Remote interviews in nurse practitioner programs: Addressing bias.

A diverse nursing workforce is key to addressing health disparities and moving the United States towards health equity. Building and sustaining a diverse nursing work force requires close attention to admissions, including interviews. Bias in nursing school interviews has been documented, particularly impacting applicants from historically excluded groups (especially racial and ethnic minorities). With the pivot to remote interviews due to Covid 19, faculty and schools now need to consider bias in remote interviews. This article describes the implementation and outcomes of a faculty training to identify and mitigate bias in remote interviews.

Mentoring and Support for Underrepresented Nursing Faculty: An Integrative Research Review.

BACKGROUND: Nursing faculty members may need several mentors to succeed in scholarly productivity, career development, work-life balance, and socialization in the academy. Underrepresented (UR) faculty report additional challenges to success. PURPOSE: The aim of this study was to search the literature for best practices in mentoring UR faculty. METHODS: An integrative review was conducted to identify best and evidence-based practices for mentoring UR faculty, including gender, sexual minority, race, ethnicity, and geographic remoteness (rural). Fifteen articles were rated on evidence and methodological quality. RESULTS: Successful mentorship programs include honest communication, including all stakeholders in forming a mentoring program, goals and activities that come from the mentees, and guaranteed resources. CONCLUSIONS: Underrepresented nursing faculty may benefit from formal mentoring programs, but more research is needed.

Teleprecepting: A timely approach to clinical education during COVID-19.

ABSTRACT: Clinical training is a key component of nurse practitioner (NP) education. The rapid shift to telehealth necessitated by the pandemic has also created a need for socially distanced education and precepting. This article presents teleprecepting as a modality for clinical opportunities and connecting students to previously limited experiences, such as training in small specialties, in rural areas, and with interdisciplinary teams. Precepting NP students using telehealth follows similar principles as in-person teaching, but some modifications and additional considerations are needed to transition to the virtual environment. At a time when many NPs have swiftly adapted to telehealth in practice, this article will offer a brief "how-to" for teleprecepting. Prior to COVID-19, teleprecepting was piloted with less than 2% of NP students in the school's pilot teleprecepting project. Seven months after the initial surge of cases and restrictions, 72% of students (n = 151) in the family nurse practitioner, psychiatric mental health nurse practitioner, and pediatric nurse practitioner specialties had transitioned to teleprecepting. This project was implemented rapidly during the pandemic, and thus, evaluations comparing competency outcomes and experiences of students and preceptors are still in process. Additionally, feasibility of this educational model may change as telehealth regulations continue to evolve. COVID-19 poses challenges for both patient care and clinical training of NP students across specialties. With some adaptation, clinical placements can be transitioned to the virtual environment of telehealth. Future studies should examine student competencies based on teleprecepting experiences and preceptor training to support teleprecepting roles.

Shared Medical Appointments: An Academic-Community Partnership to Improve Care Among Adults With Type 2 Diabetes in California Central Valley Region.

PURPOSE: The purpose of the study was to evaluate the effectiveness of ALDEA (Latinos con Diabetes en Acción), a Shared Medical Appointment (SMA) intervention, compared to usual primary care (UPC) for the treatment of adults with type 2 diabetes over a 6-month period. It was hypothesized that participants in the SMA will have greater reductions in A1C at 6 months post-intervention compared to the control group. METHODS: This study was a quasi-experimental design with a non-randomized matched control group that followed participants prospectively for 6 months. All adults living with type-2 diabetes receiving primary care at a 2 FQHC clinics were eligible for inclusion. Participants in the control group were matched retrospectively on baseline A1C and age. RESULTS: The reductions in A1C were greater in the ALDEA SMA intervention group relative to the UPC control group at 6 months in both of the FQHC centers and in the combined sample. CONCLUSIONS: This study demonstrated that patients in the ALDEA program had a significantly greater reduction in A1C at 6 months compared to the control group. Despite its limitations, the ALDEA SMA program was successful in empowering patients and improving glycemic control.

Transitioning from clinician to nurse practitioner clinical faculty: A systematic review.

BACKGROUND: Schools of nursing are challenged with recruiting and retaining nurse practitioner (NP) clinical faculty in a job market where the few qualified candidates have competing professional opportunities. The role transition from clinician to clinical faculty is stressful, and many faculty have unmet needs for support. OBJECTIVES: This article will identify strategies universities can implement to increase retention in the faculty role by facilitating the transition from clinician to NP clinical faculty. DATA SOURCES: Articles were identified from the following databases: PubMed, Embase, PsychInfo, CINAHL Plus, Web of Science, Google Scholar, and Cochrane Library. CONCLUSIONS: The transition from clinician to the NP role can be very difficult. New faculty experience culture shock and concerns about maintenance of clinical practice. Orientation, peer support, and mentoring can mitigate the challenges and support the transition. IMPLICATIONS FOR PRACTICE: Schools of nursing can facilitate the transition from clinician to NP clinical faculty by developing an onboarding program that integrates mentoring, orientation, and ongoing support.

Making the invisible visible: Implementing an implicit bias activity in nursing education.

BACKGROUND: Implicit bias (IB) is a pervasive phenomenon that negatively impacts health outcomes. IB is unconscious bias that operates at a level in which the individual is not aware of its existence. There is no requirement to include IB content in nursing education. PURPOSE: We sought to raise awareness of IB and its influence on health outcomes and support a discussion on ways to mitigate the impact of IB. METHODS: Through preparatory and interactive activities, students became familiar with IB and its effects on health outcomes, completed a self-assessment using the Implicit Association Test, and engaged in a faculty-facilitated discussion. This activity was implemented at four institutions in the United States and included 110 students at the BSN, MSN and DNP levels. RESULTS: The activity received positive evaluations. A majority of students reported the preparatory learning activities were helpful, increased awareness of their biases and felt recognition of their IB would be helpful in managing their nursing care. Student narratives are also described in this report. CONCLUSIONS: Inclusion of IB content in nursing education is acceptable to students and faculty. The content is best included at multiple points in the course of study.

Longitudinal profiling of human blood transcriptome in healthy and lupus pregnancy.

Systemic lupus erythematosus carries an increased risk of pregnancy complications, including preeclampsia and fetal adverse outcomes. To identify the underlying molecular mechanisms, we longitudinally profiled the blood transcriptome of 92 lupus patients and 43 healthy women during pregnancy and postpartum and performed multicolor flow cytometry in a subset of them. We also profiled 25 healthy women undergoing assisted reproductive technology to monitor transcriptional changes around embryo implantation. Sustained down-regulation of multiple immune signatures, including interferon and plasma cells, was observed during healthy pregnancy. These changes appeared early after embryo implantation and were mirrored in uncomplicated lupus pregnancies. Patients with preeclampsia displayed early up-regulation of neutrophil signatures that correlated with expansion of immature neutrophils. Lupus pregnancies with fetal complications carried the highest interferon and plasma cell signatures as well as activated CD4+ T cell counts. Thus, blood immunomonitoring reveals that both healthy and uncomplicated lupus pregnancies exhibit early and sustained transcriptional modulation of lupus-related signatures, and a lack thereof associates with adverse outcomes.

Use of Simulation to Increase Self-Directed Learning for Nurse Practitioner Students.

BACKGROUND: Interprofessional (IP) clinical training experiences for nurse practitioner (NP) students are on the rise. Faculty interaction with students during clinical rotations varies. Therefore, students must be prepared to use self-directed learning (SDL) to maximize learning. METHOD: Using an SDL framework, this project prepared NP students for working with IP preceptors. A didactic presentation provided students with content on a typical clinical trajectory and common pitfalls. Subsequently, an innovative simulation experience allowed students to apply information, negotiate learning objectives, and discuss their professional role with an actor playing a physician preceptor. RESULTS: Students prepared learning objectives to discuss with their preceptors. Students felt prepared to discuss their professional role and learning trajectory. Preceptors thought students were prepared for clinical rotations and ready to discuss their professional role and learning objectives. CONCLUSION: Innovative use of simulation increases NP students' ability to self-direct clinical experiences and better prepares them for working with IP preceptors. [J Nurs Educ. 2019;58(2):102-106.].

The one-minute preceptor model: A systematic review.

BACKGROUND AND PURPOSE: Teaching models provide a systemic framework for didactic and clinical teaching. The One-Minute Preceptor (OMP) is one teaching model, providing five microskills to organize a learning experience for students in the clinical environment. This review aims to integrate the literature on the OMP model by highlighting potential use for nurse practitioners while identifying directions for future research. METHODS: Electronic databases were searched from December 2017 to January 2018 for articles published in English. The databases included PubMed, CINAHL, and MEDLINE using terms including "preceptor," "clinical teaching," "time-efficient teaching," and "precepting." Of 32 articles in the final search, only 12 experimental quantitative studies were included in the synthesis and 20 descriptive studies in the discussion. CONCLUSIONS: The OMP model is supported by literature for its effectiveness as a teaching model and preference by students and preceptors. It has been shown to increase teaching techniques including feedback and assessment of students' clinical reasoning. IMPLICATIONS FOR PRACTICE: The OMP model has the potential to overcome clinicians' barriers to precepting nurse practitioner students. Future research may evaluate the use of this model specific to nurse practitioner preceptors and students, perceived time benefits in clinical teaching, overall improvement in clinical teaching, and use in interprofessional precepting.

A multidimensional blood stimulation assay reveals immune alterations underlying systemic juvenile idiopathic arthritis.

The etiology of sporadic human chronic inflammatory diseases remains mostly unknown. To fill this gap, we developed a strategy that simultaneously integrates blood leukocyte responses to innate stimuli at the transcriptional, cellular, and secreted protein levels. When applied to systemic juvenile idiopathic arthritis (sJIA), an autoinflammatory disease of unknown etiology, this approach identified gene sets associated with specific cytokine environments and activated leukocyte subsets. During disease remission and off treatment, sJIA patients displayed dysregulated responses to TLR4, TLR8, and TLR7 stimulation. Isolated sJIA monocytes underexpressed the IL-1 inhibitor aryl hydrocarbon receptor (AHR) at baseline and accumulated higher levels of intracellular IL-1ß after stimulation. Supporting the demonstration that AHR down-regulation skews monocytes toward macrophage differentiation, sJIA monocytes differentiated in vitro toward macrophages, away from the dendritic cell phenotype. This might contribute to the increased incidence of macrophage activation syndrome in these patients. Integrated analysis of high-dimensional data can thus unravel immune alterations predisposing to complex inflammatory diseases.