Objective The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID‐19 pandemic. Background The COVID‐19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored. Design A qualitative study design was used. Methods Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty‐three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study. Results The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self‐care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping. Conclusions Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses. Relevance to clinical practice Nurses face added distress as frontline at‐risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions.

Background Informal, unpaid, family caregivers provide much hospice care in the United States. These caregivers suffer physically, psychologically, emotionally, and socially from the burden of caring. The most often identified area of caregiver burden is the management of end-of-life pain. However, little empirical evidence exists of effective interventions to help caregivers manage end-of-life pain, and issues surrounding caregiver pain management remain vague and undefined. Understanding these concerns will inform the design of effective caregiver interventions. Aim The purpose of this study was to describe and organize caregiver pain management challenges faced by home hospice caregivers of cancer patients. Design A content analysis of secondary data, namely, recordings of caregiver interviews, was conducted to describe pain management issues. These interviews were part of a larger clinical trial. Setting/participants Multiple sessions with 29 informal caregivers, of patients dying of cancer, were audio-recorded. Subjects were purposively selected from two hospice programs in the Northwestern United States. Caregivers of noncancer patients were excluded from the study sample. Results A framework of six major themes with subordinate subthemes was developed through a literature review and peer review. The framework was used to organize the content of 87 caregiver interviews. The six major themes identified in the analysis included Caregiver-Centric Issues, Caregiver Medication Skills and Knowledge Issues, End-of-Life Symptom Knowledge Issues, Communication and Teamwork Issues, Organizational Skill Issues, and Patient-Centric Issues. Conclusion This analysis clearly articulated and classified caregiver issues surrounding pain management. Future hospice research may benefit from the use of this analysis and framework in the development of tools to alleviate this major cause of caregiver burden.

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Background:Electronic health records (EHRs) have the potential to enhance patient-provider communication and improve patient outcomes. However, in order to impact patient care, clinical decision support (CDS) and communication tools targeting such needs must be integrated into clinical workflow and be flexible with regard to the changing health care landscape.Design:The Stroke Prevention in Healthcare Delivery Environments (SPHERE) team developed and implemented the SPHERE tool, an EHR-based CDS visualization, to enhance patient-provider communication around cardiovascular health (CVH) within an outpatient primary care setting of a large academic medical center.Implementation:We describe our successful CDS alert implementation strategy and report adoption rates. We also present results of a provider satisfaction survey showing that the SPHERE tool delivers appropriate content in a timely manner. Patient outcomes following implementation of the tool indicate one-year improvements in some CVH metrics, such as body mass index and diabetes.Discussion:Clinical decision-making and practices change rapidly and in parallel to simultaneous changes in the health care landscape and EHR usage. Based on these observations and our preliminary results, we have found that an integrated, extensible, and workflow-aware CDS tool is critical to enhancing patient-provider communications and influencing patient outcomes.

< 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013) and compared values to those ascertained at one-year (May–July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population.

Background Community-level factors have been clearly linked to health outcomes, but are challenging to incorporate into medical practice. Increasing use of electronic health records (EHRs) makes patient-level data available for researchers in a systematic and accessible way, but these data remain siloed from community-level data relevant to health. Purpose This study sought to link community and EHR data from an older female patient cohort participating in an ongoing intervention at the Ohio State University Wexner Medical Center to associate community-level data with patient-level cardiovascular health (CVH) as well as to assess the utility of this EHR integration methodology. Materials and Methods CVH was characterized among patients using available EHR data collected May through July of 2013. EHR data for 153 patients were linked to United States census-tract level data to explore feasibility and insights gained from combining these disparate data sources. Analyses were conducted in 2014. Results Using the linked data, weekly per capita expenditure on fruits and vegetables was found to be significantly associated with CVH at the p<0.05 level and three other community-level attributes (median income, average household size, and unemployment rate) were associated with CVH at the p<0.10 level. Conclusions This work paves the way for future integration of community and EHR-based data into patient care as a novel methodology to gain insight into multi-level factors that affect CVH and other health outcomes. Further, our findings demonstrate the specific architectural and functional challenges associated with integrating decision support technologies and geographic information to support tailored and patient-centered decision making therein.

Background Cardiovascular (CV) disease continues to be a leading cause of morbidity and mortality with higher rates among cancer survivors than in the general population. Objective This study was aimed to understand oncology providers' attitudes toward a digital CV health tool, delivered via a tablet, to promote CV health in cancer survivors. Methods Using qualitative methods, 14 oncologists, from community and academic practice sites, were interviewed while they used the tool. Interviews were videotaped then analyzed using NVivo 11 software. Themes were inductively developed from the interviews. Results Three major themes emerged from the interviews as follows: (1) system functionality, (2) facilitators and barriers to integration, and (3) appropriate end-users. Oncologists recognized the critical role of CV health promotion among cancer survivors and identified features about the tool that would be helpful for CV health promotion. Workflow (subtheme) was a barrier to tool use. This feedback enabled tool redesign for further testing in the context of survivorship care. Conclusion Our findings emphasized the importance of identifying appropriate End-users which may include other survivorship care providers, patients, and primary care providers. Implications Our research addresses the knowledge gap in the use of digital tools in cancer survivorship care, specifically digital tools to promote CV health. Future research is needed to evaluate digital tools in cancer survivorship care. Research investigating patients as users of digital tools may provide additional insight.

Introduction The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses. Design We conducted a secondary thematic qualitative analysis using grounded theory methodology. Methods Data collection occurred through semi‐structured, in‐depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.’s Public Health Emergency Preparedness Framework and inductively for emergent themes. Results Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need. Conclusion From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.