Operationalizing Anti-Racism Accountability with Equitable Admissions in Nursing Education Accreditation.

For decades, health professional organizations have recommended increased diversity in the workforce and education. To address persistent inequities in health care, the racial composition of the nursing workforce needs be congruent with the U.S. population. Without first addressing structural inequity in nursing education programs, the nursing profession cannot begin to address structural racism in health care. The lack of nursing student diversity is reflective of barriers in program admissions. This article is a call to nursing accreditation bodies to operationalize anti-racism to improve U.S. nursing workforce diversity by introducing accountability structures that require evidence-based holistic admission review and analysis of admission data to ensure that student cohorts are diverse across nursing programs, thereby ensuring a future workforce that reflects the diversity of the U.S. population.

A Multimodal Protocol to Limit Opioid Exposure and Effectively Manage Postoperative Cesarean Birth Pain.

PURPOSE: To evaluate the impact of implementing a multimodal plan of care in treating the pain of the postoperative cesarean birth patient that limited opioid exposure. STUDY DESIGN AND METHODS: A retrospective medical record review was conducted to evaluate a pain management protocol implemented for postoperative cesarean patients before and after a practice change. Sample included term postoperative cesarean patients ≥ 37 weeks of gestation, who had spinal or epidural, were 18 years or older, gave birth to a singleton newborn, admitted to the maternal child health department, and were prescribed opioids as a postoperative pain management treatment plan. Participants (N = 150) were evaluated based on two groups: n = 75 in the preimplementation group and n = 75 in the postimplementation group. RESULTS: There was a significant difference in the total oral opioid milligrams administered between the pregroup (M = 27.13) and postgroup (M = 8.43), after the practice change (p < .001). There was an increase of nonopioids administered to treat and manage postoperative cesarean pain, Motrin PO (p = < .001) and Tylenol PO (p = .002). CLINICAL IMPLICATIONS: Fewer milligram equivalents of morphine were administered when postoperative cesarean patients were placed on scheduled nonopioids to treat pain.

Holistic Admissions Review Integration in Nursing Programs.

BACKGROUND: To address health inequities, the American Association of Colleges of Nursing, Institute of Medicine, and Association of American Medical Colleges recommend holistic admissions review (HAR) to increase health professional diversity. METHOD: This cross-sectional study collected admissions criteria from 1,547 nursing programs. Criteria were categorized according to the experiences, attributes, and academic metrics (EAM) model, and programs were dichotomized into those with holistic admissions criteria versus none. RESULTS: Only 43% of nursing programs considered holistic admissions criteria. Regionally, rates varied from 35% in the South to 54% in the West. The rate of HAR integration exceeded 67% in only six states. CONCLUSION: Nursing programs have not widely integrated HAR despite evidence that academic metric use alone disadvantages qualified underrepresented students. HAR implementation can be facilitated by standardizing how HAR is operationalized and applying best evidence to rubric development that appropriately weighs admissions criteria based on the EAM model, and also training reviewers for unbiased candidate evaluation. [J Nurs Educ. 2022;61(7):361-366.].

Experiences of critical care nurses during the early months of the COVID-19 pandemic.

BACKGROUND: Critical care nurses have risked their lives and in some cases their families through hazardous duty during the COVID-19 pandemic and have faced multiple ethical challenges. RESEARCH/AIM: The purpose of our study was to examine how critical care nurses coped with the sustained multi-faceted pressures of the critical care environment during the unchartered waters of the COVID-19 pandemic. It was anticipated that our study might reveal numerous ethical challenges and decision points. RESEARCH DESIGN: A qualitative descriptive study, utilizing an interpretivist paradigm. PARTICIPANTS AND RESEARCH SETTING: Critical care nurses, working in either intensive care units or emergency departments (N = 11) who were primarily from Northern California hospitals. Individual in-depth ZOOM® session interviews, guided by semi-structured questions, were used to collect data. Interviews lasted between 18 and 59 min, with an average length of 33 min. Session interviews were transcribed and analyzed. ETHICAL CONSIDERATIONS: This study was approved by the researchers' university Institutional Review Board. FINDINGS: Five main themes emerged: Fear of the Unknown, Adapting to Practice Changes and Challenges, Patient Advocacy and Moral Distress, Isolation and the Depersonalization of Care, and Professionalism and a Call to Duty. DISCUSSION AND CONCLUSION: Fear of becoming ill or bringing COVID-19 home to their families was a constant source of anxiety for nurses. There were numerous changes in policy and challenges to standard practice protocols, including most notably shortages in personal protective equipment, which nurses navigated resourcefully. Most nurses interviewed were motivated by a sense of professional duty. The nurses experienced some moral distress in their inability to advocate as they might like for their patients, especially at end of life. Infection control requirements for isolation.

Nursing Program Admission Barriers in the United States: Considerations for Increasing Black Student Enrollment.

BACKGROUND: The percentage of Black registered nurses (RN) is disproportionate to Black residents in the population, particularly in Southern states. PURPOSE: This study's purpose was to identify the potential admission barriers for Black students in RN education in the South versus Midwest, Northeast, and West. METHODS: A cross-sectional design was used to compare admission criteria for 1597 accredited associate degree in nursing and bachelor of science in nursing programs by geographic region. RESULTS: Southern programs required a significantly higher count of academic metric criteria (multiple grade point average, standardized tests) and nonacademic criteria (proof of health insurance, background checks). Southern programs had a significantly lower count of holistic admissions review criteria (references, essays, volunteer work). CONCLUSION: Approximately 50% of programs used academic metrics exclusively, and most programs using some holistic criteria assigned greatest weight to academic metrics despite evidence that this disadvantages qualified, underrepresented students. Access to RN education must be improved. Recommendations are discussed for transition to holistic admissions review.

Recruitment and Retention of Minority High School Students to Increase Diversity in the Nursing Profession.

Disparities in the quality of health care for the black population have been apparent for many decades, evidenced by the high mortality and morbidity rates for the black/African American community. Major health care organizations have recognized that a culturally diverse nursing workforce is essential to improve the health of this community. Recruitment of prenursing students from the black population is vital to building a diversified workforce sensitive to the community's needs. In recent years, innovative projects have evolved to increase nurse workforce's diversity by recruiting black/African American students. This article provides background, identifies challenges, recommends solutions, and showcases successful programs.

Comparing the effectiveness of video-assisted oral debriefing and oral debriefing alone on behaviors by undergraduate nursing students during high-fidelity simulation.

Complex healthcare, less resources, high-level medical equipment, and fewer available clinical settings have led many health professionals to use simulation as a method to further augment educational experiences for nursing students. While debriefing is recommended in the literature as a key component of simulation, the optimal format in which to conduct debriefing is unknown. This pre- and posttest two-group randomized quasi-experimental design compared the effectiveness of video-assisted oral debriefing (VAOD) and oral debriefing alone (ODA) on behaviors of 48 undergraduate nursing students during high-fidelity simulation. Further, this study examined whether roles (e.g., team leader, medication nurse), type of scenarios (i.e., pulmonary and cardiac scenarios), and student simulation team membership (i.e., VAOD and ODA groups) influenced these behaviors. Behaviors observed in this study related to patient safety, communication among team members, basic- and problem-focused assessment, prioritization of care, appropriate interventions, and delegation to healthcare team members. Both human patient simulator practice and guidance using video-assisted oral debriefing and oral debriefing alone appeared to be comparable regarding behaviors, regardless of roles, type of scenarios, and student simulation team membership. These findings suggest that nurse educators may use either video-assisted oral debriefing or oral debriefing alone to debrief undergraduate nursing students during high-fidelity simulation.

Intraorbital wooden foreign body (IOFB): mimicking air on CT.

We report the case of a 41-year-old man who presented to the ER following a fall in his back garden during which he sustained a left orbital injury. Computed tomography (CT) demonstrated an intraorbital linear lucency surrounded by haziness in the intraconal fat. An intraocular wooden twig was confirmed during subsequent surgery. The possibility of a wooden intraorbital foreign body should be strongly suspected following orbital trauma when there is intraorbital density below that of the surrounding intraorbital fat on CT, as this may mimic organic foreign bodies.