Application of Curriculum Mapping Concepts to Integrate Multidisciplinary Competencies in the Care of Older Adults in Graduate Nurse Practitioner Curricula

The number of Americans ages 65 and older is projected to more than double over the next four decades and to equal nearly one-fourth of the entire population by 2060. Recognizing that the health care workforce in the United States is not sufficiently prepared to meet the care needs of this growing population, the National Academy of Medicine has recommended curricular enhancements for health professional educational programs. To meet this challenge, the University of South Florida College of Nursing applied curriculum mapping principles and concepts to examine and align Family Nurse Practitioner and Adult-Gerontology Primary Care Nurse Practitioner program curricula for congruence with Partnership for Health in Aging multidisciplinary geriatric competencies. Through this process, we developed a geriatric-specific curriculum map and threaded geriatric-specific content, learning experiences, and learning assessment strategies to promote attainment of all 23 competencies. Given the growing role that nurse practitioners are projected to play in the delivery of primary care for older adults in the future, it is imperative that colleges and schools of nursing provide students with learning experiences to support attainment of the knowledge and skills graduates will need to care for older adults in practice. The techniques and strategies described here represent our approach.     

Faculty Support for a Culture of Scholarship of Discovery: A Literature Review

BackgroundA review of the literature was completed answering the question: “What is known about the barriers to, and support of, the scholarship of discovery that faculty members in nursing and related health sciences (i.e., medical, dental, and pharmacy) whose time is used in both the academic setting and clinical setting encounter as they develop programs of research, engage in grant writing, and pursue scientific publication?”MethodsUsing a systematic approach, a total of 29 articles were included in this review.ResultsFour major themes were identified: (1) Organizational expectations (2) administrative support (3) mentorship and (4) barriers to scholarship in nursing and related health sciences faculty. Organizational expectations and administrative support were critical in developing and maintaining a culture of scholarship, various mentorship models improved faculty scholarship skills and productivity, while multiple barriers were found to inhibit faculty development and scholarly productivity.ConclusionThe implementation of organizational, administrative, and faculty activities and interventions can promote a culture of scholarship. Further research is needed to determine which interventions are most helpful in developing health science faculty scholarship.     

Enteral and parenteral feeding of neonate

Neonates cannot get necessary nutrients through natural ways required for growth, development, maintaining body functions healthily and renewal of the organism due to some kind of limitations. In these specific conditions, it may be necessary to use enteral or parenteral feeding method. Gestation age, birth weight, the fullness of food sources, nutritional method, the existence of growth failure and metabolic changes caused by illnesses and treatments of neonates should be taken into consideration in order to be able to choose one of these methods. Nurses who are members of a multidisciplinary team are responsible for meeting nutritional requirements of neonates. Nurses who work in the neonatal intensive care units are expected to have knowledge about nutritional requirements and feeding methods and do their practices in parallel with the evidence-based guidelines while they meet the nutritional requirements of neonates.     

Advocacy and actions to address disparities in access to genomic health care: A report on a National Academies workshop

BackgroundIn the United States, access to genomic risk assessment, testing, and follow up care is most easily obtained by those who have sufficient financial, educational, and social resources. Multiple barriers limit the ability of populations without those resources to benefit from health care that integrates genomics in assessment of disease risk, diagnosis, and targeted treatment.PurposeTo summarize barriers and potential actions to reduce genomic health care disparities.MethodSummarize authors' views on discussions at a workshop hosted by the National Academy of Medicine.DiscussionBarriers include access to health care providers that utilize genomics, genetic literacy of providers and patients, and absence of evidence of gene variants importance in ancestrally diverse underserved populations.ConclusionEngagement between underserved communities, health care providers, and policy makers is an essential component to raise awareness and seek solutions to barriers in access to genomic health care for all populations.     

Prevalence of verbal and physical workplace violence against nurses in psychiatric hospitals in China

ObjectiveWorkplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China.MethodsThis was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale.ResultsA total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4–85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4–81.1), 70.9% (95% CI: 68.8–73.0) and 57.9% (95% CI: 55.7–60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV.ConclusionWPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings.     

Inertial Measurement Unit-based Evaluation of Global and Regional Lumbar Spine and Pelvis Alignment in Standing Individuals With a Flat Lumbar Posture

ObjectiveThe purpose of this study was to investigate the global and regional lumbar spine and pelvis postural alignment in standing individuals with a flat lumbar posture using an inertial measurement unit (IMU) system.MethodsA total of 80 symptomatic young volunteers (25 men and 55 women in their early 20s) were recruited at Inje University in Gimhae, South Korea for this study. Participants stood in a comfortable posture for 5 seconds with IMUs on the T10, L3, and S2 level. Participants were then categorized into 3 groups according to the global lumbar lordosis (GLL) angle (T10-S2): <20°, 20° ≤ GLL angle < 30°, and 30° ≤ GLL angle < 40°. We compared the GLL and regional lumbar lordosis (RLL) angles among the 3 groups.ResultsAs GLL increased, RLL angles (upper, P = .001; lower, P < .001) tended to increase, whereas the sacrum angle decreased (P < .001). A stepwise regression model showed that the sacrum angle was the single best predictor of GLL in standing participants. Based on IMU measurements, participants with GLL <20° are considered representative of participants with a flat lumbar posture.ConclusionPosture measurements in a standing position conducted to assess lordosis should consider the relationship between GLL and RLL rather than GLL or RLL alone. We found that S2 was the best predictor of GLL.     

Hashtags and heroes: perceptions of nursing on Twitter following a high profile nurse arrest

PurposeThe purpose of this research was to extract the perceptions of nursing by analyzing Twitter tweets following a high-profile nurse arrest.BackgroundA Utah registered nurse arrest was covered extensively on national and international news programming and social media, including Twitter.MethodsTweets related to arrest were retrieved and analyzed by text analysis techniques, Latent Dirichlet Allocation models and sentiment analysis.Results56,931 consisting of 14,150 unique tweets we retrieved. Twelve topics were identified, of which four related to nursing: nurses as protector, protecting the protector, nurses as innocent victim, and nurses as important team member. “Trust” (44.3%) was assigned to the majority of tweets.ImplicationsTo our knowledge, this is the first study examining the perceptions of nursing in Tweets. Social media provides a powerful resource to strengthen general perceptions of the nursing profession and has implications for education and outreach.     

Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study

ObjectivesTo investigate the effect of acute isometric contraction of the pelvic floor muscles (PFM) and transversus abdominis muscle (TrAM) on inter-rectus distance (IRD) from resting values in postpartum women with diastasis rectus abdominis (DRA).DesignCross sectional experimental study.SettingPhysiotherapy clinic.ParticipantsThirty eight postpartum women presenting with DRA of at least two finger widths.MethodsTwo dimensional ultrasound images of IRD were recorded using a linear probe (5 to 10 MHz) at rest, during PFM contraction, during TrAM contraction, and during combined PFM and TrAM contraction. IRD data were normally distributed.Main outcome measureChange in IRD.ResultsThere was a significant increase in IRD during PFM and TrAM contraction compared with IRD at rest. At 2 cm above the umbilicus, mean PFM was 26.9 [standard deviation (SD) 8.8] mm vs rest 25.7 (SD 8.5) mm {mean difference 1.2 [95% confidence interval (CI) 0.7 to 1.7] mm}; and mean TrAM was 28.4 (SD 9.0) mm vs rest 25.7 (SD 8.5) mm [mean difference 2.8 (95% CI 1.9 to 3.6) mm]. Similarly, 2 cm below the umbilicus, mean PFM was 22 (SD 8.3) mm vs rest 21 (SD 7.9) mm [mean difference 0.9 (95% CI 0.4 to 1.6) mm]; and mean TrAM was 23.3 (SD 8.7) mm vs rest 21 (SD 7.9) mm [mean difference 2.3 (95% CI 1.5 to 3.1) mm]. Combined TrAM and PFM contraction measured 2 cm above the umbilicus caused the greatest increase in IRD: mean PFM + TrAM 29.6 (SD 9.4) mm vs rest 25.7 (SD 8.5) mm [mean difference 3.9 (95% CI 2.8 to 5.0) mm].ConclusionBoth PFM and TrAM contraction, and combined PFM and TrAM contraction increased IRD in postpartum women with DRA.     

Models of collaboration and dissemination for nursing informatics innovations in the 21st century

BackgroundNursing informatics innovations are constantly adapting to a rapidly changing health care environment.PurposeThis study aims to present the lessons learned from 4 nursing informatics projects and rationale for development decisions to inform future informatics innovations.MethodsUsing a comparative cross-case analysis, four case studies of informatics projects led by nurse scientists were described and analyzed through the lens of the Informatics Research Organizing Model which was modified to include policy and interoperability contexts.FindingsThe comparison analysis examined dynamic relationships between processes and constructs in nursing informatics interventions and also highlighted the scientific, intellectual property, technical, and policy challenges encountered among the four case studies.DiscussionThe analysis provided implications for future intervention development and implementation in consideration of multiple contexts for nursing informatics innovations.     

Clinical manifestations and risk factors of community-onset Acinetobacter species pneumonia in Japan; case control study in a single institute in Japan

To clarify the etiology, patients' characteristics and risk factors for community-onset AP (Acinetobacter species pneumonia), we conducted this case-control study. We reviewed all patients with community-onset AP at our institute from 2010 until 2018. We defined non-AP group as a control. The patients with non-Acinetobacter spp. pneumonia (non-AP) were randomly selected during the study period without clinical information based on medical records' list among patients with community-onset pneumonia. The age (±2 years) and sex were matched to the patients with community-onset AP, and the ratio was AP:non-AP group = 1:3. Patients' characteristics, clinical outcomes, pathogens isolated and drug susceptibility were evaluated by comparing AP and non-AP group.The mean age of community-onset AP group was 79 years. They were 8 males and 5 females. The 30-day and in-hospital mortality rates of community-onset AP were 23% (v.s. 3%, p = 0.049) and 31% (v.s. 5%, p = 0.029) respectively, which are higher than the control group. Heavy alcohol consumption (23% v.v. 0%, p = 0.023), higher Charlson Comorbidity index (3.2 v.s. 2.0, p = 0.046) and lobar pneumonia by chest radiology (50% v.s. 23%, p = 0.071) were seen more frequently in community-onset AP than in the control group.In conclusion, community-onset AP shows poor outcomes despite the appropriate antibiotic therapy. Heavy alcohol history might be a risk factor of AP. Patients with community-onset AP could have more comorbidity and poor general conditions than the control group.     

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

ObjectiveTo examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.DesignSecondary analysis of inpatient Medicare claims data using Standard Analytical Files.SettingAcute hospitals across the United States.ParticipantsFrom nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010.InterventionsHospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.Main Outcome MeasuresAll-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.ResultsIn fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93).ConclusionHospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.     

Advanced Therapy in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge

ObjectiveTo use causal inference methods to determine if receipt of a greater proportion of inpatient rehabilitation treatment focused on higher level functions, for example, executive functions, ambulating over uneven surfaces (advanced therapy [AdvTx]), results in better rehabilitation outcomes.DesignA cohort study using propensity score methods applied to the traumatic brain injury practice-based evidence (TBI-PBE) database, a database consisting of multisite, prospective, longitudinal observational data.SettingAcute inpatient rehabilitation facilities.ParticipantsPatients enrolled in the TBI-PBE study (N=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first inpatient rehabilitation facility admission to 1 of 9 sites in the United States, and consented to follow-up 3 and 9 months postdischarge from inpatient rehabilitation.InterventionsNot applicable.Main Outcome MeasuresParticipation Assessment with Recombined Tools-Objective-17, FIM motor and cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9.ResultsControlling for measured potential confounders, increasing the percentage of AdvTx during inpatient TBI rehabilitation was found to be associated with better community participation, functional independence, life satisfaction, and decreased likelihood of depression during the year after discharge from inpatient rehabilitation. Participants who began rehabilitation with greater disability experienced larger gains on some outcomes than those who began rehabilitation with more intact abilities.ConclusionsIncreasing the proportion of treatment targeting higher level functions appears to have no detrimental and a small, beneficial effect on outcome. Caution should be exercised when inferring causality given that a large number of potential confounders could not be completely controlled with propensity score methods. Further, the extent to which unmeasured confounders influenced the findings is not known and could be of particular concern due to the potential for the patient’s recovery trajectory to influence therapists’ decisions to provide a greater amount of AdvTx.     

Intensive In-Hospital Rehabilitation After Hip Fracture Surgery and Activities of Daily Living in Patients With Dementia: Retrospective Analysis of a Nationwide Inpatient Database

ObjectivesTo examine the effects of earlier, more frequent, and larger daily amounts of postoperative rehabilitation on activities of daily living (ADL) after hip fracture surgery in patients with dementia.DesignRetrospective cohort study.SettingA total of 1053 acute-care hospitals.ParticipantsPatients aged ≥65 years with dementia at admission underwent hip fracture surgery and received postoperative rehabilitation from April 1, 2014 to March 31, 2016 (N=43,206).InterventionsThree rehabilitation variables as key independent variables: (1) the interval from surgery to starting rehabilitation (days); (2) the frequency of postoperative rehabilitation (days per week); and (3) the average daily units of postoperative rehabilitation (minutes per daily rehabilitation).Main Outcome MeasureADLs based on the Barthel Index (BI) at discharge from acute-care hospitals.ResultsIn the multivariable linear regression analysis, delayed rehabilitation was significantly associated with a lower BI at discharge (for each day of the interval increase, BI at discharge was 0.38 lower; 95% confidence interval [CI], 0.21-0.54), and a significant increase in the BI at discharge was observed in patients who underwent more frequent rehabilitation (BI [95% CI] was 2.62 [0.99-4.25], 5.83 [4.28-7.38], 7.56 [5.95-9.16], and 9.16 [7.34-10.97] higher for frequencies of 3.1-4.0, 4.1-5.0, 5.1-6.0, and >6.0 days per week, respectively) and larger daily amounts of rehabilitation (4.37 [3.69-5.06] and 6.60 [5.63-7.57] higher for 40-59 and ≥60 minutes per day, respectively).ConclusionsThese results suggest that earlier, more frequent, and larger daily amounts of postoperative rehabilitation in acute-care hospitals are independently associated with better recovery in ADL at discharge from acute-care hospitals after hip fracture surgery in patients with dementia.     

Efficacy and safety of erythropoietin in patients with traumatic brain injury: A systematic review and meta-analysis

ObjectiveThe purpose of this study was to evaluate the effects of erythropoietin (EPO) on mortality and neurological outcomes in patients with traumatic brain injury (TBI).Materials and methodsElectronic databases of studies published up to January 5, 2017 were searched to retrieve relevant investigations comparing the outcomes of EPO-treated patients and untreated patients following TBI. We calculated the relative risk (RR) of mortality, neurologic outcomes, and deep vein thrombosis (DVT) with corresponding 95% confidence interval (CI) using meta-analysis.ResultsSix randomized controlled clinical trials met the eligibility criteria. In total, 1041 patients were included among the studies. EPO was found to significantly reduce the occurrence of mortality (RR 0.68 [95% CI 0.50–0.95]; P = 0.02), but did not significantly reduce poor functional outcome (RR 1.22 [95% CI 0.82–1.81]; P = 0.33). There were no significant differences in the occurrence of complications, such as DVT, between the treatment groups (RR ?0.02 [95% CI ?0.06–0.02]; P = 0.81).ConclusionsResults of the present meta-analysis suggest that the use of EPO may prevent death following TBI without causing adverse events, such as deep vein thrombosis. However, the role of EPO in improving neurological outcome(s) remains unclear. Further well-designed, randomized controlled trials using modified protocols and involving specific patient populations are required to clarify this issue, and to verify the findings.