Maximizing Nurse Scientist Role Potential in Health Care Organizations.

Before Magnet designation, nurse scientists functioned primarily in academia. The Magnet model's emphasis on new knowledge required that health care organizations demonstrate knowledge generation to achieve and sustain designation. The nurse scientist role definition and function within health care organizations continues to evolve, which contributes to a lack of clarity about who and how nurses generate new knowledge. The purpose of this scoping review was to (1) identify nurse scientist role components in the context of 2 theoretical models (Thompson's Knowledge Brokering Model and Edward's Research Appreciation, Accessibility, and Application Model), (2) explore the strengths and barriers associated with existing nurse scientist practice models in US health care organizations, and (3) describe a unique, expanded practice model applied within Stanford Health Care's Office of Research and its implications for building new knowledge and innovation capacity with recommendations for ongoing role development.

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.

Improve Bystander Cardiopulmonary Resuscitation in the Chinese Community.

Though many community cardiopulmonary resuscitation (CPR) training classes are available throughout the United States, disparities exist in training and receipt of bystander CPR for Chinese immigrants with limited English proficiency. To increase the number of persons prepared to respond to a cardiac emergency, a Chinese language CPR training program was offered in the community in collaboration with the Stanford Department of Community Partnership. Program leaders imported the American Heart Association approved Chinese version of Heartsaver® for Adult CPR and AED from the China Mainland to make the training accessible to Chinese immigrants with LEP. In 2018, two CPR training events were conducted with 47 participants. All participants successfully demonstrated bystander (hands-only) CPR skills with 91% of participants reporting confidence and 97% willingness to perform CPR. As the first known CPR class offered in the Chinese language in the San Francisco Bay Area using official AHA products, this project provides valuable information regarding community interest and feasibility for expanding this educational program.

Increasing Birth Cohort Screening for Chronic Hepatitis C in a Primary Care Clinic with Panel Management.

Chronic hepatitis C affects millions of people worldwide and patients born between 1945 and 1965 are at elevated risk. Hepatitis C infection can lead to health complications including liver cirrhosis and hepatocellular carcinoma. Recent advancements in direct-acting antiviral treatments have placed the spotlight on primary care providers to identify undiagnosed patients with chronic hepatitis C for treatment and attaining a sustained-virologic response. Primary care providers do not routinely screen patients born between 1945 and 1965 for hepatitis C despite CDC recommendations. To evaluate the effectiveness of a hepatitis C screening protocol implemented in a primary care setting with no prior protocol. A multidisciplinary team was used to implement a hepatitis C screening protocol for patients born between 1945 and 1965 (birth cohort screening). A retrospective analysis was conducted to compare the rate of hepatitis C screening 2 years before and 2 years after the protocol was implemented. Frequency data were collected monthly and tracked in a run chart noting relevant events that affected screening. In the 2 years before the screening protocol began, 81 patients were screened (average = 3 per month); and in the 2 years after the intervention was implemented, a total of 637 patients were screened (average = 25 per month). The protocol was successful in increasing screening rates from 15 to 66% in the 2 years post-intervention. This quality improvement study demonstrated that targeting the birth cohort population was a successful method for increasing hepatitis C screening in a primary care clinic.

A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia.

The purpose of this study was to explore perceptions among people with type 2 diabetes about foot ulcers and lower extremity amputations. This was a qualitative observational study utilizing open-ended, semistructured interviews of 39 people with diabetes who were purposively selected because they had either a foot ulcer (n = 19) or a lower extremity amputation (n = 20). Interviews were audio-recorded, deidentified, and entered into NVivo 10.0 for coding and analysis. Our integrated analytic approach combined inductively and deductively derived codes that were applied to all transcripts. Coded data were summarized and examined for patterns. Participants' description of the relationship between diabetes and their foot ulcer or amputation revealed a limited understanding of the disease process. Disruption and loss of independence was expressed whether the person had a foot ulcer or an amputation. Treatment recommendations for foot ulcers were viewed by most as extremely difficult. Amputation was a feared outcome, but some learned to adapt and, at times felt that the amputation enhanced their quality of life. Clinicians have assumed that a focus on limb salvage is preferred over a major amputation. However, because of the complexity of care requiring frequent healthcare provider visits, the frequency of care failure, the frequency of recurrence, and mortality associated with having had a foot ulcer, it may be more appropriate for clinicians to prioritize quality-of-life salvage. Foot ulcer treatment failure may be due to a lack of providers' understanding of the impact of treatment on a patient's life.

NOS1AP genetic variation is associated with impaired healing of diabetic foot ulcers and diminished response to healing of circulating stem/progenitor cells.

It is unclear why many with diabetes develop foot ulcers (DFU) and why some do not heal. It could be associated with genetic variation. We have previously shown that NOS1AP variation is associated with lower extremity amputation in those with diabetes and that circulating stem progenitor cell concentration (SPC) is associated with impaired foot ulcer healing in those with diabetes. The goal of this study was to determine if NOS1AP variation is associated with impaired wound healing and with SPC mobilization in those with DFU. In longitudinal cohort study we demonstrate that NOS1AP variants rs16849113 and rs19649113 are associated with impaired wound healing and with SPC mobilization in those with DFU. We believe that further study of NOS1AP is merited and that it NOS1AP might be associated with a functional impairment.

Exploring Acuity-Adaptable Care in a Rural Hospital.

OBJECTIVE: The objective of this study is to assess benefits of the acuity-adaptable (AA) care model in rural hospitals. BACKGROUND: The AA model aims to provide care in the same space from admission to discharge regardless of acuity. Evidence is lacking to support claims that AA care will improve patient safety, increase nurse productivity, and improve patient/staff satisfaction in rural hospitals. METHODS: Patients admitted to a rural intensive care unit (ICU) were allocated to an AA group or an ICU group. Patients in the AA group remained in the ICU room through discharge. Patients in the ICU group transferred out of ICU when acuity permitted. Patient anxiety, depression, and perception of emotional care were measured. Staff responses were assessed qualitatively. RESULTS: Acuity-adaptable patients reported significantly more anxiety and less perceived emotional care than ICU patients. Intensive care unit nurses resisted caring for less acute patients. CONCLUSION: Disadvantages may outweigh benefits of AA care delivery in the rural ICU.

Health literacy and diabetic foot ulcer healing.

The adherence by patients to diabetic foot ulcer therapy is often difficult. The goal of this study was to begin to understand how a patient's health literacy affects their foot ulcer management decisions. Initially using a cross-sectional study design, we evaluated diabetics with foot ulcers within 4 weeks of being asked to participate in a longitudinal study. We assessed health literacy using measures of general health literacy, diabetes health literacy, diabetes self-efficacy, and diabetes numeracy. Individuals enrolled in the study had higher health literacy based on the Short Test of Functional Health Literacy in Adults [33.8 (SD 2.3) versus 27.3 (SD 9.6); p = 0.009] as compared to individuals who previously declined an invitation to enroll in the study. Furthermore, patients with lower Short Test of Functional Health Literacy in Adults scores had larger (p = 0.04) and older (p = 0.125) wounds (markers for poorer prognosis). Other measures of literacy showed similar results. In conclusion, those with diminished health literacy were less likely to enroll in an investigational study and had wounds that were less likely to heal.

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.

Promoting Civility in the Workplace: Addressing Bullying in New Graduate Nurses Using Simulation and Cognitive Rehearsal.

This evidence-based practice project implementation aimed to enhance new graduate nurses' abilities to address workplace bullying. A mixed educational methodology was used. Participants indicated applying learned behaviors to improve communication, peer relationships, teamwork, and patient safety and to address bullying. Civility ratings did not significantly increase from before to after the intervention, presumably because of high baseline ratings. Future research should identify sensitive and specific measures to detect bullying behavior changes.

Implementing High-Intensity, Trauma-Informed Sexual Risk Reduction in Women Involved in the Criminal Legal System.

Although research supports using brief or extended behavioral interventions to increase prevention of sexually transmitted infections (STIs), there is a shortage of current information about the specific effects on women in a short-stay carceral environment. This evidence-based practice implementation project aimed to employ the Safer Sex Efficacy (SSE) Workshop in a jail setting. A repeated measures design was used to compare STI knowledge acquisition and reports of condom use self-efficacy in a group of incarcerated women before, immediately after, and 3 weeks after participation in a high-intensity behavioral counseling intervention. Twenty-one females between the ages of 20 and 45 years participated in the program. STI knowledge acquisition and reports of condom use self-efficacy were measured using the Sexually Transmitted Disease Knowledge Questionnaire and the Condom Use Self-Efficacy Scale. Findings support the feasibility of implementing evidence-based sexual health education programming incorporating information about sexual risk behaviors, STI knowledge, and behavioral skills practice in a short-stay correctional setting and further investigation with a larger sample.

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.

Scientific writing development: Improve DNP student skill and writing efficiency.

BACKGROUND: Doctor of Nursing Practice (DNP) students lack sufficient opportunities to practice writing. Students and faculty require clear expectations and consistent feedback to improve skills. OBJECTIVE: This study evaluated a rubric-driven scientific writing development program. DESIGN: A mixed methods design was used. SETTING: The study was conducted in a post-Master's DNP Program. PARTICIPANTS: The sample included DNP students and faculty. METHODS: The intervention was delivered to 10 students and writing proficiency was assessed over five semesters. Overall doctoral project quality and rigor were assessed at the end of the program and compared to a similar group of students (n = 20). Seven faculty and eight students participated in qualitative interviews. RESULTS: Performance improved from Semesters 1 to 5; and though quality and rigor did not differ, the intervention group's final papers were more efficiently written with approximately 17 fewer pages and an average review time of eight fewer minutes than the comparison group. Participants identified the rubric, feedback, and scaffolding as helpful program components. CONCLUSIONS: Scientific writing development is essential to DNP education. The intervention improved skill performance and writing efficiency.

Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming.

(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors' lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the "strong Black woman" is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.

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.

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.].

Evaluating Scientific Writing Skill in DNP Program Students.

BACKGROUND/PROBLEM: Scientific writing skill development interventions in nursing are widely represented in the literature, but the specific skills required are poorly defined and measured. APPROACH: This study used a cross-sectional, descriptive design to compare scientific writing skill assessment of doctor of nursing practice students' final project reports using 2 rubrics. OUTCOMES: Of 13 skills, the strongest were: adherence to a standard structure, paraphrasing, and grammar, punctuation, and style. The weakest were: use of primary sources, concise, nonredundant presentation, and critical appraisal. Overall interrater agreement for the general essay writing rubric was 69.6%, and that for the scientific writing rubric was 82.3%. CONCLUSIONS: Compared to the essay rubric, the scientific writing rubric was more useful for identifying skill strengths and weaknesses and improved interrater consistency.

Exploring the impact of race on mental health service utilization among african americans and whites with severe mental illness.

BACKGROUND: Disparities among African Americans and Whites with severe mental illness have been identified in numerous studies. Yet it remains unknown if disparities are associated with race or other vulnerabilities common to this population. OBJECTIVES: This study used the Behavioral Model for Vulnerable Populations to examine mental health service utilization among 155 African Americans and Whites with severe mental illness for 12 months after discharge from a residential crisis program. DESIGN: This cross-sectional study was a secondary analysis of data from a randomized trial. RESULTS: Race did not emerge as a significant predictor of mental health service utilization. Factors associated with frequency of service use were diagnosis, age, drug use, gender, health benefit status, and enrollment in an outpatient mental health program. CONCLUSION: It is possible that the geographic location of the study, equal access to services, and equal rates of substance use between racial groups explain the lack of racial differences found in this sample.