Evidence-Based Practice Implementation: Dependent on Capacity and Capabilities.

OBJECTIVE: This study was conducted to determine the benefits, facilitators, and barriers of implementing evidence-based practice (EBP) into organizational culture. BACKGROUND: Implementing EBP leads to higher quality of patient outcome care, improved patient outcomes, and decreased healthcare costs. Nurse leader (NL) influence is essential for successful EBP implementation. METHODS: Data were collected using a descriptive qualitative approach with focus group interviews using 2 open-ended questions. Participants included NL attendees at the 2022 Association of California Nurse Leaders Annual Program/Conference. Data were analyzed and themes were identified using Sandelowski's method. RESULTS: Two overarching themes emerged: capacity (the amount something can produce) and capabilities (the power or ability to do something). CONCLUSIONS: Healthcare organizations need to invest in building NLs' capacity to implement EBP and allocate resources to strengthen the organization's capabilities in supporting EBP.

Characterizing the Gut Microbial Communities of Native and Invasive Freshwater Bivalves after Long-Term Sample Preservation.

Freshwater mussels are important indicators of the overall health of their environment but have suffered declines that have been attributed to factors such as habitat degradation, a loss of fish hosts, climate change, and excessive nutrient inputs. The loss of mussel biodiversity can negatively impact freshwater ecosystems such that understanding the mussel's gut microbiome has been identified as a priority topic for developing conservation strategies. In this study, we determine whether ethanol-stored specimens of freshwater mussels can yield representative information about their gut microbiomes such that changes in the microbiome through time could potentially be determined from museum mussel collections. A short-term preservation experiment using the invasive clam Corbicula fluminea was used to validate the use of ethanol as a method for storing the bivalve microbiome, and the gut microbiomes of nine native mussel species that had been preserved in ethanol for between 2 and 9 years were assessed. We show that ethanol preservation is a valid storage method for bivalve specimens in terms of maintaining an effective sequencing depth and the richness of their gut bacterial assemblages and provide further insight into the gut microbiomes of the invasive clam C. fluminea and nine species of native mussels. From this, we identify a "core" genus of bacteria (Romboutsia) that is potentially common to all freshwater bivalve species studied. These findings support the potential use of ethanol-preserved museum specimens to examine patterns in the gut microbiomes of freshwater mussels over long periods.

Concurrent enrollment pathway: A model for ADN-BSN programs.

INTRODUCTION: The purpose of this article is to share the collaborative planning and execution of these two public universities and one community college in developing an innovative program to increase BSN-prepared nurses. The aim of the collaboration is to offer a high quality, affordable, and time-saving pre-licensure, concurrent enrollment program (CEP) which allows community college ADN students direct access to BSN study, while maintaining excellent program outcomes, and increasing diverse baccalaureate-prepared nurses in practice. METHODS: Key stakeholders in two public educational systems met to discuss the development of a regional collaboration between two state universities and one local community college. The group designed university-specific, concurrent curricular roadmaps for each university. Students admitted in ADN program chose if they want to attend a concurrent enrollment or a traditional plan of study. RESULTS: In Fall 2019, the CEP program was launched admitting 40 ADN students concurrently enrolled in one university. Subsequently, another cohort started in Spring 2020 with 39 students dually enrolled at the other state university. All students in both cohorts resided in the region. Over 75 % of the total CEP enrollees came from diverse backgrounds, 49 % Hispanics, 16 %, Asians, and 8 % African Americans and 4 % native Hawaiians. Forty-four percent were first generation college students. The average age was 25 with a range of 21-39. Twenty percent of the students were male which is above the national average of 12 %. After four semesters, students completed their ADN degree, passed the licensure exam, and transitioned to earn their BSN degree in the university for another two semesters. CONCLUSION: The literature reveals that BSN-prepared nurses contribute to safe patient care. The current number of cost-effective and accessible nursing programs are not sufficient to reach the IOM 80/20 goal, which contributes to the ongoing shortage of BSN-prepared nurses in the nation, including California. Creativity and open collaboration of nurse leaders, faculty, and staff across different levels of education was instrumental in the success of the students and the program.

Inside Looking Out: Updated Competency Model for Professional Rehabilitation Nursing Practice.

BACKGROUND: The original Association of Rehabilitation Nurses (ARN) Competency Model for Professional Rehabilitation Nursing published in 2016, and updated in 2020, provides a framework for rehabilitation nursing practice. AIM: This companion, but stand-alone, article to a 2022 publication further explicates and informs the updated Competency Model from inside looking out toward an increasing application for evidence-based practice (EBP). APPROACH: An eight-member 2020 ARN Task Force used an iterative process to review the original four domains and related competencies and came to consensus for the updated model. OUTCOME: This model provides revised competency role descriptors or behaviors that guide nurses practicing at different proficiency levels in various settings. CLINICAL RELEVANCE: The Competency Model for Professional Rehabilitation Nursing is a premier resource that can advance professional rehabilitation nursing and guide EBP, including evaluation, quality improvement, and research. The model describes the nurse's role on the intra/interprofessional team and fosters collaboration with other healthcare professionals to enhance the quality of life for those affected by disability and chronic illness. CONCLUSION: The domains and associated competencies of this model clarify nursing roles at different proficiency levels, and role descriptors reflect current practice, supporting advancement of the specialty practice of rehabilitation nursing well into the 21st century.

Environment and Co-occurring Native Mussel Species, but Not Host Genetics, Impact the Microbiome of a Freshwater Invasive Species (Corbicula fluminea).

The Asian clam Corbicula fluminea (Family: Cyneridae) has aggressively invaded freshwater habitats worldwide, resulting in dramatic ecological changes and declines of native bivalves such as freshwater mussels (Family: Unionidae), one of the most imperiled faunal groups. Despite increases in our knowledge of invasive C. fluminea biology, little is known of how intrinsic and extrinsic factors, including co-occurring native species, influence its microbiome. We investigated the gut bacterial microbiome across genetically differentiated populations of C. fluminea in the Tennessee and Mobile River Basins in the Southeastern United States and compared them to those of six co-occurring species of native freshwater mussels. The gut microbiome of C. fluminea was diverse, differed with environmental conditions and varied spatially among rivers, but was unrelated to host genetic variation. Microbial source tracking suggested that the gut microbiome of C. fluminea may be influenced by the presence of co-occurring native mussels. Inferred functions from 16S rRNA gene data using PICRUST2 predicted a high prevalence and diversity of degradation functions in the C. fluminea microbiome, especially the degradation of carbohydrates and aromatic compounds. Such modularity and functional diversity of the microbiome of C. fluminea may be an asset, allowing to acclimate to an extensive range of nutritional sources in invaded habitats, which could play a vital role in its invasive success.

Evaluating Methods of Preserving Aquatic Invertebrates for Microbiome Analysis.

Research on the microbiomes of animals has increased substantially within the past decades. More recently, microbial analyses of aquatic invertebrates have become of increased interest. The storage method used while collecting aquatic invertebrates has not been standardized throughout the scientific community, and the effects of common storage methods on the microbial composition of the organism is unknown. Using crayfish and dragonfly nymphs collected from a natural pond and crayfish maintained in an aquarium, the effects of two common storage methods, preserving in 95% ethanol and freezing at -20 °C, on the invertebrate bacterial microbiome was evaluated. We found that the bacterial community was conserved for two sample types (gut and exoskeleton) of field-collected crayfish stored either in ethanol or frozen, as was the gut microbiome of aquarium crayfish. However, there were significant differences between the bacterial communities found on the exoskeleton of aquarium crayfish stored in ethanol compared to those that were frozen. Dragonfly nymphs showed significant differences in gut microbial composition between species, but the microbiome was conserved between storage methods. These results demonstrate that preserving field-collected specimens of aquatic invertebrates in 95% ethanol is likely to be a simple and effective sample preservation method for subsequent gut microbiome analysis but is less reliable for the external microbiome.

The influence of social determinants of education on nursing student persistence and professional values.

BACKGROUND: Schools of Nursing are challenged to increase student diversification as there continues to be documented college achievement gaps in students who come from under-resourced, low socioeconomic communities with difficult environmental constraints and lifestyle issues. PURPOSE: The purpose of this 3-year study was to test a social determinants of education (SDE) model with 400 diverse nursing students. METHOD: The SDE framework was analyzed using structural equation modeling (SEM)) to estimate the influence of background social determinants, emotional intelligence and lifestyle on students' ability to integrate into collegiate academic and social support systems and to persist to graduation with professional values. Qualitative analysis was completed on student input on support. RESULTS: Social determinants student lifestyles and emotional intelligence explained over 26% of the variance of academic integration, and academic integration explained over 19% of the variance of the student outcome of persistence. 11% of professional values was accounted for by the combination of parent education, social support, lifestyle and emotional intelligence, academic integration, and persistence. Qualitative analyses also supported the SDE Framework with themes that included life balance, academic relationships and communication, and career. CONCLUSION: The SDE Framework offers faculty and administrators with targeted factors to consider when assessing and providing resources to enable students to achieve their maximal capacity to succeed in college and in their careers.

Updated Competency Model for Professional Rehabilitation Nursing: Practice Applications.

BACKGROUND: The Competency Model for Professional Rehabilitation Nursing is a lens through which nurses can view their practice; the four domains provide a template that guides that practice. PURPOSE: The aim of this study was to describe a task force's review procedures and share the updated model. APPRAISAL PROCESS: A rehabilitation nursing task force appraised the model over the course of 1 year. REVISION OUTCOMES: The original four domains remain, with wording changes for content and clarity throughout. Notable changes include (1) new competency for Domain 1 that focuses on the understanding of the worldview of individuals who are culturally different and (2) case stories for each domain related to nurses' proficiency (beginner, intermediate, and expert). CLINICAL RELEVANCE: This updated model can be used to explicate the rehabilitation nurses' role on intra/interprofessional teams, as well as provide a framework for education and staff orientation/performance evaluation. CONCLUSION: This competency model reflects the current practice and advances of the specialty practice of rehabilitation nursing.

Long-Wave Infrared Imaging for Intraoperative Cancer Detection-What is the True Temperature of a Cancer?

BACKGROUND: During cancer operations, the cancer itself is often hard to delineate-buried beneath healthy tissue and lacking discernable differences from the surrounding healthy organ. Long-wave infrared, or thermal, imaging poses a unique solution to this problem, allowing for the real-time label-free visualization of temperature deviations within the depth of tissues. The current study evaluated this technology for intraoperative cancer detection. METHODS: In this diagnostic study, patients with gastrointestinal, hepatobiliary, and renal cancers underwent long-wave infrared imaging of the malignancy during routine operations. RESULTS: It was found that 74% were clearly identifiable as hypothermic anomalies. The average temperature difference was 2.4°C (range 0.7 to 5.0) relative to the surrounding tissue. Cancers as deep as 3.3 cm from the surgical surface were visualized. Yet, 79% of the images had clinically relevant false positive signals [median 3 per image (range 0 to 10)] establishing an accuracy of 47%. Analysis suggests that the degree of temperature difference was primarily determined by features within the cancer and not peritumoral changes in the surrounding tissue. CONCLUSION: These findings provide important information on the unexpected hypothermal properties of intra-abdominal cancers, directions for future use of intraoperative long-wave infrared imaging, and new knowledge about the in vivo thermal energy expenditure of cancers and peritumoral tissue.

Nursing's Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community.

Facilitating successful care transitions across settings is a key nursing competency. Although we have achieved improvements in acute stroke care, similar advances in stroke care transitions in the postacute and return to community phases have lagged far behind. In the current delivery system, care transitions are often ineffective and inefficient resulting in unmet needs and high rates of unnecessary complications and avoidable hospital readmissions. Nurses must use evidence-based approaches to prepare stroke survivors and their family caregivers for postdischarge self-management, rehabilitation, and recovery. The purpose of this article is to provide evidence on the important nursing roles in stroke care and transition management across the care continuum, discuss cross-setting issues in stroke care, and provide recommendations to leverage nursing's impact in optimizing outcomes for stroke survivors and their family unit across the continuum. To optimize nursing's influence in facilitating safe, effective, and efficient care transitions for stroke survivors and their family caregivers across the continuum we have the following recommendations (1) establish a system of coordinated and seamless comprehensive stroke care across the continuum and into the community; (2) implement a stroke nurse liaison role that provides consultant case management for the episode of care across all settings/services for improved consistency, communication and follow-up care; (3) implement a validated caregiver assessment tool to systematically assess gaps in caregiver preparedness and develop a tailored caregiver/family care plan that can be implemented to improve caregiver preparedness; (4) use evidence-based teaching and communication methods to optimize stroke survivor/caregiver learning; and (5) use technology to advance stroke nursing care. Nurses must leverage their substantial influence over the health care delivery system to achieve these improvements in stroke care delivery to improve the health and lives of stroke survivors and their families.

A Patient-Centric Tool to Facilitate Goal Attainment Scaling in Neurogenic Bladder and Bowel Dysfunction: Path to Individualization.

OBJECTIVES: People with neurogenic bladder and/or bowel dysfunction experience diverse challenges that can be difficult to evaluate with standardized outcome measures. Goal attainment scaling (GAS) is an individualized, patient-centric outcome measure that enables patients/caregivers to identify and track their own treatment goals. Because creating goals de novo can be cumbersome, we aimed to develop a neurogenic bladder/bowel dysfunction goal menu to facilitate goal attainment scaling uptake and use. METHODS: We conducted a workshop with 6 expert clinicians to develop an initial menu. Individual interviews with 12 people living with neurogenic bladder and/or bowel dysfunction and 2 clinician panels with 5 additional experts aided us in refining the menu. A thematic framework analysis identified emergent themes for analysis and reporting. RESULTS: Interview participants were adults (median = 36 years, range 25-58), most with spinal cord injury (75%; 9/12). Of 24 goals identified initially, 2 (8%) were not endorsed and were removed, and 3 goals were added. Most participants listed "Impact on Life" goals (eg, Exercise, Emotional Well-Being) among their 5 most important goals (58%; 35/60). Three main themes emerged: challenges posed by incontinence, limitations on everyday life, and need for personalized care. CONCLUSIONS: We developed a clinical outcome assessment tool following a multistep process of representative stakeholder engagement. This patient-centric tool consists of 25 goals specific to people living with neurogenic bladder and/or bowel dysfunction. Asking people what matters most to them can identify important constructs that clinicians might have overlooked.

Nursing workforce diversity: Promising educational practices.

BACKGROUND: Nursing workforce diversity is a national priority for providing culturally competent care and contributing to improved health equity. While nurses from underrepresented populations are increasing in the nursing workforce, the distribution of nurses in the United States is still not representative of the population. PURPOSE: The purpose of this paper is to describe the current state of workforce diversity in Western states and identify promising practices from programs located in Arizona, California, Colorado, and Oregon that are focused on improving nursing workforce diversity. METHODS: Four innovative programs to address nursing workforce diversity are presented. Each project has unique situations and approaches to improving admission, retention, and graduation of students underrepresented in nursing. Similar approaches each project used include holistic admission review, academic and student support, financial support, and mentoring. CONCLUSIONS: These projects contribute to knowledge development related to improving nursing workforce diversity for other colleges, universities, and states to consider. Improving nursing workforce diversity is a priority issue that could lead, through collective impact, to resolving health inequities nationally.

Two novel risk factors for postoperative venous thromboembolism: A reconsideration of standard risk assessment and prophylaxis.

BACKGROUND: Postoperative venous thromboembolism (VTE) is usually preventable with adequate prophylaxis. In an institutional study, patients with emergency operations (EO), multiple operations (MO), and perioperative sepsis (PS) were more likely to develop VTE despite standard prophylaxis. METHODS: General surgery patients in the NSQIP database from 2011 to 2014 were stratified into VTE and non-VTE groups, and statistical analyses were performed. RESULTS: Among 1,610,086 patients, 13,673 (0.8%) were diagnosed with VTE. The VTE odds ratios for patients with EO, MO and PS were 1.4 (95%CI:1.3-1.5), 1.9 (95%CI:1.7-2.0), and 2.4 (95%CI:2.2-2.5), respectively. VTE odds ratios increased with concurrence of two factors (EO+PS: 2.0 (95%CI:1.9-2.2)) (EO+MO: 2.3 (95%CI:1.9-2.7)) (MO+PS: 2.5 (95%CI:2.2-2.7)) and further still for patients with all three factors (2.7, 95%CI:2.4-3.0). CONCLUSION: General surgery patients with EO, MO, or PS have a greater likelihood of developing postoperative VTE. These factors are not necessarily captured in contemporary risk assessment models that guide chemoprophylaxis, and so these high-risk patients may receive insufficient prophylaxis.

The Competency Model for Professional Rehabilitation Nursing.

BACKGROUND: Rehabilitation nursing is practiced in various settings along the healthcare continuum. No framework is noted in the literature that defines the necessary competencies of the rehabilitation nurse. PURPOSE: To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical and educational practice. METHOD/DESIGN: A seven-member Association of Rehabilitation Nurses (ARN) task force was convened; conducted a literature review, reviewed current and historical ARN documents, including the Strategic Plan, and developed a Competency Model for Professional Rehabilitation Nursing practice. FINDINGS: The Competency Model for Professional Rehabilitation Nursing delineates four domains of rehabilitation nursing practice and essential role competencies. CONCLUSION: The Competency Model for Professional Rehabilitation Nursing addresses this diverse specialty practice in the current healthcare arena. This framework can be used to guide nurses practicing at different levels of proficiency in various settings. CLINICAL RELEVANCE: The Competency Model can be used as a structure for staff orientation, evaluation tools, clinical ladder components, role descriptions and rehabilitation nursing courses.

Stroke and heart disease prevention education via telenovela: a focus group's evaluation.

PURPOSE: To evaluate a telenovela, "La Familia Nutritiva y Balanceada," for cultural context and its efficacy as an educational tool to promote positive health behaviors in Latino families. METHOD: Ethnography was employed to interpret cultural health behaviors of 12 Latinas through a focus group after viewing the telenovela, a culturally accepted form of entertainment education. RESULTS: Analysis of the transcribed interview revealed three recurrent themes: Not all fat is bad; add fruits and vegetables daily to diet; and children need to be involved. The group purported that the inclusion of children in the marketing and preparation of the food would translate into better food habits. DISCUSSION: Participants demonstrated basic knowledge between food and health, and acknowledged that they gained an appreciation for good fat in the diet. The group related the telenovela would be a good tool for clinics, health fairs, and schools. CONCLUSION: Latinos are at high risk for cardiovascular disease and stroke. Health education messages need to incorporate cultural norms into an intervention that supports a behavior change, such as improved nutrition. Studies support that Latinos connect to media, such as telenovela and interpersonal communication, which make these appropriate choices for health education tools.

Factors influencing the participation of middle-aged and older Latin-American women in physical activity: a stroke-prevention behavior.

Despite the known benefits of regular physical activity for preventing stroke and cardiovascular disease, middle-aged and older Latin-American women continue to be physically inactive and demonstrate a high incidence of obesity. Ethnographic methodology was used to explore factors that influenced this health behavior in 25 Latin-American women. Perceptions of health, the health activities in which they engaged, and the factors that influenced their participation in physical activity comprised the three categories of responses. Facilitators and barriers were identified as the two primary categories and were further sorted into intrinsic or extrinsic factors. Conclusions of this study were that these Latin American women, despite multiple role demands and other barriers, participated in some form of physical activity; however, culturally sensitive strategies are needed to promote sustained physical activity in this population.