Data Analytics for Diagnosis and Prediction of Central Line-Associated Bloodstream Infections in Critical Care Units.

Central line-associated bloodstream infections are among the leading causes of in-hospital deaths in the United States and are a significant factor for increased morbidity, mortality, and healthcare costs. This study integrates several hospital data systems into a case-controlled database to use data analytics for the identification of significant central line-associated bloodstream infection risk factors and develop time-varying patient risk scores for central line-associated bloodstream infections. A case-control study was performed utilizing patient data collected from various sources then gathered and organized into a case-controlled dataset for analysis examining various patient-specific attributes for central line-associated bloodstream infections. Training and testing sets were created, and multivariate logistic regressions were used to identify risk factors for central line-associated bloodstream infection. Furthermore, the Cox proportional hazards model was used to infer the hazard rate and risk score for central line-associated bloodstream infections for each individual patient during hospitalization. Significant attributes for central line-associated bloodstream infection cases were the ICU location (P = .008), time from insertion (P ≤ .001), number of surgeries (P = .003), and number of central line manipulations (P = .003). Real-time data analytics and point of care at the bedside can facilitate precision care for patients with an elevated central line-associated bloodstream infection risk, subsequently changing the way healthcare prevents hospital-acquired infections.

Need for Nurse Practitioner Fellowships in Ophthalmology in the USA.

Medical attention to vision impairment and associated eye care complications are a vital component of daily living and overall well-being. In the United States today, the physician to patient deficit places great strain on the availability of medical attention tenable to patients nationwide; in terms of specialty medicine, this deficit is even more widespread. The field of ophthalmology faced the same physician to patient deficit in 2020, a grim reality that has left many states void of ophthalmic care, rending millions of aging individuals without domestic eye care. The implementation of trained, ophthalmic nurse practitioners (NPs) can fill the needs of this deficit; however, efficient, accredited, and board-approved American ophthalmic fellowships and residencies that secure proper ophthalmic NP transitions from academia to clinical practice are non-existent. Though scant, evidence-based literature presents sound findings that support the efficacy and benefit for superior patient outcomes with care provided by ophthalmic-trained NPs, offering a viable, long-term solution to the need for ophthalmic medical providers across all states without mitigating patient care, emphasizing the great need for the implementation of ophthalmic NP residencies and fellowships to ensure the continuity of impeccable ophthalmic care for all populations.

Improving knowledge and decreasing depressive symptoms in caregivers of children with asthma through the asthma academy: A randomized controlled trial.

Background: Caregivers of children with asthma demonstrate higher levels of anxious and depressive symptoms when compared to caregivers of healthy children. Objectives: The objectives of this study were to: 1) Evaluate feasibility and acceptability of two nurse-led, remotely offered interventions for caregivers of children with asthma; 2) Compare effectiveness of two interventions (a virtual education session and a virtual education session supplemented with a telehealth visit) in relation to caregiver outcomes, and 3) Assess the preliminary effect of the interventions on caregivers' knowledge of asthma, sleep, anxiety and depressive symptoms. Methods: A mixed methods approach was used inclusive of a qualitative, descriptive design and randomized controlled trial design. Caregivers were provided virtual education and telehealth visits and evaluated from pre-posttest. Results: The intervention was found to be feasible and acceptable. Both the virtual education session and telehealth visit were effective. The intervention had a significant effect on caregiver's asthma knowledge and depressive symptoms (p<.05), but did not affect caregiver's sleep or anxiety. Qualitative analysis of the virtual educational session revealed themes of 1) valuable learning experience, 2) more medication education needed, and 3) appreciated remote format. Qualitative analysis of the telehealth visits revealed themes of 1) educational, helpful, and worthwhile and 2) virtual offering was easy and convenient. Conclusions: Remotely conducted, nurse-led interventions such as virtual education sessions and telehealth visits are a feasible, acceptable, and effective way to improve caregiver outcomes.

Healthcare Providers' Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases.

PURPOSE: The purpose of this study was to identify healthcare providers' experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases. DESIGN AND METHODS: A qualitative, descriptive design was used with 13 pediatric healthcare providers. FINDINGS: Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support. CONCLUSIONS: Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers. PRACTICE IMPLICATIONS: The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.

Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children.

Preparation for surgery with the induction of general anesthesia is one of the most stressful events that a child can experience. It produces several threats to the child, including physical harm, parent separation, and fear of the unknown. Anesthesia providers utilize non-pharmacological and pharmacological interventions to decrease this preoperatively. However, little is known about the non-pharmacological interventions utilized by anesthesia providers in practice. The purpose of this study was to explore non-pharmacological interventions utilized by anesthesia providers before and during the induction of general anesthesia to reduce preoperative distress in children ages one to six years old. A qualitative descriptive approach was used in this study. Twenty anesthesia providers, fourteen registered nurse anesthetists and six anesthesiologists, participated in face to face, in-depth interviews in South Florida. Content analysis was used to identify and define the major themes that emerged from the interviews. A total of seven main themes were identified. Only the three themes directly related to parent-provider-child relationship are discussed in this paper: (I) Communication, (II) Observational Skills, and (III) Parental Presence. The anesthesia providers who participated in this study offered an opportunity to better understand the non-pharmacological interventions used to impact the management of preoperative distress among children. Study findings provide evidence about non-pharmacological anesthesia providers' clinical work not found elsewhere in the literature. Non-pharmacological interventions are effective in reducing preoperative distress in children.

Transforming Health Care Through Meaningful Doctor of Nursing Practice Community Partnerships.

BACKGROUND: A critical component of doctor of nursing practice (DNP) education is practice immersion. DNP programs require 1000 hours of clinical practice experience to obtain the DNP degree. PROBLEM: Faculty struggle with providing meaningful clinical experiences congruent with the role of the DNP. APPROACH: This article describes a unique practice immersion course joining DNP students with community health care partners to provide meaningful experiences with the potential to transform health care. DNP students are assigned system-level projects designed to create organizational change. OUTCOMES: Over the course of 4 years, the practice immersion opportunities more than doubled from 30 to 66 live projects. Integrating collaborative practice immersion into the curriculum builds students' leadership skills and strengthens long-standing bonds among academia, practice, and the community. CONCLUSIONS: The creation of structured, meaningful collaborations between DNP students and community partners is an approach that has the potential to facilitate transformative, sustainable change in health care.

Developing nurse leaders across the Americas: evaluation of an online nursing leadership course

[ABSTRACT]. Development of leadership capacities in the nursing workforce is essential to achieving universal health in the Region of the Americas. This evaluation considered the effectiveness of an online leadership course offered in English and Spanish to nurses throughout Latin America and the Caribbean. The online course was an asynchronous eight-module leadership nursing course created and offered by the Pan American Health Organization (PAHO) Virtual Campus. A retrospective, descriptive design was used to evaluate learner performance data from the modules. Learner performance on the course was analyzed. Electronic surveys were distributed to individuals who withdrew prior to course completion to obtain information regarding the reason for withdrawal. In all, 289 individuals from 41 countries participated in the online course. Learner performance demonstrated improvement from pre- to post-test. The most frequent reason for not completing the course was being too busy with other obligations. The Spanish-language course version received more enrollment applications than any other course in the virtual campus’ 12-year history. The evaluation concluded that continuing education that develops nursing leadership is desired across Latin America and the Caribbean. Online education through the PAHO Virtual Campus may be a low-cost yet powerful means of disseminating knowledge to the nursing workforce throughout the Americas.

[RESUMEN]. El desarrollo de las capacidades de liderazgo en el personal de enfermería es esencial para alcanzar la salud universal en la Región de las Américas. En esta evaluación se analizó la eficacia de un curso de liderazgo en línea en inglés y en español que se ofreció a personal de enfermería en toda América Latina y el Caribe. El curso en línea fue un curso asíncrono de liderazgo en enfermería de ocho módulos, creado y ofrecido por el Campus Virtual de la Organización Panamericana de la Salud (OPS). Se usó un diseño retrospectivo y descriptivo para evaluar los datos de desempeño de los alumnos en los módulos. Se analizó el desempeño de los alumnos en cuanto al aprendizaje el curso. Se enviaron encuestas electrónicas a las personas que abandonaron el curso antes de su finalización para obtener información sobre los motivos de deserción. En total, 289 personas de 41 países participaron en los cursos en línea. Se detectaron mejoras en el desempeño de los alumnos antes y después de la prueba. La razón más frecuente por la que no completaron el curso fue que estaban muy ocupados con otras obligaciones. La versión del curso en español tuvo más inscriptos que cualquier otro curso en los 12 años del Campus Virtual. La conclusión de la evaluación fue que en toda América Latina y el Caribe se desea recibir educación continua que fomente las capacidades de liderazgo en enfermería. La educación en línea por medio del Campus Virtual de la OPS puede ser un medio económico, pero a la vez poderoso, de difundir conocimiento al personal de enfermería en la Región de las Américas.

[RESUMO]. Desenvolver a capacidade de liderança na equipe de enfermagem é fundamental para alcançar a saúde universal na Região das Américas. Foi realizada uma avaliação da efetividade de um curso online de práticas de liderança em enfermagem ministrado em inglês e em espanhol ao pessoal de enfermagem em toda a América Latina e o Caribe. Tratou-se de um curso online assíncrono com oito módulos sobre práticas de liderança em enfermagem, elaborado e oferecido pelo Campus Virtual da Organização Pan-Americana da Saúde (OPAS). Foi usado um delineamento descritivo retrospectivo para avaliar os dados do desempenho dos alunos nos módulos. Foram enviadas aos participantes que não concluíram o curso uma pesquisa eletrônica para a coleta de dados sobre os motivos do abandono. Ao todo, 289 profissionais de 41 países fizeram o curso online. Houve melhoria no desempenho dos alunos entre o pré-teste e o pós-teste. Estar muito ocupado com outros compromissos foi o motivo mais frequentemente informado para não concluir o curso. O número de inscrições de profissionais no curso na versão em espanhol foi o mais alto dentre os cursos oferecidos nos 12 anos de vida do campus virtual. Esta avaliação demonstrou que existe uma demanda por educação continuada para desenvolver liderança em enfermagem na América Latina e Caribe. A educação online por meio do Campus Virtual da OPAS é um recurso de baixo custo, porém de grande influência, para difundir o conhecimento entre o pessoal de enfermagem nas Américas.

Developing Minority Nursing Students: Evaluation of an Innovative Mentorship and Leadership Program.

BACKGROUND: There is disparity in the nursing work-force of minority leaders. The aim of this article is to describe and evaluate an innovative program designed to provide mentorship and increase leadership skills of minority nursing students. METHOD: An innovative mentorship program was developed including coordination of financial aid meetings, incorporating technology, enacting an online preimmersion course, choosing and training mentors, hosting a lunch-and-lead leadership series, and using intensive review sessions and tutoring. Program evaluation data were analyzed using mixed methods. RESULTS: All 40 participants passed the NCLEX-RN and had obtained employment after the program. Of the 20 respondents, 25% already had obtained a leadership role in nursing. Qualitative data about the program revealed categories of leadership, networking, mentorship, more time, and gratitude. CONCLUSION: This program was successful in promoting retention, graduation, and development of future minority nurse leaders. [J Nurs Educ. 2018;57(9):526-534.].

Comparison of Telemedicine to Traditional Face-to-Face Care for Children with Special Needs: A Quasiexperimental Study.

BACKGROUND: Services for Children with Special Healthcare Needs (CSHCN) have been challenging in terms of cost and access to appropriate healthcare services. OBJECTIVES: The objectives of this study were to examine cost, caring, and family-centered care in relationship to pediatric specialty services integrating telemedicine visits compared to traditional face-to-face visits only for (CSHCN) in rural, remote, and medically underserved areas. METHODS: This study used a prospective, quasiexperimental research design with 222 parents or legal guardians of CSHCN receiving pediatric specialty care. The traditional group (n = 110) included families receiving face-to-face pediatric specialty care and the telemedicine group (n = 112) included families who had telemedicine visits along with traditional face-to-face pediatric specialty care. RESULTS: Results indicated no significant differences in family costs when the telemedicine group was compared to traditional face-to-face care. When the telemedicine group was asked to anticipate costs if telemedicine was not available, there were significant differences found across all variables, including travel miles, cost of travel, missed work hours, wages lost, child care cost, lodging cost, other costs, and total family cost (p < 0.001). There were no differences in the families' perceptions of care as caring. Parents/guardians perceived the system of care as significantly more family-centered when using telemedicine (p = 0.003). CONCLUSIONS: The results of this study underscore the importance of facilitating access to pediatric specialty care by use of telemedicine. We endorse efforts to increase healthcare access and decrease cost for CSHCN by expanding telemedicine and shaping health policy accordingly.

Developing nurse leaders across the Americas: evaluation of an online nursing leadership course.

Development of leadership capacities in the nursing workforce is essential to achieving universal health in the Region of the Americas. This evaluation considered the effectiveness of an online leadership course offered in English and Spanish to nurses throughout Latin America and the Caribbean. The online course was an asynchronous eight-module leadership nursing course created and offered by the Pan American Health Organization (PAHO) Virtual Campus. A retrospective, descriptive design was used to evaluate learner performance data from the modules. Learner performance on the course was analyzed. Electronic surveys were distributed to individuals who withdrew prior to course completion to obtain information regarding the reason for withdrawal. In all, 289 individuals from 41 countries participated in the online course. Learner performance demonstrated improvement from pre- to post-test. The most frequent reason for not completing the course was being too busy with other obligations. The Spanish-language course version received more enrollment applications than any other course in the virtual campus' 12-year history. The evaluation concluded that continuing education that develops nursing leadership is desired across Latin America and the Caribbean. Online education through the PAHO Virtual Campus may be a low-cost yet powerful means of disseminating knowledge to the nursing workforce throughout the Americas.

El desarrollo de las capacidades de liderazgo en el personal de enfermería es esencial para alcanzar la salud universal en la Región de las Américas. En esta evaluación se analizó la eficacia de un curso de liderazgo en línea en inglés y en español que se ofreció a personal de enfermería en toda América Latina y el Caribe. El curso en línea fue un curso asíncrono de liderazgo en enfermería de ocho módulos, creado y ofrecido por el Campus Virtual de la Organización Panamericana de la Salud (OPS). Se usó un diseño retrospectivo y descriptivo para evaluar los datos de desempeño de los alumnos en los módulos. Se analizó el desempeño de los alumnos en cuanto al aprendizaje el curso. Se enviaron encuestas electrónicas a las personas que abandonaron el curso antes de su finalización para obtener información sobre los motivos de deserción.En total, 289 personas de 41 países participaron en los cursos en línea. Se detectaron mejoras en el desempeño de los alumnos antes y después de la prueba. La razón más frecuente por la que no completaron el curso fue que estaban muy ocupados con otras obligaciones. La versión del curso en español tuvo más inscriptos que cualquier otro curso en los 12 años del Campus Virtual. La conclusión de la evaluación fue que en toda América Latina y el Caribe se desea recibir educación continua que fomente las capacidades de liderazgo en enfermería. La educación en línea por medio del Campus Virtual de la OPS puede ser un medio económico, pero a la vez poderoso, de difundir conocimiento al personal de enfermería en la Región de las Américas.

Desenvolver a capacidade de liderança na equipe de enfermagem é fundamental para alcançar a saúde universal na Região das Américas. Foi realizada uma avaliação da efetividade de um curso online de práticas de liderança em enfermagem ministrado em inglês e em espanhol ao pessoal de enfermagem em toda a América Latina e o Caribe. Tratou-se de um curso online assíncrono com oito módulos sobre práticas de liderança em enfermagem, elaborado e oferecido pelo Campus Virtual da Organização Pan-Americana da Saúde (OPAS). Foi usado um delineamento descritivo retrospectivo para avaliar os dados do desempenho dos alunos nos módulos. Foram enviadas aos participantes que não concluíram o curso uma pesquisa eletrônica para a coleta de dados sobre os motivos do abandono.Ao todo, 289 profissionais de 41 países fizeram o curso online. Houve melhoria no desempenho dos alunos entre o pré-teste e o pós-teste. Estar muito ocupado com outros compromissos foi o motivo mais frequentemente informado para não concluir o curso. O número de inscrições de profissionais no curso na versão em espanhol foi o mais alto dentre os cursos oferecidos nos 12 anos de vida do campus virtual. Esta avaliação demonstrou que existe uma demanda por educação continuada para desenvolver liderança em enfermagem na América Latina e Caribe. A educação online por meio do Campus Virtual da OPAS é um recurso de baixo custo, porém de grande influência, para difundir o conhecimento entre o pessoal de enfermagem nas Américas.

Developing nurse leaders across the Americas: evaluation of an online nursing leadership course / Capacitación de líderes en enfermería en toda la Región de las Américas: evaluación de un curso en línea de liderazgo en enfermería / Desenvolver a liderança em enfermagem nas Américas: avaliação de um curso online de práticas de liderança em enfermagem

ABSTRACT Development of leadership capacities in the nursing workforce is essential to achieving universal health in the Region of the Americas. This evaluation considered the effectiveness of an online leadership course offered in English and Spanish to nurses throughout Latin America and the Caribbean. The online course was an asynchronous eight-module leadership nursing course created and offered by the Pan American Health Organization (PAHO) Virtual Campus. A retrospective, descriptive design was used to evaluate learner performance data from the modules. Learner performance on the course was analyzed. Electronic surveys were distributed to individuals who withdrew prior to course completion to obtain information regarding the reason for withdrawal. In all, 289 individuals from 41 countries participated in the online course. Learner performance demonstrated improvement from pre- to post-test. The most frequent reason for not completing the course was being too busy with other obligations. The Spanish-language course version received more enrollment applications than any other course in the virtual campus' 12-year history. The evaluation concluded that continuing education that develops nursing leadership is desired across Latin America and the Caribbean. Online education through the PAHO Virtual Campus may be a low-cost yet powerful means of disseminating knowledge to the nursing workforce throughout the Americas.

RESUMEN El desarrollo de las capacidades de liderazgo en el personal de enfermería es esencial para alcanzar la salud universal en la Región de las Américas. En esta evaluación se analizó la eficacia de un curso de liderazgo en línea en inglés y en español que se ofreció a personal de enfermería en toda América Latina y el Caribe. El curso en línea fue un curso asíncrono de liderazgo en enfermería de ocho módulos, creado y ofrecido por el Campus Virtual de la Organización Panamericana de la Salud (OPS). Se usó un diseño retrospectivo y descriptivo para evaluar los datos de desempeño de los alumnos en los módulos. Se analizó el desempeño de los alumnos en cuanto al aprendizaje el curso. Se enviaron encuestas electrónicas a las personas que abandonaron el curso antes de su finalización para obtener información sobre los motivos de deserción. En total, 289 personas de 41 países participaron en los cursos en línea. Se detectaron mejoras en el desempeño de los alumnos antes y después de la prueba. La razón más frecuente por la que no completaron el curso fue que estaban muy ocupados con otras obligaciones. La versión del curso en español tuvo más inscriptos que cualquier otro curso en los 12 años del Campus Virtual. La conclusión de la evaluación fue que en toda América Latina y el Caribe se desea recibir educación continua que fomente las capacidades de liderazgo en enfermería. La educación en línea por medio del Campus Virtual de la OPS puede ser un medio económico, pero a la vez poderoso, de difundir conocimiento al personal de enfermería en la Región de las Américas.

RESUMO Desenvolver a capacidade de liderança na equipe de enfermagem é fundamental para alcançar a saúde universal na Região das Américas. Foi realizada uma avaliação da efetividade de um curso online de práticas de liderança em enfermagem ministrado em inglês e em espanhol ao pessoal de enfermagem em toda a América Latina e o Caribe. Tratou-se de um curso online assíncrono com oito módulos sobre práticas de liderança em enfermagem, elaborado e oferecido pelo Campus Virtual da Organização Pan-Americana da Saúde (OPAS). Foi usado um delineamento descritivo retrospectivo para avaliar os dados do desempenho dos alunos nos módulos. Foram enviadas aos participantes que não concluíram o curso uma pesquisa eletrônica para a coleta de dados sobre os motivos do abandono. Ao todo, 289 profissionais de 41 países fizeram o curso online. Houve melhoria no desempenho dos alunos entre o pré-teste e o pós-teste. Estar muito ocupado com outros compromissos foi o motivo mais frequentemente informado para não concluir o curso. O número de inscrições de profissionais no curso na versão em espanhol foi o mais alto dentre os cursos oferecidos nos 12 anos de vida do campus virtual. Esta avaliação demonstrou que existe uma demanda por educação continuada para desenvolver liderança em enfermagem na América Latina e Caribe. A educação online por meio do Campus Virtual da OPAS é um recurso de baixo custo, porém de grande influência, para difundir o conhecimento entre o pessoal de enfermagem nas Américas.

Increasing the pipeline and diversity of doctorally prepared nurses: Description and preliminary evaluation of a health disparities summer research program.

Despite calls to increase the number and diversity of doctorally prepared nurses, recent data indicate a severe shortage of PhD-prepared nurses, especially those of racial/ethnic minority backgrounds. This is concerning, given that evidence indicates that racial/ethnic minority PhD-prepared nurses are well-positioned to address health disparities, by attending to the needs/concerns of medically underrepresented groups. The purpose of this article is to describe and provide a preliminary evaluation of a summer research program for minority nursing students. Online surveys were administered to assess for student satisfaction, knowledge gains, attitudes toward research, and intentions to pursue a PhD among minority undergraduate nursing students (N = 6) participating in the 10-week program. Favorable trends were observed related to satisfaction, knowledge gains, and attitudes toward research. Fifty percent of the sample intended to pursue a PhD immediately after the program, compared to none before the program, and this result was maintained at 1-year post-program. The summer research program appears to be a promising strategy for increasing the number/diversity of PhD-prepared nurses. More research on the implementation of programs exposing minority nursing students to health disparities research is needed to strengthen evidence that similar programs can serve to increase the pipeline of diverse doctorally prepared nurses.

Challenges Facing Children with Special Healthcare Needs and Their Families: Telemedicine as a Bridge to Care.

Telemedicine is an increasingly utilized mode of healthcare delivery, which improves access to care for vulnerable populations. Children with Special Healthcare Needs (CSHCN) and their families face significant challenges, such as geographic, financial, and sociocultural barriers, in accessing needed healthcare services. The literature supports telemedicine as an effective accepted bridge between CSHCN and their providers. A growing body of telemedicine projects also suggests cost-effectiveness when considering the direct and indirect costs the families of CSCHN incur in seeking healthcare services. These new systems of care should prioritize caring and family centeredness while reducing the burdens of CSHCN and their families.

Developing and testing an online breastfeeding training among undergraduate nursing students.

The benefits of breastfeeding for mothers and babies have been well documented in the scientific literature, with new evidence about the benefits continuing to emerge. The Surgeon General's call to action to support breastfeeding recommends mandatory breastfeeding education and training for all healthcare providers that deliver care to mothers and babies. The purpose of this study is to analyze the development of an online computer based breastfeeding training (BT) and the preliminary outcomes of this training. The development of this training included consultation with content and technology experts. The collection of preliminary outcomes related to breastfeeding knowledge data and evaluation of the online BT was pre and posttest study. Eighty six undergraduate nursing students completed the online BT using Blackboard Learn. The online component of the BT consisted of five modules with a combined length of approximately 16 hours. After the completion of the modules, the students increased their levels of knowledge related to breastfeeding and the majority believed that they were fully able to perform skills to support breastfeeding. The results of this study indicate that a successful BT for nursing students can be effectively designed, which can in the future be disseminated to other healthcare providers and students. In addition, this online BT was cost-efficient and effective in improving students' knowledge and skills to support breastfeeding.