Better together: Coalitions committed to advancing health equity.

The Future of Nursing 2020-2030 report identifies coalitions as a driving force for advancing health equity. Five coalitions provided insight into their accomplishments, lessons learned, and role in advancing health equity. The exemplar coalitions included Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action. While all exemplar coalitions, credited relationship building and partnerships to their success, they used unique strategies for striving to meet their populations' needs, whether the needs arose from COVID-19, racial and/or ethnic disparities, socioeconomic disparities, or other barriers to health. Research and policy implications for coalitions are discussed. Nurses play a critical role in every highlighted coalition and in the national effort to make health and health care more equitable.

Advanced Closed-Loop Control System Improves Postprandial Glycemic Control Compared With a Hybrid Closed-Loop System Following Unannounced Meal.

OBJECTIVE: Meals are a major hurdle to glycemic control in type 1 diabetes (T1D). Our objective was to test a fully automated closed-loop control (CLC) system in the absence of announcement of carbohydrate ingestion among adolescents with T1D, who are known to commonly omit meal announcement. RESEARCH DESIGN AND METHODS: Eighteen adolescents with T1D (age 15.6 ± 1.7 years; HbA1c 7.4 ± 1.5%; 9 females/9 males) participated in a randomized crossover clinical trial comparing our legacy hybrid CLC system (Unified Safety System Virginia [USS]-Virginia) with a novel fully automated CLC system (RocketAP) during two 46-h supervised admissions (each with one announced and one unannounced dinner), following 2 weeks of data collection. Primary outcome was the percentage time-in-range 70-180 mg/dL (TIR) following the unannounced meal, with secondary outcomes related to additional continuous glucose monitoring-based metrics. RESULTS: Both TIR and time-in-tight-range 70-140 mg/dL (TTR) were significantly higher using RocketAP than using USS-Virginia during the 6 h following the unannounced meal (83% [interquartile range 64-93] vs. 53% [40-71]; P = 0.004 and 49% [41-59] vs. 27% [22-36]; P = 0.002, respectively), primarily driven by reduced time-above-range (TAR >180 mg/dL: 17% [1.3-34] vs. 47% [28-60]), with no increase in time-below-range (TBR <70 mg/dL: 0% median for both). RocketAP also improved control following the announced meal (mean difference TBR: -0.7%, TIR: +7%, TTR: +6%), overall (TIR: +5%, TAR: -5%, TTR: +8%), and overnight (TIR: +7%, TTR: +19%, TAR: -5%). RocketAP delivered less insulin overall (78 ± 23 units vs. 85 ± 20 units, P = 0.01). CONCLUSIONS: A new fully automated CLC system with automatic prandial dosing was proven to be safe and feasible and outperformed our legacy USS-Virginia in an adolescent population with and without meal announcement.

Black Nurses Collaborative Approach to Addressing COVID-19 in Black Communities.

As with other national disasters, epidemics, and pandemics, the novel coronavirus SARS-CoV-2 (COVID-19) pandemic has highlighted health disparities in Black communities in the USA. Healthcare providers, community activists, politicians, members of faith-based organizations, professional athletes, and Black families are asking crucial questions about why Black and Brown people are disproportionately infected by, and dying from, the COVID-19. Evidence in healthcare and social sciences literature demonstrates that historically, systemic racism and injustices play a large role in the health and well-being of Blacks living in the USA. For decades, the National Black Nurses Association has been on the forefront, engaging our people using a collaborative community-based practice model. The healthcare goal in the USA should center on health protection, promotion, and prevention, moving toward a wellness model and away from treatment of illnesses that contribute to healthcare waste. Finally, awareness of social determinants of health has taken center stage, demonstrating how laws, policies, and practice affect health outcomes and the well-being of Black and Brown communities. In order to address social determinants of health and healthcare inequity, the National Black Nurses Association has called for an increase in the number of Black registered nurses and licensed vocational and practical nurses. The healthcare goal in the USA should center on health protection, promotion, and preventions moving toward a wellness model and away from treatment of illnesses that contributes to healthcare waste.

Culturally Congruent Health Care of COVID-19 in Minorities in the United States: A Clinical Practice Paper From the National Coalition of Ethnic Minority Nurse Associations.

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial-ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial-ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.

Central Line Care: Empowering Patients to Prevent Infection and Injury Via EPIC2.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are associated with an increased risk of mortality, prolonged hospitalizations, and inflated cost of care. Patients in the hematology-oncology specialty unit are at greater risk of developing CLABSIs because of their immunocompromised state and high number of central line (CL) days. OBJECTIVES: The aim of the EPIC2 project was to reduce CLABSI rates on a hematology-oncology specialty unit with historically high CLABSI rates despite prior quality improvement efforts. METHODS: EPIC2 used the theory of planned behavior as the framework for changing patient behavior and was based on evidence from the Partners in Your Care© handwashing study that successfully engaged patients to hold healthcare professionals accountable. FINDINGS: The three-month preintervention average CLABSI rate was 5.69. During the intervention period, the average rate was 3.24. This accounted for a 43% reduction in CLABSIs. Participants in the EPIC2 project reported feeling empowered to speak up against improper CL care.

Mapping and Sustaining Leadership Development: An Innovation Academic Service Partnership.

OBJECTIVE AND BACKGROUND: To improve leadership competency, academic and clinical partners planned and implemented a 2-day facilitated workshop that actively engaged nurse leaders in preparing for their current and future careers by focusing on "The Leader Within." We anticipated that an emphasis on this particular dimension of leadership, that is, knowing oneself, would lead to improvements in the science and the art of leadership among nurse managers (NMs) and assistant NMs (ANMs). METHODS: Using the Nurse Manager Skills Inventory (NMSI), we conducted precompetency and 8-month postcompetency surveys and interviews. Although 41 nurses completed the pretest, only 17 completed the posttest. RESULTS: The sample of 50% NMs and 50% ANMs had an average age of 38.4 (SD, 8.2) years' and 8.2 (SD, 6.3) years' experience. Self-rated leadership competency scores were improved at the 8-month posttest period on all NMSI sections: the Science, the Art, and the Leader Within. CONCLUSIONS: Actively cultivating "The Leader Within" facilitates reflective practice that may lead to more deliberate leadership competency attainment and career planning.

Building Bridges: The Journey of Alabama's Health Action Coalition.

AIM: The Alabama Health Action Coalition is a state coalition whose purpose is to enable access to high-quality, safe, and patient-centered health care for all Alabamians by leading change in nursing and health care. BACKGROUND: The Alabama Health Action Coalition has four focus areas: advancing nursing education, improving nursing workforce data, promoting diversity among nursing and health care professionals, and fostering a culture of health. METHOD: From 2012 to 2014, the Advancing Education Taskforce and Health Workforce Committee initiated processes to maximize resources, track changes in workforce data, and provide support for goal achievement. RESULTS: Outcomes included an increase in the number of nurses with a BSN and higher degrees from 35 percent to 50 percent, nearing national averages. CONCLUSION: Tracking of trends continues with 2016 data. This growth is particularly important in a state with a large, underserved population and high percentage of rural areas.

Student Success Survey: Supporting Academic Success for At-Risk Nursing Students Through Early Intervention.

Diversity in the nursing workforce has a positive impact on the quality of care provided to minority patients. Although the number of students from diverse backgrounds entering nursing programs has increased, the attrition rate of these students remains high. This study assessed the construct validity of a self-assessment tool that can be used by faculty advisors to determine individual academic needs of students.

Process for Mapping Global Health Competencies in Undergraduate and Graduate Nursing Curricula.

Determining the extent to which existing nursing curricula prepare students to address global health issues is a critical step toward ensuring competence to practice in an increasingly globalized world. This article describes the process used by nursing faculty at a public university in the southern United States to assess the extent to which global health competencies for nurses were being addressed across nursing programs. Steps used and lessons learned throughout this process are discussed.

Methods dentists use to diagnose primary caries lesions prior to restorative treatment: Findings from The Dental PBRN.

OBJECTIVE: To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use. METHODS: A total of 228 DPBRN dentists recorded information on 5,676 consecutive restorations inserted due to primary caries lesions on 3,751 patients. Practitioner-investigators placed a mean of 24.9 (SD = 12.4) restorations. Lesions were categorized as posterior proximal, anterior proximal, posterior occiusal, posterior smooth, or anterior smooth. Techniques used to diagnose the lesion were categorized as clinical assessment, radiographs, and/or optical. Statistical analysis utilized generalized mixed-model ANOVA to account for the hierarchical structure of the data. RESULTS: By lesion category, the diagnostic technique combinations used most frequently were clinical assessment plus radiographs for posterior proximal (47%), clinical assessment for anterior proximal (51%), clinical assessment for posterior occlusal (46%), clinical assessment for posterior smooth (77%), and clinical assessment for anterior smooth (80%). Diagnostic technique was significantly associated with lesion category after adjusting for clustering in dentists (p < 0.0001). CONCLUSION: These results--obtained during actual clinical procedures rather than from questionnaire-based hypothetical scenarios--quantified the diagnostic techniques most commonly used during the actual delivery of routine restorative care. Diagnostic technique varied by lesion category and with certain practice and patient characteristics.

Professional development needs of nurse managers.

BACKGROUND: Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today's complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. METHOD: We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. RESULTS: Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. CONCLUSION: Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role.

Nurturing charge nurses for future leadership roles.

Charge nurses are untapped leadership resources that can be groomed for future advanced leadership positions in healthcare organizations. The purpose of this study was to understand the development needs for the charge nurse role. This study demonstrates they receive little or no training for assuming positions of leadership and offers suggestions for enhancement of preparation.

Incorporating quality and safety education into a nursing administration curriculum.

The Quality and Safety Education for Nursing initiative is aimed at developing student competences in quality and safety. Because practicing nurses have not been exposed to this initiative, nurse leaders must be aware of these competencies to develop these competencies in existing staff members. This article provides a roadmap to curriculum development in a nursing administration graduate program focused on quality and safety.

Lessons learned during the conduct of clinical studies in the dental PBRN.

Effectively addressing challenges of conducting research in nonacademic settings is crucial to its success. A dental practice-based research network called The Dental Practice-Based Research Network (DPBRN) is comprised of practitioner- investigators in two health maintenance organizations, several universities, many U.S. states, and three Scandinavian countries. Our objective in this article is to describe lessons learned from conducting studies in this research context; the studies are conducted by clinicians in community settings who may be doing their first research study. To date, twenty-one studies have been completed or are in implementation. These include a broad range of topic areas, enrollment sizes, and study designs. A total of 1,126 practitioner-investigators have participated in at least one study. After excluding one study because it involved electronic records queries only, these studies included more than 70,000 patient/participant units. Because the DPBRN is committed to being both practitioner- and patient-driven, all studies must be approved by its Executive Committee and a formal study section of academic clinical scientists. As a result of interacting with a diverse range of institutional and regulatory entities, funding agencies, practitioners, clinic staff, patients, academic scientists, and geographic areas, twenty-three key lessons have been learned. Patients' acceptance of these studies has been very high, judging from high participation rates and their completion of data forms. Early studies substantially informed later studies with regard to study design, practicality, forms design, informed consent process, and training and monitoring methods. Although time-intensive and complex, these solutions improved acceptability of practice-based research to patients, practitioners, and university researchers.