Impact of a Professional Development Course for Doctoral Nurses and Students on Genomic Conceptual Knowledge and Competencies.

BACKGROUND: Universally, nurses' limited educational opportunities to expand their genomic literacy may have implications on patient care management, research, and training. PURPOSE: To evaluate the impact of a self-paced online course on genomic knowledge and competency acquisition in a sample of nurses possessing a doctoral degree and doctoral students. METHODS: Pre- and postcourse data were collected using the "Genomic Nursing Concept Inventory" (GNCI) (N = 129) and a self-report survey based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (N = 131). RESULTS: GNCI scores in all 4 topical categories and in 9 of the 16 domains significantly improved. All Genetic Competency scores significantly improved. Significant correlations were observed between Genetic Competency self-ratings and GNCI scores precourse and change of scores. CONCLUSIONS: The positive outcomes should encourage the development of more accessible educational opportunities for nurses and other healthcare professionals to improve genomic literacy and competency.

COVID-19 contagious health care personnel 5-day early return-to-work program.

BACKGROUND: COVID-19 contagious health care personnel (HCP) who are self-isolating for a 10-day period increases burden to workforce shortages. Implementation of a 5-day early return-to-work (RTW) program may reduce self-isolation periods, without increasing transmission risk, during the COVID-19 pandemic. DESIGN AND METHODS: This observational cohort quality improvement study included newly diagnosed COVID-19 HCP at a multifacility health care system. The program allowed HCP to return to work 6 days after date of a positive test result if they were not immunocompromised, had mild and improving symptoms, and self-reported a SARS-CoV-2 antigen negative test on day 5. RESULTS: Between January 4 and April 3, 2022, 1,023 HCP self-enrolled and 344 (33.6%) self-reported negative test results. Among these, 161 (46.8%) self-reported negative test results on day 5 and were eligible for early RTW on day 6. A total of 714 days were saved from missed work in self-isolation. The number of tests purchased, dispensed, and reported per day of HCP time saved was 4.4. No transmission events were observed originating from HCP who participated in early RTW. CONCLUSION: Implementing a 5-day early RTW program that includes HCP self-reporting SARS-CoV-2 antigen test results can increase staffing availability, while maintaining a low risk of SARS-CoV-2 transmission.

Mindfulness Self-Compassion: Helping Family Caregivers Cope with Cognitive Behaviors of Dementia.

Purpose: To test the feasibility of recruiting dementia family caregivers to participate in the holistic intervention of mindfulness self-compassion (MSC) to decrease perceived distress. There are few studies focused on MSC for dementia caregivers. Design: An interdisciplinary approach (nursing and psychology) and uncontrolled experimental design tested a holistic intervention Mindfulness Self Compassion (MSC) as a coping strategy using the Stress Process framework. Findings: Twenty-four caregivers participated. Dementia caregivers' use of positive reappraisal increased with a mean difference of 2.53 (t = 2.10; SD = 5.23) (p = .049) indicating that family caregivers may have increased their use of positive reappraisal. MSC sessions impacted the caregivers ways of coping with increases in accepting responsibility [model: F(4, 13) 3.18, p-value 0.0499, R-sq = 49.5%, estimate: B = 1.11, t = 2.64, p-value = 0.02)] and impacted caregivers' ways of coping using distancing [model: F(4, 13) 1.47, p-value 0.2682, R-sq = 31.1%, estimate: B = 1.63, t = 2.19, p-value = 0.05)]. Conclusion: Satisfaction with MSC was high among caregivers. At the study's conclusion, caregivers appraised their caregiving non-judgmentally and reduced their negative thoughts of difficult situations. MSC as a holistic practice has the potential to shift caregivers' focus to positive appraisals and promote caregiver wellbeing.

Healthcare personnel early return-to-work program after higher-risk SARS-CoV-2 exposure: A learning health system quality improvement project.

BACKGROUND: Incidence of health care personnel (HCP) with a higher-risk SARS-CoV-2 exposure and subsequent 14-day quarantine period adds substantial burden on the workforce. Implementation of an early return-to-work (RTW) program may reduce quarantine periods for asymptomatic HCP and reduce workforce shortages during the COVID-19 pandemic. METHODS: This observational quality improvement study included asymptomatic HCP of a multi-facility health care system with higher-risk workplace or non-household community SARS-CoV-2 exposure ≤4 days. The program allowed HCP to return to work 8 days after exposure if they remained asymptomatic through day 7 with day 5-7 SARS-CoV-2 nucleic acid amplification test result negative. RESULTS: Between January 4 and June 25, 2021, 384 HCP were enrolled, 333 (86.7%) remained asymptomatic and of these, 323 (97%) tested negative and were early RTW eligible. Mean days in quarantine was 8.16 (SD 2.40). Median day of early RTW was 8 (range 6-9, IQR 8-8). Mean days saved from missed work was 1.84 (SD 0.52). A total of 297 (92%) HCP did RTW ≤10 days from exposure and days saved from missed work was 546.48. CONCLUSIONS: Implementing an HCP early RTW program is a clinical approach for COVID-19 workplace safety that can increase staffing availability, while maintaining a low risk of SARS-CoV-2 transmission.

Management of Cystoid Macular Edema After Vitrectomy for Proliferative Vitreoretinopathy.

BACKGROUND AND OBJECTIVE: To assess therapies for cystoid macular edema (CME) following pars plana vitrectomy for proliferative vitreoretinopathy (PVR). PATIENTS AND METHODS: Retrospective analysis of 42 eyes developing CME after PVR surgery. Treatments included topical therapy, sub-Tenon's triamcinolone acetonide (STTA), intravitreal bevacizumab and combinations thereof. Best-corrected visual acuity (BCVA) as well as central subfield thickness (CST) were tracked. RESULTS: Mean Snellen BCVA improved from 20/598 to 20/297 (logMAR change -0.21; confidence interval [CI], -0.39 to -0.03; P = .03). Mean CST improved from 448 µm to 260 µm (CI, -248.70 to -126.06; P < 0.01). There was no difference in efficacy between treatment subgroups (analysis of variance, P = 0.16, 0.43), but STTA yielded statistically significant improvement in both categories (CI, -0.79 to -0.11; P = 0.01; and CI, -333.74 to 166.51; P < .01). CONCLUSIONS: Treatment of CME following PVR surgery is possible with a variety of different options. STTA appears to yield anatomical and visual improvement. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:436-443.].

Using Evidence-Based Best Practices of Simulation, Checklists, Deliberate Practice, and Debriefing to Develop and Improve a Regional Anesthesia Training Course.

The 2011 Institute of Medicine report on the future of nursing recommended that nurses practice to the full extent of their education and training. Nurse anesthetists in certain regions of the country have been unable to maintain regional anesthesia skills because of anesthesia practice models. Factors including increased patient loads, economic motivators, and desire to maintain skill sets are driving evolution of the anesthesia practice model. In many practices, Certified Registered Nurse Anesthetists (CRNAs) now have the opportunity to expand their practice scope to include regional anesthesia. This has created the need for a pathway to rapidly develop or augment skills for CRNAs who have not been performing regional anesthesia. Well-designed and facilitated simulation methods can be effective for teaching and evaluating clinical skills with incorporation of rigorous assessment instruments to ensure consistency in training outcomes. The purpose of this quality improvement project was to determine the effectiveness of a blended-learning regional anesthesia training curriculum on improving CRNA knowledge, skill, and attitude in regional anesthesia administration as part of a clinical credentialing pathway. Forty-nine CRNAs completed all course components, including meeting all skill training thresholds through deliberate practice and use of validated checklists. Knowledge and confidence levels demonstrated significant gains.

Implementation of Acceleromyography to Increase Use of Quantitative Neuromuscular Blockade Monitoring: A Quality Improvement Project.

Residual neuromuscular blockade creates excess perioperative morbidity. Quantitative neuromuscular monitoring devices may help ensure full recovery from neuromuscular blocking agents and have been demonstrated to reduce complications associated with residual neuromuscular blockade. We studied the effectiveness of educational efforts to introduce quantitative monitoring at a large academic medical center, with predefined main outcome measures of self-reported familiarity with use of the device and actual device uptake. Anonymous surveys of knowledge, skills, and attitudes toward the devices were administered before and after the education effort. Monitor use rates were quantitatively assessed through data entry into the electronic medical record. Before-and-after results were compared by run charts, unpaired t tests (correcting for multiple comparisons), and examination of 99% confidence intervals. Users agreed that residual blockade was an important topic before and after education, and reported improvement in their ability to use the devices after education. Clinical utilization of the monitors increased from 23% to 40% of eligible cases, with the increased rate sustained in the follow-up period. Education, assessed as improved self-reported proficiency, was associated with measurable increases in utilization of new technology. However, the rate of uptake, even when applied to a problem the users agreed was important, was modest.

Development of an Online, Evidence-Based CRNA Preceptor Training Tutorial (CPiTT): A Quality Improvement Project.

Preceptorship is an effective teaching and learning model that is the mainstay of undergraduate and graduate clinical education. It has a well-documented history in healthcare literature dating back to 1946. Certified Registered Nurse Anesthetists (CRNAs) who serve as clinical preceptors have the critical job of transferring high-quality patient care and patient safety skills to the student registered nurse anesthetists (SRNAs) they precept. The education of CRNAs in best precepting practices has the potential to enhance this transfer. However, most CRNAs do not receive formal instruction in how to precept SRNAs, which has the potential to limit the CRNA preceptors' effectiveness in this critical educational role. This article describes the iterative development and evaluation of an online, evidence-based CRNA Preceptor Training Tutorial (CPiTT). Four evidence-based precepting modules were developed through expert educators' input and literature review. Feedback from CRNAs (n = 24) and SRNAs (n = 20) in a facilitated evaluation session refined the content. Additional surveys of both CRNAs (n = 97) and SRNAs (n = 36) established current local precepting practices, with gap analysis identifying areas of deficiency, which were incorporated into the learning modules. The final educational program was launched via an online learning management system.

Structured dietary intervention to facilitate weight loss after bariatric surgery: A randomized, controlled pilot study.

OBJECTIVE: To evaluate the potential utility of a structured dietary intervention to assist bariatric surgery patients with weight management. METHODS: Participants who underwent Roux-en-Y gastric bypass surgery 1 year previously were randomly assigned to a structured dietary intervention incorporating portion-controlled foods (intervention, n = 20) or a comparison group (control, n = 20). Both groups received instruction in behavioral weight loss (one 60-min session) followed by four monthly coaching telephone calls. Assessments were conducted at baseline, 4 months (post-intervention), and 6 months. RESULTS: Participants were 85% female and 80% White. Average age was 46.9 (11.1) years, and body mass index was 31.3 (5.4) kg/m(2) at enrollment. Percent weight change from enrollment was significantly greater for intervention compared with control participants at 4 months [-4.56% vs. -0.13%, t(30) = -3.29, P = 0.003] and 6 months [-4.07% vs. -0.14%, t(31) = -2.03, P = 0.05]. Change in average daily calorie intake was greater among intervention compared with control [-108 vs. 116, t(30) = -2.01, P = 0.05] at 4 months only. CONCLUSIONS: A structured dietary intervention increased weight loss and reduced calorie intake when initiated 1 year following Roux-en-Y gastric bypass. This approach holds promise for optimizing postsurgery lifestyle change.