Linda Wesp

Aims: This study aimed to describe how emergency nurses (ENs) experience secondary traumatic stress (STS) within their practice environments, focusing on the strategies they use to cope and the supportive resources they draw upon to manage its impact on their lives. Design: This paper presents the qualitative findings from a larger mixed‐methods survey study on STS among ENs. Methods: A geographically diverse U.S. sample of ENs was recruited through social media to participate in an online survey. All participants ( n = 275) were asked to respond to open‐ended survey questions, and 118 of these participants provided answers to at least one open‐ended question. A self‐selected sample of 20 ENs completed semi‐structured interviews. Inductive content analysis was used to analyse open‐ended survey responses and interview transcripts. Results: Three themes reflected ENs' experiences with STS: STS Is Real—It's Going to Affect Your Life; Something Must Be Wrong With Me: A Culture of Disconnection; and It's a Systems Issue, but We're in It Together. Participants described individual, unit, and organizational factors that influenced their experiences of STS and their access to and use of coping strategies and supportive resources. Conclusion: ENs and nurse leaders acknowledged the impact of STS on their personal and professional lives and emphasized how the practice environment shaped their experiences. They perceived the accessibility of organizational resources, leadership behaviours, and team culture as influencing the individual strategies ENs use to manage the effects of repeated exposure to others' traumatic experiences. STS is a predictable occupational hazard for ENs; thus, healthcare organizations must invest in nurse‐identified supports to preserve workforce well‐being and clinical expertise. Implications for the Profession: Assessing organizational readiness to address STS is recommended to ensure ENs receive effective, timely support. In response to these assessments, healthcare organizations should develop and implement policies that prioritize the mental health and well‐being of ENs, including proactive support systems and accessible mental health resources. Impact: This study identifies participant‐perceived individual, team, leadership, and organizational conditions that may hinder or support ENs' management of STS. These findings identify potential targets for organizational assessment and support strategies intended to foster healthier practice environments and promote safe, high‐quality care. Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct, or reporting.

Nursing's efforts at organizing in the United States have encompassed various approaches to creating change at a systemic and political level, namely shared governance, professional associations, and nurse unions. The United States is currently experiencing the effects of an authoritarian sociopolitical agenda that has taken aim at our profession's ethic of providing equitable care for all people through legislation that bans gender‐affirming care and abortions. Nursing is simultaneously experiencing a crisis of burnout and moral distress, as we navigate the everyday functions of a for‐profit healthcare system under the Capitalocene. As we situate ourselves within these policies and practices of late‐stage capitalism and an increasingly authoritarian nation‐state, we are compelled to think deeply about how nursing is currently organizing ourselves. Our paper will explore the evolution of various forms of organizing through the lens of intersectionality, which offers a framework for considering the ways that power operates, creating a matrix of sociostructural processes that fuel injustice. Intersectionality also compels us to examine whether our organizing has resisted, or perpetuated, a matrix of oppression. We will conclude by offering examples of radical imagining for a future of nursing resistance, where our collective organizing has a greater impact and responsibility for dismantling the status quo to achieve justice and liberation.

We evaluated the role of the neurotoxicant lead (Pb) in mediating racial disparities in later-life cognition in 1085 non-Hispanic Black and 2839 non-Hispanic white participants in the National Health and Nutrition and Examination Survey (NHANES, 1999-2002, 2011-2014) 60+ years of age. We operationalized Black race as a marker for the experience of racialization and exposure to systemic racism. We estimated patella bone Pb via predictive models using blood Pb and demographics. Concurrent cognition (processing speed, sustained attention, working memory) was measured by the Digit Symbol Substitution Test (DSST) and a global measure combining 4 cognitive tests. To obtain the portion mediated, we used regression coefficients (race on Pb * Pb on cognitive score)/(race on cognitive score), adjusting for age, NHANES cycle, and sample weights. Other confounder adjustment (education, poverty income ratio, smoking) was limited to the mediator-outcome (ie, Pb-cognition) pathway because these factors do not lie upstream of race and so cannot confound associations with race. Lead was estimated to mediate 0.6% of the association between race and global cognition, and 4% of the DSST. Our results suggest that later-life cognitive health disparities may be impacted by avoidable lead exposure driven by environmental injustice, noting that a large proportion of the pathway of systemic racism harming cognition remains. This article is part of a Special Collection on Mental Health.

Sexual health is multi-factorial and fluid despite overarching cultural narratives that promote cisgender heteronormative-ableist ideals and hierarchies. It is a fluctuating state of well-being that encompasses the physical, emotional, psychological, and possibly spiritual aspects of one’s sexual experience. This chapter provides clinicians with some fundamental knowledge and tools to begin customizing their communication skills and approach to care in order to meet each patient’s unique needs. It discusses the ways to take a culturally safe sexual health history and identifies options for providing a trauma-informed pelvic exam. The chapter discusses ways to support sexual function and pleasure for all patients. It describes screening recommendations for sexually transmitted infections. Providers are responsible for recognizing diversity, honoring patient agency, and facilitating patient directed goals. Clinicians can challenge dominant systematic exclusion and discrimination while creating new ways of centering patients during sexual health focused visits.

Transgender people experience intersecting forms of social marginalization and are disproportionately affected by health inequities. We elucidate a novel conceptual framework for transgender health research that theorizes the constructs and pathways through which social inequities produce health inequities for transgender populations. Drawing on theories of intersectionality and structural injustice, Intersectionality Research for Transgender Health Justice (IRTHJ) posits that social and health inequities affecting transgender populations are the result of status quo power relations produced within and between oppressive structures, institutional systems, and socio-structural processes. The IRTHJ framework delineates three main actions for improving transgender health research: (i) name intersecting power relations, (ii) disrupt the status quo, and (iii) center embodied knowledge. The authors show how IRTHJ provides tools for researchers to transform the design, implementation, and interpretation of transgender health research, and they discuss implications for programs, policy, and action for transgender health justice.