespread. Thus, we organized a symposium that addressed these compelling issues in field biology DEI through a multitude of experiential and academic lenses. This article will orient the reader to the special issue and offer summative goals and outcomes of the symposium that can provide tangible steps toward creating meaningful improvements in the state of DEI and safety in field settings.