Establishing the doctor of nursing practice project ethical review process to improve standardization,efficiency, and timeliness

BackgroundDNP Scholarly projects require review for scientific merit and human subject protection. Rapid growth of DNP programs and projects has increased Institutional Review Board (IRB) burden and increased the length of project approval time when most DNP scholarly projects are quality improvement (QI) projects and not deemed Human Subjects Research (HSR).PurposeDevelop a process and describe the rationale for creating and implementing a Project Ethical Review Committee (PERC) in the School of Nursing and to evaluate the experience of the first cohort of submissions.ProcessCommittee was formed using expert consensus approach, in collaboration with IRB. Standards of Procedures and training materials created.Outcome measure100 projects submitted to committee; 95 deemed QI (95%) and 5 projects considered HSR (5%). First 94 projects were reviewed, and approval letters sent within 8 weeks.DiscussionThis paper discusses how PERC ensures rigorous and ethical review process for standardization, timeliness, and efficiency.     

How to do human-subjects research if you do not have an institutional review board

Biomedical research with human subjects has expanded outside of traditional medical centers and hospitals into other health care entities, such as rehabilitation facilities, free-standing out-patient treatment centers, and even home-health agencies. Regardless of the location, federal regulations mandate that all human-subjects research must be overseen by an institutional review board (IRB) or ethics committee to ensure the research abide by the Code of Federal Regulations. Consequently, all human-subjects research must be reviewed and approved by an IRB prior to initiation of any research procedures. Unfortunately, many of these nontraditional research facilities do not have easy access to an IRB. This does not render such research exempt from federal oversight. Clinicians at these facilities have viable options for obtaining IRB approval and legally conducting such research. This paper outlines the available options and their pros and cons.     

The Effects of Designing an Educational Animation Movie in Virtual Reality on Preoperative Fear and Postoperative Pain in Pediatric Patients: A Randomized Controlled Trial

PurposeThe purpose of the study was to investigate the effects of watching an educational animated movie on fear and pain in children aged 6 to 12 years old.DesignA randomized controlled trial.MethodsIn this study, the CONSORT checklist was used as a guide. The sample of participants (n = 132) was allocated to the Educational Animation Group (n = 44), Documentary Group (n = 44), and Control Group (n = 44) using block randomization. During the data collection, an information form, the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale were used.FindingsPreoperative fear and postoperative pain scores were significantly lower in the Educational Animation group than in the other groups.ConclusionsThe educational animated movie was found to be an effective method in reducing preoperative fear and postoperative pain. Educational animated movies, which were effective in reducing the fear and pain of the child in the preparatory operations, increased the educational effectiveness and cooperation of the child.     

Multifaceted interventions are likely to be more effective to increase adherence to the ventilator care bundle: A systematic review of strategies to improve care bundle compliance

BackgroundThe implementation of ventilator care bundles has remained suboptimal. However, it is unclear whether improving adherence has a positive relationship with patient outcomes.ObjectivesTo identify the most effective implementation strategies to improve adherence to ventilator bundles and to investigate the relationship between adherence to ventilator bundles and patient outcomes.MethodsA systematic review followed the PRISMA guidelines. A systematic literature search from the inception of ventilator care bundles 2001 to January 2021 of relevant databases, screening and data extraction according to Cochrane methodology.ResultsIn total, 6035 records were screened, and 24 studies met the eligibility criteria. The implementation strategies were provider-level interventions (n = 15), included educational activities, checklist, and audit/feedback. Organizational-level interventions include (n = 8) included change of medical record system and multidisciplinary team. System-level intervention (n = 1) had motivation and reward. The most common strategies were education, checklists, audit feedback, which are probably effective in improving adherence. We could not perform a meta-analysis due to heterogeneity of the strategies and types of adherence measurement. Most studies (n = 7) had a high risk of bias. There were some conflicting results in determining the associations between adherence and patient outcomes because of the poor quality of the studies.ConclusionMultifaceted interventions are likely to be effective for consistent improvement in adherence. It remains uncertain whether improvements in adherence have positive outcomes on patients due to limited evidence of low to moderate uncertainty. We recommend the need for robust research methodology to assess the effectiveness of implementation strategies on improving adherence and patient outcomes.     

Factors influencing nursing students’ ability to recognise and respond to simulated patient deterioration: A scoping review

AimThe aim of this scoping review was to identify empirical literature on simulation used to develop undergraduate nursing student's clinical assessment skills to recognise and respond to patient deterioration.BackgroundEarly recognition and response to clinical deterioration is necessary to ensure the best outcome for the patient. Undergraduate nursing students have limited exposure to deteriorating patient situations, therefore simulation is widely implemented in nursing courses to address this educational need. It is imperative to identify the simulation modalities and features that best optimise student learning.DesignScoping review using the Joanna Briggs Institute scoping reviews methodology and the Arksey and O’Malley framework.Review methodsSeven health databases were searched electronically for relevant literature and complemented with hand searching for additional relevant sources. A total of 344 potential articles were identified from the seven databases: Cumulative Index to Nursing and Allied Health Literature (n = 234); PubMed (n = 16); Medline (n = 51); Scopus (n = 21); Embase (n = 3); American Psychological Association PsychInfo (n = 13); and JBI (n = 6). After applying inclusion and exclusion criteria, 15 research articles were included in the review.ResultsMost research on clinical deterioration simulation was quantitative (n = 12), two were qualitative and one used a mixed method approach. Findings included a lack of situational awareness, distractors causing incomplete patient assessment and failure to recognise deterioration. Repeated simulation showed positive results.ConclusionsFindings of this review suggest students lack situational awareness, perform incomplete assessment and fixate on single cues rather than an entire clinical picture. The use of a variety of simulation modalities was effective in improving student performance. Repeated practice within a single simulated learning experience, was shown to improve performance and situational awareness. This approach to simulation is under-researched in nursing and needs further exploration.     

Open-label,Single-dose Studies of the Pharmacokinetics of Edaravone in Subjects with Mild,Moderate, or Severe Hepatic Impairment Compared to Subjects with Normal Hepatic Functioning

PurposeTwo studies were conducted to assess the pharmacokinetic (PK) properties and tolerability of edaravone in Japanese subjects with mild to moderate hepatic impairment or normal hepatic functioning (study 1), and in white subjects with severe hepatic impairment compared to subjects with normal hepatic functioning (study 2).MethodsStudies 1 and 2 were multicenter, open-label, single-dose studies that included subjects aged 18–75 years. In study 1, subjects were stratified into 3 different groups of hepatic functioning according to Child-Pugh score: mild hepatic impairment, score 5 or 6 (n = 8); moderate hepatic impairment, score 7–9 (n = 6); or normal hepatic functioning (n = 8). In study 2, subjects had severe hepatic impairment (Child-Pugh score 10–14; n = 6) or normal hepatic functioning (n = 6). In both studies, all subjects were given edaravone 30 mg IV infused over 60 min on the morning of day 1. Blood samples for use in PK analyses were collected from days 1–3. The PK properties (C_max, AUC_0–last, and AUC_0–∞) of edaravone and its sulfate conjugate metabolite were measured.FindingsIn study 1, the geometric least-squares mean (GLSM) C_max and AUC_0–∞ of unchanged edaravone were 1.203- and 1.065-fold greater, respectively, in subjects with mild hepatic impairment versus normal hepatic functioning, and were 1.235- and 1.142-fold greater, respectively, in subjects with moderate hepatic impairment versus normal hepatic functioning. In study 2, GLSM C_max and AUC_0–∞ of unchanged edaravone were 1.203- and 1.190-fold greater, respectively, in subjects with severe hepatic impairment versus normal hepatic functioning. In both studies the AUC_0–last, AUC_0–∞, unbound AUC from time zero to infinity, and C_max of unchanged edaravone were increased slightly with increases in Child-Pugh classification. No adverse events considered related to edaravone were reported, except for 1 case of sinus bradycardia in a subject with normal hepatic functioning in study 2. The event was moderate in severity, considered as possibly related to edaravone, and resolved during the study.ImplicationsMild to moderate and severe hepatic impairment had no apparent clinically significant effects on the PK profile of edaravone in Japanese and white subjects, respectively, relative to individuals with normal hepatic functioning, and there were no notable tolerability concerns. Thus, edaravone dosage adjustments are unlikely to be needed in edaravone-treated patients with mild to moderate and severe hepatic impairment. ClinicalTrials.gov identifiers: NCT03289234 (mild to moderate hepatic impairment) and NCT03664544 (severe hepatic impairment).     

The implementation of automated red blood cell exchange (erythrocytapheresis) as a treatment modality in sickle cell disease patients: Single center experience

BackgroundImprovements of health infrastructure, preventive care and clinical management is important to reduce the morbidity and mortality of sickle cell disease (SCD).ObjectiveThis prospective, investigator-initiated non-randomized open-label intervention, single centre study describes the implementation of the automated erythrocytapheresis in low-middle income country as a treatment modality for SCD patients to improve the standard of care and highlights its benefits and challenges.MethodologyEligible patients with SCD who had overt stroke, abnormal/conditional transcranial doppler (TCD), or other indications were subjected to regular automated erythrocytapheresis program.ResultsFrom 18th Dec 2017 till 17th Dec 2022, 21 subjects were enrolled; seventeen (80.9 %) were Egyptian and four (19.1 %) were non-Egyptian (three Sudanese and one Nigerian). Totalling 133 sessions had been performed mainly in working hours with fluctuating frequency per month. All sessions maintained isovolumic status and were performed using central venous access. The target HbS concentration was set from the start; the mean final FCR % fraction was 51, most of the session (n = 78, 58.7 %) were able to achieve target FCR. The majority of session pass smoothly with no adverse event (n = 81, 60.9 %), except for certain challenges as shortage of the required blood (n = 38), hypotension (n = 2), hypocalcaemia (n = 2).ConclusionAutomated erythrocytapheresis is safe and effective modality for management of patients with sickle cell disease.     

Teaching and learning about dementia care among undergraduate nursing students: A scoping review

AimReview available evidence on teaching methods and learning outcomes among undergraduate nursing students regarding care for people with dementia. Background: The debilitating nature and the rapidly growing number of dementia cases will cause significant increase in the demand of healthcare services. Nurses play an essential role in improving the quality of care for people with dementia, although some evidence suggests that training in dementia care among nurses is poor.DesignA scoping review of the literature. following the Joanna Briggs Institute methodology for scoping reviews. The source of evidence selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review.MethodsData sources were Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Education Resources Information Centre and Scopus. Inclusion criteria were studies found through database search up to 15th December 2020, published in English or Spanish with data regarding any method used for dementia education among undergraduate nursing students.Results19 studies were included in this review. The identified methods were simulation (n = 5), awareness-raising activities (n = 4), placement (n = 3), home visits (n = 3), combined activities (n = 3) and service learning (n = 1). Learning outcomes were measured in terms of knowledge, attitudes, preparedness, empathy, self-confidence, self-efficacy, awareness and students´ perceptions.ConclusionsThis scoping review has found high heterogeneity among dementia education programs and learning outcomes. Nursing education can be enhanced by designing and measuring effective and evidence-based educational interventions so that nursing students develop competencies which make it easier to deliver quality care for people with dementia.     

The 100 top-cited systematic reviews/meta-analyses in central venous catheter research: A PRISMA-compliant systematic literature review and bibliometric analysis

ObjectiveThe central venous catheter is used extensively worldwide. The purpose of this bibliometric analysis was to identify the 100 top-cited systematic reviews/meta-analyses in the literature on central venous catheters and to capture the most important trends in this area of research.Research methodologyA search was performed in the Web of Science Core Collection on studies published prior to November 12th, 2019. The search terms included central venous catheter, systematic review and meta-analysis. Retrieved studies were ranked by citation number and selected by two of the authors. Information such as citation number, author, institution, country and year of publication was collected.ResultsThe 100 top-cited studies published between 1992 and 2017 were reviewed, with the largest proportion published in 2008 (n = 17). The number of citations ranged from 14 to 660. The country with the largest number of studies was the United States of America (n = 36). Critical Care Medicine published the greatest number of these studies (n = 13). The largest number of these studies were focused on central venous catheter-related infection (n = 56) and thrombosis (n = 19).ConclusionDeveloped countries were the most productive in the field of central venous catheters. Most meta-analyses focused on complications associated with central-venous catheters such as infection and thrombosis.     

Global requirements for DNA sample collections: results of a survey of 204 ethics committees in 40 countries

The Industry Pharmacogenomics Working Group has an interest in attaining a better understanding of global requirements for sample collections intended for pharmacogenetics research. To have adequately powered pharmacogenetics studies representative of the clinical trial population, it is important to collect DNA samples from a majority of consenting study participants under many institutional review board/ethics committee (IRB/EC) jurisdictions. A survey was distributed to gather information from local and central IRBs/ECs. The survey included questions related to the approval of pharmacogenetics studies, collection and banking of samples, and return of data to subjects. A total of 204 responses were received from global IRBs/ECs with pharmacogenetic experience. The data show that requirements for approval of pharmacogenetic research differ between IRBs/ECs within and between countries but not between regions of the United States. A better understanding of differing requirements should facilitate global sample collection of DNA for pharmacogenetics research and may provide the basis for harmonized regulations for collection of genetic samples in the future.     

Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders

BackgroundNurses play a pivotal role in improving patient care. To maximize nurses’ impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives.PurposeTo describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas.MethodsA total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically.FindingsHalf of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1–6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1–5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar.DiscussionStrategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.     

Trust of Nursing Home Staff Caring for Residents with Advanced Dementia: A Qualitative Descriptive Study of Family Caregivers’ Perspectives

Background/ObjectivesStudies of interpersonal trust within nursing homes (NHs) is limited. This study aimed to describe the perspectives of interpersonal trust in NH staff among family caregivers of residents with advanced dementia. Additionally, comparisons of Black and White caregivers' perspectives were also explored.DesignWe used data generated from a parent study, Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life (ADVANCE) to examine the experience of trust from the family caregivers’ perspectives.ParticipantsData generated from interviews with 44 family caregivers of residents with advanced dementia (Black n = 19 and White n = 25) were analyzed using thematic analysis.Results/ConclusionsWhile both Black and White family caregivers experienced trust and mistrust, Black caregivers more often experienced differential mistrust. As differential mistrust is a new concept relative to trust, additional research is required to elucidate its meaning.DesignWe used data generated from a parent study, Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life (ADVANCE) to examine the experience of trust from the family caregivers’ perspectives.ParticipantsData generated from interviews with 44 family caregivers of residents with advanced dementia (Black n = 19 and White n = 25) were analyzed using thematic analysis.Results/ConclusionsWhile both Black and White family caregivers experienced trust and mistrust, Black caregivers more often experienced differential mistrust, trust for certain staff members and mistrust of others. As differential mistrust is a new concept relative to trust, additional research is required to elucidate its meaning.     

Publishing trends in the field of urgent care medicine from 2000 to 2020: A bibliometric analysis

BackgroundWith a steady rise in the number of urgent care centers in the United States and the establishment of urgent care medicine as a specialty, research in the field is likely to emerge.ObjectivesTo perform a bibliometric analysis of published studies in the field of urgent care medicine over the past two decades.MethodsA comprehensive literature review was conducted, including original and review articles pertaining to urgent care medicine published 2000–2020. Data abstracted from each article included publication year, journal, research study design, study population, clinical relevance (clinical or non-clinical), and study topics.ResultsA total of 144 publications from 94 peer-reviewed journals were analyzed. There has been a steady increase in the annual number of publications from 2010 to 2019. The most common study designs were retrospective (55.5%), study specific (24.3%), prospective (15.3%), and quality improvement (4.9%). Adults were the most frequently identified study population (33.3%), followed by pediatrics (18%), and both adults and pediatrics (16.7%). Publications were categorized as clinical (48.6%) and non-clinical (51.4%). The most common research topics were urgent care utilization [n = 34, 23.6%; especially effectiveness (n = 9) and disease based (n = 7)], diagnostic testing [(n = 20, 13.9%; especially HIV (n = 7) and sexually transmitted infections (n = 6)], and antibiotic stewardship (n = 17, 11.8%).ConclusionBased on our sample, published research in the field of urgent care medicine has evolved. By describing current trends, we hope that clinicians and researchers continue to advance the field by developing high quality research, including prospective, multi-institutional/center studies involving both clinical and non-clinical topics.     

Perioperative temperature monitoring practices in Australia: A multidisciplinary cross-sectional survey

BackgroundPatients undergoing surgery require accurate and consistent temperature monitoring to enable identification of thermal disturbances. Internationally, evidence indicates low rates of monitoring, but knowledge of Australian practices reported by the multidisciplinary team is lacking.AimTo investigate temperature monitoring practices as reported by multidisciplinary health care workers caring for patients receiving perioperative care.MethodsA cross-sectional survey was distributed online via nursing, anaesthetic, and anaesthetic allied health practitioner professional colleges. Following low-risk ethical approval, data were collected via REDCap using a pre-piloted tool (November to December 2019). Data were analysed using IBM SPSS Statistics (Version 26). Binomial logistic regression assessed relationships between private or public facilities, location, profession, and factors influencing temperature monitoring practices.FindingsResponses were received from 545 participants: registered or enrolled nurses comprised the largest proportion (n = 281/545, 52%) followed by anaesthetists (n = 219/545, 40%). Over half were unsure whether national guidelines for perioperative temperature monitoring existed (n = 273/500, 55%), 19% (n = 106/545) stated that decision-making was influenced by guidelines, and 24% (n = 129/545) were influenced by departmental policy. The odds of influence by national guidelines in decision-making among nurses was twice than for anaesthetists (OR 2.09, 95% CI 1.26, 3.46, p <0.01).DiscussionFindings revealed a lack of awareness of perioperative temperature monitoring guidelines among all professions, but adequate availability of devices was reported. Disparities exist between reported uptake of monitoring, and existing observational evidence.ConclusionLow uptake of optimal perioperative temperature monitoring practices may be influenced by lack of awareness of guidelines and availability of accurate devices.     

Are we there yet? A scoping review of factors that increase academic research capacity in schools of nursing and midwifery

Aims1. To identify approaches and strategies that can build research capacity among academics from the disciplines of nursing and midwifery working in tertiary education institutions. 2. To identify evidence-informed strategies that enable academic transformation of professional identity from clinician to researcher.BackgroundNurses and midwives are core to leading health practice and system change through research. Despite manifold efforts to build research capacity among nurse academics over the past two decades, there is scant evidence about what specific strategies are effective and few robust evaluations of any capacity building strategies.DesignThis scoping review was guided by Arksey and O’Malley’s framework to identify key concepts and map the available evidence specifically related to volume, nature and characteristics.MethodsThe authors followed a scoping review framework and used a PRISMA flowchart to report findings. Electronic data bases (CINAHL, ERIC, Medline and Scopus) were searched between April and June 2020. Literature published between 2000 and 2020 was searched. The Mixed Methods Appraisal Tool (MMAT) was used for data coding and extraction and all included papers were subsequently thematically analysed.ResultsFourteen studies from seven countries met the inclusion criteria and were comprised of literature reviews (n = 4) case studies (n = 3) qualitative survey (n = 1) and intervention studies (n = 6). Four themes were identified as follows: academic identity, organisational changes, leadership and research skills development.ConclusionsRigorous evaluation of research capacity building strategies for academics from the disciplines of nursing and midwifery is a significant gap in the literature. To promulgate research among nurse and midwife academics, strong, supportive leadership and a range of inclusive and targeted approaches are needed. Significant work remains in terms of negotiating with the broader university to operationalise supportive systems and structures. Clarifying how self-concept has an impact on building and maintaining a research identity for nurse and midwife academics is an area worthy of further study.Tweetable abstractStrong, supportive leadership with inclusive and targeted research skills development is key to reorienting academic nursing and midwifery research culture.