Advancing Health Equity Through Artificial Intelligence: An Educational Framework for Preparing Nurses in Clinical Practice and Research.

The integration of artificial intelligence (AI) into health care offers the potential to enhance patient care, improve diagnostic precision, and broaden access to health-care services. Nurses, positioned at the forefront of patient care, play a pivotal role in utilizing AI to foster a more efficient and equitable health-care system. However, to fulfil this role, nurses will require education that prepares them with the necessary skills and knowledge for the effective and ethical application of AI. This article proposes a framework for nurses which includes AI principles, skills, competencies, and curriculum development focused on the practical use of AI, with an emphasis on care that aims to achieve health equity. By adopting this educational framework, nurses will be prepared to make substantial contributions to reducing health disparities and fostering a health-care system that is more efficient and equitable.

Increasing Diversity in the Advanced Practice Nursing Workforce Through Partnerships With Historically Black Colleges.

BACKGROUND: Health inequities have enhanced efforts to diversify the nursing workforce. Despite recruitment strategies, the percentage of Black nurse practitioners (NPs) lags in comparison with the populous. PROBLEM: Barriers to improving workforce diversity can be traced to academic nursing's lack of diversity in faculty, under-resourced education opportunities for students from underrepresented backgrounds, and historical hurdles. APPROACH: One systems-level approach to increasing NP workforce diversity is developing pathway programs aimed at preparing, recruiting, and supporting Black students into advanced practice nursing education. Current undergraduate RN students from 2 historically Black colleges and universities (HBCUs) attended a 1-week summer immersion program at a graduate school of nursing at a predominately White institution. CONCLUSION: Pathway programs for Black undergraduate RN students show promise for increasing awareness of graduate nursing, offering race and ethnicity concordant mentorship, and cultivating deep awareness for health equity.

Overcoming Marginalization by Creating a Sense of Belonging.

Marginalization encompasses structural, interpersonal, and intergroup dynamics that perpetuate inequality and exclusion. This manuscript advocates that the solution to marginalization lies in fostering a sense of belonging. Belonging is a fundamental human need, critical for mental well-being, academic success, and personal growth. It significantly impacts engagement, retention, and overall development, especially in health professional education settings like nursing schools. When individuals feel they belong, they are more likely to seek support, engage actively in learning, and perform better academically. However, achieving a sense of belonging is not straightforward, and many challenges at both individual and institutional levels hinder its realization. Individual challenges include resistance to change, implicit biases, and lack of awareness of the disparities caused by marginalization. Institutional challenges include insufficient commitment, inadequate resource allocation, and lack of representation from marginalized groups. In the United States, recent legislation obstructing initiatives toward diversity, equity, and inclusion poses additional obstacles. To overcome these challenges and promote belonging, this manuscript offers strategies that highlight the importance of aligning institutional values with policies and practices, recognizing and rewarding inclusive efforts, and actively seeking diverse perspectives.

Color Does Matter: Nursing Assessment of Varying Skin Tones/Pigmentation.

BACKGROUND: The observation of color is an integral part of the nursing assessment. However, the current understanding of individual skin qualities and pigmentation has not yet been integrated thoroughly into foundational assessment courses, clinical education, simulation, and textbooks. EVIDENCE ACQUISITION: Literature is scarce regarding racial groups, skin color, and physical assessment for patients across the lifespan, but even more so for the neonatal population. Historically, many nursing textbooks did not provide visual pictures or observational assessment strategies for the assessment of the Black, Indigenous, and people of color (BIPOC) population. This is improving in some nursing textbooks; however, the descriptors of and visual differences and anticipated assessment findings for the BIPOC population are not comprehensive. RESULTS: Evidence-based assessment findings, which may occur in newborns with varying skin tones/pigmentations, are presented. IMPLICATIONS FOR PRACTICE AND RESEARCH: The most essential step to having an accurate assessment is acknowledging the importance of color awareness. Color blindness, while thought to support inclusivity, only contributes to exclusion of one of the most important components of a person's being-their color.

Empowered Approaches to Critical/Challenging Encounters: Promoting PEACE in a School of Nursing.

The Promoting Empowered Approaches for Critical/Challenging Encounters (PEACE) program, developed at Duke University School of Nursing, is designed to navigate communication when there has been an exchange between community members, either with actions, words, or behaviors, that does not align with the school's core values. The goal of this program is to provide resources that promote conflict resolution through conversation, as well as managing conflict at the organizational level.

Implicit Racial Bias Attitudes and Mitigation in Neonatal Nurse Practitioners: A Quality Improvement Project.

PURPOSE: to assess the impact of education using the implicit bias recognition and management (IBRM) teaching approach. DESIGN: longitudinal quasi-experimental design. Surveys at baseline, immediate postimplementation, and 4-week postimplementation using the modified version of the Attitudes Toward Implicit Bias Instrument (ATIBI). The 4-week survey included items about implicit bias recognition and mitigation strategies. SAMPLE: thirty-six neonatal nurse practitioners assigned to the NICU in a Midwest urban children's hospital. RESULTS: one-way repeated-measures analysis of variance was used, and the score range was 16-96. The results showed a statistically significant model, F (1.49, 707.97) = 34.46, p <.001, partial η2 = 0.496. Pairwise comparisons showed improvement from pre (M = 73.08, SD = 9.36) to immediate postimplementation (M = 80.06, SD = 8.19), p <.001. Scores were sustained at 4-week postimplementation (M = 79.28, SD = 10.39), p = .744. CONCLUSIONS: The IBRM teaching approach improved scores from baseline on a modified ATIBI that remained improved 4 weeks after the education.

Creating a racial justice plan in a school of nursing: A journey of discovery and learning.

While there are many individuals and instances which illustrate the injustices experienced by people of color at the hands of police in the United States, the video which documented the murder of George Floyd by a law enforcement officer graphically illustrated our long and sad history of racial injustices. This and other events in 2020 forced our society to look at racism and systemic injustices that are embedded so deeply within our policies and practices that differentially advantage or disadvantage certain faculty, students and staff within higher education. This paper will describe the infrastructure and processes used to examine and address individual and systemic racism and white supremacy-based practices and policies at a School of Nursing. We describe the initial phases of racial justice work and infrastructure used to engage and support the efforts of committed faculty, staff and students aspiring to achieve racial equity. We share our challenges as well as immediate outcomes with the hope of stimulating thinking and dialogue in other schools around eliminating racial injustices in nursing education programs so the profession can achieve its' vision of preparing a diverse nursing workforce for the future who will work to improve the health of all.

Launching the Reduction of Peripartum Racial/Ethnic Disparities Bundle: A Quality Improvement Project.

INTRODUCTION: Health care organizations have a responsibility to reduce racial and ethnic perinatal health disparities. In the United States, Black women experience the worst perinatal outcomes. The process for successfully addressing this problem in clinical practice remains unclear. PROCESS: A community hospital implemented components of the Alliance for Innovation on Maternal Health Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle. The purpose was to collect and share perinatal disparities data, increase staff awareness of perinatal racial and ethnic disparities, and engage staff to address these disparities at the project site. Perinatal care data were reviewed by race and ethnicity and results were shared with staff. Staff were engaged through a series of activities including a Health Equity Party, implicit bias workshop, Snack and Learn sessions, online modules, 2 grand rounds, and the establishment of a Health Equity Committee. OUTCOMES: Racial and/or ethnic disparities were identified for perinatal outcomes and experience of care indicators including rates of cesarean birth, newborn mortality, and 30-day readmission. Of the staff 137 (65.9%) participated in project activities. The majority of participants were registered nurses (n = 82). Certified nurse-midwives (n = 10) were the profession with the highest rate of attendance (83.3%). Staff developed 26 new recommendations to address racial and ethnic disparities in care. After project implementation, mean scores of High Provider Attribution, an indicator of readiness to address health disparities, increased from preimplementation scores (P = .01). There was also a significant increase in the number of staff who reported engaging in activities to address the health care needs of racial and ethnic minority patients (P < .001). DISCUSSION: This quality improvement project demonstrated that interventions at the health care organization level can be effective in influencing health care providers and staff to address racial and ethnic perinatal disparities.

Entrenched White Supremacy in Nursing Education Administrative Structures.

The National League for Nursing, the American Nurses Association, and the American Association of Colleges of Nursing each have published directives or position statements that support initiatives that would diversify faculty in nursing education; some initiatives very specifically address increasing diversity within nursing faculty leadership ranks. Despite support for these initiatives, there is a lack of faculty members of color in higher-level leadership positions in nursing academia. This article explores two questions that unfold contributing factors. Is the absence of faculty members of color due to historical exclusionary practices of institutional racism? Or is it due to components of internalized racism that may cause faculty members of color to devalue their own potential and ability to rise to leadership roles? Either answer helps explain how entrenched white supremacy continues to be a barrier to diversifying nursing academia. Are we strong enough to dismantle the obstacles to achieving diversity in nursing academic leadership?

Revolutionizing the Nursing Curriculum.

There have long been challenges associated with integrating knowledge about diversity, disparities, and determinants into nursing curricula. Villarruel, Bigelow, and Alvarez describe these concepts as the three Ds about issues of disconnects and discrimination. These disconnects are evidenced by years of communicating the desire to reduce or eliminate disparities, without improvement in the education of future nurse professionals to prepare them to help achieve this goal. Over 10 years ago, Allen reviewed the literature on evidence to guide teaching on cross-cultural care and antiracism in nursing education, yet very little has changed. It is essential that academic nursing weaves health equity concepts throughout all programs, and establishes and maintains competency in and commitment to addressing health disparities, inequalities, and inequities. This article provides evidence of continued bias and racism, and suggestions for curricular change and student and educator training, in order to rebuild and solidify a nursing curriculum that is nonbiased and inclusive. The suggestions include a deeper look at the structures of the organization and the systemic culture, to ensure that racism is being combated as well.

Rewriting the Microaggression Narrative: Enhancing Nursing Students' Ability to Respond.

BACKGROUND: It is recognized that expanding the number of racial/ethnic minority nurses is key to addressing the challenges of health disparities. However, some schools of nursing have not typically experienced diversity. PROBLEM: Diverse nursing students experience increasingly high rates of exposure to microaggression, discrimination, and bias in the clinical and classroom settings. Providing nursing students with strategies to respond to microaggressions can reduce barriers to nursing education. APPROACH: An interactive workshop based on the Theater of the Oppressed performance technique was developed to increase students' ability to recognize/respond to microaggressions. OUTCOMES: Students (n = 97) completed a preworkshop-postworkshop evaluation. After participation, students indicated an improved ability to recognize microaggressions with intent to respond when they occur. CONCLUSIONS: Race was the most common microaggression addressed in the skits, followed by gender and ability. The interactive nature of the workshop allowed students to practice strategies to address microaggressions.

NICU Fathers: Improving the Quality of Paternal Support in the NICU.

BACKGROUND: Parental support in the neonatal intensive care unit (NICU) is critical; yet, the nursing staff may struggle to provide optimal support to NICU fathers. Generally, fathers are not viewed as equally competent caregivers when compared with mothers, and fathers often impart these beliefs on themselves. Increasing the nursing staff's knowledge and understanding of paternal support can change attitudes and foster positive behavior changes, enhancing the perception of support received by NICU fathers. PURPOSE: To implement a needs assessment and educational intervention for the nursing staff designed to increase the perception of nursing support received by NICU fathers. METHODS: The Nurse Parents Support Tool (NPST) was administered to the clinical nursing staff and fathers in a pre/posttest design comparing support given by nurses with the fathers' perception of received support. Data from the preintervention assessment was used to design an educational intervention on improving fathers' support. Following the intervention, a postintervention NPST was administered to fathers to determine whether there was an improvement in support perception. FINDINGS/RESULTS: Improvement in the NICU fathers' perception of nursing staff support was noted between father groups. In addition, the NPST can be used to assess paternal support needs and develop staff education. IMPLICATIONS FOR PRACTICE: Support provided to NICU fathers can enhance the father's perception of himself as an equal and competent caregiver, leading to improved father-infant bonding as the child ages. Educational interventions targeting father support should be a routine part of nursing staff training. IMPLICATIONS FOR RESEARCH: Future research should examine the long-term effects of early paternal support on psychosocial, cognitive, and developmental outcomes of NICU infants.

Neonatal Thermoregulation: A Golden Hour Protocol Update.

BACKGROUND: Premature infants are poor regulators of body temperature and are subjected to environmental factors that can lead to rapid heat loss, leaving them vulnerable to an increased risk of morbidity and mortality from hypothermia. Thermoregulation protocols have proven to increase survival in preterm infants. PURPOSE: To evaluate a Plan-Do-Study-Act (PDSA) cycle on a previously implemented Golden Hour protocol at a military medical care facility for infants born at less than 32 weeks of gestation and weighing less than1500 g. Specific aims included the use of increased delivery/operating room temperatures and proper use of thermoregulatory devices (polyethylene bags and thermal mattress). METHODS: Outcomes were analyzed and compared using a pre/postdesign. The data was collected using the neonatal intensive care unit admission worksheet. RESULTS: Although statistical analysis was not significant, clinical significance was illustrated by a decrease in hypothermia rates on admission and at 1 hour of life. There was a 100% compliance rate with increasing delivery room/operating room temperatures and thermal mattress use. Polyethylene bag use compliance was 50%. IMPLICATIONS FOR PRACTICE: Golden Hour protocols have proven to be an effective tool. Thermoregulation is a significant component of these protocols, and it is imperative that every step is taken to manage the environmental temperature during the birth and admission process. IMPLICATIONS FOR RESEARCH: There is a need for continued research on the impacts of thermoregulatory devices and protocols, with resulting practice and device recommendations.

40% Glucose Gel for the Treatment of Asymptomatic Neonatal Hypoglycemia.

BACKGROUND: The Mother Infant Care Center at Fort Belvoir Community Hospital (FBCH) recently revised its asymptotic neonatal hypoglycemia (ANH) protocol and adopted 40% glucose gel into its treatment pathway. The previous protocol used infant formula as the primary intervention. PURPOSE: To evaluate the effectiveness of 40% glucose gel on exclusive human milk diet rates, time on protocol, level II Special Care Nursery (SCN) admission rates, length of stay (LOS), and total hospital costs for newborns with ANH at FBCH. METHODS: Infants with ANH were treated with 40% glucose gel (n = 35) and compared with a historical group of infants with ANH (n = 29) who were treated with formula. RESULTS: Exclusive human milk diet rates increased by 33.6%. The mean time on protocol dropped by 1.13 hours. The SCN admission rates dropped by 2.4% in the postimplementation group. The mean LOS was more than 12 hours less in the postimplementation group. The mean total cost per patient was $1190.60 lower after implementation of 40% glucose gel. IMPLICATIONS FOR PRACTICE: The use of 40% glucose gel is a patient-focused, less-invasive, and cost-effective treatment of ANH. IMPLICATIONS FOR RESEARCH: More studies are needed to better define neonatal hypoglycemia. The use of 40% glucose gel is safe for use in infants with ANH; however, more studies are needed to examine its comprehensive benefits.

Looking backwards to move forward: Using a social mission lens in nursing education.

The ideals of health equity continue to be constrained by the conditions in which people live, learn and work. But to what extents are nursing schools strengthening the preparedness of nurses to extend their reach and help individuals and communities achieve their highest level of health? A culture of health and health equity is built on a framework of social mission. The authors believe that social mission is not new to the nursing profession. However, a clear understanding of the historical evolution of social mission as it relates to nursing education could provide a solid foundation for understanding the extent to which nursing curricula aligns with a commitment to advancing healthcare outcomes. This manuscript is a commentary that outlines the foundational understanding of the history of social mission in nursing education through the present time and amplifies that educators should consider how adopting a social mission lens could help schools more effectively align their curricula, policies and practices with health equity. Social mission refers to the school's commitment to advance health equity in everything it does from admissions and faculty hiring policies, to curriculum development, the extent of community based experiential learning, and, ultimately measured in their graduates' outcomes (Mullan, 2017). It is the authors' view that the rich history, the magnitude of the sector, and the current transformational conversations occurring in the nursing profession, all call for a deeper analysis and engagement of nursing leaders in this topic.

Creating a culture that values diversity and inclusion: An action-oriented framework for schools of nursing.

An organizational culture that values diversity and inclusion is essential for the achievement of high-quality nursing education, yet little literature exists to guide schools of nursing (SON) in accomplishing this goal. All SONs, regardless of size, need a framework that provides specific steps for developing and nurturing a culture that values diversity and inclusion. Using our SON as an exemplar, the goal of this article was to (a) review the barriers we faced when building a diverse and inclusive environment, (b) share our school's strategic plan designed to promote diversity and inclusion, and (c) highlight successful strategies as part of the development and ongoing implementation of our school's strategic plan. This process requires continuous commitment and intentionality as well as flexibility to address unforeseen circumstances. For example, the goals we have adopted and the strategies we have put in place have allowed members of our SON community to acknowledge and address the urgency and validity of the Black Lives Matter movement, as well as the disproportionate impact of the coronavirus disease 2019 pandemic on racial and ethnic minority groups. Although we recognize that we still have work to do within our SON community, we believe our exemplar offers an action-oriented framework for increasing diversity and inclusion among students, faculty, staff, and leadership in SONs.

Golden Hour Protocol for Preterm Infants: A Quality Improvement Project.

BACKGROUND: Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants. PURPOSE: To evaluate the effectiveness of a Golden Hour protocol for infants born at less than 32 weeks' gestation on improving the admission process in a military care facility. Specific aims focused on temperature, time to initiation of intravenous (IV) fluids, time to administration of antibiotics, and time to close of the incubator top. METHODS: A pre-/postdesign was used to compare outcomes from preimplementation to postimplementation. Predata were collected using electronic health record chart review and postdata were collected from the Neonatal Intensive Care Unit admission worksheet. RESULTS: Although we did not find statistical significance, we found that more infants had a temperature greater than 36.5°C within 1 hour of birth and decrease in time to initiation of IV fluids and antibiotics from preimplementation to postimplementation, which is clinically significant. Time to close of the incubator top remained greater than 1 hour. IMPLICATIONS FOR PRACTICE: Implementation of a Golden Hour protocol provides a guide to caring for preterm infants during the first hour of life to improve patient outcomes. Involvement of key stakeholders and staff education are key to successful implementation. IMPLICATIONS FOR RESEARCH: Researchers should examine long-term outcomes related to implementation of a Golden Hour protocol in future studies. Future quality improvement projects should include the effectiveness of similar protocols and address possible barriers.