Incorporating Omics and Precision Health in a Nursing PhD Program: The Perspectives of Student Nurse Scientists.

ABSTRACT: To engage in innovative and novel precision health and omics research, nurse scientists need to be knowledgeable about the genetic, behavioral, and environmental factors that impact health outcomes. This article illustrates the benefits of a nursing omics PhD curriculum at a state university. The purpose is to provide students' perspectives and research interests that were inspired by the omics and precision health curriculum. Exposing these early-career PhD nursing student scientists to omics and precision health engaged them to think broadly about the potential to generate original nurse-led research.

Educating Certified Nursing Assistants to Communicate Skin Changes to Reduce Pressure Injuries.

Pressure injuries (PIs) are common and costly complications in long-term care (LTC) residents. Educating and coaching certified nursing assistants (CNAs) to communicate early skin changes is a PI surveillance strategy that may influence PI outcomes. A communication guide related to Skin, Clean, Activity, and Nutrition was developed for CNAs to promote prompt upstream communication to licensed nurses. A pre-/post-intervention design measured PI knowledge and skills in 24 CNAs, and PI incidence was tracked over a 6-week time period. CNAs demonstrated improvement in their PI surveillance role, comfort in identifying and reporting skin changes, keeping skin clean and dry, and resident nutritional status. Baseline PI incidence of 9.6% decreased to 0% by Week 3, and no new PIs occurred over 6 weeks. CNAs developed role awareness and knowledge in primary PI surveillance and were instrumental in a team approach to decrease PIs in a LTC setting. [Journal of Gerontological Nursing, 47(8), 21-28.].

Potential role for age as a modulator of oral nitrate reductase activity.

Reduction of salivary nitrate to nitrite by oral nitrate reductase (NR) expressing bacteria has emerged as an integral pathway in regulating nitric oxide (NO) homeostasis and signaling. The oral microbiome is critical for this pathway. Variations in this pathway may underlie variable responses in the magnitude by which dietary or therapeutic nitrate modulates NO-signaling. The relationships between oral microbes and NR activity, and the factors that affect this relationship remain unclear however. Using a cross-sectional study design, the objective of this study was to determine the relationships between oral microbes and oral NR activity using a protocol that directly measures initial NR activity. Tongue swabs were collected from 28 subjects ranging in age from 21 to 73y. Initial NR activity showed a bell-shaped dependence with age, with activity peaking at ~40-50y and being lower but similar between younger (20-30y) and older (51-73) individuals. Microbiome relative abundance and diversity analyses, using 16s sequencing, demonstrated differences across age and identified both NR expressing and non-expressing bacteria in modulating initial NR activity. Finally, initial NR activity was measured in 3mo and 13mo old C57BL/6J mice. No differences in bacterial number were observed. However initial NR activity was significantly (80%) lower in 13mo old mice. Collectively, these data suggest that age is a variable in NR activity and may modulate responsiveness to dietary nitrate.

Promoting and Protecting the Gastrointestinal Newborn Microbiome Through Breastfeeding Practices.

Since newborns are a vulnerable population that cannot protect their own microbiome, healthcare professionals can promote, advocate, and assist with breastfeeding promotion to protect the healthy development of the newborn gastrointestinal microbiome. The newborn gastrointestinal microbiome is a dynamic community of bacteria that influence health. Breastfeeding seeds and feeds the newborn gastrointestinal microbiome. A disruption in the balance of the gastrointestinal microbiome can result in adverse health outcomes. This clinical article makes an evidence-based connection between breastfeeding and the establishment of the newborn gastrointestinal microbiome through breastfeeding promotion strategies during the childbearing year. Suggestions for healthcare profession education and future research that will continue to inform the understanding of healthy development of the microbiome will be provided. By assisting with breastfeeding promotion, healthcare professionals can protect the newborn gastrointestinal microbiome and promote overall newborn, infant, and child health.

Is the Newborn Microbiome Disrupted by Routine Newborn Suctioning? An Exploratory Approach for Policy Development.

An invasive procedure commonly used in the perinatal setting is newborn suctioning at birth. Routine newborn suctioning, without indication, is not recommended by the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council for the newborn with spontaneous respirations, adequate crying, and good muscle tone. Whether to suction a newborn is a difficult practice decision made daily by the perinatal nurse. A primary element of this practice decision is the consideration that newborn suctioning has the potential to affect health outcomes. Furthermore, routine newborn suctioning may be disrupting the newborn microbiome by removing commensal bacteria and potentially, negatively affecting newborn health. This article will explore the connection between the practice of routine newborn suctioning in the perinatal setting and the potential to disrupt the newborn microbiome. The methods employed and reported in this article consisted of review of literature and review of clinical guidelines and a descriptive study to determine the scope of practice of newborn suctioning. The premise of whether the practice of routine newborn suctioning at birth may be disrupting the newborn microbiome will also be considered. Finally, developing a microbiome-centric perspective will be explored.

Implementation of an Evidence-Based Oral Care Protocol to Improve the Delivery of Mouth Care in Nursing Home Residents.

The current project assessed the oral health of residents in a long-term care (LTC) facility, implemented a new evidence-based oral care protocol, and trained nursing staff about oral hygiene for older adults. A pre-/post-intervention design was used to measure knowledge, skills, and attitudes among 29 staff members. The oral health outcomes of 10 LTC residents without dysphagia were assessed after 14 days of protocol use. Knowledge improved from a mean total pre-test score of 88.8 to a mean total post-test score of 97.7 (Z = -2.308, p = 0.021). The Oral Health Assessment Tool measured oral health outcomes at three time points in 10 older adults, and statistically significant improvement in oral health was identified (p = 0.001). Nursing home staff play an important role in improving oral hygiene of older adults in LTC facilities by routinely using an easy to follow oral health protocol twice daily. [Journal of Gerontological Nursing, 46(5), 33-39.].

Applying the Public Health Exposome Model to Improve Kidney Disease Outcomes for Patients and Populations.

The genome is insufficient for understanding chronic health conditions, such as kidney disease. Only a small portion of chronic disease incidence can be attributed to genetic causes, and the field of exposomics provides an opportunity to explore the impact of environmental exposures on kidney disease. The environment plays a significant role in lifestyle choices and the stressors or exposures the body encounters throughout life. Exposures influence genetic expression, thereby impacting health and wellbeing of individuals exposed. Stressors or exposures are common experiences that may lend to understanding health disparities in vulnerable populations because environments are shared among families, neighborhoods, and communities. The Public Health Exposome Model examines the interplay among individuals, their personal attributes, environments, stressors/exposures, moderating factors, and individual and population health outcomes. Applying this model to kidney disease, nephrology nurses can lead community-based efforts to uncover ways to improve health outcomes for individuals with kidney disease and reduce incidence risk for future generations, thereby improving population health outcomes.

EBP Design and Translation: Teaching How to Begin a Scholarly Practice Project.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Microbial profile and characterization of blue bulb manual suction devices used to promote airway clearance in newborns in intrapartum and postpartum units.

BACKGROUND: Newborns are suctioned with a blue bulb manual suction device to remove naso-oropharyngeal secretions and promote airway clearance. This study identifies and discusses the microbial profile and characterization of the bulb used in newborns on intrapartum and postpartum units. METHODS: This was a descriptive study with convenience sampling of a total of 50 bulbs used in cesarean births, vaginal births, and on the postpartum unit. The bulbs were tested for microbial growth, and the percentages of contaminated bulbs were calculated. The χ2 test was used to compare the proportion of bulbs with microbial growth by route of birth among bulbs sampled from the intrapartum unit. RESULTS: Microbial profile and characterization identified a total of 57 different gram-positive cocci and rods and gram-negative rods. Among 50 bulbs cultured, bacterial growth was present in 42% of the bulbs, and Escherichia coli was identified in 55% of the gram-negative rod isolates. The χ2 test comparing vaginal and cesarean bulbs showed a statistically significant difference in the percentages of contaminated bulbs for any growth (P = .023) and for any Staphylococcus spp (P = .050). CONCLUSIONS: New empirical evidence confirms the bulb is a potential bacterial reservoir and poses a potential health risk for nosocomial infections for newborns. Further studies are needed to identify bacterial transmission, newborn outcomes, bactericidal bulb cleaning methods, and quality and safe suction practices.

A regional consortium for doctor of nursing practice education: Integrating improvement science into the curriculum.

The DNP curriculum prepares the graduate for evidence informed improvement translation through coursework integrating improvement, safety, and translation sciences. Innovative leadership skills are necessary to lead inter-professional unit-based and health system opportunities. Equipping the DNP with the necessary skills and competencies to accomplish any type of improvement translation requires exposure to the tools and techniques of these sciences with an emphasis in didactic content. With a foundational knowledge of the principles for improvement, translation and application will follow. It is imperative theoretical underpinnings of translational science are taught, and that the students be expected to apply these concepts in "real word" circumstances. Thus, the DNP student is afforded opportunities during their DNP program to participate in a "learning lab" for evidence informed improvement translation. In essence, the courses within the program are designed to allow conversion from theory into practice.

A new model in teaching undergraduate research: A collaborative approach and learning cooperatives.

Forming new, innovative collaborative approaches and cooperative learning methods between universities and hospitals maximize learning for undergraduate nursing students in a research course and provide professional development for nurses on the unit. The purpose of this Collaborative Approach and Learning Cooperatives (CALC) Model is to foster working relations between faculty and hospital administrators, maximize small group learning of undergraduate nursing students, and promote onsite knowledge of evidence based care for unit nurses. A quality improvement study using the CALC Model was implemented in an undergraduate nursing research course at a southern university. Hospital administrators provided a list of clinical concerns based on national performance outcome measures. Undergraduate junior nursing student teams chose a clinical question, gathered evidence from the literature, synthesized results, demonstrated practice application, and developed practice recommendations. The student teams developed posters, which were evaluated by hospital administrators. The administrators selected several posters to display on hospital units for continuing education opportunity. This CALC Model is a systematic, calculated approach and an economically feasible plan to maximize personnel and financial resources to optimize collaboration and cooperative learning. Universities and hospital administrators, nurses, and students benefit from working together and learning from each other.

Subglottic secretion volume and viscosity: effect of systemic volume and oral hydration.

OBJECTIVES: Removal of secretions from the subglottic space, which is the larynx cavity below the glottis that contains the vocal cords, reduces the risk for ventilator associated pneumonia. Relationships between factors associated with subglottic secretion volume and viscosity have not been investigated. Subglottic secretions may have a possible link with systemic volume status and oral cavity hydration. The purpose of this study was to examine the relationships among systemic volume, oral cavity hydration, and subglottic secretion (SS) volume and viscosity in mechanically ventilated adults. DESIGN: Seventy daily oral and SS samples were obtained over a 24-hour collection period from 15 mechanically ventilated adults. Markers of systemic volume and oral cavity hydration and measurements of SS volume and viscosity were collected and analyzed. RESULTS: The daily volume of oral secretions ranged from 0 to 1.0 mL (SD 0.180 mL), and SS ranged from 0 to 15 mL (SD 22.9 mL). BUN/creatinine ratio (marker of systemic volume status) was moderately correlated with oral secretion volume (r = -0.43). Weak correlations were identified between SS volume and oral volume (r = 0.29) and SS viscosity and oral viscosity (r = 0.22). No other linear relationships were identified among the variables. CONCLUSIONS: This study confirmed that SS accumulation occurs, the amount varies widely, and the secretions are highly viscous. SS volume and viscosity were not found to have a very strong relationship with the variables measured. Nevertheless, clinical implications for practice are present. Further research is needed to understand secretion dynamics in ventilated adults to prevent complications and promote positive patient outcomes.

Subglottic secretion viscosity and evacuation efficiency.

Ventilator-associated pneumonia (VAP) is a common nosocomial pneumonia that occurs in critically ill patients and results in mortality rates as high as 71%. Subglottic secretions (SSs) are a known risk factor. Several clinical trials have shown that continuous aspiration of subglottic secretions (CASS) reduces the risk of VAP by nearly half. Optimal suction pressure levels needed to efficiently evacuate viscous SSs are unknown. The purpose of this study was to describe SSs and the effective suction pressure (20 mmHg, 30 mmHg, 40 mmHg, and 50 mmHg) needed to maximize evacuation efficiency based on SS volume (2 ml, 4 ml, and 6 ml) and viscosity (watery, thick, and gel-like). A laboratory model was designed to replicate a human trachea. Thick secretions had the highest percentage of mean recovery representative of evacuation efficiency of SSs (mean recovery of 86%). The suction pressure of 30 mmHg had the highest overall mean of secretion recovery (83%) across all viscosity types and amounts. This study demonstrated that higher viscosity secretions were easier to evacuate than lower viscosity secretions when 30-mmHg suction pressure was applied. Management of secretion viscosity may assist in secretion removal and delay VAP development. With increased understanding of the molecular structure of SSs, there is the potential that clinicians will be able to manipulate secretion viscoelastic properties to maximize evacuation efficiency of the secretions. Further research is needed to identify safe suction pressures for optimal evacuation of SSs in human subjects.

Results of a national survey indicating information technology skills needed by nurses at time of entry into the work force.

A national survey was conducted to determine the information technology skills nurse administrators consider critical for new nurses entering the work force. The sample consisted of 2,000 randomly selected members of the American Organization of Nurse Executives. Seven hundred fifty-two usable questionnaires were returned, for a response rate of 38%. The questionnaire used a 5-point Likert scale and consisted of 17 items that assessed various technology skills and demographic information. The questionnaire was developed and pilot tested with content experts to establish content validity. Descriptive analysis of the data revealed that using e-mail effectively, operating basic Windows applications, and searching databases were critical information technology skills. The most critical information technology skill involved knowing nursing-specific software, such as bedside charting and computer-activated medication dispensers. To effectively prepare nursing students with technology skills needed at the time of entry into practice, nursing faculty need to incorporate information technology skills into undergraduate nursing curricula.

Physiologic factors contributing to a transition in oral immunity among mechanically ventilated adults.

Ventilator-associated pneumonia (VAP), a specific type of nosocomial pneumonia, occurs in approximately 21% of patients in intensive care, and the mortality can be as high as 71%. VAP causes considerable mortality and morbidity, and it exponentially increases health care costs. The incidence of VAP is associated with oropharyngeal colonization of gram-negative bacteria. Within 48 h of hospital admission, the composition of the oropharyngeal flora of critically ill patients undergoes a change from the usual gram-positive streptococci and dental pathogens to a predominant gram-negative flora that includes more virulent organisms, which predispose patients to VAP. Identification and understanding of this oral transition from gram-positive to predominantly gram-negative flora may assist health care professionals in differentiating among oral immune markers that suggest compromised immunity. The purpose of this article is to provide a review of the literature that promotes an understanding of current knowledge about the transition of oral immunity in mechanically ventilated patients.

Benchmarking mechanical ventilation services in teaching hospitals.

The purpose of this investigation was to examine the technical efficiency of mechanical ventilation nonsurgery (DRG 475) among University Hospital Consortium (UHC) hospitals that consists of volunteer, teaching hospitals across the nation. The data for this study was retrieved from the 1997 UHC database that includes charge and discharge information for 69 hospitals. Data on 7961 patients classified with mechanical ventilation were aggregated to the hospital level. We retained data from a total of 62 hospitals, the other seven hospitals had missing data. The research questions were (1) Do UHC hospitals differ significantly in their efficiencies in the treatment of mechanically ventilated patients? (2) What inputs and outputs contribute most to the inefficiencies associated with mechanical ventilation? Of the 62 hospitals analyzed using data envelopment analysis technique, 10 were considered efficient and 52 were inefficient as compared to their benchmark peers. Efficient and inefficient hospitals did significantly differ between the transferred output variable and between the respiratory, laboratory, and radiology input variables. All inputs demonstrated excessive resource utilization among inefficient hospitals as compared to efficient hospitals. A total reduction of about $19 million dollars in ancillary services would need to occur for inefficient hospitals to approach the frontier of efficient hospitals. This study demonstrates that mechanical ventilation is costly, yet the specified ancillary services are capable of being reduced yielding technical efficiency as demonstrated by 10 efficient hospitals.