Preparing BSN students for a new workplace: Experiences in a COVID-19 designated unit as an RN extender.

Academic nursing programs were impacted by the onset of the pandemic with the challenges of social distancing, detecting, and controlling the spread of the virus. Many traditionally campus-based, face-to-face programs transitioned quickly to include virtual activities for classes, laboratories, and clinical experiences for students. Initially direct patient care clinical activities came to a halt due to concerns for student safety and overwhelming numbers of COVID-19 cases stressing health system resources. However, as COVID-19 cases began to rise and hospitals struggled with staffing shortages, it became necessary to explore how nursing students could contribute to relieving the staffing burden while obtaining critical education as RN Extenders. Students that participated in the RN Extender program were seniors entering the nursing workforce within the next two months. Significant student screening and preparation was provided to support students serving as RN Extenders in COVID-19 units. The prior working relationships and personal contact between academic and practice leaders, a sense of equal participation, clear and realistic expectations of the benefits and responsibilities of each group were crucial. Building ongoing and frequent opportunities for formal and informal communication among all stakeholders was vital and the major contributor to the success of this program.

Using complex adaptive systems theory to guide the transition to DNP nurse anesthesia education.

The opportunities and challenges when transitioning from a master's to DNP in nurse anesthesia education are complemented by using a complex adaptive system (CAS) theory to guide the curricula modifications. Major functional changes included reorganizing the curriculum to incorporate AACN DNP Essentials, COA competencies and integrating the scholarly work of a DNP improvement project. These changes were infused while balancing the intensive clinical requirements of a nurse anesthesia curriculum. Highlights in the DNP curriculum included the driving theory of complex systems, ethical values, leadership development, evidence-based practice and adaptation to emergent situations found in nurse anesthesia practice. Goals were to produce a DNP graduate that is more reliant on strategy and vision rather than only tasks or operations. Using the CAS framework enabled our program to transition and prepare DNP graduates to contribute to improved organizational effectiveness and understand the importance of leading change to positively impact patient outcomes.

Initiation of a nursing education curriculum with accessibility to all learners.

Over the last few decades, a surge in academic programs developed and offered through distance education has occurred. Educators have embraced course work and programs delivered through asynchronous online formats. The University of South Carolina College of Nursing designed a plan to assure online courses and course components would meet all federal, state and university mandates for materials to be accessible to all students, including those with disabilities. This effort assured that all courses met the Quality Matters standards for online excellence. The authors identified challenges involved, technologies that could facilitate this process, and a step-by-step plan and process which provided the positive outcome.

Patient Advocacy at the APRN Level: A Direction for the Future.

Patient advocacy is seen as a critical role for the nursing profession. Although there is an existing body of literature surrounding the registered nurse level of patient advocacy, little is known about the advanced practice registered nurse (APRN) and patient advocacy. This article examines the existing patient advocacy research literature and existing APRN competencies to provide direction for further research.

Establishing an Individual Writing Practice.

Do you have a topic in mind for a manuscript but can't find the time or motivation to write it? This article provides step-by-step directions to encourage you to prioritize and plan your writing schedule.

Anesthetic choices and breast cancer recurrence: a retrospective pilot study of patient, disease, and treatment factors.

The purpose of this work was to investigate differences in patient, disease, and treatment factors between women who received outpatient surgical treatment of breast cancer with paravertebral and general anesthesia compared with women who received general anesthesia alone. A total of 358 patients with stage 0-III disease received a partial or total mastectomy without axillary node dissection at a large academic cancer center. Study median follow-up time was 28.8 months. Patient demographic characteristics were equally represented across anesthesia groups. Mean body mass index (kg/m) was greater in those who received general anesthesia alone (mean = 29, SD = 6.8) than in those who received paravertebral regional block with general anesthesia (mean = 28, SD = 5.1) (P = .001). The paravertebral regional block with general anesthesia group contained advanced stages of disease (P = .01) and had longer surgical procedures (P = .01) than the general anesthesia alone group. Breast cancer recurrence was detected in 1.7% of the study population (paravertebral regional block with general anesthesia: n = 4; and general anesthesia alone: n = 2). Overall, no association between anesthesia type and recurrence was detected (P = .53), with an unadjusted estimated hazard ratio of 1.84 (95% confidence interval, 0.34-10.08). The overall rate of recurrence was very small in this population. A larger study is needed to detect significant differences in rates of recurrence attributable to type of anesthesia.

The DExH box helicase domain of spindle-E is necessary for retrotransposon silencing and axial patterning during Drosophila oogenesis.

Transposable selfish genetic elements have the potential to cause debilitating mutations as they replicate and reinsert within the genome. Therefore, it is critical to keep the cellular levels of these elements low. This is especially true in the germline where these mutations could affect the viability of the next generation. A class of small noncoding RNAs, the Piwi-associated RNAs, is responsible for silencing transposable elements in the germline of most organisms. Several proteins have been identified as playing essential roles in piRNA generation and transposon silencing. However, for the most part their function in piRNA generation is currently unknown. One of these proteins is the Drosophila melanogaster DExH box/Tudor domain protein Spindle-E, whose activity is necessary for the generation of most germline piRNAs. In this study we molecularly and phenotypically characterized 14 previously identified spindle-E alleles. Of the alleles that express detectable Spindle-E protein, we found that five had mutations in the DExH box domain. Additionally, we found that processes that depend on piRNA function, including Aubergine localization, Dynein motor movement, and retrotransposon silencing, were severely disrupted in alleles with DExH box domain mutations. The phenotype of many of these alleles is as severe as the strongest spindle-E phenotype, whereas alleles with mutations in other regions of Spindle-E did not affect these processes as much. From these data we conclude that the DExH box domain of Spindle-E is necessary for its function in the piRNA pathway and retrotransposon silencing.

The role of the AANA Education Committee in developing education standards.

The purpose of this column is to describe the involvement over time of the AANA Education Committee in the development of education standards for nurse anesthetists. Collaboration between the Education Committee, Council on Accreditation of Nurse Anesthesia Educational Programs, and nurse anesthesia community of interest in developing quality doctoral standards is discussed.

MicroRNAs as modulators of smoking-induced gene expression changes in human airway epithelium.

We have shown that smoking impacts bronchial airway gene expression and that heterogeneity in this response associates with smoking-related disease risk. In this study, we sought to determine whether microRNAs (miRNAs) play a role in regulating the airway gene expression response to smoking. We examined whole-genome miRNA and mRNA expression in bronchial airway epithelium from current and never smokers (n = 20) and found 28 miRNAs to be differentially expressed (P < 0.05) with the majority being down-regulated in smokers. We further identified a number of mRNAs whose expression level is highly inversely correlated with miRNA expression in vivo. Many of these mRNAs contain potential binding sites for the differentially expressed miRNAs in their 3'-untranslated region (UTR) and are themselves affected by smoking. We found that either increasing or decreasing the levels of mir-218 (a miRNA that is strongly affected by smoking) in both primary bronchial epithelial cells and H1299 cells was sufficient to cause a corresponding decrease or increase in the expression of predicted mir-218 mRNA targets, respectively. Further, mir-218 expression is reduced in primary bronchial epithelium exposed to cigarette smoke condensate (CSC), and alteration of mir-218 levels in these cells diminishes the induction of the predicted mir-218 target MAFG in response to CSC. These data indicate that mir-218 levels modulate the airway epithelial gene expression response to cigarette smoke and support a role for miRNAs in regulating host response to environmental toxins.