Embracing midcareer in the tenure system.

Midcareer faculty are the "keystone" of academia. Faculty in midcareer experience an increase or change in responsibilities and expectations as well as reduced support and mentorship usually extended to junior faculty. Nonetheless, midcareer can be an ideal time for re-evaluating and defining one's career path and taking advantage of leadership and service opportunities. Successful navigation of midcareer is essential to ensure nursing faculty remain in the academic setting, contribute to nursing science, and have a satisfying career. In this paper, we present strategies midcareer nurse faculty can consider to maintain balance and advance their careers even during challenging times. These strategies include appraising career goals, maintaining and expanding mentoring relationships, seeking and utilizing opportunities for leadership development, selecting service strategically to advance career goals, preparing for the unexpected, maintaining/expanding scholarly productivity, learning when to say yes or no, embracing lifelong learning, and improving visibility of one's work.

Planning and implementing a practice/academic partnership during COVID-19.

Due to the COVID-19 pandemic, nursing programs were challenged to continue educating students at practice sites, and educational institutions limited or eliminated face-to-face education. The purpose of this article is to report on a university and community college nursing program and an academic medical center that implemented an academic-practice partnership with the goal of creating opportunities to continue clinical experiences for nursing students during the pandemic. Principles and implementation of this successful partnership provide direction for other nursing programs and practice settings that may continue to have challenges in returning students to clinical and keeping them in clinical as the pandemic continues.

LGBT inclusivity in health assessment textbooks.

Lesbian, gay, bisexual, and transgender (LGBT) people make up 4% of the adult population in the United States; however, it is unclear if there is sufficient material in nursing textbooks for students to learn how to provide care for sexual minority populations. A content analysis of two commonly used health assessment textbooks was completed to identify material that prepared nurses for LGBT patient interactions. Topics such as gender neutrality, same-sex partners, and other terms referring to LGBT persons were considered LGBT content. Campinha-Bacote's The Process of Cultural Competence in the Delivery of Healthcare was used as the theoretical framework to assess the textbooks' content on five constructs: awareness, knowledge, skill, encounters, and desire to learn. Eleven pages in one text and 14 in the other had at least one line that addressed LGBT health assessment. Investigators found content related to the constructs of awareness, knowledge, and skill in both textbooks. In all cases, the content was limited in depth; both textbooks lacked exemplars and application of LGBT-specific health content. Inclusion of this information in textbooks or other learning resources is needed to enhance nurses' cultural knowledge and skill to improve health care outcomes within this vulnerable population.

Programmatic Evaluation of Holistic Admissions: The Influence on Students.

BACKGROUND: Traditional nursing admission processes may pose barriers to enhancing the diversity of the nursing workforce. Holistic admission moves beyond academic metrics to include applicants' experiences, attributes, and abilities. METHOD: Demographic and academic information was examined for students admitted to a Bachelor of Science in Nursing program before and after holistic admission implementation, and a survey was completed by students admitted in 2014 through holistic admission. RESULTS: The admission of Hispanic students significantly increased, whereas admissions of non-Hispanic White students significantly decreased. Academic metrics did not change significantly. Students rated the holistic admission process positively, with the interview rated as more valuable than the written application. Some students believed it could have a negative effect on students who were not racial or ethnic minorities. CONCLUSION: Holistic admission may increase the diversity of a nursing class; however, it should be combined with other strategies to build a diverse pipeline. [J Nurs Educ. 2018;57(7):416-421.].

Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: a cross-sectional survey.

BACKGROUND: Prehospital delay of acute myocardial infarction (AMI) is common globally, and Hong Kong-home of a rapidly ageing Chinese population-is not an exception. Seeking emergency medical care promptly is important for patients. Treatment-seeking behaviours have been shown to be associated with knowledge of AMI symptoms and specific cultural beliefs. This study aimed to assess the level of knowledge of AMI symptoms and expected treatment-seeking behaviour among older Chinese in Hong Kong. METHODS: A cross-sectional population-based survey was conducted at the Elderly Health Centres in Hong Kong from March to September 2016. Face-to-face interviews were conducted with a structured questionnaire based on previous studies and local adaptations. RESULTS: Among 1804 people aged 65 years and above who completed the questionnaire, chest pain (80.2%), palpitations (75.8%) and fainting (71.9%) were the major symptoms recognised as AMI related. Meanwhile, stomach ache (46.9%), coughing (45.4%) and neck pain (40.8%) were recognised as not AMI related. The mean expected discomfort intensity during AMI onset was 7.7 out of 10 (SD=2.1). Regarding the expected treatment-seeking behaviour, seeking non-emergent medical care was the most popular action when AMI symptoms emerged during the day, without chest pain or with lower discomfort intensity, whereas calling an ambulance was the most common option when AMI symptoms emerged at night or with high discomfort intensity. CONCLUSIONS: To minimise delays in seeking treatment, future health education should focus on increasing the public knowledge of AMI symptoms and the need to call an ambulance during an emergency.

Launching Successful Beginnings for Early Career Faculty Researchers.

Junior faculty follow a research path replete with challenges as they strive to create knowledge in their area of interest while balancing new responsibilities. Unlike graduate school, where students focus inward on personal development, junior faculty must add responsibilities in ways that hold them accountable as members of a university. This special article deals with three themes of interest to new junior faulty launching research programs: personal development, collaboration and team development within university settings, and funding advice. Strategies in these areas provide guidance on navigating early careers and finding success in the academic setting.

Systematic review of symptom clusters in cardiovascular disease.

BACKGROUND: Although individual symptoms and symptom trajectories for various cardiovascular conditions have been reported, there is limited research identifying the symptom clusters that may provide a better understanding of patients' experiences with heart disease. AIMS: To summarize the state of the science in symptom cluster research for patients with acute coronary syndrome, myocardial infarction, coronary artery bypass surgery, and heart failure through systematic review and to provide direction for the translation of symptom cluster research into the clinical setting. METHODS: Databases were searched for articles from January 2000 through to May 2015 using MESH terms "symptoms, symptom clusters, acute coronary syndrome (ACS), myocardial infarction (MI), coronary heart disease (CHD), ischemic heart disease (IHD), heart failure (HF), coronary artery bypass surgery (CABS), cluster analyses, and latent classes." The search was limited to human studies, English language articles, and original articles investigating symptom clusters in individuals with heart disease. Fifteen studies meeting the criteria were included. RESULTS: For patients with ACS and MI, younger persons were more likely to experience clusters with the most symptoms. Older adults were more likely to experience clusters with the lowest number of symptoms and more diffuse and milder symptom clusters that are less reflective of classic ACS presentations. For HF patients, symptom clusters frequently included physical and emotional/cognitive components; edema clustered in only three studies. Symptom expression was congruent across geographical regions and cultures. CONCLUSIONS: The findings demonstrated similarities in symptom clusters during ACS, MI, and HF, despite multiple methods and analyses. These results may help clinicians to prepare at-risk patients for proper treatment-seeking and symptom self-management behaviors.

Selecting symptom instruments for cardiovascular populations.

The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.

Measure of Clinical Decision-Making Abilities of Nurse Practitioner Students.

BACKGROUND: This study reports the validity and reliability of using unfolding case studies to measure the clinical decision-making abilities of nurse practitioner students. METHOD: Two unfolding case studies were developed to assess students' ability to collect, interpret, and evaluate data. Content validity was assessed through percent agreement from three expert clinicians. Reliability was measured using Cronbach's alpha, test-retest, and interrater reliability. RESULTS: Fifty-two participants, primarily from family, acute care, and adult nurse practitioner programs, completed both unfolding cases. Content validation was nearly 100% for most items; other items were revised or deleted. A significant correlation was found between total mean scores at initial testing and at 1 month after both cases. High inter-rater reliability of the scored tool was noted, as measured with intraclass correlation coefficient. CONCLUSION: The use of case studies is a learner-centric method to measure the development and transition of clinical decision making.

Business Continuity Planning for Nursing Schools: Preparation for Potential Disasters.

Nursing schools are vulnerable to disasters, ranging from pandemics to weather emergencies, fires, and acts of terrorism. To ensure minimal disruptions to teaching, provision of care, research, and other critical missions, nursing faculty and administrative leaders should develop a business continuity plan. The business continuity plan can help faculty, students, and administration identify critical functions and alternative plans if an emergency occurs. We offer our experience as a guide for other nursing schools.

Normalizing Rejection.

Getting turned down for grant funding or having a manuscript rejected is an uncomfortable but not unusual occurrence during the course of a nurse researcher's professional life. Rejection can evoke an emotional response akin to the grieving process that can slow or even undermine productivity. Only by "normalizing" rejection, that is, by accepting it as an integral part of the scientific process, can researchers more quickly overcome negative emotions and instead use rejection to refine and advance their scientific programs. This article provides practical advice for coming to emotional terms with rejection and delineates methods for working constructively to address reviewer comments.

Holistic review in admissions: a strategy to diversify the nursing workforce.

Individuals both within and outside the nursing profession have called for more diversity in nursing, from the education arena to the workforce. Implementing initiatives that address diversity and determining their effects have been limited. The University of Illinois at Chicago College of Nursing used the American Association of Medical Colleges Holistic Review Project as a platform to implement a process and paradigm shift for admissions to its nursing programs. We believe that the use of holistic admissions can increase the diversity among nursing students and provide the first step toward a diversified nursing profession. In hopes of assisting other institutions, we describe our experiences with preparing and implementing a holistic admissions process within the context of lessons learned and continued challenges. Furthermore, we hope our efforts will serve as a catalyst for a national dialogue on the use of holistic review as a strategy for the development of a more diverse nursing workforce.

Disparities in patients presenting to the emergency department with potential acute coronary syndrome: it matters if you are Black or White.

OBJECTIVES: To explore disparities between non-Hispanic Blacks and non-Hispanic Whites presenting to the emergency department (ED) with potential acute coronary syndrome (ACS). BACKGROUND: Individuals with fewer resources have worse health outcomes and these individuals are disproportionately those of color. METHODS: This prospective study enrolled 663 patients in four EDs. Clinical presentation, treatment, and patient-reported outcome variables were measured at baseline, 1, and 6 months. RESULTS: Blacks with confirmed ACS were younger; had lower income; less education; more risk factors; more symptoms, and longer prehospital delay at presentation compared to Whites. Blacks experiencing palpitations, unusual fatigue, and chest pain were more than 3 times as likely as Whites to have ACS confirmed. Blacks with ACS had more clinic visits and more symptoms 1 month following discharge. CONCLUSIONS: Significant racial disparities remain in clinical presentation and outcomes for Blacks compared to Whites presenting to the ED with symptoms suggestive of ACS.

Fatigue in the presence of coronary heart disease.

BACKGROUND: Fatigue is a prevalent and disabling symptom associated with many acute and chronic conditions, including acute myocardial infarction and chronic heart failure. Fatigue has not been explored in patients with stable coronary heart disease (CHD). OBJECTIVES: The purpose of this partially mixed sequential dominant status study was to (a) describe fatigue in patients with stable CHD; (b) determine if specific demographic (gender, age, education, income), physiological (hypertension, hyperlipidemia), or psychological (depressive symptoms) variables were correlated with fatigue; and (c) determine if fatigue was associated with health-related quality of life. The theory of unpleasant symptoms was used as a conceptual framework. METHODS: Patients (N = 102) attending two cardiology clinics completed the Fatigue Symptom Inventory, Patient Health Questionnaire-9, and Medical Outcomes Study Short Form-36 to measure fatigue, depressive symptoms, and health-related quality of life. Thirteen patients whose interference from fatigue was low, moderate, or high participated in qualitative interviews. RESULTS: Forty percent of the sample reported fatigue more than 3 days of the week lasting more than one half of the day. Lower interference from fatigue was reported on standardized measures compared with qualitative interviews. Compared with men, women reported a higher fatigue intensity (p = .003) and more interference from fatigue (p = .007). In regression analyses, depressive symptoms were the sole predictor of fatigue intensity and interference. DISCUSSION: Patients with stable CHD reported clinically relevant levels of fatigue. Patients with stable CHD may discount fatigue as they adapt to their symptoms. Relying solely on standardized measures may provide an incomplete picture of fatigue burden in patients with stable CHD.

Strategies for a successful PhD program: words of wisdom from the WJNR Editorial Board.

Nursing doctoral programs prepare students for research-focused careers within academic settings. The purpose of this Editorial Board Special Article is to provide PhD students and advisors with suggestions for making the most of their doctoral experience. Editorial Board members provide their individual insights on the skills and attributes students must acquire during the course of their doctoral education in order to succeed. The authors provide practical tips and advice on how to excel in a PhD program, including how to select an advisor and a dissertation committee, the importance of attending conferences to increase visibility and develop a network of colleagues, presenting and publishing research while still a student, and balancing work and personal life. Students who take full advantage of the opportunities available to them during the course of their doctoral programs will graduate well prepared to take on the multiple responsibilities of research, teaching, and leadership.

Challenges and solutions for using informatics in research.

Computer technology provides innovations for research but not without concomitant challenges. Herein, we present our experiences with technology challenges and solutions across 16 nursing research studies. Issues included intervention integrity, software updates and compatibility, web accessibility and implementation, hardware and equipment, computer literacy of participants, and programming. Our researchers found solutions related to best practices for computer-screen design and usability testing, especially as they relate to the target populations' computer literacy levels and use patterns; changes in software; availability and limitations of operating systems and web browsers; resources for on-site technology help for participants; and creative facilitators to access participants and implement study procedures. Researchers may find this information helpful as they consider successful ways to integrate informatics in the design and implementation of future studies with technology that maximizes research productivity.

Time management strategies for research productivity.

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

Changing illness perceptions and adherence to dual antiplatelet therapy in patients with stable coronary disease.

BACKGROUND: Platelet inhibition with dual antiplatelet therapy (DAPT) is an important component of medical management in patients with stable coronary artery disease (CAD). Dual antiplatelet therapy nonadherence is associated with increased mortality. Little is known about illness perceptions (IPs) surrounding the use of antiplatelet medications and whether they differ in stable CAD patients treated with medical and/or interventional approaches. OBJECTIVE: The aim of this study was to examine temporal changes in IP scores for patients with stable CAD and examine the influence of clinical and demographic variables, IP, and depressive symptoms on adherence to DAPT. METHODS: Patients (n = 180, 71.7% men; mean [SD] age, 65.1 [8.3] years) were recruited after coronary angiography and optimal medical therapy (OMT) (n = 90) or after percutaneous coronary intervention with initiation of OMT (n = 90). The Illness Perception Questionnaire-Revised and Patient Health Questionnaire-9 were administered at baseline and 30 days after treatment, with a response rate of 52.8% (n = 95) at 30 days. Adherence to DAPT (aspirin and thienopyridine) at 30 days was collected using a health history update. RESULTS: Patients with stable CAD experienced shifts in IP within the first 30 days after treatment. Patients treated with OMT demonstrated increased symptoms after treatment (timeline cyclical) and reduced beliefs in the level of control provided by their prescribed regimen (treatment control, t = 3.26, P = .002). Both groups demonstrated an increase in perceived understanding of illness (illness coherence subscale) from baseline to 30 days (percutaneous coronary intervention/OMT, t = -4.43, P < .001; OMT, t = -3.74, P = .001). Chronic IPs were associated with 5.7% increased odds for improved adherence to thienopyridine agents (B = 0.509, P = .009, Exp(B) = 1.66) and 5.6% increased odds for aspirin use (B = 0.265, P = .031, Exp(B) = 1.30). Depressive symptoms were predictive of adherence for thienopyridine medications (B = 0.509, P = .009, Exp(B) = 1.66). CONCLUSIONS: Illness perceptions influence adherence to DAPT in patients with stable CAD. Understanding patterns in IP after treatment may help identify the best strategies to promote a tailored approach for improving adherence to DAPT.