Associations between TCA cycle plasma metabolites and fatigue in black females with systemic lupus erythematosus: An untargeted metabolomics pilot study.

OBJECTIVE: In this pilot study, we used untargeted metabolomics to identify biochemical mechanisms or biomarkers potentially underlying SLE-related fatigue. METHODS: Metabolon conducted untargeted metabolomic plasma profiling using ultrahigh performance liquid chromatography/tandem mass spectrometry on plasma samples of 23 Black females with systemic lupus erythematosus (SLE) and 21 no SLE controls. Fatigue phenotypes of general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation were measured with the reliable and valid Multidimensional Fatigue Inventory (MFI). RESULTS: A total of 290 metabolites were significantly different between the SLE and no SLE groups, encompassing metabolites related to glycolysis, TCA cycle activity, heme catabolism, branched chain amino acids, fatty acid metabolism, and steroids. Within the SLE group, controlling for age and co-morbidities, TCA cycle metabolites of alpha-ketoglutarate (AKG) and succinate were statistically significantly associated (p < .05) with physical and general fatigue. CONCLUSION: While pervasive perturbations in the entire TCA cycle have been implicated as a potential mechanism for fatigue, our results suggest individual metabolites of AKG and succinate may be potential biomarkers or targets of intervention for fatigue symptom management in SLE. Additionally, perturbations in heme metabolism in the SLE group provide additional insights into mechanisms that promote systemic inflammation.

Emerging Adults with Diabetes in Safety-Net Care: Self-Management Influences and Patient-Provider Interactions.

Emerging adults with diabetes, particularly in underserved communities, represent a growing but less studied population whose needs may differ from older adults. This study investigated perspectives of underserved emerging adults regarding diabetes self-management influences and provider interactions. Focus groups and interviews with emerging adults in a safety-net health care setting were conducted to identify perspectives regarding self-management influences and patient-provider interactions. Diabetes was perceived as a psychological burden complicated by busy lifestyles and competing responsibilities. Lack of resources, especially financial barriers, also limited self-management. Participants often perceived diabetes visits as standardized encounters providing access to diabetes supplies but desired additional guidance appropriate to their needs and life-stage. Participants valued encouragement and positive ongoing provider relationships for tailored informational and emotional support and support from family and peers. Providers and health care systems adapting to provide or facilitate this support will be better able to optimize diabetes management at and between visits.

Integrating the Social Determinants of Health Into Prelicensure Nursing Pharmacology.

BACKGROUND: Nursing organizations have called for the incorporation of social determinants of health (SDOH) throughout nursing school curricula. Guidance is needed regarding best practices to integrate SDOH into pharmacology courses in prelicensure nursing programs. METHOD: Using Emory University's School of Nursing SDOH framework to guide curriculum innovation, pharmacology faculty identified three pharmacology-centric SDOH topics: race-based medicine and pharmacogenomics, pharmacy deserts, and lack of diversity in clinical trials. These three SDOH topics were incorporated into preestablished pharmacology content. RESULTS: Faculty integrated SDOH into pharmacology courses with heavy science content, and students were receptive to open discussion of SDOH topics. CONCLUSION: The integration of SDOH into a prelicensure nursing pharmacology course across multiple cohorts of students was feasible, and student feedback was positive. Faculty faced several challenges, including time constraints. Additional and ongoing training is needed to support the integration of SDOH into nursing curricula. [J Nurs Educ. 2023;62(3):175-179.].

Body Image, Depression Symptoms, and Health-Related Quality of Life in Black Women With Systemic Lupus Erythematosus.

OBJECTIVE: To examine relationships among body image, depression symptoms, and quality of life in Black women with systemic lupus erythematosus (SLE). DESIGN: Descriptive, correlational design. SETTING/SAMPLE: Using social media advertising, we recruited Black women with self-reported SLE to complete a web-based survey. RESULTS: The female sample (N = 43) was predominantly non-Hispanic (80%) and married (58%), with a mean age of 33.5 (SD = 6.9) years. The mean time since SLE diagnosis was 5.9 (SD = 4.0) years. The majority of respondents (51%) reported using oral steroid therapy for disease control. Mean body image and depression scores, 2.0 (SD = 0.6) and 62.4 (SD = 8.5), respectively, differed from population norms of 1.80 (SD = 0.9) and 50 (SD = 10), indicating greater body image disturbance and greater depression symptoms than reported by the general population. Greater body image disturbance was significantly associated with greater depression symptoms and poorer quality of life in the area of role disruption. CONCLUSION: Depression and body image disturbance among Black women with SLE should be routinely assessed and addressed by nurses and other clinicians to help promote optimal quality of life.

Adaptation of Metabolomics and Microbiomic Research Protocols During the COVID-19 Pandemic.

BACKGROUND: When the COVID-19 pandemic hit in 2020, researchers in the P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions at Emory University's Nell Hodgson Woodruff School of Nursing faced major challenges in recruitment and data collection because of limited access to the clinic and community facilities and the risk of COVID-19 exposure associated with in-person study contact. OBJECTIVES: The purpose of this article is to (a) describe how a cadre of pilot/supplement principal investigators adapted their studies to allow for safe and trustworthy data collection during the COVID-19 pandemic (March 2020 through date of publication) and (b) discuss steps that facilitated the technical aspects of remote data collection, especially involving biological specimens. RESULTS: Four pilot studies and two administrative supplements within the center-all at different stages of execution-adopted various alternative remote recruitment, enrollment, and data and specimen collection approaches to continue their research endeavors in a way that maximized the safety of both the research participants and the research teams. DISCUSSION: The article concludes with a discussion on the importance of a participant-centered approach when using remote methods, actions, or steps initiated to facilitate the technical aspects of remote data collection and reflections on the continued use of remote research strategies beyond the COVID-19 pandemic.

Diabetes Care Provider Perceptions Regarding Emerging Adults' Diabetes Self-Management Influences and Patient-Provider Visit Interactions Within a Safety-Net Hospital.

The increasing number of emerging adults with diabetes (EAWD) being cared for in adult health care settings requires a better understanding of the needs of EAWD and their interactions with adult health care providers (HCPs). This article describes findings from interviews with endocrinologists and diabetes nurses from a safety-net health care system to investigate HCPs' perspectives regarding influences on EAWD self-management and HCP interactions with EAWD. HCPs frequently perceived lower EAWD engagement in diabetes management, which was complicated by barriers such as the emotional burden of diabetes, busy lives and multiple responsibilities, and limited access to resources; however, HCPs valued the role of information and communication at visits in tailoring care for EAWD. Measures to tailor care should address the psychosocial burden related to the life stage goals and priorities of EAWD, identification of resources for EAWD and HCPs, and further elucidation of effective self-management guidance and communication strategies to support EAWD in safety-net settings.

Strategies for successful promotion for clinical track nursing faculty.

Successful promotion of faculty yields multiple benefits including career advancement, recognition for productivity and contributions to the organization, and an increase in financial compensation for the individual. In academic settings, particularly in research intensive institutions, time and resources often are focused on supporting tenure track faculty to be successful in obtaining promotion and tenure. Although most nursing programs have substantial numbers of clinical track faculty (CTF), there may be less emphasis around planning and resources for performing activities that will lead to successful promotion for nontenure track faculty. Consequently, at the time of initial faculty appointment, CTF must begin promotion planning. This paper provides practical advice for CTF preparing for promotion including planning the promotion trajectory and identifying and facilitating the collection of evidence supporting the areas of teaching, scholarship, practice, and service. Examples are provided of activities engaged in by CTF that would serve as evidence to support promotion.

Metabolomics Research Conducted by Nurse Scientists: A Systematic Scoping Review.

Metabolomics, one of the newest omics, allows for investigation of holistic responses of living systems to myriad biological, behavioral, and environmental factors. Researcher use metabolomics to examine the underlying mechanisms of clinically observed phenotypes. However, these methods are complex, potentially impeding their uptake by scientists. In this scoping review, we summarize literature illustrating nurse scientists' use of metabolomics. Using electronic search methods, we identified metabolomics investigations conducted by nurse scientists and published in English-language journals between 1990 and November 2019. Of the studies included in the review (N = 30), 9 (30%) listed first and/or senior authors that were nurses. Studies were conducted predominantly in the United States and focused on a wide array of clinical conditions across the life span. The upward trend we note in the use of these methods by nurse scientists over the past 2 decades mirrors a similar trend across scientists of all backgrounds. A broad range of study designs were represented in the literature we reviewed, with the majority involving untargeted metabolomics (n = 16, 53.3%) used to generate hypotheses (n = 13, 76.7%) of potential metabolites and/or metabolic pathways as mechanisms of clinical conditions. Metabolomics methods match well with the unique perspective of nurse researchers, who seek to integrate the experiences of individuals to develop a scientific basis for clinical practice that emphasizes personalized approaches. Although small in number, metabolomics investigations by nurse scientists can serve as the foundation for robust programs of research to answer essential questions for nursing.

Using Deliberate Practice and Simulation for Psychomotor Skill Competency Acquisition and Retention: A Mixed-Methods Study.

BACKGROUND: Quality, safe patient care is dependent on graduates who are proficient in the psychomotor skills of nursing. Competent skill acquisition and retention are key to reducing skill-based errors and reducing the risk of adverse patient events. PURPOSE: The purpose of this study was to explore the effect of deliberate practice combined with skill practice during high-fidelity simulation (HFS) scenarios on urinary catheter insertion skill competency and retention in prelicensure nursing students. METHODS: A convergent, parallel mixed-methods design was used. RESULTS: The group participating in skill practice before and during HFS scenarios demonstrated a reduction in errors when performing the skill and an improvement in retention of skill competency. CONCLUSIONS: This article describes how the combination of deliberate skill practice prior to and during HFS scenarios may improve student skill acquisition and retention.

A mixed-methods study of coping and depression in adolescent girls with polycystic ovary syndrome.

BACKGROUND AND PURPOSE: Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with clinical manifestations that could be psychologically distressing to adolescent girls considering the concern of body image during the developmental stage of adolescence. Poor psychological functioning is related to increased mortality, higher health care costs, and negative health outcomes. Coping has been identified as impacting health and adaptation to illness; therefore, the purpose was to examine coping and depression in adolescent girls with PCOS. METHODS: Adolescent girls, aged 13-18 years and diagnosed with PCOS completed questionnaires regarding coping and depression and participated in interviews. A convergent, parallel, mixed-method design was used. CONCLUSIONS: Girls perceived very little control over the aspects of PCOS, with menstrual irregularities and the threat of infertility reported as the most stressful and least controllable aspects of PCOS. Lower control was a predictor of greater depression among the participants. IMPLICATIONS FOR PRACTICE: Providers should strive to establish rapport with adolescent girls and ask specifically about their concerns surrounding PCOS to provide meaningful health education. Providers should also be aware of the risk for depression among this population and should routinely screen patients and keep channels of communication open regarding the symptoms of depression.

Time-Motion Analysis of Nurses Utilizing Insulin Pen Devices Compared to Vial and Syringe in an Inpatient Setting.

OBJECTIVE: To compare the time taken and steps completed by nurses in the process of insulin preparation and administration using the pen device compared to the vial and syringe method. METHODS: Observational and exploratory study utilizing a time-motion analysis of nurses' administration of insulin using the pen versus vial and syringe delivery methods. Nurses were observed, video-recorded, and timed during insulin preparation and administration using each delivery method. The steps performed by nurses were observed against recommended processes for preparing and administering insulin, and the percentage of nurses completing each step was noted. RESULTS: A total of 137 (94%) nurses participated. Nurses took less time preparing and administering insulin with the pen device compared with the vial and syringe method (79 ± 18 seconds vs 88 ± 20 seconds, respectively, P < .001). The overall average completion rate of steps with the pen device was 90% ± 7% compared to 88% ± 7% with the vial and syringe method. CONCLUSION: The time taken by nurses to prepare and administer insulin was lower with the pen device compared with vial and syringe. Furthermore, areas were identified for potential nursing education to enhance safe and appropriate use of insulin with both delivery methods.

A Randomized Clinical Trial of the Effect of an Angina Self-Management Intervention on Health Outcomes of Patients With Coronary Heart Disease.

PURPOSE: The aim of this study was to test the effect of a psychoeducational intervention to enhance angina pectoris (AP) symptom self-management. DESIGN: A two-group, single-blind, randomized controlled trial. METHODS: Following institutional review board approval, a convenience sample of cardiac inpatients was recruited. Within 2 weeks following discharge, the Angina Self-Management (ASM) intervention group (n = 39) received a nurse-delivered, telephone intervention focused on AP symptom monitoring and management. The control group (n = 41) received an attention-control telephone call. Physical function, anxiety, and angina frequency were assessed between 3 and 6 months postintervention. FINDINGS: Men in the ASM group (n = 24) reported better physical function and lower anxiety than men in the control group (n = 26). Women in the ASM group (n = 15) reported worse physical function and higher anxiety than women (n = 15) in the control group. CONCLUSIONS: Angina symptom monitoring may be more difficult for women. Rehabilitation nurses should be proactive in addressing issues associated with women's AP symptom management.

Predicting student attrition using social determinants: Implications for a diverse nursing workforce.

BACKGROUND: Attrition of academically qualified nursing students affects the size of the nursing workforce. A better understanding of the multifaceted predictive factors of attrition is needed to inform targeted interventions to promote program progression and maintain an adequate nursing workforce. PURPOSE: The purpose of this study was to identify demographic, academic, and social determinant factors associated with attrition at the end of the first semester in an upper-division baccalaureate nursing program. METHOD: Students' demographic and academic data from an administrative database were combined with social determinants data collected via a web-based survey. RESULTS: Among this cohort (n=164), social determinants were significantly associated with attrition. A significantly greater percentage of students who failed were born outside the United States (U.S.), had one or both parents born outside the U.S., reported English was not the primary language spoken in the home, and were racially/ethnically diverse. CONCLUSIONS: Attrition was primarily among students with diverse racial, ethnic, and/or cultural backgrounds, which has implications for achieving a diverse nursing workforce. Proactive strategies to support success should be especially targeted on diverse students.

A qualitative study of nuisance bleeding and medication-related beliefs with dual antiplatelet drug therapy.

OBJECTIVES: The purpose of this qualitative study was to explore perceptions of nuisance bleeding and medication-related beliefs among adults taking dual antiplatelet drug therapy. METHODS: We conducted qualitative telephone interviews with 34 community-dwelling adults with cardiovascular disease. RESULTS: Using qualitative content analysis, we identified 4 dominant themes: nuisance bruising, nuisance bleeding, importance of medication adherence, and duration of therapy. Participants' bruising was frequently more severe than expected given the force of the bump that caused it. Concerns focused on whether increased bleeding tendencies would lead to hemorrhage in the event of a major traumatic injury, confusion about the duration of therapy, and the rationale for when and why therapy should be discontinued. CONCLUSION: Excessive bruising and medication-related concerns about hemorrhage and duration of treatment were salient issues for participants. Effective clinician-patient communication should be used to assist individuals in managing concerns to help assure positive health outcomes with antiplatelet drugs.

An Adaptation of the Original Fresno Test to Measure Evidence-Based Practice Competence in Pediatric Bedside Nurses.

PURPOSE: Instruments used to assess evidence-based practice (EBP) competence in nurses have been subjective, unreliable, or invalid. The Fresno test was identified as the only instrument to measure all the steps of EBP with supportive reliability and validity data. However, the items and psychometric properties of the original Fresno test are only relevant to measure EBP with medical residents. Therefore, the purpose of this paper is to describe the development of the adapted Fresno test for pediatric nurses, and provide preliminary validity and reliability data for its use with Bachelor of Science in Nursing-prepared pediatric bedside nurses. METHODS: General adaptations were made to the original instrument's case studies, item content, wording, and format to meet the needs of a pediatric nursing sample. The scoring rubric was also modified to complement changes made to the instrument. Content and face validity, and intrarater reliability of the adapted Fresno test were assessed during a mixed-methods pilot study conducted from October to December 2013 with 29 Bachelor of Science in Nursing-prepared pediatric nurses. RESULTS: Validity data provided evidence for good content and face validity. Intrarater reliability estimates were high. LINKING EVIDENCE TO ACTION: The adapted Fresno test presented here appears to be a valid and reliable assessment of EBP competence in Bachelor of Science in Nursing-prepared pediatric nurses. However, further testing of this instrument is warranted using a larger sample of pediatric nurses in diverse settings. This instrument can be a starting point for evaluating the impact of EBP competence on patient outcomes.

A Factor Analysis of the Perceived Value of Certification Tool for Nurse Educators: Evidence for Construct Validity.

AIM: The purpose of this study was to examine construct validity of the Perceived Value of Certification Tool for Nurse Educators (PVCT-NE). BACKGROUND: Preliminary testing of the PVCT-NE demonstrated content validity and strong evidence of internal consistency reliability. Construct validity evidence for the tool is lacking. METHOD: Using data from a descriptive study about nurses' perceived value of nurse educator certification, exploratory factor analysis was used to examine whether the factor structure of the PVCT-NE was consistent with the two-factor structure reported for the original PVCT. RESULTS: Data (n = 221) were analyzed using principal components analysis to identify factors. The observed two-factor solution and individual item loadings in this sample were consistent with the original PVCT's intrinsic and extrinsic value subscales and accounted for 64 percent of the total instrument variance. CONCLUSION: Overall, the PVCT-NE is a valid tool to measure perceived value of certification in nurse educators.

What Is the Value of Nurse Educator Certification? A Comparison Study of Certified and Noncertified Nurse Educators.

AIM: The purpose of this study was to examine differences in how certified nurse educators and noncertified nurse educators valued nurse educator certification. BACKGROUND: No studies have investigated the differences in perceptions of certified and noncertified nurse educators. Understanding these differences may influence how the nursing profession recognizes and promotes excellence within the academic nursing specialty. METHOD: Perceived Value of Certification Tool-Nurse Educator and demographic survey were administered via a web-based survey to a national sample of nursing faculty. RESULTS: Certified nurse educators valued certification with greater agreement than noncertified nurse educators. Personal accomplishment, personal satisfaction, and validation of knowledge were identified as the greatest rewards to certification. CONCLUSION: Nurse educators identified with intrinsic rewards of certification. Despite overall positive perceptions of nurse educator certification, strategies focused on extrinsic rewards may be necessary to increase certification rates. Such strategies may help overcome factors preventing educators from attaining certification.

Dementia Care Content in Prelicensure Nursing Curricula: A Pilot Mixed-Methods Study.

BACKGROUND: Having a nursing workforce equipped to provide quality care for patients living with dementia is essential. The purpose of this study was to investigate how undergraduate nursing programs integration of dementia care content into their curricula. METHOD: Using sequential explanatory mixed methods, a stratified sample of 137 representatives of programs in 11 states with dense elderly populations completed a quantitative survey. A subsample (n = 8) completed qualitative e-mail interviews. RESULTS: Most respondents indicated dementia care content was integrated into their curricula (n = 103, 92.8%). Clinical partnership with dementia care centers was associated with a greater proportion of students interacting with individuals having dementia (p = .02). Curriculum overload was the most significant challenge to integrating dementia content (n = 61, 43.9%). Qualitative themes supported the quantitative results. CONCLUSION: Future research is needed to identify best practices to ensure that nursing curricula provide essential content to meet the care needs of the growing population of individuals with dementia. [J Nurs Educ. 2018;57(2):88-95.].

Subjective cognitive complaints, psychosocial factors and nursing work function in nurses providing direct patient care.

AIMS: The aim of this study was to examine relationships among subjective cognitive complaints, psychosocial factors and nursing work function in nurses providing direct patient care. BACKGROUND: Cognitive functioning is a critical component for nurses in the assurance of error prevention, identification and correction when caring for patients. Negative changes in nurses' cognitive and psychosocial functioning can adversely affect nursing care and patient outcomes. DESIGN: A descriptive correlational design with stratified random sampling. METHOD: The sample included 96 nurses from the major geographic regions of the United States. Over 9 months in 2016-2017, data were collected using a web-based survey. Stepwise multiple linear regression analyses were used to examine relationships among subjective cognitive complaints, psychosocial factors and nursing work function. RESULTS: Overall, participants reported minimal work function impairment and low levels of subjective cognitive complaints, depression and stress. In multivariate analyses, depression was not associated with nurses' work function. However, perceived stress and subjective concerns about cognitive function were associated with greater impairment of work function. CONCLUSION: Nurses experiencing subjective cognitive complaints should be encouraged to address personal and environmental factors that are associated with their cognitive status. Additionally, stress reduction in nurses should be a high priority as a potential intervention to promote optimal functioning of nurses providing direct patient care. Healthcare institutions should integrate individual and institutional strategies to reduce factors contributing to workplace stress.