External Scholarship Mentors for DNP-Prepared Faculty: A Practice-Oriented Exemplar.

BACKGROUND: Variability surrounding what practice scholarship should entail and how to incorporate into academic life exists among DNP-prepared faculty teaching across nursing programs. PROBLEM: DNP-prepared faculty entering an academic role are expected to maintain a clinical practice, teach/advise students, and fulfill service obligations, often leaving minimal time to build a program of scholarship. APPROACH: Building upon the archetype of external mentors for PhD researchers, we introduce a new model for external mentorship for DNP-prepared faculty to facilitate scholarship. OUTCOMES: In the first dyad to use this model, the mentor-mentee met/exceeded all contractual goals, including presentations, manuscripts, leadership behaviors, and role navigation within higher education. More external dyads are currently in development. CONCLUSIONS: Securing an external, seasoned mentor as a match for a junior member of the faculty in a yearlong partnership demonstrates promise for positive change in the scholarship trajectory of DNP-prepared faculty in higher education.

The experience of a new deanship for two Robert Wood Johnson Foundation executive nurse fellows.

With the graying of the professoriate, many deans in nursing are moving toward retirement, which provides an opportunity for emerging leaders to move into deanships. New deans move through predictable stages and enjoy a honeymoon, allowing for some mistakes that might not be tolerated later. Early wins are essential in addition to planned changes so as not to overwhelm faculty with change. It is critical to learn the new culture, identify leaders, perform a thorough assessment as the basis for a strategic plan, and be honest and transparent. The ability to mobilize a cohesive, functioning team is critical to success.

Innovative nursing educational curriculum for the 21st century.

The changing landscape of health care in America requires that clinicians be skilled in responding to varying patient expectations and values; provide ongoing patient management; deliver and coordinate care across teams, settings, and time frames; and support patients' endeavors to change behavior and lifestyle--education that is in short supply in today's academic and clinical settings (Institute of Medicine, 2003). Nursing education needs to innovate at the micro and macro system levels for the 21st century. It cannot be business as usual. In order to truly transform care, practice and education will need to partner on curriculum development and the professional socialization of the new nurse.

Nasogastric tube position and intragastric air collection in a neonatal intensive care population.

PURPOSE: For neonates receiving intensive care, nasogastric tube feeding is essential. Since nasogastric tube placement techniques are not well standardized and common verification methods can be unreliable, placement errors may lead to unsafe situations. In mechanically ventilated neonates and neonates on continuous positive airway pressure, malpositioning of the nasogastric tube may prevent excess air within the stomach to escape. In this study, we aimed to relate tube position to amount of air. The hypothesis was: the better the position of the tube, the smaller the amount of air in the stomach. SUBJECTS: A 1-year cohort of neonates in a level IIIc neonatal intensive care unit with a nasogastric tube. DESIGN AND METHODS: We retrospectively reviewed 326 radiographs and classified nasogastric tube position and gastric air. Descriptive statistics were used to describe demographic data. Kendal's tau statistic was applied to explore the relationship between nasogastric tube position and amount of gastric air. A Mann-Whitney U test was performed to confirm the differences in gastric air in neonates with Ch5 and Ch6 gastric tubes and neonates with Ch8 gastric tubes. RESULTS: One or both orifices of nasogastric tubes were in the esophagus in 7.1% of cases, tubes were curled up in the stomach in 35.3% of cases, and tube tips were beyond the pyloric sphincter in 5.5% of cases. Substantial or excessive air was found in 37.7% of cases. Kendal's tau value indicated that there was no significant correlation between nasogastric tube position and gastric air. The Mann-Whitney U value indicated that children with Ch5 and Ch6 gastric tubes had significantly more gastric air than children with Ch8 gastric tubes. CONCLUSION: Nasogastric tubes were malpositioned in nearly half of cases, and substantial or excessive air was found in more than one-third of cases. The hypothesis-the better the position of the tube, the smaller the amount of gastric air-was not confirmed by the data. However, a significant relationship was found between tube size and gastric air.

The nursing care of the infant receiving bubble CPAP therapy.

There are increasing numbers of low birth-weight and premature infants surviving with conditions such as chronic lung disease or bronchopulmonary dysplasia due to complications of assisted mechanical ventilation and other factors. Continuous positive airway pressure (CPAP) has been used as an alternative respiratory treatment to prevent and manage lung disease in preterm infants since the 1970s. Evidence has demonstrated the usefulness of CPAP in the delivery room, as a rescue therapy, as an extubation tool, and a method for managing apnea of prematurity. Bubble CPAP is a unique, simple, inexpensive way of providing continuous positive pressure to infants. Some background and training in the setup, care, and evaluation of the infant on bubble CPAP is essential for positive outcomes.

A pilot study of changes in cerebral blood flow velocity, resistance, and vital signs following a painful stimulus in the premature infant.

PURPOSE: The purpose of this pilot study was to determine the cerebral blood flow velocity and resistance changes and vital signs following a painful stimulus in the premature infant. SUBJECTS: A convenience sample of 12 infants was randomly assigned to one of 2 treatment groups. In the final analysis, there were 10 infants younger than 24 hours of age and between 25 and 32 weeks' gestational age. DESIGN: A randomized 2-period, 2-group, crossover design was used. METHODS: Cerebral blood flow velocity and resistance were measured via a Doppler head ultrasound transducer placed over the anterior fontanel. Vital signs were measured with a cardiorespiratory monitor. The infant then received the heel stick procedure or the sham procedure (heel preparation with no heel puncture). Each infant served as his or her own control. After each procedure, there was ultrasound and vital sign measurement at 15, 60, 120, 180, 240, and 300 seconds. Thereafter, the alternate treatment was used and 6 more measurements were taken. MAIN OUTCOME MEASURES: Cerebral values: peak systolic velocity (PSV) and resistive index (RI); vital signs: heart rate, respiratory rate, oxygen saturation (SpO2), and blood pressure. RESULTS: Treatment groups were similar at baseline except for gestational age. There were no carryover or period effects in the crossover design for the primary outcomes except for SpO2. There was a significant group effect (heel stick compared with sham) (P = .009) for peak systolic velocity; however, there were no significant differences between groups at each time point. Two subjects had a distinctive pattern based on simultaneous changes in flow and resistance: when flow velocity increased, resistance decreased. This may be reflective of risk for intraventricular hemorrhage (IVH). Mean arterial blood pressure (MAP) was not significant. However, heart rate was significantly different between stick and sham at 15 seconds (P = .022); respiratory rate was significant at 180 seconds (P = .029); and SpO2 was significant at 3 different time points. There were no significant correlations between PSV and mean arterial blood pressure and PSV and SpO2 when comparing stick to sham. CONCLUSIONS: This is a study based on a small sample size. However, the Doppler-measured peak systolic velocity increases significantly after a painful stimulus. The clinical implication of this finding needs to be established.

Infant massage as a component of developmental care: past, present, and future.

Infant massage has been practiced for centuries by segments on the continents of Africa and South America and in the Far East. Infant massage is a relatively new modality in North America. Numerous studies support its use in preterm infants, who have exhibited decreased stress levels, increased weight gain, and improved motor function when compared with non-massaged controls. Research has recently turned to the benefits of massage in the cocaine-exposed population and in those with human immunodeficiency virus. Massage in ill preterms has been targeted for clinical testing.