A blueprint for genomic nursing science.

PURPOSE: This article reports on recommendations arising from an invitational workshop series held at the National Institutes of Health for the purposes of identifying critical genomics problems important to the health of the public that can be addressed through nursing science. The overall purpose of the Genomic Nursing State of the Science Initiative is to establish a nursing research blueprint based on gaps in the evidence and expert evaluation of the current state of the science and through public comment. ORGANIZING CONSTRUCTS: A Genomic Nursing State of the Science Advisory Panel was convened in 2012 to develop the nursing research blueprint. The Advisory Panel, which met via two webinars and two in-person meetings, considered existing evidence from evidence reviews, testimony from key stakeholder groups, presentations from experts in research synthesis, and public comment. FINDINGS: The genomic nursing science blueprint arising from the Genomic Nursing State of Science Advisory Panel focuses on biologic plausibility studies as well as interventions likely to improve a variety of outcomes (e.g., clinical, economic, environmental). It also includes all care settings and diverse populations. The focus is on (a) the client, defined as person, family, community, or population; (b) the context, targeting informatics support systems, capacity building, education, and environmental influences; and (c) cross-cutting themes. It was agreed that building capacity to measure the impact of nursing actions on costs, quality, and outcomes of patient care is a strategic and scientific priority if findings are to be synthesized and aggregated to inform practice and policy. CONCLUSIONS: The genomic nursing science blueprint provides the framework for furthering genomic nursing science to improve health outcomes. This blueprint is an independent recommendation of the Advisory Panel with input from the public and is not a policy statement of the National Institutes of Health or the federal government. CLINICAL RELEVANCE: This genomic nursing science blueprint targets research to build the evidence base to inform integration of genomics into nursing practice and regulation (such as nursing licensure requirements, institutional accreditation, and academic nursing school accreditation).

Missed nursing care: a concept analysis.

AIM: This paper is a report of the analysis of the concept of missed nursing care. BACKGROUND: According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention. METHOD: An 8-step method of concept analysis - select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents - was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008. FINDINGS: Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided. CONCLUSION: Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope.

Navigating the perfect storm: balancing a culture of safety with workforce challenges.

Balancing the development of cultures of safety with nursing workforce challenges is similar to navigating the perfect storm. The perfect storm is characterized as a tempest of extreme intensity that happens rarely, maybe once every 100 years, as a result of multiple factors that end in a situation worse than people have ever seen. Such a storm is currently evident when attempting to ensure patient safety while being confronted with a shortage of nurses and nursing faculty unlike any other shortage experienced in over a number of decades. Based on research, the threats to patient safety from healthcare system and health professional errors have become of paramount concern. The prevention of such errors is the focus of healthcare organizations as they create cultures of safety. A major aspect of cultures of safety is nurses with their many roles in caring for patients and families, especially the constant surveillance they provide, which often prevents complications and deaths secondary to failure to rescue. However, providing such surveillance requires adequate numbers of well-prepared nurses in attendance. The perfect storm is created because of the existence of a steadily worsening shortage of nurses and nursing faculty. Multiple factors have converged to develop and sustain such a shortage. A blueprint for healthcare organizations is proposed, with examples of numerous innovative strategies that are being developed and studied for handling the major challenges posed by this perfect storm.

National surveys of military personnel, nursing students, and the public: drivers of military nursing careers.

OBJECTIVES: The U.S. health care system is facing a projected nursing shortage of unprecedented magnitude. Although military nursing services recently have been able to meet their nursing recruitment quotas, national studies have predicted a long-term nursing shortage that may affect future recruitment for the Nurse Corps of the three military services. Data are needed to plan for recruitment incentives and the impact of those incentives on targeted populations of likely future nurses. METHODS: Data are drawn from three online surveys conducted in 2011-2012, including surveys of 1,302 Army, Navy, and Air Force personnel serving on major military bases, 914 nursing students at colleges with entry Bachelor of Science in Nursing programs located nearby major military bases, and a qualitative survey of 1,200 young adults, age 18-39, in the general public. FINDINGS: The three populations are different in several demographic characteristics. We explored perceptions of military careers, nursing careers and barriers, and incentives to pursue military nursing careers in all populations. Perceptions differ among the groups. CONCLUSION: The results of this study may help to inform strategies for reaching out to specific populations with targeted messages that focus on barriers and facilitators relevant to each to successfully recruit a diverse Nurse Corps for the future.

Keeping Patients Safe: a collaboration among nurse administrators and researchers.

Translating the recommendations from the Institute of Medicine's landmark report, Keeping Patients Safe: Transforming the Work Environment of Nurses, into practice and healthcare policy will require an extensive collaboration among nurse administrators and nurse researchers. The insights and skills of both groups are critical for evaluating the recommendations and their implications for practice, for filling gaps in research, and for influencing significant health system change.

Nursing leadership in genomics for health and society.

PURPOSE: This article is part of the series regarding genomics and nursing practice, science, education, and policy. Issues in genetic testing, genetic information and the lessons learned through applications of genetic and genomic science are analyzed and discussed. FRAMEWORK: Scientists, scholars, and members of the public have articulated a vision to guide genomics research and scholarship. The three overarching themes of this conceptual framework are genomes to biology, genomes to health, and genomes to society. CONCLUSIONS: Nurses can promote the use of genomic research technologies and information in the context of health, biology, and society, as well as in nursing research, practice, education, and policy.