Strategies for developing faculty confidence and competencies to mentor quality improvement DNP projects.

DNP faculty who mentor students in quality improvement (QI) DNP projects often lack essential knowledge of QI principles. The purpose of this article is to guide DNP programs in developing confident and competent faculty mentors for QI DNP projects, facilitating DNP student success. At a multi-campus practice- and research-intensive university, strategies employed to teach College of Nursing faculty essential knowledge of QI principles comprise structural and process components. Structural supports standardize faculty workload, promote potential for collaborative scholarship, and provide instructional and resource support for faculty mentors. Organizational processes facilitate identification of practice sites and meaningful projects. A College of Nursing and university Institutional Review Board collaboration established policy to guide human subjects protection regarding DNP project activity, streamlining and standardizing the process. Library support mechanisms, access to ongoing faculty QI training and resources, and faculty feedback processes to improve QI faculty development are ongoing and sustained. Peer coaching provides continued support for faculty development. Initial process outcomes indicate that implemented strategies are well-received by faculty. The transition to competency-based education provides opportunities to create tools to measure multiple student quality and safety competencies highlighted in Domain 5 of The Essentials: Core Competencies for Professional Nursing Education and inform future directions for faculty development essential to support student success.

Strategies used by teens growing up in families with Huntington disease.

The purpose of this study was to identify helpfulness of strategies used by teens growing up in families with Huntington disease (HD). Forty-four participants responded to a mailed HD Family Survey-Teens Strategies. Strategies were those with strong positive correlation between use and perceived helpfulness, and those with negative or inverse relationships. Obtaining information, thinking about or doing something else, and actions on behalf of the parent with HD were rated as highest use and perceived helpfulness. Emotional suppression had high use but low helpfulness. Participants reported using numerous helpful strategies. Social support was often unavailable to help manage teen concerns.

Development of the HD-Teen Inventory.

Adolescents, who have a parent with Huntington Disease (HD), not only are at genetic risk for HD but also are witness to its onset and devastating clinical progression as their parent declines. To date, no mechanism has been developed to direct health care providers to the atypical adolescent experiences of these teens. The purpose of this report is to describe the process of developing the HD-Teen Inventory clinical assessment tool. Forty-eight teens and young adults from 19 U.S. states participated in the evaluation of the HD-Teen Inventory tool. Following item analysis, the number of items was reduced and item frequency and reaction scales were combined, based on the strong correlation (r = .94). The resultant tool contains 15 inventory and 2 open-ended response items. The HD-Teen Inventory emerged as a more compact and efficient tool for identifying the most salient concerns of at-risk teens in HD families in research and/or clinical practice.

Patient and family issues regarding genetic testing for cystic fibrosis: a review of prenatal carrier testing and newborn screening.

Cystic fibrosis (CF) is a potentially life-shortening autosomal recessive genetic condition resulting in chronic progressive respiratory involvement, malnutrition, electrolyte imbalance, and male infertility It is the most common autosomal inherited condition in the white population, and its presence is recorded with varying prevalence across ethnicities. Since the 1989 discovery of the genetic variant F508del, the most common cystic fibrosis transmembrane conductance regulator (CFTR) mutation, more than 1900 CF mutations have been identified. The 1997 National Institutes of Health (NIH) Consensus Statement on Cystic Fibrosis, along with 2001 and 2005 recommendations from the American College of Obstetricians and Gynecologists (ACOG), provide the basis for population CF carrier screening in the prenatal setting. Recommendations for newborn screening (NBS) for cystic fibrosis were released in 2004, with NBS programs in the United States initiated thereafter. With the wide variety of CFTR mutations and mutation combinations, there is not a clear understanding of the genotype-phenotype correlations or of the anticipated clinical trajectory for an individual who has identified CFTR mutations. This ambiguity creates challenges for patients and families in decision making related to CFTR carrier screening during the prenatal period, understanding the results of newborn screening for CF, or coping with the new genetic knowledge obtained. This literature review examines research regarding genetic testing for CF as it related to population screening. Patient and family issues from both the prenatal period and newborn testing are reviewed. Opportunities for future nursing research and implication for nursing practice are discussed.

Pregnancy as foreground in cystic fibrosis carrier testing decisions in primary care.

Cystic fibrosis carrier testing (CFCT) is among the first of the DNA tests offered prenatally in primary care settings. This paper from a descriptive qualitative study describes the influence of pregnancy in CFCT decisions by women receiving community-based prenatal care. Twenty-seven women receiving prenatal care in Midwestern U.S. primary care clinics completed semistructured interviews. Audiotaped interviews were analyzed using content analysis. Participants described decision-making influences and strategies from the perspective of "being pregnant." Patterns of attitudes and beliefs include (1) dealing with emotions, (2) pregnancy is natural, and (3) thinking about the baby. Strategies in the decision-making process included (1) reducing stress, (2) choosing what is relevant, (3) doing everything right, (4) wanting to be prepared, (5) delaying information, and (6) trusting God. While other factors were mentioned by some women, major themes reflect the influence of currently being pregnant on the decision-making process. These findings suggest that pregnancy is a powerful influence on the decision-making process and may not be the optimal time to make fully informed decisions regarding genetic carrier testing. Further understanding of factors influencing the genetic testing decision-making process is needed. Offering CFCT prior to conception is advocated.

Experiences of teens living in the shadow of Huntington Disease.

Research on families with Huntington Disease (HD) has primarily focused on adult decision-making surrounding predictive genetic testing and caregiver stress. Little is known about the experiences of teens living in these families. This qualitative study explored the experiences of 32 teens living in families with HD. Six focus groups were conducted across the U.S. and Canada. Data were analyzed using descriptive qualitative analysis. Huntington disease appeared to cast a shadow over the experiences described by teens. Four themes were identified: watching and waiting; alone in the midst of others; family life is kind of hard; and having to be like an adult. These experiences highlight the need for genetic counselors, health care providers, and school personnel to be aware of issues facing teens living in families with HD. Recognizing patterns of teen experiences may help health care providers develop strategies to support coping by teens in HD families.

Hospital readmission from a transitional care unit.

The purpose of this project was to characterize patients readmitted to the hospital during a stay in a transitional care unit (TCUT). Typically, readmitted patients were females, widowed, with 8 medical diagnoses, and taking 12 different medications. Readmission from the TCU occurred within 7 days as a result of a newly developed problem. Most patients did not return home after readmission from the TCU. Understanding high-risk patients' characteristics that lead to costly hospital readmission during a stay in the TCU can assist clinicians and healthcare providers to plan and implement timely and effective interventions, and help facility personnel in fiscal and resource management issues.

Abuse-related post-traumatic stress during the childbearing year.

BACKGROUND: Women with abuse-related post-traumatic stress who are pregnant experience symptoms that nurses and midwives may not recognize or know how to respond to. AIM: The purpose of this article is to increase familiarity with the post-traumatic stress disorder diagnostic framework by illustrating the symptom categories and associated features with women's descriptions of the symptoms from qualitative interviews. METHODS: A secondary analysis was performed with data from a qualitative interview study of the maternity care experiences of 15 American women who had abuse-related post-traumatic stress during pregnancy. Content analysis was used to extract all participant statements describing how post-traumatic stress disorder symptoms and associated features manifested in pregnancy. These were then juxtaposed with the post-traumatic stress disorder diagnostic framework. RESULTS: Participants' interviews included a range of descriptions of the intrusive re-experiencing, avoidance and numbing, and hyperarousal core symptoms of post-traumatic stress disorder, as well as associated psychological features such as somatization, dissociation and interpersonal sensitivity, and associated behavioural features such as substance abuse, disordered eating, high-risk sexual behaviours, suicidality, and revictimization. CONCLUSIONS: Limitations of this study include that it is a secondary analysis, using a small North American sample, and focusing only on abuse-related post-traumatic stress disorder. Descriptive information from this qualitative study may bridge the gaps between psychiatric technical language, women's subjective experiences, and clinicians' perceptions of a woman's post-traumatic stress reactions.

Abuse-related posttraumatic stress and desired maternity care practices: women's perspectives.

Qualitative research participants who self-identified as having a history of childhood sexual abuse and abuse-related posttraumatic stress during the childbearing year were interviewed for the purpose of determining what these women perceive as optimal maternity care. Using a process of narrative analysis, desired care practices were identified. With the exception of one woman, all of the study participants wanted their maternity care provider to be competent to address trauma-related needs. Three groups emerged from the data, providing a useful structure for informing providers on how best to respond to diverse abuse-survivor clients: 1) women far along in recovery, 2) women who were not safe, and 3) women who were not ready to "know." The first group had the best trauma-related and maternity outcomes and the best childbearing experiences. For these women, having a provider who was a "collaborative ally" seemed beneficial. The second group had safety needs that required a "compassionate authority figure" who offered referral and follow-up care. Women in the third group were not ready to address trauma-related symptoms or issues overtly and appeared to need a provider who was a "therapeutic mentor." Four assessment factors help providers determine how to respond.