Experiences of Doctor of Nursing Practice (DNP)-prepared nurses choosing to pursue a Doctor of Philosophy (PhD) degree.

BACKGROUND: Increasingly, nurses with a Doctor of Nursing Practice (DNP) degree are seeking a Doctor of Philosophy (PhD) degree. This subset of students may provide valuable insight for bolstering the PhD-prepared workforce, which is in decline. PURPOSE: The purpose of this research was to understand the essence of the lived experience of DNP-prepared nurses choosing to pursue a PhD degree. METHOD: An existential phenomenological study was undertaken, with 10 DNP-to-PhD students interviewed. RESULTS: The DNP-to-PhD experience is about being On a Mission. The Nursing Hierarchy was an implicit force influencing students' missions, and their experiences were characterized by five themes: (a) Having Needs the DNP Can't Meet: "I had to go back and do more," (b) Considering Dreams and Circumstances: "Now's the time," (c) Developing Confidence: "You can do this!" (d) "I've been very supported"/"I had no support," and (e) "It had to be an internal drive for me." CONCLUSIONS: Study findings demonstrate profound effects of the nursing hierarchy on students' decisions as well as misperceptions that still surround DNP and PhD education and careers. Nursing academicians, organizational leaders, and researchers must address PhD program disinterest, intimidation, and imposter syndrome and improve messaging about both degrees.

Media competencies for nurses: A Delphi study.

BACKGROUND: Media raises awareness of important health issues, provides guidance to promote health, and shapes health policies. However, nurses are poorly represented in media. PURPOSE: To propose competencies that can be used to advance nurses' knowledge and skills in using media to advance health. METHODS: A Delphi study design of three successive surveys was employed. The Round 1 survey was sent to 70 nurse media leaders, and 28 (40%) responded. Seventeen respondents (61%) participated in Round 2. The Round 3 survey was not needed. DISCUSSION: These competencies provide direction for academia, healthcare organizations, nursing associations and others who seek to develop the leadership and population health skills of nurses. Ways the competencies can be used are outlined. CONCLUSION: There is an urgent need to improve population health outcomes by reducing disparities and promoting equity in health and health care. Media engagmeent is an importnat strategy for promoting population health. Additionally, promotion of better media representation of nurses and improved media engagement by nurses and nursing organizations all speak to the importance of advancing media competence.

Prevalence and Impact of Adverse Childhood Experiences in an Interdisciplinary, School-Based Pediatric Clinic.

INTRODUCTION: This study's purpose was to ascertain the prevalence of adverse childhood experiences (ACEs) in a pediatric population and their connection to other health history information. METHOD: Using health history data, a retrospective, descriptive study was undertaken with 1,028 children seen at a school-based, interprofessional clinic over 1 academic year. RESULTS: Nearly 58% of children had at least one ACE, and 9.5% had four or more, similar to the prevalence of ACEs in adults reported in the original study by Felitti et al. (1998). With increasing ACEs, children had higher rates of intrauterine drug exposure, intensive care on delivery, homelessness, substance abuse, behavioral problems, mental illness, learning difficulties, and weight issues. DISCUSSION: Because ACEs are prevalent among children, pediatric providers should use trauma-informed care principles and teach and model a loving and supportive adult presence in children's lives.

COVID-19 effects on practice: Perspectives of Tennessee APRNs.

BACKGROUND: In response to the COVID-19 pandemic, Tennessee's Governor issued executive orders temporarily suspending certain practice restrictions on advanced practice registered nurses (APRN), which expired after 2 months as the pandemic worsened. PURPOSE: This purpose of this qualitative study was to analyze APRN interview data to evaluate how prepandemic APRN practice barriers, executive orders, and the pandemic affected APRN practice in Tennessee. METHODS: Fifteen Tennessee APRNs who completed the National APRN Practice and Pandemic study also completed follow-up interviews via a HIPAA-compliant Zoom platform. Given the unprecedented circumstances associated with the COVID-19 pandemic, we conducted a qualitative descriptive study seeking descriptions and unique perspectives of Tennessee APRNs. Consistent with qualitative study design, we conducted an atheoretical study that featured interviews, purposeful sampling with maximum variation sampling, and content analysis. RESULTS: The major themes were practice changes, impact of executive orders, and ongoing care barriers. The data revealed that patients, APRNs, and other health care providers were strained in new and profound ways during the pandemic. An underlying theme was Tennessee APRNs' frustration with continued regulatory and other practice barriers despite their state's health and health care disparities and under resourced health care system. CONCLUSION: These findings indicate the need to improve care access and health outcomes, advocate for full practice authority for APRNs, support telehealth expansion, address transportation deficiencies, and respond to the pandemic-precipitated mental health crisis.

Interventions to boost enrollment in nursing doctor of philosophy (PhD) programs.

BACKGROUND: Nursing Doctor of Philosophy (PhD) enrollments are languishing, and little is known about PhD enrollment strategies that may lessen nursing's PhD shortage. PURPOSE: This study examined strategies for bolstering PhD enrollments or enrollment intentions among college students and graduates. METHODS: An integrative review was undertaken using Whittemore and Knafl's methodology and Garrard's Matrix Method. Nine databases were searched, and a hand search was conducted. FINDINGS: Strategies were predominantly situated in science, technology, engineering, and mathematics (STEM) disciplines. Features of successful strategies contained core components of faculty mentoring, hands-on research, funding and compensation, undergraduate participation, summer timeframe, informational sessions, and social support. DISCUSSION: Less rigorous study designs and mostly STEM samples inhibit the transferability of these strategies to nursing. Qualitative research is needed to better understand nursing students' perspectives about the PhD. Additionally, current PhD enrollment strategies within nursing schools need to be systematically evaluated and the findings disseminated.

COVID-19 Pandemic Mental Health Challenges: Patients and Providers.

Interviews with 15 Tennessee Advanced Practice Registered Nurses early in the COVID-19 pandemic revealed a major theme of mental health challenges unrelated to the primary study purpose. Without direct prompts, 13 out of 15 interviewees mentioned mental health issues among patients and 14 of the 15 interviewees discussed provider mental health problems. A secondary analysis of interview transcripts revealed three themes associated with mental health challenges: general barriers to mental health care, patient-specific concerns, and provider issues. Responding to the new and worsening mental health and substance use disorders revealed by informants and cited in the literature is an urgent priority.

Purposeful Language Exposure by Neonatal Nurses and Caregivers in the NICU.

BACKGROUND: Preterm infants are at significant risk of neurocognitive deficits including language delay. Extended hospitalization in the neonatal intensive care unit (NICU) causes missed opportunities for language exposure at critical developmental periods of neural pathways for language processing. Healthcare providers (HCPs), particularly nurses, may be instrumental in providing infant-directed speech to improve neurodevelopmental outcomes. PURPOSE: To evaluate current evidence to determine what is known about the characteristics of HCP communication to infants in the NICU. SEARCH/STRATEGY: Four databases and forward searching were used to respond to the clinical question: "What is known about the characteristics of HCP communication to infants in the NICU?" Empiric, primary research studies published in English without date restriction were included. FINDINGS: Eight studies, primarily descriptive, were reviewed. Overall, infant-directed speech was rarely provided by HCPs. Language was more often directed to sicker infants, occurred in contexts of procedural pain, and was sometimes combined with touch. Perceptions of language by nurses, infants, and parents as well as inhibitors and benefits of infant-directed speech were reported. IMPLICATIONS FOR PRACTICE: As frontline neonatal providers, nurses can serve as role models of infant-directed speech for parents, helping them gain comfort and understand the importance of speaking to their preterm infants. Nurses can also provide much-needed language nutrition to preterm infants when parents cannot be present. IMPLICATIONS FOR RESEARCH: Methods to reduce barriers and support infant-directed speech in the NICU require testing. Predictive modeling using measures of language exposure in the NICU may support differences in neurodevelopmental outcomes.

Graduate student self-efficacy: Implications of a concept analysis.

BACKGROUND: Nurses with graduate degrees play pivotal roles in nursing care, education, and research. Alarming trends of a nurse faculty shortage and high levels of graduate nursing student attrition highlight the need to better understand the experiences of graduate nursing students. PURPOSE: The purpose of this paper is to define the concept of self-efficacy in graduate students as it pertains to enrollment, retention, and graduation. METHODS: Using Rodgers' Evolutionary Method of concept analysis, self-efficacy was analyzed from the literature of various disciplines, including nursing. RESULTS: Antecedents, attributes, and consequences of self-efficacy were identified from 23 studies. Self-efficacy in graduate students is sourced by perceived, positive experiences. Its attributes are personal, malleable, goal-driven, a resource, knowledge, and trust. Graduate student self-efficacy results in productive thoughts, feelings, and actions that culminate in successful outcomes. CONCLUSION: Self-efficacy has been identified by researchers in other disciplines as a helpful concept for understanding why and how graduate students initiate, continue, and complete their degrees. With a dearth of research exploring nursing graduate student self-efficacy, qualitative research is needed to understand the role this concept plays in graduate nursing education. Nevertheless, the findings of this concept analysis may serve as a starting point to inform nursing graduate education practice.