Associations between TCA cycle plasma metabolites and fatigue in black females with systemic lupus erythematosus: An untargeted metabolomics pilot study.

OBJECTIVE: In this pilot study, we used untargeted metabolomics to identify biochemical mechanisms or biomarkers potentially underlying SLE-related fatigue. METHODS: Metabolon conducted untargeted metabolomic plasma profiling using ultrahigh performance liquid chromatography/tandem mass spectrometry on plasma samples of 23 Black females with systemic lupus erythematosus (SLE) and 21 no SLE controls. Fatigue phenotypes of general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation were measured with the reliable and valid Multidimensional Fatigue Inventory (MFI). RESULTS: A total of 290 metabolites were significantly different between the SLE and no SLE groups, encompassing metabolites related to glycolysis, TCA cycle activity, heme catabolism, branched chain amino acids, fatty acid metabolism, and steroids. Within the SLE group, controlling for age and co-morbidities, TCA cycle metabolites of alpha-ketoglutarate (AKG) and succinate were statistically significantly associated (p < .05) with physical and general fatigue. CONCLUSION: While pervasive perturbations in the entire TCA cycle have been implicated as a potential mechanism for fatigue, our results suggest individual metabolites of AKG and succinate may be potential biomarkers or targets of intervention for fatigue symptom management in SLE. Additionally, perturbations in heme metabolism in the SLE group provide additional insights into mechanisms that promote systemic inflammation.

Adaptation of Metabolomics and Microbiomic Research Protocols During the COVID-19 Pandemic.

BACKGROUND: When the COVID-19 pandemic hit in 2020, researchers in the P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions at Emory University's Nell Hodgson Woodruff School of Nursing faced major challenges in recruitment and data collection because of limited access to the clinic and community facilities and the risk of COVID-19 exposure associated with in-person study contact. OBJECTIVES: The purpose of this article is to (a) describe how a cadre of pilot/supplement principal investigators adapted their studies to allow for safe and trustworthy data collection during the COVID-19 pandemic (March 2020 through date of publication) and (b) discuss steps that facilitated the technical aspects of remote data collection, especially involving biological specimens. RESULTS: Four pilot studies and two administrative supplements within the center-all at different stages of execution-adopted various alternative remote recruitment, enrollment, and data and specimen collection approaches to continue their research endeavors in a way that maximized the safety of both the research participants and the research teams. DISCUSSION: The article concludes with a discussion on the importance of a participant-centered approach when using remote methods, actions, or steps initiated to facilitate the technical aspects of remote data collection and reflections on the continued use of remote research strategies beyond the COVID-19 pandemic.

Diabetes Care Provider Perceptions Regarding Emerging Adults' Diabetes Self-Management Influences and Patient-Provider Visit Interactions Within a Safety-Net Hospital.

The increasing number of emerging adults with diabetes (EAWD) being cared for in adult health care settings requires a better understanding of the needs of EAWD and their interactions with adult health care providers (HCPs). This article describes findings from interviews with endocrinologists and diabetes nurses from a safety-net health care system to investigate HCPs' perspectives regarding influences on EAWD self-management and HCP interactions with EAWD. HCPs frequently perceived lower EAWD engagement in diabetes management, which was complicated by barriers such as the emotional burden of diabetes, busy lives and multiple responsibilities, and limited access to resources; however, HCPs valued the role of information and communication at visits in tailoring care for EAWD. Measures to tailor care should address the psychosocial burden related to the life stage goals and priorities of EAWD, identification of resources for EAWD and HCPs, and further elucidation of effective self-management guidance and communication strategies to support EAWD in safety-net settings.

Subjective cognitive complaints, psychosocial factors and nursing work function in nurses providing direct patient care.

AIMS: The aim of this study was to examine relationships among subjective cognitive complaints, psychosocial factors and nursing work function in nurses providing direct patient care. BACKGROUND: Cognitive functioning is a critical component for nurses in the assurance of error prevention, identification and correction when caring for patients. Negative changes in nurses' cognitive and psychosocial functioning can adversely affect nursing care and patient outcomes. DESIGN: A descriptive correlational design with stratified random sampling. METHOD: The sample included 96 nurses from the major geographic regions of the United States. Over 9 months in 2016-2017, data were collected using a web-based survey. Stepwise multiple linear regression analyses were used to examine relationships among subjective cognitive complaints, psychosocial factors and nursing work function. RESULTS: Overall, participants reported minimal work function impairment and low levels of subjective cognitive complaints, depression and stress. In multivariate analyses, depression was not associated with nurses' work function. However, perceived stress and subjective concerns about cognitive function were associated with greater impairment of work function. CONCLUSION: Nurses experiencing subjective cognitive complaints should be encouraged to address personal and environmental factors that are associated with their cognitive status. Additionally, stress reduction in nurses should be a high priority as a potential intervention to promote optimal functioning of nurses providing direct patient care. Healthcare institutions should integrate individual and institutional strategies to reduce factors contributing to workplace stress.

A Factor Analysis of the Perceived Value of Certification Tool for Nurse Educators: Evidence for Construct Validity.

AIM: The purpose of this study was to examine construct validity of the Perceived Value of Certification Tool for Nurse Educators (PVCT-NE). BACKGROUND: Preliminary testing of the PVCT-NE demonstrated content validity and strong evidence of internal consistency reliability. Construct validity evidence for the tool is lacking. METHOD: Using data from a descriptive study about nurses' perceived value of nurse educator certification, exploratory factor analysis was used to examine whether the factor structure of the PVCT-NE was consistent with the two-factor structure reported for the original PVCT. RESULTS: Data (n = 221) were analyzed using principal components analysis to identify factors. The observed two-factor solution and individual item loadings in this sample were consistent with the original PVCT's intrinsic and extrinsic value subscales and accounted for 64 percent of the total instrument variance. CONCLUSION: Overall, the PVCT-NE is a valid tool to measure perceived value of certification in nurse educators.

What Is the Value of Nurse Educator Certification? A Comparison Study of Certified and Noncertified Nurse Educators.

AIM: The purpose of this study was to examine differences in how certified nurse educators and noncertified nurse educators valued nurse educator certification. BACKGROUND: No studies have investigated the differences in perceptions of certified and noncertified nurse educators. Understanding these differences may influence how the nursing profession recognizes and promotes excellence within the academic nursing specialty. METHOD: Perceived Value of Certification Tool-Nurse Educator and demographic survey were administered via a web-based survey to a national sample of nursing faculty. RESULTS: Certified nurse educators valued certification with greater agreement than noncertified nurse educators. Personal accomplishment, personal satisfaction, and validation of knowledge were identified as the greatest rewards to certification. CONCLUSION: Nurse educators identified with intrinsic rewards of certification. Despite overall positive perceptions of nurse educator certification, strategies focused on extrinsic rewards may be necessary to increase certification rates. Such strategies may help overcome factors preventing educators from attaining certification.

An Adaptation of the Original Fresno Test to Measure Evidence-Based Practice Competence in Pediatric Bedside Nurses.

PURPOSE: Instruments used to assess evidence-based practice (EBP) competence in nurses have been subjective, unreliable, or invalid. The Fresno test was identified as the only instrument to measure all the steps of EBP with supportive reliability and validity data. However, the items and psychometric properties of the original Fresno test are only relevant to measure EBP with medical residents. Therefore, the purpose of this paper is to describe the development of the adapted Fresno test for pediatric nurses, and provide preliminary validity and reliability data for its use with Bachelor of Science in Nursing-prepared pediatric bedside nurses. METHODS: General adaptations were made to the original instrument's case studies, item content, wording, and format to meet the needs of a pediatric nursing sample. The scoring rubric was also modified to complement changes made to the instrument. Content and face validity, and intrarater reliability of the adapted Fresno test were assessed during a mixed-methods pilot study conducted from October to December 2013 with 29 Bachelor of Science in Nursing-prepared pediatric nurses. RESULTS: Validity data provided evidence for good content and face validity. Intrarater reliability estimates were high. LINKING EVIDENCE TO ACTION: The adapted Fresno test presented here appears to be a valid and reliable assessment of EBP competence in Bachelor of Science in Nursing-prepared pediatric nurses. However, further testing of this instrument is warranted using a larger sample of pediatric nurses in diverse settings. This instrument can be a starting point for evaluating the impact of EBP competence on patient outcomes.

Factors Associated With Clopidogrel Adherence in Community-Dwelling Patients.

OBJECTIVE: The purpose of this study was to characterize predictors of adherence to clopidogrel therapy focusing on patients' perceptions of clopidogrel and nuisance bleeding. METHODS: This was a cross-sectional study of community-dwelling cardiovascular patients with a self-reported prescription for clopidogrel. Self-report questionnaires assessed depressive symptoms, social support, nuisance bleeding, perceptions of clopidogrel, and adherence to therapy. Low, moderate, and high adherence groups based on the Morisky Medication Adherence Scale were compared and hierarchical multiple linear regression analysis was used to predict adherence. RESULTS: A total of 102 subjects were enrolled, and 55%, 28%, and 16% were classified as having low, moderate, and high adherence, respectively. Greater perceptions of clopidogrel necessity, lower perception of clopidogrel concern, and increased severity of nuisance bleeding were predictors of better adherence. CONCLUSIONS: Data from this cross-sectional study suggest that concerns about clopidogrel and feelings about its necessity play an important role in clopidogrel adherence.

What Goes Into a Decision? How Nursing Faculty Decide Which Best Practices to Use for Classroom Testing.

AIM: To explore the decision-making process of BSN faculty when determining which best practices to use for classroom testing. METHOD: A descriptive, correlational study was conducted with a national sample (N = 127) of full-time BSN faculty. Participants completed a web-based survey incorporating instruments that measured beliefs about evaluation, decision-making, and best practices for item analysis and constructing and revising classroom tests. RESULTS: Study participants represented 31 states and were primarily middle-aged white women. In multiple linear regression analyses, faculty beliefs, contextual factors for decision-making, and decision-making processes accounted for statistically significant amounts of the variance in item analysis and test construction and revision. Strong faculty beliefs that rules were important when evaluating students was a significant predictor of increased use of best practices. CONCLUSION: Results support that understanding faculty beliefs around classroom testing is important in promoting the use of best practices.

The nurse-led equitable learning framework for training programs: A framework to grow, bolster and diversify the nursing and public health workforce.

BACKGROUND: Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation. PURPOSE STATEMENT: This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution. METHODS: The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs. RESULTS: Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education. CONCLUSIONS: Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care.

Integrating the Social Determinants of Health Into Prelicensure Nursing Pharmacology.

BACKGROUND: Nursing organizations have called for the incorporation of social determinants of health (SDOH) throughout nursing school curricula. Guidance is needed regarding best practices to integrate SDOH into pharmacology courses in prelicensure nursing programs. METHOD: Using Emory University's School of Nursing SDOH framework to guide curriculum innovation, pharmacology faculty identified three pharmacology-centric SDOH topics: race-based medicine and pharmacogenomics, pharmacy deserts, and lack of diversity in clinical trials. These three SDOH topics were incorporated into preestablished pharmacology content. RESULTS: Faculty integrated SDOH into pharmacology courses with heavy science content, and students were receptive to open discussion of SDOH topics. CONCLUSION: The integration of SDOH into a prelicensure nursing pharmacology course across multiple cohorts of students was feasible, and student feedback was positive. Faculty faced several challenges, including time constraints. Additional and ongoing training is needed to support the integration of SDOH into nursing curricula. [J Nurs Educ. 2023;62(3):175-179.].

Emerging Adults with Diabetes in Safety-Net Care: Self-Management Influences and Patient-Provider Interactions.

Emerging adults with diabetes, particularly in underserved communities, represent a growing but less studied population whose needs may differ from older adults. This study investigated perspectives of underserved emerging adults regarding diabetes self-management influences and provider interactions. Focus groups and interviews with emerging adults in a safety-net health care setting were conducted to identify perspectives regarding self-management influences and patient-provider interactions. Diabetes was perceived as a psychological burden complicated by busy lifestyles and competing responsibilities. Lack of resources, especially financial barriers, also limited self-management. Participants often perceived diabetes visits as standardized encounters providing access to diabetes supplies but desired additional guidance appropriate to their needs and life-stage. Participants valued encouragement and positive ongoing provider relationships for tailored informational and emotional support and support from family and peers. Providers and health care systems adapting to provide or facilitate this support will be better able to optimize diabetes management at and between visits.

Body Image, Depression Symptoms, and Health-Related Quality of Life in Black Women With Systemic Lupus Erythematosus.

OBJECTIVE: To examine relationships among body image, depression symptoms, and quality of life in Black women with systemic lupus erythematosus (SLE). DESIGN: Descriptive, correlational design. SETTING/SAMPLE: Using social media advertising, we recruited Black women with self-reported SLE to complete a web-based survey. RESULTS: The female sample (N = 43) was predominantly non-Hispanic (80%) and married (58%), with a mean age of 33.5 (SD = 6.9) years. The mean time since SLE diagnosis was 5.9 (SD = 4.0) years. The majority of respondents (51%) reported using oral steroid therapy for disease control. Mean body image and depression scores, 2.0 (SD = 0.6) and 62.4 (SD = 8.5), respectively, differed from population norms of 1.80 (SD = 0.9) and 50 (SD = 10), indicating greater body image disturbance and greater depression symptoms than reported by the general population. Greater body image disturbance was significantly associated with greater depression symptoms and poorer quality of life in the area of role disruption. CONCLUSION: Depression and body image disturbance among Black women with SLE should be routinely assessed and addressed by nurses and other clinicians to help promote optimal quality of life.

Symptom clusters and health-related quality of life in people with chronic stable angina.

AIM: This paper reports findings of a study to examine the independent contribution of chest pain, fatigue and dyspnoea to health-related quality of life in people with chronic stable angina. BACKGROUND: People with chronic stable angina experience poorer quality of life in multiple areas including physical and emotional health. Emerging evidence suggests the presence of concomitant symptoms yet there are no systematic studies examining the impact of symptom clusters on quality of life in people with chronic angina. METHOD: Outpatients (n = 134), recruited over a 16-month period in 2000 and 2001, with confirmed coronary heart disease and chronic angina completed reliable and valid questionnaires measuring chest pain frequency, fatigue, dyspnoea and quality of life. The data have contemporary relevance because despite changes in treatment of coronary heart disease, chronic angina remains prevalent worldwide. Hierarchical multiple linear regression was used to examine the symptom cluster of chest pain frequency, fatigue and dyspnoea in predicting quality of life. RESULTS: The sample was predominantly white (74·6%), men (59·7%) with a mean age of 63·4 (sd 12·12) years. Controlling for age, gender, social status and co-morbidities, the symptom cluster of chest pain frequency, dyspnoea and fatigue accounted for a statistically significant increase in unadjusted R² (F of Δ, P < 0·05) for the models predicting physical limitation (R² Δ 24·1%), disease perception (R² Δ 24·6%), Short Form-36 Physical Component Score (R² Δ 24·3%) and Mental Component Score (R² Δ 07·0%). CONCLUSION: Symptom assessment and management of people with chronic stable angina should involve multiple symptoms. Greater fatigue predicted poorer quality of life in multiple areas. As a possible indicator of depression, it warrants further assessment and follow-up.

Nurses' knowledge of heart failure education principles survey: a psychometric study.

AIMS: To compare the psychometric properties of the original dichotomously scored Nurses' Knowledge of Heart Failure Self-Management Education Principles Survey with a Likert scored version. BACKGROUND: Nurses must be knowledgeable of HF self-management principles to provide optimal education to patients. Psychometrically strong instruments to measure nurses' knowledge of HF self-management provide important insight into gaps of nurses' knowledge. DESIGN: This psychometric study had a two phase non-experimental design comparing the psychometric characteristics of two versions of an existing survey in addition to test-retest reliability of the revised survey. METHODS: A convenience sample of 122 nurses was recruited from a healthcare system located in the Southeastern USA. Data were collected from August 2006 through December 2006. Nurses completed the two versions of the survey. RESULTS: The sample was predominantly Caucasian (76%), female (95%) with a mean age of 42 years (SD 11·4). Internal consistency reliability was 0·27 for the dichotomously scored version of the survey and 0·70 for the Likert scored version. The test-retest reliability of the Likert scored survey was r = 0·66. Data from individual Likert scored items indicated nurses were most knowledgeable about the need to continue daily weights even after HF symptoms are gone (mean = 4·43, SD 0·51) and least knowledgeable about how to advise asymptomatic patients to manage a low BP reading (mean = 2·11, SD 0·98). CONCLUSION: The Likert scored version of the Nurses' Knowledge of Heart Failure Self-Management Principles Survey was stronger psychometrically than the dichotomously scored version. RELEVANCE TO CLINICAL PRACTICE: Teaching HF self-management skills to patients is challenging and it is important to identify nurses' gaps in knowledge of self-management principles. The psychometrically sound Likert scored version of the survey potentially may be used to identify nurses' knowledge gaps and inform staff development in-services.

Human patient simulation evaluation rubrics for nursing education: measuring the Essentials of Baccalaureate Education for Professional Nursing Practice.

With the call for curriculum that meets the educational needs of nurses in the 21st century, the American Association of Colleges of Nursing provided nine essentials for baccalaureate nursing education in The Essentials of Baccalaureate Education for Professional Nursing Practice, which serves as a critical guide to inform and shape baccalaureate nursing program curricula. Nursing programs must demonstrate program outcomes that reflect all of the essentials. Human patient simulation was specifically acknowledged as an appropriate educational tool for meeting these needs. This article identifies and assesses six rubrics purported to measure outcomes of human patient simulation and evaluates how these rubrics measure outcomes reflecting the baccalaureate essentials. Psychometric data were limited for the majority of the rubrics, especially validity data. The rubrics consistently failed to measure Essentials V and VII. Suggestions for how these Essentials might be integrated into the existing rubrics are provided.

Perceptions of cardiac risk factors and risk-reduction behavior in women with known coronary heart disease.

BACKGROUND: Risk factor reduction has been linked to personal perceptions of risk, yet few data exist about women's personal perceptions of coronary heart disease (CHD) risk, especially women who have experienced a cardiac event or intervention. OBJECTIVE: The purpose of this study was to explore perceptions of risk for CHD and to examine perceptions of risk-reducing behaviors in women with known CHD. METHODS: Because women's attitudes are conceptualized to be embedded in their everyday practices, an interpretative qualitative approach was chosen to reveal this phenomenon. The purposive sample consisted of 7 women with CHD. Interviews were conducted and transcribed verbatim. Data collection continued until saturation occurred. Efforts were made to increase trustworthiness through participant review of transcripts, peer debriefing, and using field notes. RESULTS: Three major themes emerged from the data: "out of sight, out of mind," "why doesn't he talk to me like that?" and "it's scary." The women indicated their CHD was currently not a major problem because they were asymptomatic or did not "feel sick," which led to decreased focus on their CHD, including risk factor reduction. They expressed the desire to return to normal, rather than focus on the chronicity of CHD. Participants felt that physicians treated them differently because they were women and that their concerns were taken less seriously. They perceived that the patient-physician relationship lacked open dialogue. Fear was experienced by all women, and many feared the unknown, especially not knowing when something was wrong with their heart. CONCLUSIONS: Data indicated that, during stable periods in the CHD trajectory, women may not understand the chronicity of their disease and may not recognize the importance of reducing their risk for future cardiac events. Helping women understand CHD chronicity even when they may not feel sick may assist them in engaging in risk-reducing behaviors.

Metabolomics Research Conducted by Nurse Scientists: A Systematic Scoping Review.

Metabolomics, one of the newest omics, allows for investigation of holistic responses of living systems to myriad biological, behavioral, and environmental factors. Researcher use metabolomics to examine the underlying mechanisms of clinically observed phenotypes. However, these methods are complex, potentially impeding their uptake by scientists. In this scoping review, we summarize literature illustrating nurse scientists' use of metabolomics. Using electronic search methods, we identified metabolomics investigations conducted by nurse scientists and published in English-language journals between 1990 and November 2019. Of the studies included in the review (N = 30), 9 (30%) listed first and/or senior authors that were nurses. Studies were conducted predominantly in the United States and focused on a wide array of clinical conditions across the life span. The upward trend we note in the use of these methods by nurse scientists over the past 2 decades mirrors a similar trend across scientists of all backgrounds. A broad range of study designs were represented in the literature we reviewed, with the majority involving untargeted metabolomics (n = 16, 53.3%) used to generate hypotheses (n = 13, 76.7%) of potential metabolites and/or metabolic pathways as mechanisms of clinical conditions. Metabolomics methods match well with the unique perspective of nurse researchers, who seek to integrate the experiences of individuals to develop a scientific basis for clinical practice that emphasizes personalized approaches. Although small in number, metabolomics investigations by nurse scientists can serve as the foundation for robust programs of research to answer essential questions for nursing.

Using Deliberate Practice and Simulation for Psychomotor Skill Competency Acquisition and Retention: A Mixed-Methods Study.

BACKGROUND: Quality, safe patient care is dependent on graduates who are proficient in the psychomotor skills of nursing. Competent skill acquisition and retention are key to reducing skill-based errors and reducing the risk of adverse patient events. PURPOSE: The purpose of this study was to explore the effect of deliberate practice combined with skill practice during high-fidelity simulation (HFS) scenarios on urinary catheter insertion skill competency and retention in prelicensure nursing students. METHODS: A convergent, parallel mixed-methods design was used. RESULTS: The group participating in skill practice before and during HFS scenarios demonstrated a reduction in errors when performing the skill and an improvement in retention of skill competency. CONCLUSIONS: This article describes how the combination of deliberate skill practice prior to and during HFS scenarios may improve student skill acquisition and retention.