Sharing Our Journey: Implementing a Multicounty Substance Use Prevention Program in Area Schools.

The purpose of this article is to describe an interprofessional, evidence-based, nurse-led, substance use prevention program implemented in local and surrounding county school settings by university nursing and other health science students and to explore these students' perceptions of their training and implementation of the program. This program was developed from a community assessment revealing the rise of adolescent substance use and the need for ongoing substance use prevention. This program's journey encompasses a 4-year period with feedback from students in four university departments (nursing, psychological and brain sciences, public health, and social work) who learned and implemented the Say It Straight program targeting elementary and middle school-aged children. This program was taught over six weeks, with 45-minute lessons per week. Feedback collected over the period of the program reveals what is felt to be the most useful parts of the training, as well as the strengths and weaknesses of the model implementation. School nurses are child advocates and often serve as leaders in developing health policies and programs in the school setting. This nurse-led, interprofessional, health promotion project can be viewed as a model for school nurses in establishing university partnerships to address community health needs.

Developing interprofessional collaborative practice competencies in rural primary health care teams.

BACKGROUND: Leaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs. PURPOSE: Describe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture. METHODS: The implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP. FINDINGS: Significant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership. DISCUSSION: Partnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.

Coaching Strategies Used to Support Interprofessional Teams in 3 Primary Care Centers.

PURPOSE/AIMS: Clinical nurse specialists and other advanced practice registered nurses use healthcare team coaching to foster interprofessional practice and enhance healthcare quality. Although coaching has been shown to support positive changes in healthcare, little is known about how coaching strategies are used in practice. The purpose of this study was to describe the strategies used by an experienced healthcare team coach tasked with advancing interprofessional care and teamwork in primary care clinics. METHODS: This qualitative description study was part of a larger project that included an objective to increase interprofessional practice in 3 primary care clinics in the midwestern United States. Data drawn from 35 audio-recorded and transcribed coaching telephone calls were analyzed using content analysis. RESULTS: Twelve coaching strategies were identified and divided into the following groups: (a) enhancing team development, (b) affirming the work of the team, (c) facilitating progress, (d) providing resources, and (e) connecting work to theoretical frameworks. CONCLUSIONS: The coaching strategies described in this study can inform the work of clinical nurse specialists and other advanced practice registered nurses charged with advancing interprofessional collaborative practice. Future research is recommended to examine the efficacy of strategies and develop a comprehensive model of healthcare team coaching.

Integration of ecosystem science into radioecology: A consensus perspective.

In the Fall of 2016 a workshop was held which brought together over 50 scientists from the ecological and radiological fields to discuss feasibility and challenges of reintegrating ecosystem science into radioecology. There is a growing desire to incorporate attributes of ecosystem science into radiological risk assessment and radioecological research more generally, fueled by recent advances in quantification of emergent ecosystem attributes and the desire to accurately reflect impacts of radiological stressors upon ecosystem function. This paper is a synthesis of the discussions and consensus of the workshop participant's responses to three primary questions, which were: 1) How can ecosystem science support radiological risk assessment? 2) What ecosystem level endpoints potentially could be used for radiological risk assessment? and 3) What inference strategies and associated methods would be most appropriate to assess the effects of radionuclides on ecosystem structure and function? The consensus of the participants was that ecosystem science can and should support radiological risk assessment through the incorporation of quantitative metrics that reflect ecosystem functions which are sensitive to radiological contaminants. The participants also agreed that many such endpoints exit or are thought to exit and while many are used in ecological risk assessment currently, additional data need to be collected that link the causal mechanisms of radiological exposure to these endpoints. Finally, the participants agreed that radiological risk assessments must be designed and informed by rigorous statistical frameworks capable of revealing the causal inference tying radiological exposure to the endpoints selected for measurement.

Production of Cyanotoxins by Microcystis aeruginosa Mediates Interactions with the Mixotrophic Flagellate Cryptomonas.

Eutrophication of inland waters is expected to increase the frequency and severity of harmful algal blooms (HABs). Toxin-production associated with HABs has negative effects on human health and aquatic ecosystem functioning. Despite evidence that flagellates can ingest toxin-producing cyanobacteria, interactions between members of the microbial loop are underestimated in our understanding of the food web and algal bloom dynamics. Physical and allelopathic interactions between a mixotrophic flagellate (Cryptomonas sp.) and two strains of a cyanobacteria (Microcystis aeruginosa) were investigated in a full-factorial experiment in culture. The maximum population growth rate of the mixotroph (0.25 day-1) occurred during incubation with filtrate from toxic M. aeruginosa. Cryptomonas was able to ingest toxic and non-toxic M. aeruginosa at maximal rates of 0.5 and 0.3 cells day-1, respectively. The results establish that although Cryptomonas does not derive benefits from co-incubation with M. aeruginosa, it may obtain nutritional supplement from filtrate. We also provide evidence of a reduction in cyanotoxin concentration (microcystin-LR) when toxic M. aeruginosa is incubated with the mixotroph. Our work has implications for "trophic upgrading" within the microbial food web, where cyanobacterivory by nanoflagellates may improve food quality for higher trophic levels and detoxify secondary compounds.

Fostering interprofessional collaborative practice in acute care through an academic-practice partnership.

An interprofessional collaborative practice (IPCP) environment was implemented in four inpatient acute care unit accountable care teams (ACT) through an academic-practice partnership. An action research methodology was implemented to empower healthcare professionals and promote ownership and sustainment of the IPCP strategies. Healthcare professionals on the ACT units, students, and faculty engaged in the multi-year project. Interventions included staff engagement exercises and coaching and support of individual ACT unit IPCP strategies and education. Healthcare professional outcome data were collected in the form of participant surveys, measuring collaboration about care decisions and the extent to which professionals engaged in a culture of safety, collected at baseline and 6-month intervals. Healthcare outcome measures of the ACT units were also collected at baseline and 6-month intervals. Students had clinical learning experiences in the IPCP settings and completed post clinical surveys. Implementation of the interventions resulted in a positive trend in the healthcare professionals, although statistical significance was not observed. Student outcome data demonstrated statistically significant positive learning outcomes. Healthcare outcome measures demonstrated a significant decrease in readmissions and an overall decrease in catheter-associated urinary tract infections over time. Other measures were not significantly impacted. In conclusion, an academic - practice partnership can strengthen and support an IPCP environment by allowing healthcare clinicians to be directly involved in the selection and implementation of IPCP strategies and contribute to improved professional, healthcare and student outcomes.

An interprofessional patient assessment involving medical and nursing students: a qualitative study.

Interprofessional collaboration is fundamental to providing optimal patient care. The readiness of the team entering a framework of interprofessional collaborative practice is critical to its success. In this study, we conducted an interprofessional education (IPE) activity for medical and nursing students in an acute care setting. Over nine occasions, 21 student pairs (one nursing and one medical student per pair) jointly assessed a patient and created a list of problems and interventions to achieve the patient's goals. Immediately after the activity, students were debriefed to gain insight into their experiences. Debriefing sessions were audiotaped and analysed using a phenomenological approach and four major themes were identified. Overall, students felt responsible for representing their profession and were initially apprehensive about the interprofessional task. Nevertheless, they identified their own shortcomings and recognized the value in their partner's approach. These realizations promoted convergence on a shared vision to provide optimal care for patients as a team. Acknowledging and understanding these perceptions may help design better ways to improve patient care. This educational model may be utilized by others who are seeking IPE activities in acute care.

Empowering Nurses to Lead Interprofessional Collaborative Practice Environments Through a Nurse Leadership Institute.

A year-long Nurse Leadership Institute (NLI) for emerging leaders in primary care clinics and acute care environments was developed, implemented, and evaluated. The NLI's goal was to foster empowerment in interprofessional collaborative practice environments for nurses in the three cohorts of NLIs. The NLI was framed around the Five Leadership Practices of modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart. To create a professional learning environment, foster community, and enhance leadership skills, the Lean In Circle materials developed by Sandberg were adapted for content reorganization and discussion. Minimal literature exists specifically addressing nursing leadership professionals' development based on Sandberg's Circle materials. The findings of the three NLI cohorts reported in this article begin to fill this existing knowledge gap. Participants reported a significant increase in leadership skills. Recommendations for refinement of future NLI offerings are provided. J Contin Educ Nurs. 2018;49(2):61-71.

Facilitators and Barriers for Interprofessional Rounding: A Qualitative Study.

PURPOSE: The purpose of this qualitative study was to describe the barriers and facilitators for interprofessional patient-centered rounding across 4 acute care units in a large urban hospital. DESIGN: A qualitative descriptive method that included data gathered over an 18-month period was used. METHODS: Three data sources were included: participant observation of rounding activities, focused meetings related to interprofessional practice, and exit interviews with key informants representing multiple professions and roles. The data were analyzed, and the findings were developed through an extensive transcription, coding, and discussion process. RESULTS: The facilitators and barriers related to the team included high versus low turnover of team membership, structured versus unstructured rounding, valuing versus skepticism about interprofessional practice, and confidence versus hesitancy about skills. Facilitator/barrier pairs related to the environment included rounding aligned versus mismatched with hospital's mission, time for rounding versus competing demands, geographically cohorted versus distributed teams, and readiness for change and innovation versus saturation. CONCLUSION: Factors associated with the members of the interprofessional team were important in successful implementation of interprofessional rounding. The organizational context and structure were also important. Leaders who anticipate implementing interprofessional rounding may incorporate knowledge of these facilitators and barriers into their planning process.

Student, Preceptor, and Faculty Perceptions of Three Clinical Learning Models.

BACKGROUND: Nursing faculty members strive to use optimal clinical learning environments that educate students for clinical competence and sense of salience. The purpose of this study was to offer insight into the perceptions of students, preceptors, and faculty in three clinical models: traditional, precepted, and a hybrid blend. METHOD: One hundred fifty students, seven preceptors, and 12 faculty members responded to open-ended survey questions about their experience in one of the models. Conventional content analysis revealed themes for each group and theme intersections across groups. RESULTS: The students' themes included Making Connections (traditional), The Land of Opportunity (precepted), and The Total Package (hybrid). Preceptor themes included Giving of Self and Reflection on Practice. The Value of the Nurse theme emerged from faculty responses across all models. Students desired additional skill performance, and preceptors suggested improved communication and role clarity. CONCLUSION: Clinical models that maximize faculty and preceptor expertise should be formalized and studied. [J Nurs Educ. 2017;56(5):281-286.].

Enhancement of Professional Development of Front-Line Nurse Preceptors in a Dedicated Education Unit.

BACKGROUND: Dedicated education units (DEUs) have been well established throughout the country as a means of developing clinical skills in nursing students. In a DEU, maintaining an adequate number of well-prepared clinical nurse preceptors is essential for unit sustainability and effective student perception. METHOD: This study was a quasi-experimental design using self-reported survey data. A comparison analysis was conducted using the initial results of the Revised Professional Practice Environment (RPPE) survey (i.e., pre-participation and no orientation) after completion of an orientation program and participation as preceptor in a DEU. RESULTS: Front-line nurses who participated as preceptors for one semester in a DEU demonstrated statistically significant improvement in two of the eight components of professional practice measured by the RPPE. CONCLUSION: This study lends support to the notion that preceptors do experience improvement in professional practice as a result of participation in a DEU. J Contin Educ Nurs. 2017;48(1):40-46.

Concept-Based Curriculum: Changing Attitudes and Overcoming Barriers.

Many nursing educators have considered the implementation of a concept-based curriculum, with active, conceptual teaching and learning strategies, which offers a way to respond to the overwhelming content saturation in many nursing curricula. However, barriers abound, including faculty concerns about loss of control, changing faculty role and identity, and fear of failure. This article clarifies these legitimate barriers and offers practical strategies for success in curriculum change.

Stakeholder Perceptions, Learning Opportunities, and Student Outcomes in Three Clinical Learning Models.

BACKGROUND: Understanding the strengths and challenges of various clinical models is important for nursing education. METHOD: Three long-standing clinical models (preceptored, hybrid, and traditional) were compared on several outcome measures related to satisfaction, learning opportunities, and student outcomes. Students, faculty, and preceptors participated in this study. RESULTS: Although no differences were noted in satisfaction or standardized examination scores, students in the preceptored clinical model were able to practice more psychomotor skills. Although participants in the preceptored model reported spending more time communicating with staff nurses than did those in the other models, students in the traditional model spent more time with faculty. No differences were noted among groups in student clinical observation time. CONCLUSION: All clinical learning models were focused on how clinical time was structured, without an emphasis on how faculty and preceptors work with students to develop nursing clinical reasoning skills. Identifying methodology to impact thinking in the clinical environment is a key next step. [J Nurs Educ. 2016;55(5):271-277.].

Triangulating Competencies, Concepts, and Professional Development in Curriculum Revisions.

Curricular reform, as reported in the literature, has been described as a tortuous change process. This article demonstrates how a series of retreats using consensus building methodologies facilitated efficient change among a large faculty body. Nimble work groups completed discrete aspects of the project and promoted engagement. The curriculum is described, including assimilation of concepts, competencies, and professional development. Lessons learned for creating a positive and timely curricular change are presented.

Outcomes and lessons learned regarding the use of interviewing for baccalaureate nursing school admission.

This article presents a case study of the adoption, use, and outcomes of an admission interview process for selection into a large public baccalaureate nursing program between 2007 and 2011. This article reports the effects of implementation, including how interviews affected the grade point average of incoming students as well as student diversity, retention, and National Council Licensure Examination scores, over nine consecutive admission cycles. During the initial implementation cycles, reported satisfaction with the process was high; however, as implementation progressed, it became clear that the anticipated gains from the interview process related to ethnic and gender diversity were not being realized. Furthermore, implementation of the interview strategy created unforeseen difficulties. These two factors led to a decision to stop using this strategy for admission into the baccalaureate program. Lessons learned in the implementation of interviews as an admission criterion are included in the discussion.

Comparing the effectiveness, practice opportunities, and satisfaction of the preceptored clinical and the traditional clinical for nursing students.

AIM: A preceptored clinical education model was introduced in partnership with a health care agency and compared with the traditional model for nursing clinical education. The preceptored model provided clinical education that more realistically approached the job responsibilities of the registered nurse. METHOD: Students were surveyed and measured at three points in their curriculum. RESULTS: Students in the preceptored clinical reported significantly more practice opportunities, but there were no significant differences on any cognitive measures of performance. In the first semester, the preceptored group reported higher satisfaction and perception of learning facilitation. These differences disappeared at the mid and endpoint measures. CONCLUSIONS; Preceptored students appeared to have greater practice opportunities, but this experience did not alter classroom performance or satisfaction beyond the first semester.

Creating tomorrow's leaders and innovators through an RN-to-bachelor of science in nursing consortium curricular model.

The critical need to increase the number of baccalaureate-prepared RNs to improve the safety and quality of patient care in today's complex health care system is a pressing issue in health care. One part of the solution lies in the attainment of higher education of RNs prepared at the associate and diploma levels who make up the majority of the nursing workforce in the United States today. The Indiana University Schools of Nursing located throughout the state of Indiana collaborated to create a statewide RN-to-bachelor of science in nursing curriculum that is flexible, innovative, and meaningful. The plan focuses on the strengths and unique learning needs of returning RN students. Specifically, this curriculum offers year-round online courses in 7-week terms, which allows students to enter and exit the program within 1 year, and a curriculum with more choices and fewer constraints than is typical for baccalaureate nursing degrees. This learner-centered plan fully incorporates the American Association of Colleges of Nursing Essentials for Baccalaureate Education (2009) throughout the curriculum. It is conveniently delivered online, takes into account and gives credit for students' previous learning and work experience, and allows the students to pursue nursing specialty knowledge for college credit. Working together as a consortium to achieve these goals across an entire state with 8 regional campuses required focused attention on the concerns and strengths of all the stakeholders and successful implementation of effective communication strategies.

Characterization of neurophysiological and behavioral changes, MRI brain volumetry and 1H MRS in zQ175 knock-in mouse model of Huntington's disease.

Huntington's disease (HD) is an autosomal neurodegenerative disorder, characterized by severe behavioral, cognitive, and motor deficits. Since the discovery of the huntingtin gene (HTT) mutation that causes the disease, several mouse lines have been developed using different gene constructs of Htt. Recently, a new model, the zQ175 knock-in (KI) mouse, was developed (see description by Menalled et al, [1]) in an attempt to have the Htt gene in a context and causing a phenotype that more closely mimics HD in humans. Here we confirm the behavioral phenotypes reported by Menalled et al [1], and extend the characterization to include brain volumetry, striatal metabolite concentration, and early neurophysiological changes. The overall reproducibility of the behavioral phenotype across the two independent laboratories demonstrates the utility of this new model. Further, important features reminiscent of human HD pathology are observed in zQ175 mice: compared to wild-type neurons, electrophysiological recordings from acute brain slices reveal that medium spiny neurons from zQ175 mice display a progressive hyperexcitability; glutamatergic transmission in the striatum is severely attenuated; decreased striatal and cortical volumes from 3 and 4 months of age in homo- and heterozygous mice, respectively, with whole brain volumes only decreased in homozygotes. MR spectroscopy reveals decreased concentrations of N-acetylaspartate and increased concentrations of glutamine, taurine and creatine + phosphocreatine in the striatum of 12-month old homozygotes, the latter also measured in 12-month-old heterozygotes. Motor, behavioral, and cognitive deficits in homozygotes occur concurrently with the structural and metabolic changes observed. In sum, the zQ175 KI model has robust behavioral, electrophysiological, and histopathological features that may be valuable in both furthering our understanding of HD-like pathophyisology and the evaluation of potential therapeutic strategies to slow the progression of disease.

Formation of the avian nucleus magnocellularis from the auditory anlage.

In the avian auditory system, the neural network for computing the localization of sound in space begins with bilateral innervation of nucleus laminaris (NL) by nucleus magnocellularis (NM) neurons. We used antibodies against the neural specific markers Hu C/D, neurofilament, and SV2 together with retrograde fluorescent dextran labeling from the contralateral hindbrain to identify NM neurons within the anlage and follow their development. NM neurons could be identified by retrograde labeling as early as embryonic day (E) 6. While the auditory anlage organized itself into NM and NL in a rostral-to-caudal fashion between E6 and E8, labeled NM neurons were visible throughout the extent of the anlage at E6. By observing the pattern of neuronal rearrangements together with the pattern of contralaterally projecting NM fibers, we could identify NL in the ventral anlage. Ipsilateral NM fibers contacted the developing NL at E8, well after NM collaterals had projected contralaterally. Furthermore, the formation of ipsilateral connections between NM and NL neurons appeared to coincide with the arrival of VIIIth nerve fibers in NM. By E10, immunoreactivity for SV2 was heavily concentrated in the dorsal and ventral neuropils of NL. Thus, extensive pathfinding and morphological rearrangement of central auditory nuclei occurs well before the arrival of cochlear afferents. Our results suggest that NM neurons may play a central role in formation of tonotopic connections in the auditory system.

Taste bud cell dynamics during normal and sodium-restricted development.

Taste bud volume increases over the postnatal period to match the number of neurons providing innervation. To clarify age-related changes in fungiform taste bud volume, the current study investigated developmental changes in taste bud cell number, proliferation rate, and life span. Taste bud growth can largely be accounted for by addition of cytokeratin-19-positive taste bud cells. Examination of taste bud cell kinetics with 3H-thymidine autoradiography revealed that cell life span and turnover periods were not altered during normal development but that cells were produced more rapidly in young rats, a prominent modification that could lead to increased taste bud size. By comparison, dietary sodium restriction instituted during pre- and postnatal development results in small taste buds at adulthood as a result of fewer cytokeratin-19-positive cells. The dietary manipulation also had profound influences on taste bud growth kinetics, including an increased latency for cells to enter the taste bud and longer life span and turnover periods. These studies provide fundamental, new information about taste bud development under normal conditions and after environmental manipulations that impact nerve/target matching.