Virtual Reality Simulation Integration in a Prelicensure Nursing Program: Lessons Learned.

BACKGROUND: Simulation, whether conducted live or through virtual technologies, provides students with experiential learning by replicating realistic clinical experiences that can develop learner competencies in a safe environment. Virtual reality simulation may provide the same level of effective and engaging experiential learning in a fully immersive learning environment without many of the limitations inherent to traditional live simulation environments, such as simulation equipment and designated labs. PROBLEM: While there are vendor-provided resources and a new tool kit covering immersive technology simulation implementation in nursing, a lived example to contextualize the implementation process is missing from the literature. APPROACH: This article discusses the selection and implementation of virtual reality simulations in a nursing undergraduate program and lessons learned in the process. CONCLUSIONS: Nurse educators seeking such experiences for their students may benefit from the insights shared in this article.

Planned change in modern hierarchical organizations: A three-step model.

Change is often uncomfortable and it is challenging when the need for substantive change emerges in a hierarchical organization. It is critical to consider both processes and people when planned change becomes necessary. Members of the organization may look to existing theories and models that would be helpful to navigate planned change. The authors present the Proposed Model of Planned Change, which is a synthesis of three well-known change theories/models into one cohesive three-step model. This model integrates process, change agent(s), and collaboration with other group members. The authors highlight the model's strengths and limitations in the context of a hierarchical nursing school's curriculum revision as an example. This model could prove useful for similar organizations seeking similar changes, as well as for a variety of organizations in any circumstance where change is desired. The authors will provide a progress report of implementation of this three-step model with lessons learned in a subsequent manuscript.

Metabolic Profiling of Blood and Urine for Exploring the Functional Role of the Microbiota in Human Health.

The quantification of metabolites in blood and urine allows nurses to explore new hypotheses about the microbiome. This review summarizes findings from recent studies with a focus on how the state of the science can influence future nursing research initiatives. Metabolomics can advance nursing research by identifying physiologic/pathophysiologic processes underlying patients' symptoms and can be useful for testing the effects of nursing interventions. To date, metabolomics has been used to study cardiovascular, respiratory, endocrine, autoimmune, and infectious conditions, with research focused on understanding the microbial metabolism of substrates resulting in circulating/excreted biomarkers such as trimethylamine N-oxide. This review provides specific recommendations for the collection of specimens and goals for future studies.

Physical Symptom Cluster Subgroups in Chronic Kidney Disease.

BACKGROUND: Symptom burden associated with chronic kidney disease can be debilitating, with a negative effect on patient health-related quality of life. Latent class clustering analysis is an innovative tool for classifying patient symptom experience. OBJECTIVES: The aim of the study was to identify subgroups of patients at greatest risk for high symptom burden, which may facilitate development of patient-centered symptom management interventions. METHODS: In this cross-sectional analysis, baseline data were analyzed from 3,921 adults enrolled in the Chronic Renal Insufficiency Cohort Study from 2003 to 2008. Latent class cluster modeling using 11 items on the Kidney Disease Quality of Life symptom profile was employed to identify patient subgroups based on similar observed physical symptom response patterns. Multinomial logistic regression models were estimated with demographic variables, lifestyle and clinical variables, and self-reported measures (Kidney Disease Quality of Life physical and mental component summaries and the Beck Depression Inventory). RESULTS: Three symptom-based subgroups were identified, differing in severity (low symptom, moderate symptom, and high symptom). After adjusting for other variables in multinomial logistic regression, membership in the high-symptom subgroup was less likely for non-Hispanic Blacks and men. Other factors associated with membership in the high-symptom subgroup included lower estimated glomerular filtration rate, history of cardiac/cardiovascular disease, higher Beck Depression Inventory scores, and lower Kidney Disease Quality of Life physical and mental component summaries. DISCUSSION: Three symptom subgroups of patients were identified among patients with mild-to-moderate chronic kidney disease. Several demographic and clinical variables predicted membership in subgroups. Further research is needed to determine if symptom subgroups are stable over time and can be used to predict healthcare utilization and clinical outcomes.

Focusing on the Fundamentals: Reading Quantitative Research with a Critical Eye.

Nephrology nurses must be able to critically analyze research to improve their practice. This article defines the components of a quantitative research article, reviews principles that nephrology nurses can use when reading and interpreting a quantitative research article, and provides a methodical way of approaching a quantitative research article to determine its merits and limitations.

Clinical Relevance of Gastrointestinal Microbiota During Pregnancy: A Primer for Nurses.

Emerging evidence about the human microbiome, a collective term for all the microorganisms living in and on the human body, consistently demonstrates the critical influence it has on host physiology and disease risk. The microbiota in the gastrointestinal (GI) tract has the most significant and far-reaching effect on human physiology. The maternal GI microbiota can decrease the risk of adverse pregnancy outcomes by modulating energy extraction, glucose metabolism, vitamin production, and host immunity essential for optimal maternal and neonatal health. Moreover, the maternal GI microbiota is thought to influence colonization of the fetus and neonate that may predispose them to different health trajectories. This article provides a basic understanding about the influence of the structure of the maternal GI microbiota, the fundamental role it plays during pregnancy, and the factors that influence the structure, and subsequently function, of the GI microbiota in the general and pregnant population. While only a small number of studies have examined this topic during pregnancy, the preponderance of the evidence supports the need to clarify baseline structure and function of GI microbiota and its associations with pregnancy outcomes. In addition, the results from the studies conducted in the general population can be extrapolated to pregnancy in many cases. This knowledge is essential for clinicians who need to understand the implications of the microbiota for disease and wellness in order to address the care factors that may adversely influence the GI microbiota during pregnancy.

CE: Health and the Human Microbiome: A Primer for Nurses.

: The profound impact of the human microbiome on health makes it imperative that nurses understand the basic structures and functions of the various microbial communities. In studying the human microbiome, advances in DNA and RNA sequencing technology offer benefits over traditional culture-based methods. Such technology has permitted more thorough investigations of microbial communities, particularly those of the gastrointestinal (GI) and female reproductive tracts. Although individual variations exist, each site exhibits distinct compositions. The diverse GI microbiota aid in digestion, mood regulation, and vitamin synthesis. While many factors affect the composition and functions of the GI microbiota, diet likely exerts the strongest influence. Vaginal microbiota tend to be less diverse, and mainly serve to protect women from infection. The composition of the vaginal microbiota is influenced by sexual activity, hygienic practices, medications, smoking, and other factors. Our increasing knowledge about the structures and functions of the GI and vaginal microbiota allows nurses to provide targeted, evidence-based education and care for various populations.

Insulin Resistance and Inflammation in Black Women with and without Breast Cancer: Cause for Concern.

OBJECTIVE: After chemotherapy for breast cancer, Black women gain more weight and have an increased mortality rate compared with White women. Our study objective was to compare biomarkers associated with obesity in Black women with and without a history of breast cancer. DESIGN: Case-control. SETTING: Academic/federal institution. PARTICIPANTS: Black women with a history of breast cancer (cases) and age-matched controls. MAIN OUTCOME MEASURES: Insulin resistance (HOMA-IR); inflammation (TNF-α, IL-1b, IL-6, IL-8, CRP); lipids (cholesterol, triglycerides). METHODS: We compared insulin resistance, inflammation, and lipids in overweight and obese Black women with a history of breast cancer (n=19), age similar controls (n=25), and older controls (n=32). Groups did not differ on mean body mass index (BMI), which was 35.4 kg/m2, 36.0 kg/m2, and 33.0 kg/m2, respectively. RESULTS: Cases had 1.6 and 1.38 times higher HOMA-IR values compared with age similar and older controls, respectively (P≤.001 for both). TNF-α and IL-1b were significantly higher in cases compared with both control groups (P<.001 for both). IL-6 was also higher in cases compared with age-similar controls (P=.007), and IL-8 was lower in cases compared with older controls (P<.05). Lipids did not differ between cases and either control group. CONCLUSIONS: Black women with breast cancer were significantly more insulin resistant with increased inflammation compared not only with age similar controls but with women who were, on average, a decade older. These biomarkers of insulin resistance and inflammation may be associated with increased risk of breast cancer recurrence and require ongoing evaluation, especially given the relatively abnormal findings compared with the controls in this underserved group.

Testing reliability and validity of the eHealth Literacy Scale (eHEALS) for older adults recruited online.

Currently, vast amounts of health information and health management tools are available to the public online. To maximize the benefits of these e-health technologies, it is important to assess the e-health literacy of individuals. The eHealth Literacy Scale has been used widely in the past several years, but mainly in younger populations. The purpose of this study was to test the psychometric aspects of the eHealth Literacy Scale for older adults using a secondary data analysis (N=866; mean age, 62.8±8.5 years). Reliability of the eHealth Literacy Scale was examined by calculating α coefficients and conducting test-retest procedures. Its validity was assessed using exploratory factor analysis and the hypothesis testing procedure. Findings demonstrated that eHealth Literacy Scale was internally consistent (α=.94) and stable (t244=-1.48, P=.140). The exploratory factor analysis yielded a single factor structure explaining 67.3% of the variance. The hypothesis testing also supported the validity of eHealth Literacy Scale. In recent years, there have been great efforts to use e-health interventions to engage patients in healthcare and to help them manage their own health. Our study suggests that the eHealth Literacy Scale, a short screening tool for e-health literacy, can be successfully used for older adults.

Evaluation of a pet-assisted living intervention for improving functional status in assisted living residents with mild to moderate cognitive impairment: a pilot study.

BACKGROUND: In older adults with cognitive impairment (CI), decreased functional status and increased behavioral symptoms require relocation from assisted living (AL) to nursing homes. Studies support positive effects of pets on health/function. PURPOSE: Evaluate the effectiveness of the Pet AL (PAL) intervention to support physical, behavioral, and emotional function in AL residents with CI. METHODS: Cognitively impaired AL residents randomized to 60-90 minute sessions [PAL (n = 22) or reminiscing (n = 18)] twice/week for 12 weeks. PAL interventionist encourages residents to perform skills with the visiting dog; reminiscing interventionist encourages residents to reminisce. Monthly assessment of physical (energy expenditure, activities of daily living), emotional (depression, apathy), and behavioral (agitation) function. RESULTS: In linear mixed models, physical activity depressive symptoms improved more with PAL. CONCLUSION: Evidence supports that the PAL program helps preserve/enhance function of AL residents with CI. Additional study is required to evaluate the duration and predictors of effectiveness of the PAL intervention.

Measuring nursing informatics competencies of practicing nurses in Korea: Nursing Informatics Competencies Questionnaire.

Informatics competencies are a necessity for contemporary nurses. However, few researchers have investigated informatics competencies for practicing nurses. A full set of Informatics competencies, an instrument to measure these competencies, and potential influencing factors have yet to be identified for practicing nurses. The Nursing Informatics Competencies Questionnaire was designed, tested for psychometrics, and used to measure beginning and experienced levels of practice. A pilot study using 54 nurses ensured item comprehension and clarity. Internal consistency and face and content validity were established. A cross-sectional survey was then conducted on 230 nurses in Seoul, Korea, to determine construct validity, describe a complete set of informatics competencies, and explore possible influencing factors on existing informatics competencies. Principal components analysis, descriptive statistics, and multiple regression were used for data analysis. Principal components analysis gives support for the Nursing Informatics Competencies Questionnaire construct validity. Survey results indicate that involvement in a managerial position and self-directed informatics-related education may be more influential for improving informatics competencies, whereas general clinical experience and workplace settings are not. This study provides a foundation for understanding how informatics competencies might be integrated throughout nurses' work lives and how to develop appropriate strategies to support nurses in their informatics practice in clinical settings.