The Ongoing Conundrum About DNP Project Variability.

An important publication titled The State of Doctor of Nursing Practice Education in 2022 reports on a national study that examined the current state of DNP graduates both in practice and in academia. The key findings, conclusions, and recommendations of the 2022 report provide an updated snapshot of current DNP education and practice along with recommendations for curricula and utilization of DNP graduates. This article focuses on the DNP Project as an integral component of the DNP curriculum in developing clinical leaders and scholars to improve healthcare outcomes and significantly impact healthcare transformation. Many publications have addressed the significant variability of the DNP Project among programs. This AACN report further underscores variability among DNP Projects regarding purpose, focus, format, development, evaluation, dissemination, and contribution to practice. The purpose of this article is to provide a perspective for nurse leaders and faculty about selected key findings, conclusions, and recommendations from this 2022 report that relate to DNP Projects as a means to improve the value and rigor of DNP Projects and decrease the variability among DNP programs.

An Infrastructure to Provide Safer, Higher-Quality, and More Equitable Telehealth.

The rapid expansion and prompt widescale adoption of telehealth during the COVID-19 pandemic resulted in telehealth practice variations across health care settings and has implications for patient safety, health equity, and quality of care. Telehealth is part of the public health infrastructure, and health care stakeholders have an opportunity to strategically plan for telehealth expansion and sustainability in organizations as the pandemic wanes. A framework to guide organizational telehealth integration is needed that can support safe, accessible, and high-quality telehealth to patients regardless of social and/or economic status. The purpose of this article is to propose an innovative telehealth model, supported by systems theory, to address the complexity of telehealth implementation in health care organizations. A Donabedian approach is used to address quality. The telehealth model is an organizational infrastructure that outlines how policy and authority requirements, organization factors, provider competencies, and patient determinants of health influence safer, more equitable, higher-quality telehealth. The framework can guide leaders in building, redesigning, and measuring the impact of telehealth programs as health care shifts into a revolutionary technology era to meet the needs of diverse organizations and populations.

Retrospective Review of Reproductive Outcomes Comparing Vaginal Progesterone to Intramuscular Progesterone as Luteal Support in Frozen Embryo Transfer Cycles.

OBJECTIVE: Recent literature suggests that progesterone in oil (PIO) is superior to vaginal progesterone (VP; Prometrium) for endometrial preparation in frozen embryo transfer cycles (FET), improving the live birth rate and reducing the rate of miscarriage. PIO has disadvantages including cost, pain, and stress of administration. The objective of this study was to evaluate whether VP is non-inferior to PIO for medicated FET cycles. METHODS: We conducted a retrospective analysis comparing pregnancy, miscarriage, and live birth rates for PIO versus VP for medicated FET cycles, from 2017 to 2020 at a single fertility clinic. A total of 745 participants were included in the study; 438 received VP, and 307 received PIO. Univariate and multivariate binary and ordinal logistic regression analyses were performed to compare the rates of pregnancy, miscarriage, and live birth between VP and PIO. RESULTS: Our data demonstrated no difference between PIO and VP with respect to the rates of pregnancy (51% vs. 53%), miscarriage (20% vs. 18%), or live birth (31% vs. 34%) (all P > 0.05). For participants taking PIO, the odds of pregnancy were 0.93 [95% CI (0.70, 1.25), P = 0.65] that of participants on VP. CONCLUSION: In our single-centre experience, VP was non-inferior to PIO for endometrial preparation in FET cycles.

Doctor of nursing practice students' perceptions of professional change through the DNP program.

BACKGROUND: This thematic analysis study examined how post master's Doctor of Nursing Practice (DNP) students described personal and professional growth in their views of self, healthcare, and clinical practice that evolved as a result of the curriculum and experiences in the DNP program. PURPOSE: The purpose of this thematic analysis was to describe and discuss perceptions of graduating post master's DNP students regarding personal and professional development that occurred during the DNP program to identify how DNP graduates saw themselves change and grow during the course of the DNP program. METHOD: A thematic analysis method was used to code, categorize, and summarize data from 42 reflection papers of post master's DNP students into a thematic framework based on the eight DNP Essentials which are the framework upon which DNP programs build their curriculum and design student experiences. The authors systematically analyzed the statements from each student paper and drew interpretation of the students' statements into themes that were congruent with the eight DNP Essentials and one stand-alone category. RESULTS: Data analysis yielded 15 themes that were aligned within eight categories of the DNP Essentials and one stand-alone category. CONCLUSIONS: The eight DNP Essentials provided a framework for the themes which reflected professional growth attributed to the journey through the DNP program. A ninth category entitled Personal Advancements described students' perceptions of their personal and professional development. These dimensions are proposed in the new DNP Essentials currently in development. Increasing understanding of the DNP students' journey serves to inform DNP curriculum development and program experiences, and informs faculty of the influence they have on molding students into a more robust professional role.

Scholarship in Neuroscience Nursing.

BACKGROUND: Scholarship is a hallmark of all professions and includes research and practice scholarship. Building the science for practice and care is a major responsibility of each profession. METHODS: The purpose of this article is to define clinical science as it applies to neuroscience nursing as well as to establish the foundation for the work of the Clinical Science Committee of the American Association of Neuroscience Nursing. CONCLUSIONS: Research scholars conduct investigations for discovery of new knowledge. Practice scholars develop clinical knowledge through clinical practice and experience and an inquiring mindset that questions why and how certain methods or processes contribute to the achievement of certain outcomes; they look for better ways to improve processes of care and practice that will achieve optimal evidence-based outcomes. Scholarship in both research and practice domains is critical to the advancement of neuroscience nursing. Many opportunities exist for neuroscience nurses to contribute to clinical science.

Intravenous Acetaminophen for Perioperative Pain Control in Adult Elective Neurospine Surgical Patients: A Retrospective Case-Control Study.

Adding intravenous (IV) acetaminophen to an opioid-based regimen as multimodal pain management for perioperative pain control in adults undergoing spine surgery can lead to effective pain control, reduce the risk of opioid-related adverse effects, and facilitate postoperative neurologic evaluation for surgical outcomes. This descriptive pilot study investigated the analgesic effect of a single dose of IV acetaminophen administered intraoperatively as routine practice for perioperative pain management for adults undergoing elective spine surgery. A retrospective comparative cohort study compared an IV acetaminophen group with a group not receiving IV acetaminophen for primary outcomes measured by visual analog scale (VAS) and associated secondary outcomes. The IV acet-aminophen group had lower mean VAS scores than the group not receiving IV acetaminophen (4.33 vs 6.22, P = .01, at 60 minutes after entry into the postanesthesia care unit [PACU] for procedure level 4; 2.43 vs 3.11, P = .002, at PACU discharge for procedure level 3). The study did not show consistently lower VAS scores for the IV acetaminophen group vs the group not receiving IV acetaminophen. No difference was found for other secondary outcomes between groups. Future prospective studies are needed to assess the analgesic effects of IV acetaminophen for spine surgery cases.

Anesthesia Information Management Systems: An Underutilized Tool for Outcomes Research.

Perioperative outcomes research using anesthesia information management systems (AIMS) is an emerging research method that has not been comprehensively reviewed. This review reports an initial analysis of the use of AIMS for perioperative patient outcomes research from articles published between January 1980 and January 2013. Perioperative patient outcomes research based on AIMS has increased greatly since 2001. Although risk stratification studies involving large study populations were most commonly reported, AIMS were also used to report a rare life-threatening anesthesia-related complication, malignant hyperthermia. Use of AIMS for perioperative outcomes research can address clinically relevant topics that traditional research methods have been unable to adequately address, mainly because of the innate challenges presented by perioperative anesthesia practice. It is expected that perioperative effectiveness and outcomes research using large AIMS databases will be more widely embraced in the future to generate useful evidence and knowledge to improve anesthesia care.

Funding big research with small money.

This department highlights change management strategies that maybe successful in strategically planning and executing organizational change initiatives.With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools,and resources that mobilize and sustain organizational change initiatives.In this article, the guest authors introduce crowd sourcing asa strategy for funding big research with small money.

Credentialing: the need for a national research agenda.

A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.

Penetrating head injury.

Traumatic brain injury affects more than 1 million civilians annually. Functional outcomes in this population are less than favorable. This case report describes a patient with a penetrating injury to the head and brain from a gunshot wound including the pathophysiology of injury and outlines evidence-based management guidelines to provide comprehensive care.

Intracranial pressure waveform analysis during rest and suctioning.

Cerebral compliance is a measure of cerebral adaptability to increases in volume within the intracranial space and an indicator of risk for neurological deterioration. However, no direct measurement of compliance exists in clinical practice to guide nursing care or treatment decisions. Current use of mean intracranial pressure (MICP) and gross morphological intracranial pressure waveform (ICPW) analysis have great variability in predicting outcomes. The purpose of this review and pilot study was to evaluate the effects of suctioning on MICP and other measures estimating cerebral compliance derived from analysis of ICPW on patient outcome. We analyzed arterial blood pressure waveforms (ABPWs), ICPWs, and respiratory cycle variations using Fourier Transform analysis, to explore the potential benefits of studying ICPWs across single cardiac and respiratory cycles using linear modeling and calculation of correlation coefficients. ABPWs, ICPWs, and MICP were measured over individual cardiac cycles across multiple respiratory phases in five critically ill neurological patients. Both direct and derived ICP measures, including Fourier analysis of ABP and ICP and the cross-transform between ABP and ICP, were correlated with patient outcome. This more complex waveform analysis of individual ABPW and ICPW together, and derived measures during both single cardiac and respiratory cycles, may provide information relevant to cerebral compliance and patient outcomes. Pending confirmation with additional data sets, this technique may be a useful real-time clinical tool to provide a measure of compliance and risk of neurological deterioration for clinicians.

Faculty workload calculation.

Faculty members and nursing education administrators have long examined faculty workloads and documentation thereof but have had difficulty quantifying the work faculty members accomplish in academia. Workloads become even more complicated as faculty members incorporate many activities into their roles of teaching, research, clinical practice, and community service. A form that was simple yet fairly complete was developed at the University of Texas Health Science Center at Houston School of Nursing. The purpose of this article is to describe our workload documentation and issues surrounding its use. This form has been a useful beginning for discussions about accomplishing the work of the mission areas of the school. Our experience and documents may be useful to others.

The neuroscience ICU nurse's perceptions about end-of-life care.

The purpose of this qualitative descriptive study was to describe neuroscience intensive care unit (NICU) nurses' perceptions regarding their roles and responsibilities in the decision-making process during the change in intensity of care and end-of-life care for patients. Twelve NICU nurses agreed to a private moderately structured interview. Three major themes summarize the data: (1) providing guidance, (2) being positioned in the middle of the communication process, and (3) feeling the emotions of patients and families. The nurse caring for a patient at the end of life provides guidance from the middle or "hub" of the communication process between family members and physicians. The nurses in this study describe an array of feelings associated with this role. This research adds to the limited body of knowledge concerning critical care nurses' experiences with end-of-life care. Providing guidance and being in the middle of the communication process can be a lonely, challenging, yet rewarding position. Results of this study provide a basis for offering emotional support to NICU nurses who care for patients at the end of life.