Diversity dynamics: The experience of male Robert Wood Johnson Foundation nurse faculty scholars.

BACKGROUND: Managing diversity dynamics in academic or clinical settings for men in nursing has unique challenges resulting from their minority status within the profession. PURPOSE: The purpose of this study was to share challenges and lessons learned identified by male scholars in the Robert Wood Johnson Foundation Nurse Faculty Scholars program and suggest strategies for creating positive organizations promoting inclusive excellence. METHODS: Multiple strategies including informal mentored discussions and peer-to-peer dialogue throughout the program, formal online surveys of scholars and National Advisory Committee members, and review of scholar progress reports were analyzed as part of the comprehensive evaluation plan of the program. DISCUSSION: Diversity dynamic issues include concerns with negative stereotyping, microaggression, gender intelligence, and differences in communication and leadership styles. CONCLUSION: Male nurse faculty scholars report experiencing both opportunities and challenges residing in a predominately female profession. This article attempts to raise awareness and suggest strategies to manage diversity dynamics in service of promoting the development of a culture of health that values diversity and inclusive excellence for both men and women in academic, research, and practice contexts.

Defining Procedural Distress in the NICU and What Can Be Done About It.

Procedural distress is a common occurrence in the NICU and is tied to attempts to support the life and development of vulnerable premature infants. We discuss the epidemiology of procedural distress and the potential negative consequences on infant neurodevelopment. We define procedural distress in the NICU and outline three approaches to limit or to reduce its detrimental effects including minimizing the number of procedures, instituting measures for developmentally supportive care, and using preemptively pharmacologic and nonpharmacologic analgesia. Despite the pervasiveness of procedural distress in the NICU, clinical and administrative measures are available to ameliorate possible harmful outcomes.

Can ChatGPT Accurately Answer a PICOT Question? Assessing AI Response to a Clinical Question.

BACKGROUND: ChatGPT, an artificial intelligence (AI) text generator trained to predict correct words, can provide answers to questions but has shown mixed results in answering medical questions. PURPOSE: To assess the reliability and accuracy of ChatGPT in providing answers to a complex clinical question. METHODS: A Population, Intervention, Comparison, Outcome, and Time (PICOT) formatted question was queried, along with a request for references. Full-text articles were reviewed to verify the accuracy of the evidence summary provided by the chatbot. RESULTS: ChatGPT was unable to provide a certifiable response to a PICOT question. The references cited as evidence included incorrect journal information, and many study details summarized by ChatGPT proved to be patently false, including providing fabricated data. CONCLUSIONS: ChatGPT provides answers that appear legitimate but may be factually incorrect. The system is not transparent in how it gathers data to answer questions and sometimes fabricates information that looks plausible, making it an unreliable tool for clinical questions.

Comparing the Learning Effectiveness of Three Virtual Simulation Tools With Nursing Students During the Coronavirus Disease (COVID-19) Pandemic.

Background: We explored the learning effectiveness of three virtual simulation tools used in the Coronavirus Disease pandemic environment. Sample: Study participants consisted of students from two nursing classes, a junior and a senior class. Method: A mixed-methods approach compared three tools' performance across five learning domains. Descriptive statistics and analysis of variance compared mean ratings for learning domains. Open-ended questions were included for qualitative evaluation. Results: Thirty-six respondents rated the Resource Simulation Center (RSC), based on the observation of videos of students undergoing simulation exercises, as superior to the other two. There were no differences between the other two tools. Qualitative findings echoed preference by students for "RSC". Conclusion: "RSC" was preferred over a commercial product based on computer generated graphics, and a free-online product based on clinical scenarios acted out in short videos. Differences in debriefing practices may have influenced the results, thereby emphasizing the role of debriefing with virtual simulation tools.

Exploring the association between pain intensity and facial display in term newborns.

BACKGROUND: Facial expression is widely used to judge pain in neonates. However, little is known about the relationship between intensity of the painful stimulus and the nature of the expression in term neonates. OBJECTIVES: To describe differences in the movement of key facial areas between two groups of term neonates experiencing painful stimuli of different intensities. METHODS: Video recordings from two previous studies were used to select study subjects. Four term neonates undergoing circumcision without analgesia were compared with four similar male term neonates undergoing a routine heel stick. Facial movements were measured with a computer using a previously developed 'point-pair' system that focuses on movement in areas implicated in neonatal pain expression. Measurements were expressed in pixels, standardized to percentage of individual infant face width. RESULTS: Point pairs measuring eyebrow and eye movement were similar, as was the sum of change across the face (41.15 in the circumcision group versus 40.33 in the heel stick group). Point pair 4 (horizontal change of the mouth) was higher for the heel stick group at 9.09 versus 3.93 for the circumcision group, while point pair 5 (vertical change of the mouth) was higher for the circumcision group (23.32) than for the heel stick group (15.53). CONCLUSION: Little difference was noted in eye and eyebrow movement between pain intensities. The mouth opened wider (vertically) in neonates experiencing the higher pain stimulus. Qualitative differences in neonatal facial expression to pain intensity may exist, and the mouth may be an area in which to detect them. Further study of the generalizability of these findings is needed.

PICO: What it is and what it is not.

AIM: To assess the role and effectiveness of the mnemonic PICO (Population, Intervention, Comparator and Outcome) in evidence-based practice (EBP) pedagogy. BACKGROUND: The mnemonic "PICO" is a well-established tool in nursing EBP pedagogy. Nevertheless, application of this tool in nursing curricula is not currently supported by evidence of its effectiveness. Further, there are reports that PICO as a tool is unhelpful in the classroom. DESIGN/METHODS: We reviewed the literature on PICO; specifically, the mnemonic's origin, purpose, and effectiveness in practice. RESULTS: Our analysis reveals that PICO is limited in terms of its effectiveness and scope of inquiry. CONCLUSION: A reevaluation of PICO's role in nursing pedagogy is essential. To start, we propose a de-emphasis on PICO as an exclusive or preferred tool, and an emphasis on critical evaluation of the literature, and the whole of the EBP process. We propose a search for more effective methods to improve matching native clinical questions to the retrieval of data that informs patient care.

Reevaluating simulation in nursing education: beyond the human patient simulator.

The human patient simulator or high-fidelity mannequin has become synonymous with the word simulation in nursing education. Founded on a historical context and on an evaluation of the current application of simulation in nursing education, this article challenges that assumption as limited and restrictive. A definition of simulation and a broader conceptualization of its application in nursing education are presented. The need for an ideological basis for simulation in nursing education is highlighted. The call is made for theory to answer the question of why simulation is used in nursing to anchor its proper and effective application in nursing education.

Facial expression and pain assessment in the pediatric patient: the primal face of pain.

PURPOSE: This paper aims to explore the role of facial expression in pediatric pain assessment. A comparison of tools employing facial expression methodology is presented. The concept of the primal face of pain (PFP) is introduced. CONCLUSION: The PFP offers an explanation to the utility and deficiency of facial pain scales and facial expression in pain assessment. PRACTICE IMPLICATIONS: The complexities of pain measurement should preclude the clinical application of untested instruments. For reported tools, a careful evaluation of the psychometric properties and the clinical context must precede application. The concept of the PFP warns against the application of facial pain scales as proxy measures in their intended population. Reliance on facial expression to assess pain in the school-age child is imprecise.

Othering in the nursing context: A concept analysis.

AIM: 'Othering' is described as a social process whereby a dominant group or person uses negative attributes to define and subordinate others. Literature suggests othering creates exclusive relationships and puts patients at risk for suboptimal care. A concept analysis delineating the properties of othering was conducted to develop knowledge to support inclusionary practices in nursing. DESIGN: Rodgers' Evolutionary Method for concept analysis guided this study. METHODS: The following databases were searched spanning the years 1999-2015: CINAHL, PUBMED, PsychINFO and Google. Search terms included "othering", "nurse", "other", "exclusion" and "patient". RESULTS: Twenty-eight papers were analyzed whereby definitions, related concepts and othering attributes were identified. Findings support that othering in nursing is a sequential process with a trajectory aimed at marginalization and exclusion, which in turn has a negative impact on patient care and professional relationships. Implications are discussed in terms of deriving practical solutions to disrupt othering. We conclude with a conceptual foundation designed to support inclusionary strategies in nursing.

Lomb algorithm versus fast Fourier transform in heart rate variability analyses of pain in premature infants.

Heart rate variability analysis is a promising method for measuring pain in premature infants. The Lomb algorithm was adapted and compared with fast Fourier transform (FFT) for the purposes of PSD estimation. Both FFT and the Lomb algorithm had similar low frequency (LF) estimation error rates. However, the Lomb algorithm had a significant smaller error rate than FFT when estimating high frequency (HF). In addition, the ECG signals of two premature infants in the newborn intensive care unit were analyzed while undergoing a routine heel stick, a common painful procedure. The Lomb algorithm performed as expected marking a decrease in both LF and HF power in the presence of pain.

Pain assessment during a vaso-occlusive crisis in the pediatric and adolescent patient: rethinking practice.

Pain assessment of the child and adolescent with sickle cell disease is complex and challenging. We present a paradigm of pain assessment during a vaso-occlusive crisis in children and adolescents based on the Pain Assessment as a Social Transaction model. Using this model, the assessment of pain severity in sickle cell disease is uniquely highlighted as comprising at least 4 key factors: the limitations of current pain assessment tools, the existence of acute pain of various origins and the emergence and coexistence of chronic pain, the prevalence of cognitive deficits, and the sociocultural dynamics in America. Improved tools for pain assessment and targeted practitioner education are warranted.

Development of a scale for estimating procedural distress in the newborn intensive care unit: the Procedural Load Index.

BACKGROUND: Infants in the newborn intensive care unit (NICU) are exposed to routine procedures that often cause distress and carry a negative burden or load on the infant's neurodevelopment. AIM: A ratio level index is introduced to estimate procedural load so as to begin to develop a system to monitor the intensity of distress associated with common NICU procedures. STUDY DESIGN: Two psychophysical methods, magnitude estimation (ME) and the general labeled magnitude scale (gLMS) were used to survey 86 clinicians via the internet to estimate the distress associated with 55 common NICU procedures. RESULTS: gLMS and ME estimations correlated highly across all procedures (r = 0.97). gLMS values were used to derive the procedural load index (PLI) as a ratio level estimation of procedural distress. CONCLUSION: The PLI ranks and differentiates distress among common NICU procedures more precisely than current tools. This methodology, if correlated with infant physiological indices and health outcomes, may be operationalized at the bedside to measure procedural distress, and help to guide the ideal timing to perform procedures and minimize their negative consequence.

A Quantitative Examination of Extreme Facial Pain Expression in Neonates: The Primal Face of Pain across Time.

Many pain assessment tools for preschool and school-aged children are based on facial expressions of pain. Despite broad use, their metrics are not rooted in the anatomic display of the facial pain expression. We aim to describe quantitatively the patterns of initiation and maintenance of the infant pain expression across an expressive cycle. We evaluated the trajectory of the pain expression of three newborns with the most intense facial display among 63 infants receiving a painful stimulus. A modified "point-pair" system was used to measure movement in key areas across the face by analyzing still pictures from video recording the procedure. Point-pairs were combined into "upper face" and "lower face" variables; duration and intensity of expression were standardized. Intensity and duration of expression varied among infants. Upper and lower face movement rose and overlapped in intensity about 30% into the expression. The expression reached plateau without major change for the duration of the expressive cycle. We conclude that there appears to be a shared pattern in the dynamic trajectory of the pain display among infants expressing extreme intensity. We speculate that these patterns are important in the communication of pain, and their incorporation in facial pain scales may improve current metrics.

Pain assessment as a social transaction: beyond the "gold standard".

Pain assessment conventionally has been viewed hierarchically with self-report as its "gold-standard." Recent attempts to improve pain management have focused on the importance of assessment, for example, the initiative to include pain as the "fifth vital sign." We question the focus in the conceptualization of pain assessment upon a "vital sign," not in terms of the importance of assessment, but in terms of the application of self-report as a mechanistic index akin to a biologic measure such as heart rate and blood pressure. We synthesize current inclusive models of pain and pain assessment and propose a more comprehensive conceptualization of pain assessment as a transaction based on an organismic interplay between the patient and clinician.

Neonatal pain facial expression: evaluating the primal face of pain.

The primal face of pain (PFP) is postulated to be a common and universal facial expression to pain, hardwired and present at birth. We evaluated its presence by applying a computer-based methodology consisting of "point-pair" comparisons captured from video to measure facial movement in the pain expression by way of change across two images: one image before and one image after a painful stimulus (heel-stick). Similarity of facial expression was analyzed in a sample of 57 neonates representing both sexes and 3 ethnic backgrounds (African American, Caucasian and Hispanic/Latino) while controlling for these extraneous and potentially modulating factors: feeding type (bottle, breast, or both), behavioral state (awake or asleep), and use of epidural and/or other perinatal anesthesia. The PFP is consistent with previous reports of expression of pain in neonates and is characterized by opening of the mouth, drawing in of the brows, and closing of the eyes. Although facial expression was not identical across or among groups, our analyses showed no particular clustering or unique display by sex, or ethnicity. The clinical significance of this commonality of pain display, and of the origin of its potential individual variation begs further evaluation.

Is there a Primal Face of Pain? A methodology answer.

Pain assessment is of high priority in the clinical setting. Facial Pain Scales (FPSs) are pain assessment tools generally used with school-aged children. The implicit theoretical bases for the success of FPSs have seldom been explored. Explanations why and how FPSs work (or do not work) have not been addressed. We support the existence of a universal pain expression--the Primal Face of Pain (PFP), which is present at birth, evolved in nature, and modulated through sociocultural factors. We propose it to be key in understanding the applicability of FPSs. We present here the design of a computer-assisted descriptive study that will observe, quantify and model the PFP as present in newborns. Measurement of the PFP will lead to exploration of the theoretical consequences of its existence, particularly as related to pediatric pain assessment and the valid use of FPSs. Further, this work can lay a foundation for the development of a new generation of FPSs.