Leveraging an Academic Practice Partnership to Support a COVID-19 Mass Vaccination Clinic.

BACKGROUND: When the first coronavirus disease 2019 (COVID-19) vaccines received emergency use authorization by the U.S. Food and Drug Administration in December 2020, distribution of the vaccine began within 24 hours. METHOD: Nursing faculty leveraged a long-standing practice partnership with the academic health center (AHC) to lead an innovative effort mobilizing nursing and interprofessional student volunteers to support the COVID-19 mass vaccination program for AHC frontline health care staff, patients, and community members. RESULTS: Student vaccinators administered 98,000 vaccinations and contributed a significant service to the university health system by supporting the swift rollout of the vaccine program. The total number of volunteer vaccinator hours (11,820) resulted in an approximate cost savings of $768,300 to the AHC. CONCLUSION: During a global health crisis, nursing students and faculty demonstrated a strong commitment to the academic-practice partnership and improved access to COVID-19 vaccinations for residents of the health system's underserved communities. [J Nurs Educ. 2022;61(6):308-313.].

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic.

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.

Health Literacy Assessment of Detained Individuals and Correctional Officers Within a Large Urban Jail: Optimizing Health Education.

BACKGROUND: Little research has been done to address the health literacy level of detained individuals and correctional officers. PURPOSE: The aim of this pilot project was to describe the health literacy of individuals detained or working within a large urban jail to inform their health education. METHODS: Health literacy assessments were conducted using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) and the Newest Vital Sign (NVS) tools. RESULTS: Of the 48 participants, 17% (n = 8) exhibited low health literacy on the REALM-SF, whereas 38% (n = 18) demonstrated the need for improved health literacy when assessed with the NVS. Detained individuals from the women's tiers were more likely to have lower health literacy than the detained veterans or correctional officers. CONCLUSIONS: Results indicate that tailored health education programming, using evidence-based health literacy improvement techniques, should be offered to the individuals detained or working within a correctional facility.

Home Oxygen Therapy for Patients With COPD: Time for a Reboot.

Just over 100 years ago, John Scott Haldane published a seminal report about the therapeutic potential of supplemental oxygen to treat hypoxemia. In the 1980s, a pair of clinical trials confirmed the benefit of long-term oxygen therapy in improving survival in patients with COPD associated with severe resting hypoxemia. This review provides a summary of evidence supporting long-term and short-term oxygen therapy, as well as the various types of oxygen equipment commonly used in homes to deliver supplemental oxygen. Because the majority of orders for home oxygen occur at hospital discharge following acute illness, a typical conversation between a patient and their pulmonologist following a COPD exacerbation is presented. The SHERLOCK Consortium, a multi-stakeholder group established following the publication of the COPD National Action Plan in 2017 is also detailed. Interim results of the SHERLOCK Consortium, which suggest a chain of care involving 9 steps to ensure that patients are successfully initiated on home oxygen therapy during transitions from hospital to home, are presented. Recommendations to support evidence-based policies in this high-risk population are provided.

Facilitating faculty knowledge of DNP quality improvement projects: Key elements to promote strong practice partnerships.

Enrollment in Doctor of Nursing Practice (DNP) programs is growing rapidly. This poses a challenge to faculty because there is a gap in knowledge about evidence-based practice and quality improvement DNP projects. Challenged by the growing unavailability of preceptors and mentors in the practice setting, solutions are needed to help students meet the essentials of the degree and competencies for practice. Faculty knowledge of key DNP quality improvement project elements, measuring, monitoring, and sustaining improvement outcomes, may help students design projects to provide value to practice partners. A literature review was conducted to identify gaps in faculty knowledge of potential practice partners' value-added elements of DNP quality improvement projects (measuring, monitoring, and sustainability) to make recommendations for faculty development to improve DNP project mentoring. There is evidence in the literature that faculty feel ill-prepared to mentor DNP projects. Quality improvement content is available for faculty development in the nursing and other health sciences literature. Optimizing faculty knowledge regarding evidence-based practice, quality improvement processes, and mentoring of sustainable DNP projects that improve health care provides value to practice partners and may advance long-term partnerships. Adding structures to support faculty knowledge in these areas contributes to solutions to the challenges of rapidly expanding DNP programs.

Cluster Analysis in Nursing Research: An Introduction, Historical Perspective, and Future Directions.

The use of cluster analysis in the nursing literature is limited to the creation of classifications of homogeneous groups and the discovery of new relationships. As such, it is important to provide clarity regarding its use and potential. The purpose of this article is to provide an introduction to distance-based, partitioning-based, and model-based cluster analysis methods commonly utilized in the nursing literature, provide a brief historical overview on the use of cluster analysis in nursing literature, and provide suggestions for future research. An electronic search included three bibliographic databases, PubMed, CINAHL and Web of Science. Key terms were cluster analysis and nursing. The use of cluster analysis in the nursing literature is increasing and expanding. The increased use of cluster analysis in the nursing literature is positioning this statistical method to result in insights that have the potential to change clinical practice.

Mobilization of prolonged mechanical ventilation patients: An integrative review.

Mobilization of mechanical ventilation patients has broadened to include patients requiring prolonged mechanical ventilation (PMV). A previous systematic review outlined methodological flaws in the literature. The purpose of this integrative review is to evaluate existing publications to determine if mobilization interventions in PMV patients improve physical function, weaning rates, pulmonary mechanics, and hospital outcomes. An electronicsearch covering 2005-2016, included five bibliographic databases: CINHAL, PubMed, PEDro, EMBASE, and Web of Science. Key terms: PMV, mobilization, therapy, and rehabilitation. Eight research studies were identified; 3 RCT's, 3 medical records reviews, 1 prospective cohort, and 1 undefined prospective interventional. Improvements in functional status, shorter duration of mechanical ventilation and hospitalization, decreased mortality, and superior 1-year survival rates in mobilized PMV patients were reported. Persistent methodological limitations impair the ability to determine if these outcomes were the result of improvements in pulmonary mechanics, overall functional status, or a combination of both.

Effective management of ARDS.

Acute respiratory distress syndrome is a serious complication of critical illness that is associated with high morbidity and mortality. There are no effective treatment options, so prevention, early recognition, and appropriate supportive care are essential to improve outcomes. This article provides an overview of the disorder, including current treatment considerations.

Enhancing clinical decision making: development of a contiguous definition and conceptual framework.

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice.

Nurses' knowledge of inhaler technique in the inpatient hospital setting.

PURPOSE/OBJECTIVES: High rates of inhaler misuse in patients with chronic obstructive pulmonary disease and asthma contribute to hospital readmissions and increased healthcare cost. The purpose of this study was to examine inpatient staff nurses' self-perception of their knowledge of proper inhaler technique compared with demonstrated technique and frequency of providing patients with inhaler technique teaching during hospitalization and at discharge. DESIGN: A prospective, descriptive study. SETTING: A 495-bed urban academic medical center in the Midwest United States. SAMPLE: A convenience sample of 100 nurses working on inpatient medical units. METHODS: Participants completed a 5-item, 4-point Likert-scale survey evaluating self-perception of inhaler technique knowledge, frequency of providing patient education, and responsibility for providing education. Participants demonstrated inhaler technique to the investigators using both a metered dose inhaler (MDI) and Diskus device inhaler, and performance was measured via a validated checklist. FINDINGS: Overall misuse rates were high for both MDI and Diskus devices. There was poor correlation between perceived ability and investigator-measured performance of inhaler technique. Frequency of education during hospitalization and at discharge was related to measured level of performance for the Diskus device but not for the MDI. CONCLUSIONS: Nurses are a key component of patient education in the hospital; however, nursing staff lack adequate knowledge of inhaler technique. IMPLICATIONS: Identifying gaps in nursing knowledge regarding proper inhaler technique and patient education about proper inhaler technique is important to design interventions that may positively impact patient outcomes. Interventions could include one-on-one education, Web-based education, unit-based education, or hospital-wide competency-based education. All should include return demonstration of appropriate technique.

Implementation of an interprofessional educational model.

Despite literature that supports the benefits of interprofessional collaboration among healthcare practitioners, such as better patient outcomes and more efficient use of resources, many education programs continue to educate in silos, leading to a lack of awareness of the role of other disciplines. The nurse practitioner role, as example, requires positive collaboration with other healthcare providers, including physicians. The authors describe the development, implementation, and evaluation of an innovative interprofessional clinical educational model that was integrated into a nurse practitioner curriculum, as well as lessons learned during the first 2 years this program has been in place.

Autotaxin production of lysophosphatidic acid mediates allergic asthmatic inflammation.

RATIONALE: Bioactive lipid mediators, derived from membrane lipid precursors, are released into the airway and airspace where they bind high-affinity cognate receptors and may mediate asthma pathogenesis. Lysophosphatidic acid (LPA), a bioactive lipid mediator generated by the enzymatic activity of extracellular autotaxin (ATX), binds LPA receptors, resulting in an array of biological actions on cell proliferation, migration, survival, differentiation, and motility, and therefore could mediate asthma pathogenesis. OBJECTIVES: To define a role for the ATX-LPA pathway in human asthma pathogenesis and a murine model of allergic lung inflammation. METHODS: We investigated the profiles of LPA molecular species and the level of ATX exoenzyme in bronchoalveolar lavage fluids of human patients with asthma subjected to subsegmental bronchoprovocation with allergen. We interrogated the role of the ATX-LPA pathway in allergic lung inflammation using a murine allergic asthma model in ATX-LPA pathway-specific genetically modified mice. MEASUREMENTS AND MAIN RESULTS: Subsegmental bronchoprovocation with allergen in patients with mild asthma resulted in a remarkable increase in bronchoalveolar lavage fluid levels of LPA enriched in polyunsaturated 22:5 and 22:6 fatty acids in association with increased concentrations of ATX protein. Using a triple-allergen mouse asthma model, we showed that ATX-overexpressing transgenic mice had a more severe asthmatic phenotype, whereas blocking ATX activity and knockdown of the LPA2 receptor in mice produced a marked attenuation of Th2 cytokines and allergic lung inflammation. CONCLUSIONS: The ATX-LPA pathway plays a critical role in the pathogenesis of asthma. These preclinical data indicate that targeting the ATX-LPA pathway could be an effective antiasthma treatment strategy.

Implementing team-based learning in a nurse practitioner curriculum.

Team-based learning (TBL) is an innovative, learner-centered teaching strategy that promotes active learning. The authors describe their experience with implementing TBL in an adult-gerontology acute and primary care course for nurse practitioners as well as their evaluation of student outcomes.

Poor sleep, hazardous breathing: an overview of obstructive sleep apnea.

Obstructive sleep apnea is a chronic disorder resulting from upper airway collapse during sleep. It is linked to a variety of health and safety risks but can often be effectively treated. This article provides an overview of the disorder, including an evidence-based approach to diagnosis and management.

Online learning versus simulation for teaching principles of mechanical ventilation to nurse practitioner students.

Patient simulation is increasingly used in the education of healthcare providers, yet few studies have compared simulation to other teaching modalities. The purpose of this study was to determine differences in knowledge acquisition and student satisfaction between two methods of teaching the principles of mechanical ventilation to advanced practice nursing (APN) students: high-fidelity patient simulation (including face-to-face instruction) versus an online, narrated PowerPoint presentation. Twenty APN students were randomized to either the simulation or online teaching method in this pre/posttest study. Measures included a 12-item knowledge questionnaire and a 5-item satisfaction survey. Both groups had significant improvement in knowledge scores from pretest to posttest, but knowledge scores were not significantly different at posttest between groups. Student satisfaction with their learning method was significantly higher in the simulation group. Students choosing to participate in the alternative teaching method after study completion preferred the simulation to the online method.