Creating a Research Agenda and Setting Research Priorities for Clinical Nurse Specialists.

PURPOSE/OBJECTIVES: The purpose of this article is to describe the evolution and results of the process for establishing a research agenda and identification of research priorities for clinical nurse specialists, approved by the National Association of Clinical Nurse Specialists (NACNS) membership and sanctioned by the NACNS Board of Directors. DESCRIPTION OF THE PROJECT/PROGRAM: Development of the research agenda and identification of the priorities were an iterative process and involved a review of the literature; input from multiple stakeholders, including individuals with expertise in conducting research serving as task force members, and NACNS members; and feedback from national board members. OUTCOME: A research agenda, which is to provide an enduring research platform, was established and research priorities, which are to be applied in the immediate future, were identified as a result of this process. CONCLUSION: Development of a research agenda and identification of research priorities are a key method of fulfilling the mission and goals of NACNS. The process and outcomes are described in this article.

Clinical Nurse Specialist Roles in Conducting Research: Changes Over 3 Years.

PURPOSE: The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research. DESIGN: This study was a descriptive, multicohort design. METHODS: Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests. RESULTS: Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research. CONCLUSIONS: Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.

Complications of Sedation in Critical Illness: An Update.

Sedation is a necessary component of care for the critically ill. Oversedation, however, is associated with immediate complications and long-term problems, termed post-intensive care unit syndrome. It also contributes to unnecessary costs of care. This article describes the physical, functional, psychiatric, and cognitive complications of oversedation, and multiple research-based strategies that minimize complications.

Motivational interviewing and dietary counseling for obesity in primary care: an RCT.

BACKGROUND AND OBJECTIVE: Few studies have tested the impact of motivational interviewing (MI) delivered by primary care providers on pediatric obesity. This study tested the efficacy of MI delivered by providers and registered dietitians (RDs) to parents of overweight children aged 2 through 8. METHODS: Forty-two practices from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics were randomly assigned to 1 of 3 groups. Group 1 (usual care) measured BMI percentile at baseline and 1- and 2-year follow-up. Group 2 (provider only) delivered 4 MI counseling sessions to parents of the index child over 2 years. Group 3 (provider + RD) delivered 4 provider MI sessions plus 6 MI sessions from a RD. The primary outcome was child BMI percentile at 2-year follow up. RESULTS: At 2-year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for groups 1, 2, and 3, respectively. The group 3 mean was significantly (P = .02) lower than group 1. Mean changes from baseline in BMI percentile were 1.8, 3.8, and 4.9 across groups 1, 2, and 3. CONCLUSIONS: MI delivered by providers and RDs (group 3) resulted in statistically significant reductions in BMI percentile. Research is needed to determine the clinical significance and persistence of the BMI effects observed. How the intervention can be brought to scale (in particular, how to train physicians to use MI effectively and how best to train RDs and integrate them into primary care settings) also merits future research.

Nursing journal clubs and the clinical nurse specialist.

PURPOSE/OBJECTIVES: The purpose of this article was to describe the clinical nurse specialist's role in developing and implementing a journal club. Tools for critiquing clinical and research articles with an application of each are provided. BACKGROUND: The journal club provides a forum through which nurses maintain their knowledge base about clinically relevant topics and developments in their specific clinical discipline, analyze and synthesize the relevant scientific literature as evidence, and engage in informal discussions about evidence-based and best practices. RATIONALE: The value of journal clubs includes nursing staff education, review of and support for evidence-based practice, promotion of nursing research, and fostering of organization-wide nursing practice changes. DESCRIPTION: The process for establishing a journal club and suggested appraisal tools are discussed. In addition, strategies for overcoming barriers to the implementation of a journal club are outlined. Suggested article review questions and a reporting format for clinical and research articles are provided with examples from 2 articles. Finally, a glossary of terms commonly used by research scientists and manuscript writers are listed and additional resources provided. OUTCOME/CONCLUSION: The clinical nurse specialist's role in developing and implementing a journal club will be facilitated through the use of this article. IMPLICATIONS: Enhanced nursing staff education, evidence-based practice, organization-wide nursing practice changes, and nursing research may be conducted following the implementation of a nursing journal club.

Energy balance for kids with play: design and implementation of a multi-component school-based obesity prevention program.

BACKGROUND: Improving nutrition and physical activity behaviors associated with childhood obesity are significant national public health goals. Energy Balance for Kids with Play (EB4K with Play), developed through a partnership between the Academy of Nutrition and Dietetics Foundation and Playworks, is a multi-component school-based intervention designed to address youth's nutrition and physical activity behaviors. This article describes the EB4K with Play intervention and evaluation study and presents the baseline data. METHODS: The evaluation is a 2-year cluster-randomized design targeting third- to fifth-grade students enrolled in a low-income, urban school district in northern California. Six schools were recruited to participate. Four were randomized to the intervention group and two into a control group. Baseline student-level data pertaining to nutrition, physical activity, fitness, and BMI were collected in the fall of 2011. The EB4K with Play program, which includes direct-to-student nutrition and physical activity interventions, a school wellness component, and parent/community partner outreach components, began immediately after baseline data collection. RESULTS: An ethnically diverse sample of students (n=844) was recruited to participate in the study. Baseline data showed a higher percent of eligibility for free and reduced-price school lunch and higher rates of obesity/overweight than the California state averages. Fitness levels and levels of moderate-to-vigorous physical activity were comparable to state averages. CONCLUSIONS: End-point data will be collected after 2 years of the intervention. The findings from this study should help guide future efforts to design effective intervention programs to support the prevention of pediatric obesity.

Challenges in Clinical Nurse Specialist Education and Practice.

Clinical nurse specialists (CNSs) are well-positioned to participate in the transformation of healthcare as outlined by the Institute of Medicine and called upon by the Patient Protection and Affordable Care Act of 2010. CNSs exercise their expertise through population-based care across three spheres of influence (patient/family, nurses/other professionals, systems). However, challenges during the educational process as well as implementation in practice can be barriers to optimization of the role, denying the public full benefit from the potential of CNSs. This article highlights some of the issues and provides solutions for mitigating these difficulties.

A pilot study to test the feasibility of a nonpharmacologic intervention for the prevention of delirium in the medical intensive care unit.

PURPOSE/OBJECTIVES: The aims of this study were to determine the feasibility of and test a multicomponent, nonpharmacologic, nurse-driven intervention for prevention of delirium. DESIGN: This was a prospective, cohort pilot study. SETTING: This study was carried out in a 12-bed medical intensive care unit in a Magnet-designated community hospital in a major metropolitan city in the Southwest United States. SAMPLE: A convenience sample of consented patients meeting inclusion criteria was included in this study. METHODS: A multicomponent prevention protocol consisting of sedation cessation, sleep-wake cycles, sensory stimulation, mobility, and music was tested. FINDINGS: Capturing data for the interventions was problematic. Insufficient documentation systems and inadequate multidisciplinary participation in carrying out the protocol, especially mobility, were barriers. CONCLUSIONS: There was little difference in the proportion of delirium before and after intervention. Success in the identification and prevention of delirium requires a multidisciplinary approach. IMPLICATIONS: Further research is needed using a larger sample size. Refinement of a mobility program is needed.

PP2B-dependent NO production in the medullary thick ascending limb during diabetes.

Calcineurin (PP2B) has recently been shown to be upregulated in the medullary thick ascending limb (mTAL) during diabetes. The mTAL expresses all three isoforms of nitric oxide synthase (NOS), which are subject to phosphoregulation and represent substrates for PP2B. Therefore, we hypothesized that diabetes induces PP2B-dependent upregulation of NOS activity and NO production in the mTAL. Three weeks after injection of streptozotocin (STZ rats) or vehicle (sham rats), mTAL suspensions were prepared for use in functional and biochemical assays. PP2B activity and expression were increased in mTALs from STZ rats compared with sham. Nitrite production was significantly reduced in mTALs from STZ rats compared with sham. However, incubation with the free radical scavenger, tempol, unmasked a significant increase in nitrite production by mTALs from STZ rats. Inhibition of PP2B attenuated the increase in nitrite production and NOS activity evident in mTALs from STZ rats. Analysis of specific NOS isoform activity revealed increased NOS1 and NOS2 activities in mTALs from STZ rats. All three NOS isoform activities were regulated in a PP2B-dependent manner. Western blot analysis detected no differences in NOS isoform expression, although phosphorylation of pThr(495)-NOS3 was significantly reduced in mTALs from STZ rats. Phosphorylation of pSer(852)-NOS1, pSer(633)-NOS3, and pSer(1177)-NOS3 was similar in mTALs from STZ and sham rats. Inhibition of PP2B did not alter the phosphorylation of NOS1 or NOS3 at known sites. In conclusion, while NO bioavailability in mTALs is reduced during diabetes, free radical scavenging with tempol unmasks increased NO production that involves PP2B-dependent activation of NOS1 and NOS2.

Medication safety: just a label away.

In perioperative settings, medications are removed from manufacturers' identifying containers; therefore, scrub personnel should label medications placed on the sterile field. Compliance with medication labeling practices with the use of both blank and preprinted labels was tested in the OR at a Houston, Texas, hospital. Scrub personnel were more likely to label medications and medication-delivery devices when preprinted medication labels were provided. Data obtained from this project influenced the hospital's management team to supply preprinted labels for all procedures to improve safety for surgical patients.

Complications of sedation and critical illness.

Critically ill patients require sedation to reduce anxiety, agitation, and achieve therapeutic goals. Over-sedation in combination with multiple causes for extreme muscle weakness, however, interferes with recovery from critical illness. This article describes contributing factors and explores methods of preventing over-sedation and related sequelae.

Critical illness--a lived reality for patients and their families.

This case study tells of one family's experience surrounding the diagnosis of rare cancer, where both the medical system and family struggle with a critical, largely unknown illness. The experience was complicated by communication issues between the medical profession and family, support from counselling services, and lack of information--compounded by a health system concentrated in metropolitan areas.