Total added sugar consumption is not significantly associated with risk for prediabetes among U.S. adults: National Health and Nutrition Examination Survey, 2013-2018.

Prediabetes affects 38% of U.S. adults and is primarily linked to added sugars consumed from sugar-sweetened beverages. It is unclear if total dietary intake of added sugar also increases the risk for prediabetes. This study examined if total (g/day) and percent intakes of <10%, 10-15%, or >15% added sugar increase the odds for prediabetes in U.S. adults. A cross-sectional, secondary analysis using 2013-2018 NHANES data was conducted. This study included data from U.S. adults ≥ 20 years with normoglycemia (N = 2,154) and prediabetes (N = 3,152) with 1-2 days of dietary recall information. Prediabetes was defined as a hemoglobin A1c of 5.7%-6.4% or a fasting plasma glucose of 100-125 mg/dL. Survey-weighted logistic regression was used to estimate odds ratios of prediabetes based on usual intakes of added sugar (total and percent intakes) using the National Cancer Institute Method. Differences in prediabetes risk and total and percent intakes of added sugar were compared by race/ethnicity. The sample's total energy intake from added sugar was 13.9%. Total (unadjusted: OR: 1.01, 95% CI: .99-1.00, p = .26; adjusted: OR: 1.00, 95% CI: .99-1.00, p = .91) and percent intakes of added sugar (unadjusted [<10%: (ref); 10-15%: OR: .93, 95% CI: .77-1.12, p = .44; >15%: OR: 1.03, 95% CI: .82-1.28, p = .82] and adjusted [<10%: (ref); 10-15%: OR: .82, 95% CI: .65-1.04, p = .09; >15%: OR: .96, 95% CI: .74-1.24, p = .73]) were not significantly associated with an increased odds of prediabetes. Prediabetes risk did not differ by race/ethnicity for total (unadjusted model [p = .65]; adjusted model [p = .51]) or percent (unadjusted model [p = .21]; adjusted model [p = .11]) added sugar intakes. In adults ≥20 years with normoglycemia and prediabetes, total added sugar consumption did not significantly increase one's risk for prediabetes and risk estimates did not differ by race/ethnicity. Experimental studies should expand upon this work to confirm these findings.

Integrating a simulated electronic medical record system and barcode medication administration into a pre-licensure nursing program.

BACKGROUND: Many healthcare facilities implement technology to reduce medication errors. Nursing schools are exploring implementing similar technology to promote best practice. PURPOSE: Our institution developed a quality improvement project to evaluate the integration of similar technology into pre-licensure curriculum. METHOD: Our quality improvement project examined using a simulated electronic medical record (EMR) and a barcode medication administration (BCMA) system in pre-licensure nursing curriculum. In our initial project, 96 second-semester BSN students participated in a skill check off using the system. RESULTS: Student perception was positive, 96% of respondents stated the system increased realism, and 94% indicated improved clinical preparedness. CONCLUSION: Implementing this system was a positive experience which enriched our pre-licensure curriculum.

Intensive Care Unit Nurses' Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients.

BACKGROUND: Intensive care unit (ICU) nurses are enduring unprecedented burden caring for COVID-19 patients. Few studies have reported types of work-related events that lead to occupational stress and post-traumatic stress disorder (PTSD). METHODS: ICU nurses were recruited at an academic health science center to explore their experiences of caring for COVID-19 patients. Participants were interviewed for 1 hour using open-ended questions. Symptoms of PTSD were assessed using the PTSD Checklist, job satisfaction with a Likert-type scale, and intention to leave their job with a "yes or no" question. Semi-structured interviews were transcribed and analyzed using NVivo software; quantitative data were analyzed using frequencies and means with R 4.0.5. FINDINGS: The ICU nurse sample comprised nine females and one male, all Caucasian, with a mean age of 26.6 years. Analysis of interview transcripts revealed six recurring themes: Change in Practice, Emotion, Patient's Family, Isolation, Job Satisfaction, and Public Reaction. Quantitative findings revealed 7 of 10 met diagnostic criteria for PTSD. Most participants (7/10) were "somewhat satisfied" with their job. Five of 10 considered leaving their job in the last 6 months. CONCLUSION/IMPLICATIONS FOR PRACTICE: Understanding the impact stressful pandemic-related patient care has on ICU nurses provides evidence that new policies are needed. Furthermore, qualitative findings provide insight into the best design and deployment of interventions to reduce stress and prevent development of PTSD. More research is needed to understand long-term effects of PTSD and to evaluate strategies to prevent PTSD during stressful emergency surges in intensive care.

Impact of Data Entry Interface Design on Cognitive Workload, Documentation Correctness, and Documentation Efficiency.

Clinical documentation serves as the legal record of patient care and used to guide clinical decision making. Inadequately designed data entry user-interfaces may result in unintended consequences that negatively impact patient safety and outcomes because inaccurate information is used to guide clinical decision making. This study utilized an electronic simulated documentation interface (i.e., artificial electronic health record) combined with eye-tracking hardware to analyze documentation correctness, documentation efficiency, and cognitive workload of anesthesia providers (N = 20) generating documentation using different computer-assisted data entry types (drop-down box, radio button, check-box, and free text with autocomplete suggestions). Our study methodology incorporating eye-tracking with electronic health record user interfaces to assess documentation correctness, efficiency, and cognitive workload can be translated to other health care provider types.

Post-Traumatic Stress Disorder in Intensive Care Unit Nurses: A Concept Analysis.

BACKGROUND: Intensive care unit (ICU) nurses are at an increased risk of post-traumatic stress disorder (PTSD) due to their stressful work environment. Using the Walker and Avant conceptual analysis method, we sought to review the literature to better understand PTSD as it pertained to ICU nurses and its impact on their lives, patient care, and health care organizations. METHODS: For the review, we searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO. The keyword searches included the terms "post-traumatic stress disorder" AND "psychological stress" AND "intensive care unit nurses." Abstract and full text reviews were conducted. Ten articles met our inclusion criteria of being published in the past 10 years (2010-2020), peer reviewed, written in English, and referred specifically to PTSD and psychological stress in ICU nurses. FINDINGS: Antecedents for PTSD in ICU nurses are their stressful work environment, where exposure to traumatic events is experienced, and a lack of support from their manager, coworkers, and organization. Defining attributes for ICU nurses with PTSD included reexperiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Consequences identified included burnout, job dissatisfaction, and the intention to leave their job. The conceptual definition of PTSD in ICU nurses was illustrated by the attributes, antecedents, consequences, model case, empirical referents, and by the negative impact on the nurse, patients, and the health care organization. CONCLUSION/APPLICATION TO PRACTICE: Hospital administrators, nurse managers, and occupational health nurses should ensure that policies and interventions are in place to recognize and reduce the risk of PTSD among ICU nurses.

A Distance Accessible Education Model: Teaching Skills to Nurse Practitioners.

INTRODUCTION: Health care providers in rural areas are often unable to attend continuing education trainings due to limited staffing coverage. The coronavirus pandemic has created a unique situation, requiring many health care providers to obtain continuing education through virtual offerings. METHODS: This study used a descriptive design with a team-developed presurvey for demographics, 2 posttraining instruments, and a team-developed competency validation checklist. RESULTS: The study sample included nurse practitioner (NP) students and practicing NPs. All participants met competency in the skills validation. DISCUSSION: The results indicate that continuing education and competency validation of procedures is feasible in a virtual format.

Medical Surgical Nurse Self-perceived Competency in Posttraumatic Stress Disorder/Substance Use Disorder Veteran Care in a Non-Veterans Health Administration Setting.

OBJECTIVE: This study evaluated the self-perceived readiness of medical-surgical nurses in a non-Veterans Health Administration (VHA) facility to care for veterans with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). BACKGROUND: Nurses caring for veterans with PTSD and SUD at facilities other than the VHA should be equipped with the knowledge, skills, and attitudes to provide care for this population. METHODS: Nurses evaluated their self-perceived knowledge, skills, attitudes, experiences, and perspectives related to caring for veterans. RESULTS: Nurses overwhelmingly indicated that they had no knowledge of the "Have you served?" campaign, and fewer than half inquired about military status when assessing patients CONCLUSION: Nurses caring for veterans in non-VHA facilities do not consistently identify veterans or assess for service-related conditions, including PTSD and SUD. Nurses report low skill levels related to identifying, addressing, and referring patients with service-related conditions.

Strengthening universal health: development of a nursing and midwifery education quality improvement toolkit.

OBJECTIVE: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. METHODS: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. RESULTS: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. CONCLUSIONS: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.

Virtual Postoperative Visits for New Ostomates.

Postoperative education, discharge instructions, and follow-up appointments provide a foundation for new ostomates after discharge, but a gap in care remains. New ostomates utilize resources twice as much as other colorectal patients. Virtual visits allow visual inspection of the patient while providing verbal support. The purposes of this project were to determine the feasibility of Virtual Postoperative Visits, to define specific issues patients want addressed, and to assess patient satisfaction with a virtual format. In this pilot project, 10 patients attended two outpatient virtual visits following hospital discharge. The virtual visits were conducted using video conferencing software. Descriptive statistics were used to analyze data from a survey assessing patient satisfaction; content analysis described video interactions. All patients successfully completed two virtual visits from their homes. Ninety percent felt these visits helped with ostomy management and agreed they should be part of a discharge plan. All patients felt comfortable with a virtual format. Common themes discussed included pouching and skin irritation. We found that virtual visits are feasible, and patients are satisfied with this format to address goals of care. Future work will focus on large-scale implementation of virtual visits for new ostomates.

The Impact of Patient and Family Advisors on Critical Care Nurses' Empathy.

OBJECTIVE: The objective of this study was to determine if patient and family advisors' (PFAs) collaboration in an educational program could increase the empathy levels of intensive care unit (ICU) nurses. BACKGROUND: Data suggest that nurse empathy is on the decline. Ensuring that nurses consistently empathize with patients and families helps create positive patient experiences. METHODS: Thirty nurses participated in a PFA-designed educational intervention using simulation-based role playing. The Toronto Empathy Questionnaire (TEQ) was used to measure empathy before and after the intervention. RESULTS: The TEQ empathy scores increased significantly after nurses completed the PFA-designed educational program. Younger nurses (<30 years) improved on average 3.03 ± 3.6 points compared with older nurses (>30 years), who improved, on average, only 0.43 ± 2.06 points (t24.4 = 2.46, P = .021). For the changes in TEQ scores from preintervention to postintervention, age was significantly associated with improvements in TEQ scores. CONCLUSIONS: Patient and family advisors can positively impact empathy among ICU nurses.

Using Simulation to Teach Telehealth Nursing Competencies.

BACKGROUND: The use of telehealth to provide care to millions of patients who have difficulty accessing care through traditional means is growing exponentially. Nurse educators must prepare students to meet the challenge of managing this mode of care delivery. METHOD: A simulated telehealth experience was designed using the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: Simulation™, student learning objectives, and telehealth competencies. The design promoted active participation in a telehealth visit with a standardized patient. RESULTS: The simulation provided students with the opportunity to demonstrate use of telehealth equipment and become familiar with telehealth competencies. This hands-on experience increased student engagement related to telehealth as a health care delivery option and was an effective objective structured clinical examination. CONCLUSION: Integration of telehealth into the nursing curriculum is a necessity as health care technology advances. Simulation is one strategy available to expose students to telehealth and increase student engagement. [J Nurs Educ. 2018;57(10):624-627.].

A Competency-Based Curriculum for Critical Care Nurse Practitioners' Transition to Practice.

BACKGROUND: Nearly one-third of new-graduate nurse practitioners report undergoing no formal orientation process, and postcertification orientation processes vary. A validated curriculum would address the need for structured training to enhance new graduates' practice transition. METHODS: A competency-based practice transition curriculum for intensive care unit nurse practitioners was created using a literature review and expert panels. Competencies were established that were based on clinical categories essential to nurse practitioner practice in the intensive care unit and adapted from existing Accreditation Council for Graduate Medical Education training, aligned with the precertification nursing curriculum. Participants recruited from academic and clinical backgrounds were asked to rank curriculum items using a 4-point Likert scale. Competencies were refined on the basis of participants' survey feedback. RESULTS: A total of 31 participants from academic medical centers and schools of nursing throughout the United States responded to the request for competency validation; 29% of participants provided qualitative data. All 9 competency topics received a mean rating greater than 3.5 and were deemed valid. Using the combined quantitative and qualitative data, a final set of competencies for nurse practitioners in the intensive care unit was developed. CONCLUSIONS: The curriculum developed and validated in this study can become the basis for practice transition for novice nurse practitioners. The curriculum is adaptable and can be used for surgical and medical intensive care units. As refined, the competencies provide a validated foundation for training of new-graduate nurse practitioners in the intensive care unit.

The effect of data-entry template design and anesthesia provider workload on documentation accuracy, documentation efficiency, and user-satisfaction.

INTRODUCTION: Currently, there are few evidence-based guidelines to inform optimal clinical data-entry template design that maximizes usability while reducing unintended consequences. This study explored the impact of data-entry template design and anesthesia provider workload on documentation accuracy, documentation efficiency, and user-satisfaction to identify the most beneficial data-entry methods for use in future documentation interface design. METHODOLOGY: A study using observational data collection and psychometric instruments (for perceived workload and user-satisfaction) was conducted at three hospitals using different methods of data-entry for perioperative documentation (auto-filling with unstructured data, computer-assisted data selection with semi-structured documentation, and paper-based documentation). Nurse anesthetists at each hospital (N = 30) were observed completing documentation on routine abdominal surgical cases. RESULTS: Auto-filling (61.2%) had the lowest documentation accuracy scores compared to computer-assisted (81.3%) and paper-based documentation (76.2%). Computer-assisted data-entry had the best documentation efficiency scores and required the least percentage of the nurse anesthetists' time (9.65%) compared to auto-filling (11.43%) and paper-based documentation (15.23%). Paper-based documentation had the highest perceived workload scores (M = 288, SD = 88) compared to auto-filling (M = 160, SD = 93, U = 16.5, p < 0.01) and computer assisted data-entry (M = 93, SD = 50, U = 4.0, P < 0.001). CONCLUSIONS: Auto-filling with unstructured data needs to be used sparingly because of its low documentation accuracy. Computer-assisted data entry with semi-structured data needs to be further study because of its better documentation accuracy, documentation efficiency, and perceived workload.

Evidence-Based Guidelines for Interface Design for Data Entry in Electronic Health Records.

Electronic health records use a variety of data entry methods that are often customized to clinician needs. Data entry interfaces must be appropriately designed to maximize benefits and minimize unintended consequences. There was relatively little evidence in the literature to guide the selection of specific data entry methods according to the type of data documented. This literature review summarizes existing data entry design recommendations to guide data entry interface design. Structured data entry uses predefined charting elements to limit acceptable data entry to standard coded data and improve completeness and data reuse at the expense of correctness. Unstructured data entry methods use natural language and improve correctness, at the expense of completeness and data reusability. Semistructured data entry uses a combination of these data entry methods to complement the strengths and minimize the weaknesses of each method. Documentation quality is influenced by the method of data entry. It is important to choose data entry methods based on the type of data to be documented. This literature review summarizes data entry design guidelines to inform clinical practice and future research.

The reliability and validity of three questionnaires: The Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire.

PURPOSE: The purpose of this study was to adapt the "Student Satisfaction and Self-Confidence in Learning Scale" (SCLS), "Simulation Design Scale" (SDS), and "Educational Practices Questionnaire" (EPQ) developed by Jeffries and Rizzolo into Turkish and establish the reliability and the validity of these translated scales. METHODS: A sample of 87 nursing students participated in this study. These scales were cross-culturally adapted through a process including translation, comparison with original version, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Perceived Learning Scale, Patient Intervention Self-confidence/Competency Scale, and Educational Belief Scale. FINDINGS: Cronbach's alpha values were found as 0.77-0.85 for SCLS, 0.73-0.86 for SDS, and 0.61-0.86 for EPQ. CONCLUSIONS: The results of this study show that the Turkish versions of all scales are validated and reliable measurement tools.

Beginning and advanced students' perceptions of the use of low- and high-fidelity mannequins in nursing simulation.

BACKGROUND: There is little research evidence that demonstrates the difference between the use of low- and high-fidelity mannequins in assisting students to acquire their skills when students are at different points in their nursing education experience. OBJECTIVES: Our study examined differences between the use of low- and high-fidelity mannequins on student outcomes with both beginner and advanced students. DESIGN: A quasi-experimental investigation. SETTINGS: Participants performed two simulations, one simulation using a low-fidelity mannequin and the other simulation using a high-fidelity mannequin. PARTICIPANTS: First and fourth semester pre-licensure students from a Bachelor of Science in Nursing program and an accelerated nursing entry program participated in this study. METHODS: A Students' Satisfaction and Self-confidence Scale and Simulation Design Scale were used to obtain data. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 17.0. The results obtained from scales were compared using Wilcoxon sign test and Mann-Whitney U test. A p value of <0.05 was considered statistically significant. RESULTS: The student satisfaction score of the students in the low-fidelity mannequin group was 3.62±1.01, while that of the students in the high-fidelity mannequin group was 4.67±0.44'dir (p=0.01). The total score of the simulation design scale in the low-fidelity mannequin group was 4.15±0.63, while it was 4.73±0.33 in the high-fidelity mannequin group (p=0.01). CONCLUSIONS: Students' perceptions of simulation experiences using high-fidelity mannequins were found to be higher in contrast to their perceptions of experiences using low-fidelity mannequins.

Veteran Competencies for Undergraduate Nursing Education.

Military Veterans comprise approximately 10% of the US population. Most Veterans do not receive their health care through Veterans Affairs facilities, are seen across the health care system, and their prior military service and associated health issues often go unrecognized. In this study, a modified Delphi design was used to develop a set of 10 Veteran Care Competencies and associated knowledge, skills, and attitudes for Undergraduate Nursing Education: Military and Veteran Culture, Post Traumatic Stress Disorder, Amputation and Assistive Devices, Environmental/Chemical Exposures, Substance Use Disorder, Military Sexual Trauma, Traumatic Brain Injury, Suicide, Homelessness, and Serious Illness Especially at the End of Life.

Evaluating clinical decision support tools for medication administration safety in a simulated environment.

OBJECTIVES: The specific aims of this study were to develop a methodology and tools for the design of clinical decision support systems to decrease the incidence of medication administration errors. METHODS: A mixed-methods design was utilized in this study. First, observations of medication administration practice were used to inform the design of a simulated information system with a variety of decision support tools. Then, nurses were observed administering medications in a simulated environment using the simulated system. Finally, the nurses participated in focus groups to provide input into system tools design. Observations of nurses' use of the decision support tools as well as semi-structured focus groups were used to evaluate nurses' use and perceptions of the utility of the system decision support tools. RESULTS: Nurses' evaluation of the medication administration decision support tools as well as their actual performance revealed a tendency to underestimate their need for support. Their preferences were for decision support that was short, color coded, and easily accessed. Observations of medication administration showed that nurses exhibit a variety of work processes to prepare and administer medications to patients and access system decision support tools at a variety of points in this process. System design should allow flexibility of multiple points and types of information delivery to accommodate variations in workflow to minimize the tendency for system workarounds. CONCLUSIONS: This study was performed in one hospital and results may not generalize beyond this setting. However, this method used to design and test decision support could be transferred to other settings. Using simulation in this study provided a method for testing new information system design, related to a potentially dangerous procedure, in a manner that eliminated the hazards of potential unintended consequences for patients.

Nursing domain of CI governance: recommendations for health IT adoption and optimization.

CONTEXT: There is a lack of recommended models for clinical informatics (CI) governance that can facilitate successful health information technology implementation. OBJECTIVES: To understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders. DESIGN, SETTING, PARTICIPANTS: We conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. We interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects. RESULTS: We found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. We described specific lessons learned and a model of CI governance with recommended roles, partnerships, and councils from the perspective of nursing informatics leaders. CONCLUSION: Applied CI work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures. Our model of the nursing domain of CI governance with recommended roles, partnerships, and councils provides a starting point that should be further explored and validated. Not only can the model be used to understand, shape, and standardize roles, competencies, and structures within CI practice for nursing, it can be used within other clinical domains and by other informaticians.

Promoting teamwork and surgical optimization: combining TeamSTEPPS with a specialty team protocol.

This quality improvement project was a 300-day descriptive preintervention and postintervention comparison consisting of a convenience sample of 18 gynecology surgical team members. We administered the Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) Teamwork Perception Questionnaire to measure the perception of teamwork. In addition, we collected data regarding rates of compliance (ie, huddle, time out) and measurable surgical procedure times. Results showed a statistically significant increase in the number of team members present for each procedure, 2.34 µ before compared with 2.61 µ after (P = .038), and in the final time-out (FTO) compliance as a result of a clarification of the definition of FTO, 1.05 µ before compared with 1.18 µ after (P = .004). Additionally, there was improvement in staff members' perception of teamwork. The implementation of team training, protocols, and algorithms can enhance surgical optimization, communication, and work relationships.