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.

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.

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.

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.

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.

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.

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.

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.

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.

CSEY service provider perceptions of critical needs for effective care as youth transition from juvenile detention to the community.

BACKGROUND: The Victims of Trafficking and Prevention Act of 2000 initiated necessary change to treat CSEY as victims rather than criminals. Without sufficient resources, CSEY service providers encounter significant challenges in meeting youth care needs in the community. OBJECTIVE: This study's purpose was to examine service providers' perceptions of these challenges. PARTICIPANTS AND SETTING: Semistructured interviews were conducted with nine California CSEY service providers. Thematic analysis principles guided data analysis and interpretation. Key findings indicated needs for improvement of: 1) CSEY screening, 2) relationship building, 3) community resource access, 4) clarity regarding ambiguous feelings and practices associated with the treatment of CSEY as victims or criminals, 5) support systems for service providers experiencing vicarious trauma and acute/chronic stress. CONCLUSION: Future research is needed to continue to explore the experience of service providers who work with CSEY. Implications for practice include the need for funding to support the development of community-based services for CSEY, particularly for training and professional supports for education, health, social service, and criminal justice professionals.

Commercial Sexual Exploitation of Youth in the United States: A Qualitative Systematic Review.

BACKGROUND: Homeless, runaway, and transgender youth are at high risk for commercial sexual exploitation in the United States. Research examining this phenomenon is growing but requires synthesis to facilitate its use by professionals who serve this population. The purpose of this review was to aggregate the qualitative evidence regarding commercially sexually exploited youth (CSEY) in the United States. METHODS: The search included published and unpublished qualitative studies with current or former CSEY who reside in the United States. RESULTS: There were 19 studies included in the review with a total of 795 participants. Eight themes were identified and grouped into three broader categories: experiences that preceded sex work entry, experiences that facilitated sex work continuation, and experiences that facilitated sex work exit. CONCLUSIONS: Understanding the barriers and facilitators of commercial sexual exploitation can inform the development of interventions that address the needs of CSEY and youth at risk for exploitation. The results of this review highlight the social and economic influences as well as the role of positive and negative reinforcements involved in sex work entry, its continuation, and exit. Needs for services, research, and advocacy are also discussed.

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 5-Year Evaluation of Faculty Use of Practical Within-Course Writing Development Strategies in a DNP Program.

BACKGROUND: Nursing students are underprepared for the rigors of graduate writing. The lack of sufficient writing opportunities and skill development in prelicensure nursing education creates barriers that threaten course and program progression. APPROACH: This study used a prospective, repeated-measures design to evaluate 5 years of faculty-implemented writing development strategies in a DNP program. OUTCOMES: Faculty adopted 12 strategies in 10 courses. The strategies addressed skill building in content, construction, format, plagiarism, and citation use. The most frequently used strategies were rubrics, plagiarism detection software, multistep assignments, and examples of well-written papers, all strategies that increased in use over the 5-year study. CONCLUSIONS: Graduate faculty interact with students and assess writing development outcomes firsthand. Changes in faculty practices over time can indicate the strategies they consider most valuable for writing development.

A Bone Health Intervention for Chinese Immigrants in Santa Clara County.

BACKGROUND: Among Chinese immigrants, osteoporosis is undertreated, misdiagnosed, and a leading cause of fragility fractures. In orthopaedic surgery departments, prevention education and health behavior change programs are necessary to improve their bone health. PURPOSE: The purpose of this study was to examine the effectiveness of an osteoporosis prevention education program on participants' self-efficacy with regard to exercise and nutrition when provided by an orthopaedic surgery team during an annual Chinese Health Fair in Santa Clara County, CA. METHODS: This pilot study used a single-group pretest and posttest design. Chinese immigrants at risk of osteoporosis were recruited during a 1-day health fair. The Bone Health Intervention (BHI) included orthopaedic surgeon consultation, visual aids including osteoporosis images and bone models, a video that included a discussion on calcium and vitamin D in the Chinese diet and culturally-acceptable exercise, and osteoporosis educational handouts. The Osteoporosis Self-Efficacy Scale (OSES) was utilized to measure participants' confidence in the ability to participate in self-care behaviors related to physical activity and calcium intake before and after the intervention. Paired t tests were used to compare participants' OSES scores pre- and postintervention. RESULTS: There was a significant increase in mean OSES scores postintervention, indicating that the intervention could be an effective method of increasing participants' self-efficacy regarding calcium intake and time spent in exercising. CONCLUSION: These results indicate that a culturally meaningful education program can potentially reduce fragility fracture risk. Orthopaedic health providers are ideal candidates to deliver preventive care education to improve outcomes for Chinese immigrants.

Effectiveness of probiotics in reducing the incidence of Clostridium difficile-associated diarrhea in elderly patients: a systematic review.

BACKGROUND: Clostridium difficile bacteria are a leading cause of infectious diarrhea. This is an anaerobic, gram-positive and spore-forming rod responsible for significant morbidity and mortality, especially among elderly hospitalized patients. Standard management of C. difficile-associated diarrhea (CDAD) consists of discontinuing a causative antibiotic, correcting fluid-electrolytes imbalance and initiating an antibiotic treatment for CDAD. Alternative approaches for prevention of CDAD include probiotics. This systematic review will provide a comprehensive, unbiased summary of the available research on the effectiveness of probiotics in decreasing the incidence of infectious diarrhea in elderly hospitalized patients. OBJECTIVES: To conduct a systematic review to determine the best available evidence related to the effectiveness of probiotics in the prevention of CDAD in elderly hospitalized patients. The review question was: are probiotics effective in decreasing the incidence of CDAD in elderly hospitalized patients? INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review included studies of participants who were aged 60 years and more and who were residents of acute- and post-acute care facilities undergoing or planning to undergo antibiotic treatment for the management of any infectious conditions, except CDAD. TYPES OF INTERVENTION(S): The current review included studies that evaluated the effectiveness of probiotics for prevention of CDAD in elderly hospitalized patients in acute- and post-acute care settings compared to usual care. OUTCOMES: The current review included studies examining the following outcome measures: incidence or relapse of CDAD. Cases of CDAD were defined by presence of diarrhea and verified by positive results for stool enzyme immunoassay for toxins A and B. TYPES OF STUDIES: The current review included only experimental study designs including randomized controlled trials. SEARCH STRATEGY: The search strategy included studies published in English between 1978, when the first case of CDAD was reported, and 2015. ASSESSMENT OF METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from the JBI Meta-Analysis of Statistics Assessment and Review Instrument. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. DATA SYNTHESIS: Quantitative data were pooled using statistical meta-analysis. Effect sizes were expressed as odds ratios, and their 95% confidence intervals were calculated to determine if probiotic treatment was superior to placebo in reducing CDAD incidence. Heterogeneity was assessed using the standard I statistic. RESULTS: Five studies were included in the review. The individual study results were conflicting, including non-significant results for four studies and statistically significant results in one that demonstrated fewer cases of CDAD among patients receiving probiotics compared to placebo. The meta-analysis finding indicated that there was no statistically significant difference in CDAD incidence in elderly hospitalized patients taking probiotics when compared to a placebo. CONCLUSION: Probiotics were not found to be more effective than placebo for reducing CDAD incidence in elderly hospitalized patients. However, studies that demonstrate improved outcomes must be examined to determine future needs for research. Studies varied with regard to the dose, frequency, method of administration (probiotic drinks versus capsule), length of administration and the number of strains of bacteria administered. Further studies are needed to evaluate the effectiveness of probiotics for CDAD prevention in this population. Clinical trials with evidence-based administration methods and meta-analyses that pool the results of studies with congruent methodologies are needed to enable conclusions to be drawn on the effectiveness of probiotic administration for CDAD prevention.

Efficacy of direct factor Xa inhibitors compared to warfarin in preventing stroke in adults with non-valvular atrial fibrillation: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to determine the overall efficacy of direct factor Xa inhibitors in comparison with warfarin in preventing the incidence of stroke in adults with non-valvular atrial fibrillation with moderate-to-high risk for stroke.