Development and Preliminary Psychometric Testing of the Drake Atrial Electrogram Assessment Survey: DAEGAS.

BACKGROUND: Critical care nurses who care for postoperative cardiac surgery patients need such specialty knowledge as atrial electrograms (AEGs). An inadequate audit trail exists for psychometric performance of instruments to measure knowledge of AEGs. OBJECTIVES: The aim of this study was to revise a previously tested instrument and assess evidence for content validity (content validity index), internal consistency (Cronbach α), and stability (correlation coefficient, r) reliability against the a priori criterion of 0.80. METHODS: The multiple-choice response, self-administered, paper-and-pencil instrument was revised to 20 items and named the Drake Atrial Electrogram Assessment Survey (DAEGAS). A panel of 6 AEG experts reviewed the DAEGAS for content validity evidence. The instrument was further revised to 19 items (13 knowledge and 6 AEG interpretation) and tested with 76 critical care nurses from the greater Houston metropolitan area. RESULTS: The content validity index was 0.93. Cronbach α was .51, and test-retest r was 0.74. Cronbach α increased to .60 and r was 0.73 with removal of 3 items: 2 items with a negative item-total correlation and 1 item that was transitioned to a sample question. DISCUSSION: Content validity evidence exceeded the a priori criterion. Internal consistency and stability reliability estimates did not meet the criterion, albeit the latter met the criterion recommended by psychometricians for a new instrument. Recommendations include further development of the DAEGAS to improve internal consistency estimates and testing for evidence of other forms of validity. Reliable and valid assessment of critical care nurse knowledge of AEGs will require improved psychometric performance of the DAEGAS.

Promoting Differentiated Competencies Among RN-to-Bachelor of Science in Nursing Program Graduates.

BACKGROUND: Bolstered by the Institute of Medicine's employment goal of 80% of baccalaureate (BSN)-prepared RNs by 2020, the number of RN-to-BSN programs has grown dramatically. This rapid growth has led to concerns about lack of standardization and significant variability in requirements related to content and expected competencies. METHOD: The Differentiated Essential Competencies (DECs) of Graduates of Texas Nursing Programs was reviewed to tease out the concepts, content, and competencies that are BSN-level specific and thereby appropriate for RN-to-BSN programs. RESULTS: The current review was a compilation of differentiated competencies based on education level. In this article, numerous examples are drawn from the DECs and are organized by the major content areas common to RN-to-BSN programs. CONCLUSION: Faculty should examine the DECs to consider how they may be used to enhance RN-to-BSN programs, to evaluate their congruence with traditional BSN programs, and to ensure that program graduates are educationally prepared for practice in today's complex health care system.

Essential content in RN-BSN programs.

Currently, there are more than 600 registered nurse to bachelor of science in nursing (RN-BSN) programs in the United States, and the number of students enrolled in them is growing quickly. This growth is at least partially in response to the Institute of Medicine's recent recommendation that 80% of RNs be BSN prepared by 2020. Proliferation of RN-BSN programs suggests a need to examine them more critically, as very little information is available in the nursing literature or through accrediting bodies regarding what courses and content they should include. This study was conducted to determine what directors of RN-BSN educational programs report as being "essential" content. The findings can be used as a guide for developing new programs or revising existing programs. They may also be used as a starting place for nursing educators to dialogue on what content and competencies are truly essential for BSN-prepared nurses and where education should be focused in RN-BSN programs.

Eighty percent by 2020: the present and future of RN-to-BSN education.

More than 600 RN-to-BSN programs currently exist in the United States, and the numbers of programs and students are growing rapidly. This unprecedented growth is a result of several factors, including the Institute of Medicine's recommendation that 80% of RNs be BSN prepared by 2020. This survey was undertaken to explore key ideas and issues related to RN-to-BSN education to gather information on how RN-to-BSN programs are changing and to uncover concerns posited by program directors. The survey indicated that lack of standardization has resulted in significant variability in expectations and requirements among RN-to-BSN programs. Further, numerous questions need to be answered and concerns addressed to develop strategies to maintain growth, improve access, and remove barriers without sacrificing quality. Findings can be used to ensure that RN-to-BSN education prepares graduates for the future health care system and that the outcome is not just a piece of paper.

Antioxidant properties of Neu2000 on mitochondrial free radicals and oxidative damage.

Neu2000 [2-hydroxy-5-(2,3,5,6-tetrafluoro-4 trifluoromethylbenzylamino) benzoic acid] is a dual-acting neuroprotective agent that functions both as a noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist and a free radical scavenger. In the present study, we investigated the scavenging activity of Neu2000 on various classes of reactive oxygen species and reactive nitrogen species (ROS/RNS) as well as its efficacy for reducing free radicals and oxidative stress/damage induced in spinal cord mitochondrial preparations. Neu2000 exerted scavenging activity against superoxide, nitric oxide, and hydroxyl radicals, and efficiently scavenged peroxynitrite. In the mitochondrial studies, Neu2000 markedly inhibited ROS/RNS and hydrogen peroxide levels following antimycin treatment. In addition, Neu2000 effectively scavenged hydroxyl radicals generated by iron(III)-ascorbate, reduced protein carbonyl formation mediated by hydroxyl radicals and peroxynitrite, and prevented glutathione oxidation caused by tert-butyl hydroperoxide in isolated mitochondria. Interestingly, incubation of isolated mitochondria with Neu2000 followed by centrifugation and removal of the supernatant also resulted in a concentration-dependent decrease in lipid peroxidation. This observation suggests that Neu2000 enters mitochondria to target free radicals or indirectly affects mitochondrial function in a manner that promotes antioxidant activity. The results of the present study demonstrate that Neu2000 possesses potent in vitro antioxidant activity due, most likely, to its active phenoxy group.

National survey of RN-to-BSN programs.

More than 600 RN-to-BSN programs exist in the United States. Little information is available describing many aspects of these programs (e.g., curricula, program length, prerequisites). This study was undertaken to obtain a snapshot of RN-to-BSN education. This review is vital given the rapid growth of these programs and the anticipated increase in number of "completion" students necessary to meet the Institute of Medicine's goal that 80% of RNs be BSN-prepared by 2020. Data were collected and analyzed within general areas, including background information, curriculum, instructional formats, and evaluation. Findings from the survey can be used by educators to evaluate their RN-to-BSN programs and compare them with other programs. Further, evidence of potential weaknesses were identified, and educators are challenged to ensure that encouraging growth, focusing on flexibility, and making programs more user friendly does not result in inferior education. Rather, academic and programmatic rigor must be maintained.

Post-injury administration of the mitochondrial permeability transition pore inhibitor, NIM811, is neuroprotective and improves cognition after traumatic brain injury in rats.

Mitochondrial dysfunction is known to play a pivotal role in cell death mechanisms following traumatic brain injury (TBI). N-methyl-4-isoleucine-cyclosporin (NIM811), a non-immunosuppressive cyclosporin A (CsA) analog, inhibits the mitochondrial permeability transition pore (mPTP) and has been shown to be neuroprotective following TBI in mice. However, the translation of the neuroprotective effects of mPTP inhibitors, including CsA and NIM811, into improved cognitive end points has yet to be fully investigated. Therefore, to build upon these results, a severe unilateral controlled cortical impact model of TBI was used in the present study to establish a dose-response curve for NIM811 in rats. The findings demonstrate that the neuroprotection afforded by NIM811 is dose dependent, with the 10 mg/kg dose being the most effective dose. Once the dose response was established, we evaluated the effect of the optimal dose of NIM811 on behavior, mitochondrial bioenergetics, and mitochondrial oxidative damage following TBI. For behavioral studies, rats were administered NIM811 at 15 min and 24 h post-injury, with cognitive testing beginning 10 days post-injury. Mitochondrial studies involved a single injection of NIM811 at 15 min post-injury followed by mitochondrial isolation at 6 h post-injury. The results revealed that the optimal dose of NIM811 improves cognition, improves mitochondrial functioning, and reduces oxidative damage following TBI.

Targeting mitochondrial function for the treatment of acute spinal cord injury.

Traumatic injury to the mammalian spinal cord is a highly dynamic process characterized by a complex pattern of pervasive and destructive biochemical and pathophysiological events that limit the potential for functional recovery. Currently, there are no effective therapies for the treatment of spinal cord injury (SCI) and this is due, in part, to the widespread impact of the secondary injury cascades, including edema, ischemia, excitotoxicity, inflammation, oxidative damage, and activation of necrotic and apoptotic cell death signaling events. In addition, many of the signaling pathways associated with these cascades intersect and initiate other secondary injury events. Therefore, it can be argued that therapeutic strategies targeting a specific biochemical cascade may not provide the best approach for promoting functional recovery. A "systems approach" at the subcellular level may provide a better strategy for promoting cell survival and function and, as a consequence, improve functional outcomes following SCI. One such approach is to study the impact of SCI on the biology and function of mitochondria, which serve a major role in cellular bioenergetics, function, and survival. In this review, we will briefly describe the importance and unique properties of mitochondria in the spinal cord, and what is known about the response of mitochondria to SCI. We will also discuss a number of strategies with the potential to promote mitochondrial function following SCI.

Proteomic and phosphoproteomic analyses of the soluble fraction following acute spinal cord contusion in rats.

Traumatic spinal cord injury (SCI) causes marked neuropathological changes in the spinal cord, resulting in limited functional recovery. Currently, there are no effective treatments, and the mechanisms underlying these neuropathological changes are not completely understood. In this study, two-dimensional gel electrophoresis coupled with mass spectrometry was used to investigate injury-related changes in the abundance (SYPRO Ruby stain) and phosphorylation (Pro-Q Diamond stain) of proteins from the soluble fraction of the lesion epicenter at 24 h following SCI. Over 1500 SYPRO Ruby-stained spots and 100 Pro-Q Diamond-stained spots were examined. We identified 26 unique proteins within 38 gel spots that differentially changed in abundance, phosphorylation, or both in response to SCI. Protein redundancies among the gel spots were likely due to differences in proteolysis, post-translational modifications, and the existence of isoforms. The proteins affected were blood-related proteins, heat-shock proteins, glycolytic enzymes, antioxidants, and proteins that function in cell structure, cell signaling, DNA damage, and protein degradation. These protein changes post injury may suggest additional avenues of investigation into the underlying molecular mechanisms responsible for the pathophysiological consequences of SCI.

Post-treatment with the cyclosporin derivative, NIM811, reduced indices of cell death and increased the volume of spared tissue in the acute period following spinal cord contusion.

Cyclosporin A (CsA) is a potent immunosuppressive drug shown to inhibit mitochondrial permeability transition (mPT). Although the therapeutic efficacy of CsA in traumatic brain injury is being investigated, CsA is highly neurotoxic and any neuroprotective effect in models of spinal cord injury (SCI) is unclear. NIM811 is a non-immunosuppressive CsA derivative that inhibits mPT, and is significantly less cytotoxic than CsA. Presently, we investigated the effects of NIM811 post-treatment on indices of apoptosis, lesion size, and tissue sparing at acute time-points following SCI. Adult rats received a "mild/moderate" contusion to the spinal cord, and were administered either 20 mg/kg NIM811 or vehicle by oral gavage 15 min later. One group of rats was euthanized at 1, 4, or 24 h post-injury, and the cytosolic levels of cytochrome c and fragmented DNA in the spinal cord were quantified. The remaining rats received an additional dose of NIM811 or vehicle at 24 h post-injury, and were euthanized on day 7 for morphometric assessments of the lesion and tissue spared. Control groups included rats that received sham surgery or no surgery. The results revealed that NIM811 post-treatment reduced the cytosolic levels of cytochrome c and fragmented DNA during the first 24 h following SCI. NIM811 also reduced the volume of the lesion, and enhanced the volumes of spared gray and white matter at 7 days post-injury. Together, these findings suggest that NIM811 treatment promoted tissue survival following SCI, in part, through inhibition of apoptotic mechanisms. This is the first study to demonstrate the therapeutic potential of NIM811 post-treatment in a model of acute SCI, and supports the need for continued investigation into NIM811 as a neuroprotective treatment for human SCI.

Pretreatment with the cyclosporin derivative, NIM811, improves the function of synaptic mitochondria following spinal cord contusion in rats.

Trauma to the spinal cord causes a cascade of secondary events, such as mitochondrial dysfunction, which disrupts cellular functions and ultimately leads to cell death. Cyclosporin A (CsA) is a potent immunosuppressant that promotes mitochondrial function by inhibiting mitochondrial permeability transition (mPT). Clinical trials examining CsA in traumatic brain injury are currently under-way, but CsA is potentially neurotoxic. NIM811 is a non-immunosuppressive CsA derivative that inhibits mPT at nanomolar concentrations and with significantly less cytotoxicity than CsA. In the present study, we investigated the effects of NIM811 treatment on mitochondrial bioenergetics and the production of reactive oxygen species following spinal cord injury (SCI) in rats. Rats were pretreated with NIM811 or vehicle, and after 15 min the rats received a "mild/moderate" spinal cord contusion. After 24 h, the spinal cords were rapidly removed and synaptosomal mitochondria were isolated. NIM811 pretreatment significantly improved mitochondrial respiratory control ratios, and the maximal electron transport capacity of complex I and II, as well as their ATP-producing capacity. Consistent with the improvements in mitochondrial function, NIM811 pretreatment significantly decreased free radical production in isolated mitochondria. These studies are the first to demonstrate the therapeutic potential of CsA derivatives in a model of SCI, and support the need for continued investigation of compounds like NIM811 as an acute treatment for human SCI.

Quantification of locomotor recovery following spinal cord contusion in adult rats.

Injury to the spinal cord not only disrupts the functioning of spinal circuits at the site of the impact, but also limits sensorimotor function caudal to the level of the lesion. Ratings of gross locomotor skill are generally used to quantify locomotor recovery following spinal cord injury (SCI). The purpose of this study was to assess behavioral recovery following SCI with three tasks: (1) BBB ratings, (2) walking on a horizontal ladder, and (3) footprint analyses. Behavioral testing was conducted for 6 postoperative weeks, and then the spinal cords were processed for the amount of white matter spared. As expected, BBB ratings dramatically decreased and then improved during recovery. The number of hindlimb foot-faults on the horizontal ladder increased after injury and remained elevated during the recovery period. Footprint analyses revealed that sham-control rats used several different gaits to cross the runway. In contrast, the locomotor function of rats with a SCI was impaired throughout the postoperative period. Some locomotor parameters of the injured rats improved slightly (velocity, stride length, stride duration, stance duration), some did not change (interlimb coordination, swing duration, forelimb base of support, hindpaw angle), and others declined (hindlimb base of support) during the recovery period. Together, these results show that gross locomotor skill improved after SCI, while recovery of fine locomotor function was more limited. Multiple tests should be included in future experiments in order to assess gross and fine changes in sensorimotor function following SCI.

Called to nursing: perceptions of student nurses.

PURPOSE: This study uncovers reasons students report for wanting to become nurses, to quantify those who feel that they are called to nursing, and to learn what "being called" means to them. METHOD: A descriptive, cross-sectional survey was conducted with all students enrolled in nursing courses at one program in a private, faith-based university. FINDINGS: Most students decided to go to nursing school while in high school or college and chose nursing because they had a desire to help others. The most common personal characteristics they identified that will be helpful in nursing were being caring or compassionate. Almost two thirds of the students indicated they were "called" by God to become nurses. CONCLUSION AND IMPLICATIONS: Findings can help nursing educators and leaders determine how to better recruit and retain individuals into the nursing profession and how to support and encourage caring and compassionate qualities in all nurses.

A mapping study of caspase-3 activation following acute spinal cord contusion in rats.

Spinal cord injury (SCI) initiates a cascade of biochemical changes that results in necrotic and apoptotic cell death. There is evidence that caspase-3 activation and apoptotic cell death occur within hours after SCI. However, the time course and cellular localization of activated caspase-3 has not been examined. Such information is essential because caspase-3-independent apoptotic pathways do exist. In this experiment, we describe the distribution of and cell types containing activated caspase-3 at 4 hr, 1 day, 2 days, 4 days, and 8 days following SCI in rats. Numerous caspase-3-positive cells were observed at 4 hr and 1 day postinjury and colocalized most often with CC1, a marker for oligodendroglia. Both markers disappeared near the injury epicenter over the next several days. Activated caspase-3 was again present in the injured spinal cord on postoperative day 8, which coincided with a reemergence of CC1-positive cells. Many of these CC1-positive cells again colocalized activated caspase-3. NeuN-positive neurons of the dorsal horn were occasionally immunopositive for activated caspase-3 at early time points. OX42-positive microglia/macrophages rarely contained activated caspase-3. The results indicate a biphasic pattern of caspase-3 activation during the first 8 days postinjury, suggesting that at least two mechanisms activate caspase-3 following SCI. This time-course study provides a framework for investigating and understanding the different signaling events contributing to this biphasic pattern of caspase-3 activation.

Spiritual nursing care: state of the art.

Until recently, little attention has been given to spiritual dimensions in the nursing literature. This article reviews spiritual nursing care in the nursing literature, including basic concepts and current thoughts on spirituality-related research. In addition, it describes mechanisms that may be used to promote spiritual care and outlines the need to enhance research efforts in this vital area.

Actions and beliefs related to hepatitis B and influenza immunization among registered nurses in Texas.

Studies indicate that roughly half of health care workers are not immunized against hepatitis B and influenza. Findings from a survey of 1,000 registered nurses (RNs) conducted to analyze their beliefs and actions related to immunization recommendations are reported. Only 8% of the responding RNs chose not to receive vaccination against hepatitis B. The primary reasons that nurses declined hepatitis B vaccination were because they were not working in nursing or did not believe they were at risk of exposure. Similarly, 86% of the RNs reported they had ever received a flu shot, and 69% reported of being immunized during 2 of the previous 4 years. Rationale for receiving immunization included belief in its effectiveness, belief that they were at risk of exposure, and that it was provided free of charge. Reasons for declining included concerns about side effects, lack of concern about getting the illness, and doubts about effectiveness. The nurses who responded to the survey appear to value immunizations and generally adhere to immunization recommendations. Further study needs to be conducted on related issues, including follow-up for assessment of long-term protection of hepatitis B immunization and adherence to guidelines for postexposure prophylaxis. Ongoing monitoring and further study of serious complications of hepatitis B immunizations are also needed.

Analysis of spirituality content in nursing textbooks.

Although most nurses believe spiritual care is an integral component of quality, holistic nursing care, they rarely address spiritual issues and typically feel unprepared to do so. One reason for nurses' lack of preparedness to provide spiritual interventions is that their basic education only minimally discusses spirituality and related issues. This is compounded by the problem that only sporadic reference to spiritual care is found in most nursing textbooks. This study was conducted to analyze the content related to spirituality in nursing textbooks in order to determine where spiritual care is addressed and evaluate its adequacy. A total of 50 textbooks from a wide variety of nursing specialty areas were selected from the most recent Brandon Hill list. These books were examined to assess the percentage of pages discussing spiritual issues and analyze inclusion of core content essential for nursing practice. Although there was considerable variation among the books from all specialty areas, overall, hospice/terminal care, fundamentals of nursing, health assessment/health promotion, and transcultural nursing textbooks provided the most information about spirituality and spiritual care. Textbooks focusing on professional issues, medical-surgical nursing, maternal-child health nursing, critical care nursing, and community health nursing contained the least spiritual content. Suggestions are made regarding how to integrate spiritual issues and spiritual care in all nursing textbooks that pertain directly to patient care.

The mitochondrial uncoupling agent 2,4-dinitrophenol improves mitochondrial function, attenuates oxidative damage, and increases white matter sparing in the contused spinal cord.

The purpose of this study was to investigate the potential neuroprotective efficacy of the mitochondrial uncoupler 2,4-dinitrophenol (DNP) in rats following a mild to moderate spinal cord contusion injury. Animals received intraperitoneal injections of vehicle (DMSO) or 5 mg/mL of DNP prior to injury. Twenty-four hours following surgery, mitochondrial function was assessed in mitochondria isolated from spinal cord synaptosomes. In addition, synaptosomes were used to measure indicators of reactive oxygen species formation, lipid peroxidation, and protein oxidation. Relative to vehicle-treated animals, pretreatment with DNP maintained mitochondrial bioenergetics and significantly decreased reactive oxygen species levels, lipid peroxidation, and protein carbonyl content following spinal cord injury. Furthermore, pretreatment with DNP significantly increased the amount of remaining white matter at the injury epicenter 6 weeks after injury. These results indicate that treatment with mitochondrial uncoupling agents may provide a novel approach for the treatment of secondary injury following spinal cord contusion.

Overexpression of XIAP inhibits apoptotic cell death in an oligodendroglial cell line.

1. This study describes the use of an oligodendroglial cell line (158N) to study the protective effects of X-chromosome-linked inhibitor of apoptosis (XIAP) overexpression. 2. 158N cells were transiently transfected with either pCMV-Myc-XIAP or control pCMV-Myc vector. At 48 h post-transfection, immunoblotting and immunocytochemical staining showed robust myc-XIAP overexpression in pCMV-Myc-XIAP transfected cells relative to pCMV-Myc-transfected cells and normal 158N cells. 158N cells were treated with either 100 nm staurosporine (STS) or 300 microM dopamine (DA) and cell survival/function determined using two cell viability assays. 3. Both STS and DA treatments resulted in increased apoptotic death of pCMV-Myc transfected cells. In contrast, there was significant decrease in apoptotic cell death in cells transfected with pCMV-Myc-XIAP. Finally, XIAP overexpression was found to significantly reduce caspase-3 enzyme activity levels in response to apoptotic stimuli. 4. These results provide evidence that XIAP overexpression promotes cell survival in a non-neuronal cell type derived from the central nervous system. In addition, these data suggest that the 158N oligodendroglial cell line is a suitable tool for transient transfection studies, which is a problem frequently encountered when attempting to introduce genes of interest in cultures of primary oligodendroglia.