Challenges of Screening Prospective Stool Donors for Fecal Microbiota Transplantation.

Despite high efficacy rates, significant costs and logistical challenges associated with procuring stool from healthy donors for fecal microbiota transplantation (FMT) have presented barriers to broader institutional adoption and limited the availability of this life-saving treatment. Published outcomes for donor screening programs report donor deferral rates between 90% and 96%. Due to the paucity of FMT donor screening data, a secondary analysis on a cohort of previously screened donors (n = 7,968) was conducted to provide a synopsis of the observed trends and rationales for prospective stool donor deferrals. Upon completion of the evaluation, 1.7% of prospective donors (n = 134) qualified for stool donation. Over 50% of donors who completed the online pre-screen were deferred, primarily for a body mass index of 30 kg/m2 or greater (n = 1,516, 37.0%), logistics (n = 841, 20.5%), and travel history (n = 638, 15.5%). Despite pre-screening, 569 donors (72.8%) who completed the in-person clinical assessment were ultimately deferred due primarily to potentially microbiome-mediated diseases (n = 187, 32.9%). A notably small portion of donors (n = 46, 25.6%) were deferred during the laboratory assessment process suggesting the clinical assessment was effective at deferring donors at higher risk for transmissible diseases. Donors lost to follow-up throughout the screening process presented a significant challenge and contributed to a notable (n = 3,117; 39.1%) portion of donor attrition. Findings were used to support recommendations for improving prospective stool donor screening programs and to provide suggestions for future research.

Misconceptions About Genomics Among Nursing Faculty and Students.

A comparison of 2 research studies revealed that nursing faculty and students share limited understanding and specific misconceptions about foundational genomic concepts. Mean scores on the Genomic Nursing Concept Inventory were 48% for faculty and 42% for students. Identifying misconceptions is important when designing educational strategies for students who will inevitably care for patients with genomic concerns. Common clinical scenarios requiring accurate interpretation of genomic terminology, gene function and expression, and genetic counseling principles are presented.

Factors Associated With Removal of Urinary Catheters After Surgery.

Publicly available data from the Centers for Medicaid & Medicare Services were used to analyze factors associated with removal of the urinary catheter within 48 hours after surgery in 59 Massachusetts hospitals. Three factors explained 36% of the variance in postoperative urinary catheter removal: fewer falls per 1000 discharges, better nurse-patient communication, and higher percentage of Medicare patients. Timely urinary catheter removal was significantly greater in hospitals with more licensed nursing hours per patient day.

Beyond the Pain Scale: Provider Communication and Staffing Predictive of Patients' Satisfaction with Pain Control.

This paper examined hospital characteristics, staffing, and nursing care factors associated with patient perception of poor pain control by conducting a secondary analysis of the Hospital Consumer Assessment of Health Care Providers Systems (HCAHPS) survey in California, Massachusetts, and New York hospitals. Analysis of variance was used to analyze the relationship between nurse, hospitalist, physician, and resident staffing and patients' perception of pain control. Twenty-one factors correlated with patients' reports of pain control were included in the stepwise linear regression analysis. Patients' perception of pain control significantly improved with higher numbers of registered nurses (p = .045), nursing staff (p = .005), and hospitalists (p = .035) and worsened with higher numbers of residents or interns (p = .010). Six predictors explained 79% of the variance in patients' self-reports of pain control. Four factors increased the likelihood that patients reported their pain was poorly controlled: (1) patients did not receive help as soon as they wanted (p < .001), (2) poor nurse communication (p < .001), (3) poor medication education (p < .001), and (4) teaching hospitals (p < .001). Two factors decreased the likelihood that patients reported their pain was poorly controlled: (1) higher numbers of nursing staff (p = .001) and (2) nonprofit hospitals (p = .001). Nurse staffing and nurse-patient communication are highly predictive of patients' perception of pain management. In teaching hospitals, with rotating intern/resident assignments, patients reported less satisfaction with pain management. This study provides new evidence for the importance of continuity of care in controlling the pain of hospitalized patients.

Primer in Genetics and Genomics, Article 3-Explaining Human Diversity: The Role of DNA.

Genetic variation lays the foundation for diversity and enables humans to adapt to changing environments. The order of the nucleotides adenine, guanine, cytosine, and thymine on the deoxyribonucleic acid (DNA) molecules of the nuclear chromosomes and mitochondrial DNA (mtDNA) plays an important role in normal cell division, tissue development, and reproduction but is susceptible to alteration from a large number of random, inherited, or environmental events. Variations can range from a change in a single nucleotide to duplication of entire chromosomes. Single nucleotide polymorphisms are the major source of human heterogeneity. Other variations that can alter phenotypes and adversely impact growth, development, and health include copy number variations, aneuploidies, and structural alterations such as deletions, translocations, inversions, duplications, insertions, or mutations in mtDNA. In addition, DNA rearrangements in somatic cells underlie the uncontrolled cell growth found in cancer. This article explores the mechanisms by which variations in DNA arise and the impact those changes can have on human health.

Nurse Staffing and Hospital Characteristics Predictive of Time to Diagnostic Evaluation for Patients in the Emergency Department.

In the 2014 Emergency Department Benchmarking Alliance Summit, for the first time, participants recommended tracking nursing and advanced practice nurse hours. Performance data from the Centers for Medicare and Medicaid Services provides an opportunity to analyze factors associated with delays in emergency care. The purpose of this study was to investigate hospital characteristics associated with time to a diagnostic evaluation in 67 Massachusetts emergency departments from 2013 to 2014. METHODS: Covariates significantly correlated with time to diagnostic evaluation, and factors associated with timely care in emergency departments were included in the stepwise linear regression analysis. Differences in nurse staffing and performance measures in trauma and nontrauma emergency departments were examined with analysis of variance and t tests. RESULTS: Two predictors explained 38% of the variance in time a diagnostic evaluation (1): nurse staffing (P < .001) and (2) trauma centers (P <.001). In trauma centers, the time to a diagnostic evaluation significantly increased (P = .042) from 30.2 minutes when a nurse cared for fewer than 11.32 patients in 24 hours to 61.4 minutes when a nurse cared for 14.85 or more patients in 24 hours. DISCUSSION: Efforts to improve patient flow often focus on process interventions such as improved utilization of observation beds or transfers of patients to inpatient units. In this study, time to diagnostic evaluation significantly increased when emergency nurses care for higher numbers of patients. The findings present new evidence identifying the relationship of specific nurse to patient ratios to wait time in emergency departments.

Building Genetic Competence Through Partnerships and Interactive Models.

BACKGROUND: Nurses are increasingly using genetic-directed therapies in routine care, but evidence indicates that nurse educators lack knowledge about basic genetic concepts and related clinical implications. Educators are the key to preparing future nurses for effective practice in the genomic era, and creative approaches are needed for faculty development. METHOD: Nurse educators in academic and clinical settings partnered with science educators who use sophisticated DNA, RNA, and protein models to explore ways to teach abstract genetic concepts. RESULTS: Hands-on learning enabled the workshop participants to understand how transcription of gene mutations leads to the translation of defective proteins responsible for specific diseases. Participants found using the models helped clarified complex concepts that occur at the cellular level. CONCLUSION: Partnerships with science educators can address gaps in nurse educators' knowledge about genetics and introduce creative teaching strategies. [J Nurs Educ. 2016;55(5):300-303.].

Social Change: A Framework for Inclusive Leadership Development in Nursing Education.

BACKGROUND: The social change model (SCM) promotes equity, social justice, self-knowledge, service, and collaboration. It is a relevant framework for extracurricular leadership development programs that target students who may not self-identify as leaders. METHOD: Application of the SCM in a leadership development program for prelicensure nursing students from underresourced or underrepresented backgrounds is described. Students' opinions about leadership for social change were explored through a focus group and a pilot test of an instrument designed to assess the values of the SCM. RESULTS: Students lack the experience required to feel comfortable with change, but they come into nursing with a sense of commitment that can be nurtured toward leadership for social change and health equity through best practices derived from the SCM. These include sociocultural conversations, mentoring relationships, community service, and membership in off-campus organizations. CONCLUSION: Nurse educators can cultivate inclusive leadership for social change using the SCM as a guide.

Faculty Performance on the Genomic Nursing Concept Inventory.

PURPOSE: To use the newly developed Genomic Nursing Concept Inventory (GNCI) to evaluate faculty understanding of foundational genomic concepts, explore relative areas of strength and weakness, and compare the results with those of a student sample. DESIGN: An anonymous online survey instrument consisting of demographic or background items and the 31 multiple-choice questions that make up the GNCI was completed by 495 nursing faculty from across the United States in the fall of 2014. METHODS: Total GNCI score and scores on four subcategories (genome basics, mutations, inheritance, genomic health) were calculated. Relationships between demographic or background variables and total GNCI score were explored. FINDINGS: The mean score on the GNCI was 14.93 (SD = 5.31), or 48% correct; topical category scores were highest on the inheritance and genomic health items (59% and 58% correct, respectively), moderate on the mutations items (54% correct), and lowest on the genome basics items (33% correct). These results are strikingly similar to those of a recent study of nursing students. Factors associated with a higher total score on the GNCI included higher self-rated proficiency with genetic/genomic content, having a doctoral degree, having taken a genetics course for academic credit or continuing education, and having taught either a stand-alone genetic/genomic course or lecture content as part of nursing or related course. Self-rated proficiency with genetic/genomic content was fair or poor (70%), with only 7% rating their proficiency as very good or excellent. CONCLUSIONS: Faculty knowledge of foundational genomic concepts is similar to that of the students they teach and weakest in the areas related to basic science information. CLINICAL RELEVANCE: Genomics is increasingly relevant in all areas of clinical nursing practice, and the faculty charged with educating the next generation of nurses must understand foundational concepts. Faculty need to be proactive in seeking out relevant educational programs that include basic genetic/genomic concepts.

The challenges of inclusivity in baccalaureate nursing programs.

Nurse educators must meet the challenge of preparing a new generation of nurse leaders who can address the health care needs of an increasingly multicultural society. Institutional culture change that promotes inclusivity develops in response to an intentional embracement of diversity and is key to the success of any program initiatives. Providing resources for students can backfire if they experience the negative consequences of labeling, if incentives are distributed without thoughtful consideration of the related expectations, and if the advising system focuses on prescriptive, rather than developmental, principles. A deficit-thinking perspective that brands a student as at risk can undermine the goal of providing support. Faculty must engage in open discussions about labels, underlying assumptions about student aptitudes, and strategies for ensuring student success. Most importantly, faculty must actively solicit and seriously consider the students' accounts of their experiences and perspectives on changes that would make the climate more welcoming.

Semester abroad opportunities in baccalaureate nursing programs.

An experience of studying abroad enhances undergraduate nursing education by broadening the student's perspective about different cultures, heightening awareness of a global society and foreign customs and traditions, stimulating interest in international work and research, fostering personal development, building skill in a foreign language, and serving as a bridge between theory and practice. Despite a large number of published reports about international experiences for nursing students, little is known about the number of baccalaureate programs that offer a semester abroad or the percent of students who participate. A mailed paper-and-pencil survey was completed by 382 administrators of baccalaureate nursing programs listed in the American Association of Colleges of Nursing database. Eighty-nine schools (23.3%) offer a semester study abroad opportunity. Of those, 39 (44%) offer clinical nursing courses taught by nursing faculty. Most (76%) of the 89 schools reported that only 0%-5% of students participated in the semester abroad program. Despite the small number of baccalaureate programs that offer a semester abroad experience and the small percentage of students who participate, respondents listed a large number and variety of advantages and offered strategies that facilitate their programs. Curricular innovations that allow 17%-26% of juniors in the baccalaureate nursing program at Boston College to study abroad for a semester are elucidated.

Implications for educating the next generation of nurses on genetics and genomics in the 21st century.

PURPOSE: To provide nurse educators with an updated overview of advances in genetics and genomics in the context of the holistic perspective of nursing. ORGANIZING FRAMEWORK: Recent advances in genetic and genomic research, testing, therapies, and resources are presented, and the continuing importance of the family history is discussed. METHODS: Genomic nurse experts reviewed recent literature and consumer resources to elucidate updates in technology through the lens of the genetically vulnerable patient and family. FINDINGS: Genetic and genomic technologies are becoming routinely used in health care, and nurse educators will be challenged to incorporate these technologies and implications for patients and families into educational programs. CONCLUSIONS: New technology and its applications are perennial challenges to nurse educators, but the common focus for nursing, historically and geographically, is health promotion, symptom management, and disease prevention. Education for the next generation of nurses can lay a foundation in genetics and genomics that will enable interpretation and responsible integration of new technologies in a context of individual and family value systems, personal experiences, risk perception, decision consequences, and available resources. CLINICAL RELEVANCE: Nurses are ideally situated to inform patients about new options in healthcare, and nurse educators are challenged to prepare their students to interpret and responsibly integrate new genetic-genomic information into practice.

Genetic association studies in nursing practice and scholarship.

PURPOSE: To explore the role of genetic association studies in risk assessment for common complex diseases. ORGANIZING FRAMEWORK: An introduction to the types of genetic association studies is followed by a discussion of their potential use in risk assessment for age-related macular degeneration and type 2 diabetes mellitus. The benefits and limitations of this burgeoning technology are explored and related to nursing practice and scholarship. CONCLUSIONS: Nurses in practice must be prepared to assist clients with decisions about seeking and interpreting results from genetic association studies and nurse researchers must apply current guidelines for conducting robust studies and applying the results of such studies in clinical practice. CLINICAL RELEVANCE: Data collected from genetic association studies will increasingly be used to identify novel prevention and treatment strategies for many complex diseases. An understanding of the principles that underlie this new science is essential for nurses in all areas of clinical practice as they design, test, and implement appropriate intervention and prevention strategies based on genetic association studies.

Design and psychometric evaluation of the Psychological Adaptation to Genetic Information Scale.

PURPOSE: To develop and psychometrically evaluate the Psychological Adaptation to Genetic Information Scale (PAGIS). DESIGN: A cross-sectional, Web-based survey of participants (n=323) recruited via Internet electronic mailing lists or Websites for people affected by genetic diseases. METHODS: Item analysis, confirmatory principal components analysis, and internal consistency reliability using Cronbach's alpha were used to construct the 26-item PAGIS. FINDINGS: Five factors (nonintrusiveness, support, self-worth, certainty, and self-efficacy) explained 57.7% of the variance in psychological adaptation to genetic information. The internal consistency reliability of the total PAGIS was .90, and the subscale reliabilities ranged from .77 to .87. CONCLUSIONS: Psychological adaptation to genetic information is a multidimensional phenomenon comprised of nonintrusiveness, support, self-worth, certainty, and self-efficacy. The PAGIS has initial reliability and validity for use in future research.

Using the impact of event scale to evaluate psychological response to being a phenylketonuria gene carrier.

The birth of a child with phenylketonuria (PKU) is almost always a shock to the parents, who are faced with the realities of caring for a child with special needs and the need to cope with the realization that they are obligate carriers of the responsible gene. The Impact of Event Scale (IES) was used to assess the psychological impact of being a PKU gene carrier on 83 parents of children with PKU. IES scores decreased significantly from the time of initial diagnosis of PKU to the current time. The magnitude of the psychological impact did not correlate with the age of the parent, the number of years since the diagnosis of PKU, or the health or development of the child. As more tests become available for detecting the presence of disease-related genes, instruments such as the IES may prove useful in the evaluation of psychological responses to genetic information.

Promoting integration of genetics core competencies into entry-level nursing curricula.

Nurse educators must respond to the growing need to teach genetics content in undergraduate nursing curricula. Recently developed genetics core competencies can be used to guide curriculum assessment and planning. This article describes a 5-year effort to integrate genetics education into a baccalaureate nursing curriculum and provides the results of a curriculum survey based on published genetics core competencies.

Brief report: Predictors of parenting stress among parents of children with biochemical genetic disorders.

OBJECTIVE: To examine predictors of parenting stress in parents whose children were diagnosed with a biochemical genetic disorder clinically or through newborn screening. METHODS: Parents of 263 children with biochemical genetic disorders (139 identified by newborn screening, 124 identified clinically) completed interviews focused on child health, medical service use, satisfaction with services, parenting stress, and family functioning. RESULTS: Multiple regression analyses suggested that child adaptive functioning, parental satisfaction with support, and difficulties parents experienced meeting their child's health care needs were associated with scores on the Parenting Stress Index (R2 =.51). CONCLUSIONS: Initiatives to improve child adaptive functioning and parental support as well as practical assistance to help parents meet their child's health needs may reduce parental stress and family disruption in this population.