Enhancing Nurse Roles in Community Health (ENRICH): The Impact of a Primary Care-Based Undergraduate Nursing Fellowship.

BACKGROUND: Low numbers of new graduate nurses entering careers in primary care settings are insufficient to meet the demand of the current nursing shortage. The Enhancing Nurse Roles in Community Health (ENRICH) Fellowship is aimed at increasing undergraduate nursing students' exposure to population health concepts by providing opportunities to practice in primary care settings. PURPOSE: The purpose of this study was to implement and evaluate an undergraduate nursing fellowship program to enhance competency development in the primary care setting. METHODS: Fellows received targeted exposure to population health content and immersive primary care experiences through participation in 150 dedicated clinical hours in primary clinics, coupled with up to 250 hours of dedicated curriculum. RESULTS: Students who participated in the ENRICH Fellowship showed increased knowledge, improved perception of skills performance, and changed attitudes about population health and primary care nursing. CONCLUSION: Participation in a population health-based fellowship that includes targeted curricular content and primary care-based clinical experiences during an undergraduate nursing program improves knowledge, attitudes, and competency-based skills related to primary care and population health.

"Ditch the white coats": What LGBTQ+ patients prefer in their primary care provider.

BACKGROUND: Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population. PURPOSE: The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals. METHODOLOGY: In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results. RESULTS: Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: "Ditch the white coats"; "Meet me where I am"; "The relationship is key"; and "Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs." CONCLUSIONS: The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population. IMPLICATIONS: These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.

Corrigendum to The Professional Quality of Life and Work Engagement of Nurse Leaders [Nurse Leader 19 (2021) 95-100].

[This corrects the article DOI: 10.1016/j.mnl.2020.08.001.].

Incorporating climate change into Doctor of Nursing Practice curricula.

Climate change is a global crisis with major impacts on planetary health and quality of life. Nurses are well positioned to recognize the major health consequences of climate change on health. Therefore, highlighting nurses' active engagement in mitigating climate change impact and resilience efforts is essential. However, there is little evidence of climate change content in nursing curricula. Climate change/planetary health content could be integrated into existing Doctor of Nursing Practice programs so that graduates, as influential leaders, are equipped to meet the challenges ahead. The domains, competencies and sub-competencies outlined in the Essentials: Core competencies for professional nursing education (American Association of Colleges of Nursing (AACN), 2021) are proposed as a curricular scaffold to integrate climate change content in DNP curricula. Climate change content matched to the AACN domains and competencies could be included in many existing DNP courses. Climate change would become a consistent concept throughout all DNP curricular programs rather than a specified course addressing climate change. The curricular structure presented would provide a foundation for enhancing DNP students' knowledge, attitudes and skills related to climate change. These students and future graduates would be well prepared to introduce changes in practices and policies at the local, national, and global levels.

Effects of Postpartum Fatigue and Depressive Cognitions on Life Satisfaction and Quality of Life in Arab Postpartum Women: The Intervening Role of Resourcefulness.

The purpose of this study is to explore the relationships among postpartum fatigue (PPF), depressive cognitions, resourcefulness, quality of life, and life satisfaction in Arab postpartum mothers. A conceptual framework is used in this study based on the middle range theory of resourcefulness, which Zauszniewski developed in 2006. The study is a cross-sectional descriptive design with 123 postpartum women who had given birth within the past six months. used WhatsApp and Facebook for recruitment. developed the self-administered online survey in Qualtrics and collected data from 6 January 2017, to 6 February 2017. Correlation analysis is used to address the research aim and used the P value of 0.05 to determine the significance of the results. There were significant correlations among depressive cognitions and resourcefulness, life satisfaction, and quality of life; there were also significant correlations between PPF and life satisfaction, as well as among resourcefulness, quality of life, and life satisfaction. The results of this study emphasized the importance of assessing depressive symptoms and PPF in mothers early in the postpartum period. The results may contribute to designing future intervention studies aimed toward decreasing the risk of mothers with PPF developing more serious depressive symptoms.

Outcomes Associated With the Adjunctive Use of Dipeptidyl Peptidase-4 Inhibitors With Insulin Versus Other Antihyperglycemic Medications in Patients With Prediabetes or Diabetes After Cardiac Surgery.

BACKGROUND: Dipeptidyl peptidase-4 inhibitors (DPP-4i) plus basal insulin is noninferior to insulin monotherapy for glycemic control in medical-surgical patients, but data in postoperative cardiac surgery patients are sparse. OBJECTIVE: To compare glucose control in postoperative cardiac surgery patients with prediabetes or diabetes receiving a DPP-4i plus insulin versus other antihyperglycemic regimens. METHODS: We retrospectively identified patients with prediabetes or diabetes who underwent cardiac surgery at our hospital between May 2016 and June 2017. Included patients were stratified into cohorts: (1) DPP-4i plus insulin and (2) other antihyperglycemic regimens. Blood glucose levels were collected on postoperative days 2 to 7. Uncontrolled glucose (≥2 measurements <80 or >180 mg/dL in 1 day), hyperglycemia (>2 measurements ≥180 mg/dL in 1 day), and hypoglycemia (any measurement <70 mg/dL) were compared between cohorts using logistic regression adjusted for home antihyperglycemics. RESULTS: We included 135 cardiac surgery patients, of which 65 received DPP-4i plus insulin. Eighty-two patients received antihyperglycemics at home. Uncontrolled glucose occurred in 61 (45.2%) patients; while hyperglycemia and hypoglycemia occurred in 50 (37.0%) and 24 (17.8%) patients, respectively. There was no difference in the adjusted odds of uncontrolled glucose (odds ratio [OR] = 1.43; 95% confidence interval [CI] = 0.65-3.11), hyperglycemia (OR = 1.20; 95% CI = 0.52-2.78), or hypoglycemia (OR = 0.69; 95% CI = 0.27-1.75) for those receiving DPP-4i plus insulin versus other regimens. CONCLUSION: Glucose control was no different among postoperative cardiac surgery patients receiving a DPP-4i plus insulin versus other regimens. DPP-4i use was not associated with hypoglycemia.

The Professional Quality of Life and Work Engagement of Nurse Leaders.

Even before the current pandemic, the nurse leader (NL) role was demanding of time, energy, and resources. These demands often cause stress, fatigue, and burnout. The focused-on outcome metrics, increased regulations, and economic downturn are challenges that NLs have continued to face. This study, undertaken before the pandemic, provides understanding of the professional quality of life and work engagement among NLs. Findings revealed that experienced NLs with doctorates have higher levels of compassion satisfaction and engagement, and have lowest levels of burnout and secondary traumatic stress. Minimizing compassion fatigue among NLs is imperative as they foster organizational cultures of compassion and engagement. Future research post-pandemic is recommended, especially as the demands have increased significantly.

The Role of Skin-to-Skin Contact and Breastfeeding on Atonic Postpartum Hemorrhage.

Objectives: were to (a) determine incidence of postpartum hemorrhage (PPH) in all women delivering between 2009 and 2015, and (b) determine the amount of Estimated Blood Loss (EBL) and duration of the third stage of labor in each subgroup for women with or without PPH, and (c) compare EBL and duration of 3rd stage of labor between subgroups in groups of women with or without PPH. Design: A retrospective chart review conducted using codes for atonic PPH. Setting: Records from a University based tertiary setting, 264 charts were reviewed and data from 154 charts were analyzed. One-way ANOVAs followed with post-hocs and a 2-way ANOVA were conducted. Results: PPH rate increased by 47.50% from 2009-2015. For women with PPH, EBL was lower in skin to skin contact (SSC) + Breastfeeding (BF) subgroup. For women without PPH, EBL was lower in SSC only subgroup. Third stage of labor duration was longer in women with PPH. Conclusions: Study confirmed the increasing trends of PPH due to uterine atony and proposed role of SSC and BF in decreasing EBL and shorten the duration of the 3rd stage of labor for PPH women, usefulness of SSC and BF as physiologic practices merit further study.

Nursing Student Perceptions of Faculty Advising.

AIM: The aim of the study was to determine student perceptions of faculty advising and the most effective method of faculty advising. BACKGROUND: The nursing faculty advisor is important in facilitating the timely completion of the program. Faculty members have initiated synchronous electronic methods of advising to facilitate advising. METHOD: A descriptive study was conducted with a convenience sample of members of a student nurses' association. The Faculty Advisor Evaluation Questionnaire was used for data collection via online survey. RESULTS: With 106 respondents, results demonstrated high levels of student-perceived effectiveness of the advising session, advocacy/accountability, faculty advisor knowledge, and availability. The majority of nursing students reported that face-to-face advising (58.5 percent, n = 62) was the most helpful method. CONCLUSION: This study is one of the first to examine nursing students' perceptions of faculty advising. As nursing faculty implement online methods of advising, it is important to evaluate the evidence.

Staff Nurses' Perceptions of Their Nurse Managers' Transformational Leadership Behaviors and Their Own Structural Empowerment.

OBJECTIVE: The aim of this study was to investigate staff nurses' perception of their nurse managers' transformational leadership behaviors and their own structural empowerment. BACKGROUND: Transformational leadership behaviors in nurse managers have been linked to increased staff nurse satisfaction and decreased turnover and burnout. Perception of nurse managers' leadership behaviors by staff nurses and the relationship to the staff nurses' structural empowerment is important to advance our understanding of the leadership role of nurse managers. METHODS: A descriptive correlational design was used to examine the relationship between staff nurses' perception of their nurse managers' transformational leadership behaviors and their own structural empowerment. Staff nurses at a conference were offered an opportunity to participate in the study. RESULTS: The transformational leadership behaviors of nurse managers were moderately correlated to staff nurses' structural empowerment. Transactional leadership behaviors were associated with staff nurses' structural empowerment to a lesser degree. CONCLUSION: Nurses who perceived their nurse managers as demonstrating transformational leadership behaviors experienced higher structural empowerment.

Transformational Leadership Practices and Work Engagement Among Nurse Leaders.

OBJECTIVE: The aim of this study was to develop better understanding of the leadership characteristics of clinical nurse leaders. BACKGROUND: Transformational leaders are the essential to support nursing in taking control of patient and family care coordination. One prior study of leadership and work engagement among clinical nurse leaders was identified. METHODS: This descriptive correlational study explored the relationship between transformational leadership practices and work engagement among nurse leaders in the United States. Sample consisted of clinical nursing leaders attending the 2016 Magnet® Conference. RESULTS: A significant positive relationship was identified between leadership practices and work engagement. Differences were noted in areas of select leadership practices and work engagement among nurse leaders based on different levels of education. Nurse leaders underperform in inspiring a shared vision, support for innovation, and taking risks, while also showing relatively weak levels of engagement in areas of vigor and absorption. CONCLUSION: There is a need for additional research to better understand the characteristics of clinical nurse leaders to promote the principles of transformational leadership.

Throat Swabs and Sputum Culture as Predictors of P. aeruginosa or S. aureus Lung Colonization in Adult Cystic Fibrosis Patients.

BACKGROUND: Due to frequent infections in cystic fibrosis (CF) patients, repeated respiratory cultures are obtained to inform treatment. When patients are unable to expectorate sputum, clinicians obtain throat swabs as a surrogate for lower respiratory cultures. There is no clear data in adult subjects demonstrating the adequacy of throat swabs as a surrogate for sputum or BAL. Our study was designed to determine the utility of throat swabs in identifying lung colonization with common organisms in adults with CF. METHODS: Adult CF subjects (n = 20) underwent bronchoscopy with BAL. Prior to bronchoscopy, a throat swab was obtained. A sputum sample was obtained from subjects who were able to spontaneously expectorate. All samples were sent for standard microbiology culture. RESULTS: Using BAL as the gold standard, we found the positive predictive value for Pseudomonas aeruginosa to be 100% in both sputum and throat swab compared to BAL. However, the negative predictive value for P. aeruginosa was 60% and 50% in sputum and throat swab, respectively. Conversely, the positive predictive value for Staphylococcus aureus was 57% in sputum and only 41% in throat swab and the negative predictive value of S. aureus was 100% in sputum and throat swab compared to BAL. CONCLUSIONS: Our data show that positive sputum and throat culture findings of P. aeruginosa reflect results found on BAL fluid analysis, suggesting these are reasonable surrogates to determine lung colonization with P. aeruginosa. However, sputum and throat culture findings of S. aureus do not appear to reflect S. aureus colonization of the lung.

Mental health nursing workforce under pressure as numbers slump.

The number of mental health nurses in England has fallen, leaving the remaining nursing workforce to 'bear the brunt' of increasing pressures, the RCN has warned.

Emotional Intelligence and Transformational Leadership in Nurse Managers.

OBJECTIVE: This study describes the relationship between emotional intelligence (EI) and transformational leadership (TL) in nurse managers (NMs). BACKGROUND: Effective NM leadership is important as they have direct influence over RN performance and patient outcomes. Research has demonstrated that a TL style generates greater commitment from followers than other leadership styles. EI is 1 potential characteristic of TL. METHODS: A descriptive exploratory research study was conducted to correlate EI and TL practices of NMs. RESULTS: EI was significantly positively correlated with TL and outcome measures of extra-effort, effectiveness, and satisfaction and significantly negatively correlated with laissez-faire leadership. A positive relationship was found between TL and NMs with advanced education and administrative certification. CONCLUSION: Nursing administrators should consider EI characteristics when hiring NMs and lead efforts to advance education to align with organization needs for business and strategic essentials necessary for NM effectiveness.

Serum Iron Level Is Associated with Time to Antibiotics in Cystic Fibrosis.

BACKGROUND: Serum levels of hepcidin-25, a peptide hormone that reduces blood iron content, are elevated when patients with cystic fibrosis (CF) develop pulmonary exacerbation (PEx). Because hepcidin-25 is unavailable as a clinical laboratory test, we questioned whether a one-time serum iron level was associated with the subsequent number of days until PEx, as defined by the need to receive systemic antibiotics (ABX) for health deterioration. METHODS: Clinical, biochemical, and microbiological parameters were simultaneously checked in 54 adults with CF. Charts were reviewed to determine when they first experienced a PEx after these parameters were assessed. Time to ABX was compared in subgroups with and without specific attributes. Multivariate linear regression was used to identify parameters that significantly explained variation in time to ABX. RESULTS: In univariate analyses, time to ABX was significantly shorter in subjects with Aspergillus-positive sputum cultures and CF-related diabetes. Multivariate linear regression models demonstrated that shorter time to ABX was associated with younger age, lower serum iron level, and Aspergillus sputum culture positivity. CONCLUSIONS: Serum iron, age, and Aspergillus sputum culture positivity are factors associated with shorter time to subsequent PEx in CF adults.