Clinical Nurse Instructor Competencies: An Exploratory Study of Role Requirements

Background: Baccalaureate nursing education consists of theoretical and practical training that prepares students for the role of competent nursing care providers. The practical application of knowledge and skills is vital in nursing curricula worldwide. Nursing programs have changed over the last few decades and have become increasingly dependent on part-time Clinical Instructors (CIs) to teach the clinical components of the curricula. However, CIs receive minimal instruction to prepare for this complex role. It has been acknowledged in Canada that there is limited research to inform CI specific competencies. Purpose: The purpose of this research was to conduct an exploratory study to identify the CIs perceptions of the importance of the World Health Organization’s (WHO) nurse educator core competencies and their importance to the clinical teaching role. Methodology: This was an exploratory quantitative study. A self-report survey was developed guided by the WHOs Nurse Educator Core Competencies (NECC). Donabedian’s structure-process-outcome conceptual framework guided this study. Sample and setting: Convenience sampling of participants employed as CIs in a baccalaureate in nursing program in an Ontario university. CIs who taught theory courses were excluded. The survey response rate was 23.9% (n=27). Results: The study results confirm that all the NECC have merit but need to be adapted to a CI-specific role. This is a multi-phased research project and the findings of the study have implications for all stakeholders, including schools of nursing and CIs. Ongoing research is required to inform the policy direction as it pertains to the CI-specific role and competencies in Canada. Implications for nursing programs, research and policy will be shared. Conclusions: Clinical Instruction is an area of nursing which deserves to be acknowledged as a specialty. National standardized CI-specific competencies will provide a strong foundation for CI preparation in Canada. Contexte : Le baccalauréat en sciences infirmières comprend des cours théoriques et pratiques préparant les étudiantes au rôle de professionnelles compétentes en soins de santé. Dans les programmes d’études en sciences infirmières partout dans le monde, l’application pratique des connaissances et habiletés est essentielle. Les programmes de sciences infirmières se sont transformés au cours des dernières décennies, dépendant de plus en plus des enseignantes de clinique (Clinical Instructors; CI), à temps partiel, pour le volet pratique du programme d’études. Ces enseignantes reçoivent toutefois très peu de soutien pour les préparer à jouer ce rôle complexe. Au Canada, il a été reconnu que peu de recherches renseignent sur les compétences spécifiques des enseignantes de cliniques. Objectif : Cette étude exploratoire avait pour but d’identifier les perceptions des enseignantes de clinique quant à l’importance des Compétences essentielles des infirmières enseignantes (Nurse Educator Core Competencies; NECC) décrites par l’Organisation mondiale de la Santé (OMS) ainsi qu’à leur importance pour le rôle d’enseignante de clinique. Méthode : Il s’agissait d’une étude quantitative exploratoire. Un sondage a été élaboré en s’appuyant sur les compétences essentielles des infirmières enseignantes de l’OMS. Le cadre conceptuel « structure-processus-résultats » de Donabedian a guidé cette étude. Échantillon et milieu : Un échantillonnage de convenance a été constitué de participantes volontaires employées comme enseignantes de clinique dans un programme de baccalauréat en sciences infirmières d’une université en Ontario. Les enseignantes qui donnaient des cours théoriques étaient exclues. Le taux de réponse au sondage a été de 23,9 % (n=27). Résultats : Les résultats de l’étude confirment que toutes les compétences sont pertinentes, mais qu’elles doivent être adaptées au rôle spécifique propre aux enseignantes de clinique. Ce projet de recherche comporte plusieurs étapes, et les résultats de cette étude ont des retombées pour toutes les parties prenantes, y compris les écoles de sciences infirmières et les enseignantes de clinique. Les travaux devront se poursuivre afin d’orienter la politique en ce qui concerne le rôle et les compétences spécifiques des enseignantes de clinique au Canada. Les retombées pour les programmes de sciences infirmières, la recherche et les politique seront présentées. Conclusions : L’enseignement clinique constitue un domaine des sciences infirmières méritant d’être reconnu comme une spécialité. Des normes nationales de compétences spécifiques aux enseignantes de clinique serviront de base solide pour la préparation de ces enseignantes au Canada

An Evidence-based Framework for Reporting Student Nurse Medication Incidents: Errors, Near Misses and Discovered Errors

Purpose: To share an evidence-based framework for reporting and analysing three types of medication incidents in an undergraduate nursing program. Incident types include errors, near misses and discovered errors. Background: Medication errors are underreported. Published studies on errors by nursing students indicate that although errors occur during clinical placements, there is a lack of consensus on how the factors that contributed to the errors are reported and analyzed. This limits our understanding of the factors that impact safe medication administration and reduces our ability to apply this knowledge to education and practice. Method: Quality improvement project. Results: Our reporting framework quantifies system factors that are supported by the literature as contributing to errors but not usually captured in incident reporting. Contributing factors for errors and near misses varied. This finding has not been documented in the literature. Conclusion: Nursing schools should prepare nursing students with a strong commitment to report all incidents and provide them with the competencies and a reporting system that allows them to report efficiently and effectively. As these graduates enter the workforce, they can influence the reporting practices of seasoned nurses. The ten factor framework provides nursing schools with the ability to quantify the individual and system factors that influence the safety of the student nurse medication administration process and the opportunity to implement strategies to reduce and/or prevent these incidents from occurring. Objectif : Présenter un cadre fondé sur des résultats probants pour signaler et analyser trois types d’incidents liés aux médicaments dans un programme de premier cycle en sciences infirmières, soit les erreurs, les quasi-incidents et les erreurs découvertes. Contexte : Les erreurs de médication ne sont pas toutes signalées. Les études publiées portant sur les erreurs causées par des étudiantes infirmières indiquent que, même si les erreurs se produisent durant les stages cliniques, la manière de signaler et d’analyser les facteurs contributifs ne fait pas consensus. Cela limite notre compréhension des facteurs influant sur l’administration sécuritaire des médicaments et réduit notre capacité à mettre en application ces connaissances en formation et en pratique. Méthode : Projet d’amélioration de la qualité. Résultats : Notre cadre de signalements quantifie les facteurs systémiques qui, selon la littérature sur le sujet, contribuent à des erreurs, mais ne figurent pas normalement dans les déclarations d’incident. Les facteurs ayant contribué à des erreurs et quasi-incidents étaient variables. Ce résultat n’a pas été rapporté dans la littérature. Conclusion : Les écoles de sciences infirmières devraient enseigner aux étudiantes infirmières l’importance de signaler l’ensemble des incidents tout en leur fournissant les habiletés et un système de déclaration qui leur permet de les déclarer de façon efficace et efficiente. Lorsque les diplômées intègreront le marché du travail, elles pourront influencer les pratiques des infirmières chevronnées en matière de signalement. Le cadre composé de dix facteurs permet aux écoles de sciences infirmières de quantifier les facteurs individuels et systémiques ayant un impact sur la sécurité du processus d’administration des médicaments par des étudiantes infirmières; il leur permet aussi de mettre en œuvre des stratégies de réduction ou de prévention de tels incidents

\u3ci\u3eScaphanocephalus\u3c/i\u3e-Associated Dermatitis as the Basis for Black Spot Disease in Acanthuridae of St. Kitts, West Indies

Acanthurus spp. of St. Kitts and other Caribbean islands, including ocean surgeonfish A. bahianus, doctorfish A. chirurgus, and blue tang A. coeruleus, frequently show multifocal cutaneous pigmentation. Initial reports from the Leeward Antilles raised suspicion of a parasitic etiology. The aim of this study was to quantify the prevalence of the disease in St. Kitts’ Acanthuridae and describe its pathology and etiology. Visual surveys demonstrated consistently high adjusted mean prevalence at 3 shallow reefs in St. Kitts in 2017 (38.9%, 95% CI: 33.8−43.9) and 2018 (51.5%; 95% CI: 46.2−56.9). There were no differences in prevalence across species or reefs, but juvenile fish were less commonly affected than adults. A total of 29 dermatopathy-affected acanthurids were sampled by spearfishing for comprehensive postmortem examination. Digenean metacercariae were dissected from \u3c1 mm cysts within pigmented lesions. Using partial 28S rDNA sequence data they were classified as Family Heterophyidae, members of which are commonly implicated in black spot disease of other fishes. Morphological features of the parasite were most typical of Scaphanocephalus spp. (Creplin, 1842), and 2 genetic profiles were obtained suggesting more than 1 digenean species. Histologically, pigmented lesions had mild chronic perivascular dermatitis and increased melanophores and melanin density, often centered on encysted digenean metacercariae. In 1 affected A. chirurgus, similar metacercariae were histologically identified in skeletal and cardiac muscle. Further research is needed to clarify impact on host fitness, establish the number of heterophyid digenean species that cause black spots on Caribbean fishes and to determine the intermediate and definitive host species

Persistence of Supplemented Bifidobacterium longum subsp. infantis EVC001 in Breastfed Infants.

Attempts to alter intestinal dysbiosis via administration of probiotics have consistently shown that colonization with the administered microbes is transient. This study sought to determine whether provision of an initial course of Bifidobacterium longum subsp. infantis (B. infantis) would lead to persistent colonization of the probiotic organism in breastfed infants. Mothers intending to breastfeed were recruited and provided with lactation support. One group of mothers fed B. infantis EVC001 to their infants from day 7 to day 28 of life (n = 34), and the second group did not administer any probiotic (n = 32). Fecal samples were collected during the first 60 postnatal days in both groups. Fecal samples were assessed by 16S rRNA gene sequencing, quantitative PCR, mass spectrometry, and endotoxin measurement. B. infantis-fed infants had significantly higher populations of fecal Bifidobacteriaceae, in particular B. infantis, while EVC001 was fed, and this difference persisted more than 30 days after EVC001 supplementation ceased. Fecal milk oligosaccharides were significantly lower in B. infantis EVC001-fed infants, demonstrating higher consumption of human milk oligosaccharides by B. infantis EVC001. Concentrations of acetate and lactate were significantly higher and fecal pH was significantly lower in infants fed EVC001, demonstrating alterations in intestinal fermentation. Infants colonized by Bifidobacteriaceae at high levels had 4-fold-lower fecal endotoxin levels, consistent with observed lower levels of Gram-negative Proteobacteria and Bacteroidetes. IMPORTANCE The gut microbiome in early life plays an important role for long-term health and is shaped in large part by diet. Probiotics may contribute to improvements in health, but they have not been shown to alter the community composition of the gut microbiome. Here, we found that breastfed infants could be stably colonized at high levels by provision of B. infantis EVC001, with significant changes to the overall microbiome composition persisting more than a month later, whether the infants were born vaginally or by caesarean section. This observation is consistent with previous studies demonstrating the capacity of this subspecies to utilize human milk glycans as a nutrient and underscores the importance of pairing a probiotic organism with a specific substrate. Colonization by B. infantis EVC001 resulted in significant changes to fecal microbiome composition and was associated with improvements in fecal biochemistry. The combination of human milk and an infant-associated Bifidobacterium sp. shows, for the first time, that durable changes to the human gut microbiome are possible and are associated with improved gut function

UNC System Math Pathways’ Digital Course Enhancement Collaboration to Improve Equity, Instruction, and Access During the COVID-19 Pandemic

This study examines how faculty members and students evaluated, perceived, and used a digital course content collection developed to support high quality remote instruction during the Covid-19 pandemic. The collections were the result of a multi-institutional, collaborative effort within the University of North Carolina System to support its students and faculty. Using surveys from faculty and demographically identified students enrolled in their classes, the authors evaluate the perceived utility and impact of the open educational resource collections. Faculty members rated the collections highly and typically found utility in at least some of the components of the collections. They found activities, videos and assessments to be the most useful tools. Students generally responded positively to the classes using the collections. While students who identified as minority found the materials useful or beneficial, they did not do so in proportional numbers to non-minority students

Inflammation, insulin resistance, and diabetes-mendelian randomization using CRP haplotypes points upstream

Background Raised C-reactive protein (CRP) is a risk factor for type 2 diabetes. According to the Mendelian randomization method, the association is likely to be causal if genetic variants that affect CRP level are associated with markers of diabetes development and diabetes. Our objective was to examine the nature of the association between CRP phenotype and diabetes development using CRP haplotypes as instrumental variables. Methods and Findings We genotyped three tagging SNPs (CRP + 2302G > A; CRP + 1444T > C; CRP + 4899T > G) in the CRP gene and measured serum CRP in 5,274 men and women at mean ages 49 and 61 y (Whitehall II Study). Homeostasis model assessment-insulin resistance (HOMA-IR) and hemoglobin A1c (HbA1c) were measured at age 61 y. Diabetes was ascertained by glucose tolerance test and self-report. Common major haplotypes were strongly associated with serum CRP levels, but unrelated to obesity, blood pressure, and socioeconomic position, which may confound the association between CRP and diabetes risk. Serum CRP was associated with these potential confounding factors. After adjustment for age and sex, baseline serum CRP was associated with incident diabetes (hazard ratio = 1.39 [95% confidence interval 1.29-1.51], HOMA-IR, and HbA1c, but the associations were considerably attenuated on adjustment for potential confounding factors. In contrast, CRP haplotypes were not associated with HOMA-IR or HbA1c (p=0.52-0.92). The associations of CRP with HOMA-IR and HbA1c were all null when examined using instrumental variables analysis, with genetic variants as the instrument for serum CRP. Instrumental variables estimates differed from the directly observed associations (p=0.007-0.11). Pooled analysis of CRP haplotypes and diabetes in Whitehall II and Northwick Park Heart Study II produced null findings (p=0.25-0.88). Analyses based on the Wellcome Trust Case Control Consortium (1,923 diabetes cases, 2,932 controls) using three SNPs in tight linkage disequilibrium with our tagging SNPs also demonstrated null associations. Conclusions Observed associations between serum CRP and insulin resistance, glycemia, and diabetes are likely to be noncausal. Inflammation may play a causal role via upstream effectors rather than the downstream marker CRP

English and Black Walnut Phenolic Antioxidant Activity in Vitro and Following Human Nut Consumption

ABSTRACT Background: Walnut consumption may reduce the risk of cardiovascular disease by providing antioxidant protection to low density lipoproteins (LDL). Aim: This study compared the phenolic profile and antioxidant activity of English versus black walnuts. Methods: Nuts were extracted in methanol or acetone prior to analysis with HPLC/LC-MS-MS for phenolic identification and quantitation. The ability to prevent oxidation of LDL was examined in vitro using walnut extracts and ex vivo after walnut consumption for 28 days. Results: Flavonoids identified/quantified with HPLC/LC-MS-MS included the phenolic acids 5-caffeoylquinic acid, 3-caffeoylquinic acid (black walnut only), 4-caffeoylquinic acid, and the flavonol glycosides querceti

Identification of heparin modifications and polysaccharide inhibitors of Plasmodium falciparum merozoite invasion that have potential for novel drug development

Despite recent successful control efforts, malaria remains a leading global health burden. Alarmingly, resistance to current antimalarials is increasing and the development of new drug families is needed to maintain malaria control. Current antimalarials target the intraerythrocytic developmental stage of the Plasmodium falciparum life cycle. However, the invasive extracellular parasite form, the merozoite, is also an attractive target for drug development. We have previously demonstrated that heparin-like molecules, including those with low molecular weights and low anticoagulant activities, are potent and specific inhibitors of merozoite invasion and blood-stage replication. Here we tested a large panel of heparin-like molecules and sulfated polysaccharides together with various modified chemical forms for their inhibitory activity against P. falciparum merozoite invasion. We identified chemical modifications that improve inhibitory activity and identified several additional sulfated polysaccharides with strong inhibitory activity. These studies have important implications for the further development of heparin-like molecules as antimalarial drugs and for understanding merozoite invasion

WldS requires Nmnat1 enzymatic activity and N16–VCP interactions to suppress Wallerian degeneration

Slow Wallerian degeneration (WldS) encodes a chimeric Ube4b/nicotinamide mononucleotide adenylyl transferase 1 (Nmnat1) fusion protein that potently suppresses Wallerian degeneration, but the mechanistic action of WldS remains controversial. In this study, we characterize WldS-mediated axon protection in vivo using Drosophila melanogaster. We show that Nmnat1 can protect severed axons from autodestruction but at levels significantly lower than WldS, and enzyme-dead versions of Nmnat1 and WldS exhibit severely reduced axon-protective function. Interestingly, a 16–amino acid N-terminal domain of WldS (termed N16) accounts for the differences in axon-sparing activity between WldS and Nmnat1, and N16-dependent enhancement of Nmnat1-protective activity in WldS requires the N16-binding protein valosin-containing protein (VCP)/TER94. Thus, WldS-mediated suppression of Wallerian degeneration results from VCP–N16 interactions and Nmnat1 activity converging in vivo. Surprisingly, mouse Nmnat3, a mitochondrial Nmnat enzyme that localizes to the cytoplasm in Drosophila cells, protects severed axons at levels indistinguishable from WldS. Thus, nuclear Nmnat activity does not appear to be essential for WldS-like axon protection

GenBio-MAPS: A Programmatic Assessment to Measure Student Understanding of Vision and Change Core Concepts across General Biology Programs

The Vision and Change report provides a nationally agreed upon framework of core concepts that undergraduate biology students should master by graduation. While identifying these concepts was an important first step, departments also need ways to measure the extent to which students understand these concepts. Here, we present the General Biology-Measuring Achievement and Progression in Science (GenBio-MAPS) assessment as a tool to measure student understanding of the core concepts at key time points in a biology degree program. Data from more than 5000 students at 20 institutions reveal that this instrument distinguishes students at different stages of the curriculum, with an upward trend of increased performance at later time points. Despite this trend, we identify several concepts that advanced students find challenging. Linear mixed-effects models reveal that gender, race/ethnicity, English-language status, and first-generation status predict overall performance and that different institutions show distinct performance profiles across time points. GenBio-MAPS represents the first programmatic assessment for general biology programs that spans the breadth of biology and aligns with the Vision and Change core concepts. This instrument provides a needed tool to help departments monitor student learning and guide curricular transformation centered on the teaching of core concepts.</p