Essential Components of a Neuroscience Nursing Orientation: A Delphi Study.

ABSTRACT: BACKGROUND: The essential components of an effective neuroscience nurse orientation program for those caring for the adult general care population have not been well defined or standardized. METHODS : Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 experts in neuroscience nursing orientation to gain consensus on the essential components of orientation for the neuroscience nurse. Survey data included demographics of the expert, literature-based components of neuroscience nurse orientation, and an opportunity to agree/disagree or write in additional components. RESULTS : Round 1 of the consensus survey elicited a response rate of 55% (29/53), and round 2 had a 51% (27/53) response rate. On the basis of round 1 expert responses, 4 new orientation components were added, and 36 components of a neuroscience nursing orientation were revised to include only the elements with ≥75% agreement. Twenty-two elements in round 2 met the criteria of ≥75% very important and important to include as components of a neuroscience nursing orientation. CONCLUSION : An expert consensus was reached on the necessary components of a neuroscience nursing orientation. The identified neuroscience nursing orientation components concentrated on improving nursing practice and provision of care to adult neuroscience patients. This study demonstrates priority components within a standardized orientation program for neuroscience nurses based on literature and expert consensus. A comprehensive neuroscience nursing orientation is a vital step in sustaining high-quality care for patients and improving neurological outcomes.

Validating Psychometric Properties of a Revised Patient Version of the Combined Assessment of Psychiatric Environments (CAPE).

BACKGROUND: Measuring patient experience is an essential challenge in the inpatient behavioral health population. AIM: This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey. METHODS: The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R. RESULTS: Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the "staff competency and engagement" and "treatment effectiveness" domains than presented in the original instrument development research. CONCLUSIONS: Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.

Challenges and Opportunities in Stroke Nursing Research: Global Views From a Panel of Nurse Researchers.

ABSTRACT: INTRODUCTION: A diverse group of neuroscience nurse experts discussed stroke nursing research at the 5th International Neuroscience Nursing Research Symposium. Panel experts from Singapore, India, Australia, New Zealand, the Philippines, Malawi, Germany, Palestine, Kenya, Japan, and the United States collaborated to examine similarities and differences in nurse-led stroke research conducted in their home countries. This article reflects panel insights on challenges and opportunities for nurse-led stroke research. DISCUSSION: The research challenges discussed include nursing independence, the processes of informed consent and randomization process, obtaining adequate independent funding, recruiting research subjects, and working with vulnerable groups. The major opportunities to leverage and improve stroke nursing research include facilitating the nurse investigator role, information digitalization, improving health literacy, and collaboration between nurse researchers. SUMMARY: We are living in a volatile, uncertain, complex, and ambiguous world, and the COVID-19 pandemic has accentuated many challenges. There is a need to allow for creativity around recruitment and conducting stroke research. The use of technology reduces travel needs and mitigates many safety, financial, and transportation-related problems. Although the pandemic has highlighted the challenges faced when conducting stroke-related research, there are remarkable similarities in opportunities to improve outcomes.

Developing and Aligning a Safety Event Taxonomy for Inpatient Psychiatry.

OBJECTIVE: The aim of this project was to develop and align an inpatient psychiatric safety event taxonomy that would blend well-established safety events with psychiatry-specific concerns. METHODS: A hybrid inductive-deductive thematic analysis was used to generate novel descriptive safety event categories for inpatient psychiatry and align these categories with an established taxonomic framework. In the inductive phase, an initial taxonomy was developed by describing the semantic subject and context of reported safety concerns. In the deductive phase, existing literature, national standards, and local content experts were used to align our taxonomy with the safety event measurement system at our institution. RESULTS: A total of 2291 events were extracted and 483 were analyzed. After thorough review, the data was divided into 4 domains: (1) Provision of care, (2) patient actions, (3) environment/equipment, and (4) safety culture. Each domain reflects a mutually exclusive typology of events and provides a parsimonious view of safety concerns in inpatient psychiatry. Each domain was further divided into categories, subcategories, and subcategory details. CONCLUSIONS: Safety events on inpatient psychiatric units are understudied and lack the measurement infrastructure to identify care processes that result in exposure to harm. We develop and align an inpatient psychiatric safety taxonomy based on real-world data, existing literature, and measurement standards. This taxonomy can be used by psychiatric hospitals to improve their patient safety measurement systems-and ultimately-the safety of their patients and communities.

A Delphi Study to Establish Research Priorities for Neuroscience Nursing.

ABSTRACT: BACKGROUND: Establishing research priorities is essential not only to support evidence-based nursing practice but also to direct research agendas for nursing organizations such as the American Association of Neuroscience Nursing. METHODS: A 6-member Research Agenda Task Force selected potential research priorities based on a literature search of neuroscience nursing research. Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 neuroscience nursing experts to gain consensus on the research priorities for neuroscience nursing. Survey data included demographics, agreement with selected gaps in neuroscience nursing research, and impact of selected neuroscience nursing research topics on the field. RESULTS: Twenty-six of 53 experts (49% response rate) participated in round 1, and 30 of 53 experts (57% response rate) participated in round 2. In round 1, the Research Agenda Task Force members revised the list of gaps in neuroscience nursing research to include only the top 39 ranked topics with greater than or equal to 73% agreement, created a new category "Professional Practice Issues," and added 1 additional topic. In round 2, 14 topics were ranked greater than or equal to 70% impactful and identified as the top neuroscience nursing research priorities. CONCLUSION: The results of this study served as an effort for creating research priorities and enhancing research collaboration that focuses on neuroscience nursing. Focusing on gaps in the literature and setting research priorities can ultimately improve patient outcomes. Neuroscience nursing research priorities can be used to inform, guide, and aid nurse scientists, educators, and providers, and to inform agencies that provide research and program funding.

Research Priority Setting: The Current Landscape of Neuroscience Nursing Research.

ABSTRACT: BACKGROUND: The American Association of Neuroscience Nurses established a 6-member Research Agenda Task Force in 2019 to identify neuroscience nursing research priorities to lead the field for the next 3 to 5 years. An early step in the process was a literature search to gain an understanding of the current landscape of neuroscience nursing research. METHODS: A search strategy was developed to locate relevant neuroscience nursing research. An experienced medical librarian performed a comprehensive systematic search of multiple databases. Task force members then further refined the search. A separate search was conducted to locate published research by 21 known neuroscience nurse researchers. RESULTS: An initial search located 466 qualitative articles and 1243 quantitative articles, with a further 655 articles published by known neuroscience nurse researchers. All 2364 citations were reviewed by task force members of the working in pairs to screen titles and abstracts for relevance. Nine categories of neuroscience nursing research were identified: quality of life, nursing practice, biomarkers, health promotion, professional development, technology, nursing care outcomes, assessment, and caregivers. Most of the research used descriptive methods, including both quantitative and qualitative methods of inquiry, providing a foundation for more rigorous investigation and interventional research. Research following stroke and the critical care setting were most prevalent. DISCUSSION: New and emerging trends in neuroscience nursing research include the use of technology, biomarkers, lay caregivers, strategies, and tools, including measure development for neurological assessment, and the evaluation of nursing practice including the practice environment and advanced practice nurse providers. Gaps were also evident. CONCLUSION: There is a significant need to expand neuroscience nursing in areas of emerging trends and to use rigorous methods to evaluate nursing practice effects on patient outcomes. The results of this search were used to revise the neuroscience nursing priorities last determined in 2011.

Themes of Worry Among Psychiatric Inpatients That Persist Through Acute Hospitalization.

INTRODUCTION: Problems that worry patients throughout hospitalization are complex and varied, but they fall within the scope of safe, effective, patient-centered care. To our knowledge, there is no evidence describing the problems that worry patients in inpatient psychiatric units. AIM: The purpose of this quality improvement project was to describe common themes of worry experienced by individuals in psychiatric inpatient units in order to improve patient experience. METHOD: This project took place at an urban, safety net hospital at an academic medical center in the northeastern United States between March and December 2019. All patients across five inpatient psychiatric units were offered the Combined Assessment of Psychiatric Environments (CAPE) survey as they approached the end of their stay. RESULTS: A total of 1,800 patients took the survey. Of these patients, 36% (650/1,800) patients responded never/sometimes to "During my hospitalization, I found solutions to problems that worried me," and 46% (297/650) patients provided a response to the follow-up question "What are the problems that worry you the most?" Common themes of worry for inpatient behavioral health patients include (a) life in the hospital, (b) self, and (c) outside life. CONCLUSIONS: Each of these worry themes that emerged from this thematic analysis has implications for behavioral health staff who are preparing the psychiatric/behavioral health inpatient for discharge. These themes can also be used to focus on a variety of quality improvement initiatives to improve the patients experience while in an inpatient psychiatric/behavioral health unit.

Cultural Perspectives on Pain Assessment and Opioid Use: International Neuroscience Nursing Research Symposium Conference Proceedings.

ABSTRACT: INTRODUCTION: In August of 2020, the 4th International Neuroscience Nursing Research Symposium was held. The purpose of the symposium was to share neuroscience nursing research from around the world. One of the topics thought most notable that stimulated a crucial conversation was how different countries assessed pain and their use of opioids for pain management. BACKGROUND: Neuroscience nurses are global. What is not known is their experience with and what challenges exist with pain management for human beings in their country. Crossing geographic and cultural boundaries, pain affects all human beings. Each culture has unique values and beliefs regarding pain. Patient barriers, pivotal in this article, included poverty, poor health literacy, opioid phobia, and cultural as well as social beliefs. RESULTS: Neuroscience nurses from Australia, Brazil, Germany, Singapore, India, Ghana, Kenya, Philippines, South Africa, and the United States each collaborated to provide a short summary of assessing pain and use of opioids for pain management for the neuroscience patient. CONCLUSION: Neuroscience patients have varying degrees of pain based on many factors. Various countries have religious, spiritual, and cultural traditions that influence the reporting and management of pain. Pain assessment and management can be challenging, especially for the neuroscience nurses around the world.

Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making.

BACKGROUND: There is a critical need to improve support for families making difficult shared decisions about patient care with clinicians in the neuroscience ICU (neuro-ICU). The aim of this study is to identify patient- and family-related factors associated with dissatisfaction with shared decision-making support among families of neuro-critically ill patients. METHODS: We conducted a retrospective observational cohort study using survey data that had been collected from a consecutive sample of family members of patients in the neuro-ICU (one family member per patient) at two US academic centers. Satisfaction with shared decision-making support on ICU discharge had been measured among family members using one specific Likert scale item on the Family Satisfaction in the ICU 24 survey, a validated survey instrument for families of patients in the ICU. We dichotomized top-box responses for this particular item as an outcome variable and identified available patient- and family-related covariates associated with dissatisfaction (i.e., less than complete satisfaction) via univariate and multivariate analyses. RESULTS: Among 355 surveys, 180 (49.5%) of the surveys indicated dissatisfaction with support during decision-making. In a multivariate model, no preexisting characteristics of families or patients ascertainable on ICU admission were predictive of dissatisfaction. However, among family factors determined during the ICU course, experiencing three or fewer formal family meetings (odds ratio 1.93 [confidence interval 1.13-3.31]; p = 0.01) was significantly predictive of dissatisfaction with decisional support in this cohort with an average patient length of stay of 8.6 days (SD 8.4). There was also a trend toward a family's decision to keep a patient as full code, without treatment limitations, being predictive of dissatisfaction (odds ratio 1.80 [confidence interval 0.93-3.51]; p = 0.08). CONCLUSIONS: Family dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy.

Aptamer-functionalized metal-organic frameworks (MOFs) for biosensing.

As a class of crystalline porous materials, metal-organic frameworks (MOFs) have attracted increasing attention. Due to the nanoscale framework structure, adjustable pore size, large specific surface area, and good chemical stability, MOFs have been applied widely in many fields such as biosensors, biomedicine, electrocatalysis, energy storage and conversions. Especially when they are combined with aptamer functionalization, MOFs can be utilized to construct high-performance biosensors for numerous applications ranging from medical diagnostics and food safety inspection, to environmental surveillance. Herein, this article reviews recent innovations of aptamer-functionalized MOFs-based biosensors and their bio-applications. We first briefly introduce different functionalization methods of MOFs with aptamers, which provide a foundation for the construction of MOFs-based aptasensors. Then, we comprehensively summarize different types of MOFs-based aptasensors and their applications, in which MOFs serve as either signal probes or signal probe carriers for optical, electrochemical, and photoelectrochemical detection, with an emphasis on the former. Given recent substantial research interests in stimuli-responsive materials and the microfluidic lab-on-a-chip technology, we also present the stimuli-responsive aptamer-functionalized MOFs for sensing, followed by a brief overview on the integration of MOFs on microfluidic devices. Current limitations and prospective trends of MOFs-based biosensors are discussed at the end.

Health Promotion Behaviors among Urban Black Women.

Health-promotion behaviors among urban Black women are the forefront of US health policy regarding health disparities. This cross-sectional study explored factors such as health literacy, self-efficacy, and readiness for change with health-promotion behaviors of urban Black women. Although these variables are relevant, urban Black women have identified that spirituality and history of domestic violence were also relevant. The sample consists of 152 participants from outpatient clinics, community events, and grocery stores in one Northeastern US city. The anonymous online survey contained the following Instruments: Newest Vital Sign, New General Self-efficacy Scale, Health Risk Instrument, Daily Spiritual Assessment Scale, FAST Survey, and Health-Promoting Lifestyle Profile II. Univariate statistics and bivariate/simultaneous linear regression identified significant relationships between health-promotion behaviors and the following: eeadiness for change, self-efficacy, and spirituality. Participants who engaged in health-promotion behaviors were ready to change, but these behaviors were negatively associated with spirituality, self-efficacy, and a history of domestic violence.

Innovative Classroom Upgrade: Simulating an Intensive Care Unit Environment in an Undergraduate Academic Classroom.

ABSTRACT: There are limited opportunities for undergraduate nursing students to take part in hands-on critical care. A course was developed to expose students to the critically ill patient in the intensive care unit environment and introduce skills that students may not have the opportunity to engage in during their clinical hours. Led by two faculty currently practicing in critical care, this course used multiple learning modalities, including high-fidelity simulation; didactic teaching; online discussion; and narrative, reflective writing, to teach critical care concepts and entry-level skills.

Monitoring for Poststroke Seizures.

It is unpredictable which stroke survivors will experience a seizure following a stroke. Stroke is a major cause of seizures. Critical care nurses need to know the risk factors, type of stroke at risk, stroke location, and severity for the poststroke patient who is at risk for an early or late seizure. Poststroke seizures require appropriate nursing assessments, management, and support.

Comparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit.

OBJECTIVE: The objective of the study was to compare the performance of intravenous (IV) lorazepam (IVL) and intranasal midazolam (INM) for seizure termination and prevention of seizure clusters in adults admitted to the epilepsy monitoring unit (EMU) in whom seizures were captured on continuous video-electroencephalogram. METHODS: Retrospective cohort of consecutive adults (≥18 years) with epilepsy admitted to the EMU at a single tertiary academic center, who experienced epileptic seizures (confirmed electroencephalographically) and required rescue therapy. The study spanned from January 2015 until December 2016, which included one year before and one year after transitioning from IVL to INM as the standard rescue therapy at our institution. RESULTS: A total of 50 subjects received rescue therapy and were included in the analysis. In the first year, out of 216 patients with epilepsy admitted to the EMU, 27 (13%) received IVL; in the second year, 23/217 (11%) received INM. There were no differences in baseline characteristics and markers of epilepsy severity, the median duration of index seizure (1.7 min [interquartile range (IQR): 1.1-2.7] in IVL vs. 2.0 min [IQR: 1.5-2.6] in INM group, p = 0.20), or in the number of subjects requiring repeat benzodiazepine administrations (IVL 8/27 [29.6%] vs. INM 7/23 [30.4%], p = 0.95). There were no differences in the median number of recurrent seizures in 24 h (1 [IQR: 1-3] in IVL vs. 2 [IQR: 1-4] in INM, p = 0.27), occurrence of status epilepticus (IVL 4/27 [14.8%] subjects vs. INM 1/23 [4.3%] subjects, p = 0.36), incidence of seizure clusters (IVL 8/27 [29.6%] subjects vs. INM 7/23 [30.4%] subjects, p = 0.95), need for transfer to an intensive care unit (ICU), or other adverse events. SIGNIFICANCE: In our retrospective study, INM was comparable with IVL for seizure termination and prevention of seizure clusters in the adult EMU. Intranasal midazolam circumvents the need for IV access to be maintained throughout hospitalization and is an attractive alternative to IVL as a rescue therapy in this setting. Ideally, future large, prospective, randomized, and double blind studies are needed to confirm these findings.

Telehealth Use to Promote Quality Outcomes and Reduce Costs in Stroke Care.

Stroke can cause severe disability and death in the adult population. Many stroke patients do not have access to resources required to provide a timely diagnosis and treatment. Telestroke can provide these patients the accurate diagnosis and appropriate treatment they require. Telestroke has been linked to improved functional outcomes in the treatment of acute ischemic strokes. There are several barriers to providing a telestroke service, such as licensure and liability, reimbursement, technology, and financial issues. It is important to recognize these barriers and begin to implement strategies to overcome them. Telestroke use is cost-effective by reducing stroke complications and disabilities.

Marketing component of the "Chécate, mídete, muévete" program evaluation in rural communities of Tabasco, Mexico / Componente de mercadeo del programa de evaluación "Chécate, mídete, muévete" en comunidades rurales de Tabasco, México

Abstract Objective: To evaluate the marketing component of the "Chécate, Mídete, Muévete" Program in rural communities of Tabasco, Mexico. Methods: Mixed design research, divided into two phases: Documentary Analysis, and Field-work through the application of checklists, observation guides, questionnaire and focus groups. Results: The medical units ("place") presented deficiencies in infrastructure (67%) and in equipment (33%), 65% of the nurses and promoters were unaware of the Program. Regarding "promotion", 73% of users recognized the advertising image, resulting understandable (33%), attractive (46%), identifiable (57%) and motivating (43%). Television was the broadcast channel with the greatest impact. In relation to the expected "product" in the "Chécate" block, 53% of the users referred to a medical check-up; In the "Mídete" block, 32% said they took care of their diet, and in the "Muévete" block, 45% mentioned not practicing physical activity. Based on the focus group, the existence of motivation for the care of their health was noticed and with this, avoiding diseases associated with obesity. The main change that the population tries to make to improve their health is to balance their diet, but with little inclusion of physical activities in their daily routine. Conclusions: The advertising image of the campaign has the right characteristics of dissemination and transmission of the message, however, in order to achieve the expected impact, it is fundamental that the care actions by the health personnel of the medical units be permanent and properly executed.

Resumen Objetivo: Evaluar el componente de mercadotecnia del programa "Chécate, Mídete, Muévete" en las comunidades rurales de Tabasco, México. Métodos: Investigación de diseño mixto, dividida en dos fases: análisis documental y trabajo de campo mediante la aplicación de listas de verificación, guías de observación, cuestionarios y grupos focales. Resultados: Las unidades médicas ("lugar") presentaron deficiencias en infraestructura (67%) y en equipamiento (33%), el 65% de las enfermeras y promotoras desconocían el Programa. En cuanto a la "promoción", el 73% de los usuarios reconoció la imagen publicitaria, resultando comprensible (33%), atractiva (46%), identificable (57%) y motivadora (43%). La televisión fue el canal de difusión con mayor impacto. En relación con el "producto" esperado en el bloque "Chécate", el 53% de los usuarios se refirió a un chequeo médico; En el bloque "Mídete", el 32% dijo que cuidaba su dieta, y en el bloque "Muévete", el 45% dijo que no practicaba actividad física. Con base en el grupo focal, se notó la existencia de motivación para el cuidado de su salud y con esto, evitando enfermedades asociadas a la obesidad. El principal cambio que la población intenta hacer para mejorar su salud es equilibrar su dieta, pero con poca inclusión de actividades físicas en su rutina diaria. Conclusiones: La imagen publicitaria de la campaña tiene las características correctas de difusión y transmisión del mensaje; sin embargo, para lograr el impacto esperado, es fundamental que las acciones de atención por parte del personal de salud de las unidades médicas sean permanentes y se ejecuten correctamente.

Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care.

PURPOSE: An intensive care unit (ICU) patient's primary care physician (PCP) may be able to assist family with certain ICU shared medical decisions. We explored whether families of patients in nonopen ICUs who nevertheless report involvement of a patient's PCP in medical decision making are more satisfied with ICU shared decision making than families who do not. METHODS: Between March 2013 and December 2015, we administered the Family Satisfaction in the ICU 24 survey to family members of adult neuroscience ICU patients. We compared the mean score for the survey subsection regarding shared decision making (graded on a 100-point scale), as well as individual survey items, between those who reported the patient's PCP involvement in any medical decision making versus those who did not. RESULTS: Among 263 respondents, there was no difference in mean overall decision-making satisfaction scores for those who reported involvement (81.1; SD = 15.2) versus those who did not (80.1; SD = 12.8; P = .16). However, a higher proportion reporting involvement felt completely satisfied with their 1) inclusion in the ICU decision making process (75.9% vs 61.4%; P = .055), and 2) control over the care of the patient (73.6% vs 55.6%; P = .02), with no difference regarding consistency of clinical information provided by the medical team (64.8% vs 63.5%; P = 1.00). CONCLUSIONS: Families who report involvement of a patient's PCP in medical decision making for critically ill patients may be more satisfied than those who do not with regard to specific aspects of ICU decision making. Further research would help understand how best to engage PCPs in shared decisions.