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Surgeons request intraoperative parathyroid hormone (PTH) monitoring during parathyroidectomy procedures to confirm identification of abnormal gland tissue. Generally, a 50% decrease in the baseline PTH level indicates the abnormal tissue has been removed. A delay in collecting and processing PTH blood samples can complicate intraoperative decision making and prolong the procedure. The purpose of this quality improvement project was to develop tools to facilitate the specimen management process (eg, requesting, transporting, analyzing) for PTH blood samples and decrease the average total time required for transit and assay. We implemented a two‐pronged initiative that involved improving the laboratory requisition form and creating a parathyroid tote box to contain all the needed information and supplies. The average total time for transit and assay decreased from 31.36 minutes before implementation to 22.06 minutes after implementation. Perioperative nurses expressed satisfaction with the changes and continue to use the revised process. [ABSTRACT FROM AUTHOR]

• Appropriate treatment of UTI in hospitalized NH residents is low. • The Cooper tool and Stone criteria have moderate levels of diagnostic agreement for UTI. • Appropriate UTI treatments were seen more frequently with catheterized residents. • Fever and change in mental or functional status were the most reported signs of UTI. • Only 24% of treated UTIs had a documented culture and sensitivity. • Use of UTI specific sign and symptom terminology may improve diagnostic accuracy. Inappropriate antibiotic treatments for urinary tract infection (UTI) in nursing home (NH) residents are common and contribute to antibiotic resistance. Published guidelines aim to improve accurate assessment, diagnosis, and treatment of UTIs. This study assessed whether records from hospitalized NH residents diagnosed with UTI, while comparing the Cooper Tool and Stone criteria, supported appropriate treatment. A retrospective chart review was conducted using electronic medical record (EMR) data from residents of 3 NHs who were diagnosed with UTI when hospitalized over a 3-year period. The Cooper Tool and Stone criteria were used to assess treatment appropriateness. Of 79 hospitalized residents treated for UTI, 11 (13.9%) were appropriately treated according to the Cooper Tool and 9 (11.4%) according to Stone. The 2 criteria agreed in 9 of the cases including 100% of those with catheters. Urinalysis was documented in 72% of residents and 24% had documentation of culture and sensitivity. Appropriate UTI treatment rates using both tools were low but much higher in those with catheters. Future research is necessary to validate the use of these tools in the hospital setting which have the potential to improve treatment accuracy and reduce unnecessary antibiotics use. [ABSTRACT FROM AUTHOR]

• Nursing students are an essential workforce during a pandemic. • The coronavirus disease 2019 pandemic provides opportunities for nurse leaders to identify creative solutions. • Future policies need to focus on the role of advanced practice simulation training and telehealth. The coronavirus disease 2019 (COVID-19) disrupted the education and clinical training of nursing students. Clinical sites shut out students over low equipment supplies, physical distancing requirements, and redeployment of staff. The purpose of this paper is to highlight a progressive solution to engage nurse practitioner students as part of the COVID-19 response given the disruption of their traditional clinical training environments so that student could continue to matriculate and graduate in a timely manner. Nurse practitioner students swiftly responded and were deemed an essential part of the nursing workforce. Policy implications for advanced nursing practice and education for telehealth and simulation research moving forward is also provided. [ABSTRACT FROM AUTHOR]

A growing body of literature is examining the relationships between socio-demographic factors influencing recruitment and retention of students in higher education. The purpose of this study was to explore the characteristics of first generation to college (First-Gen) nursing applicants including socio-demographic variables compared to applicants whose parents received a higher education degree. We also aimed to explore whether acceptance or rejection into the program varied based on an applicant's First-Gen identification. A total of 3469 applications were analyzed over a six-year admission period from 2012 to 2017 across three programs: Accelerated Registered Nursing; Graduate (Master's degree), and PhD. Data analysis included descriptive and inferential statistics (e.g., chi-square, t -tests) aimed at describing the sample of First-Gen applicants as well as comparing First-Gen applicants to those whose parents received at least a university degree. Approximately 30% of applicants identified as First-Gen. First-Gen applicants were significantly more likely to be a student of color, older, a Veteran, immigrant or international student. PhD first-gen applicants were significantly more likely to be rejected than those who whose parents had higher education degrees. This study describes a growing population of nursing student applicant requiring further research and engagement on what supports are most needed. The long-term goal of boosting the diversity of our workforce is to increase recruitment, improve retention, increase graduation rates, and ultimately increase access to and quality of care to the patients we serve. • First Generation to College (First-Gen) nursing students increase the diversity of nursing. • First-Gen nursing applicants experience barriers at the admissions phase. • Recommendations for improving the application process and review for First-Gen students are included. [ABSTRACT FROM AUTHOR]

BACKGROUND: Airway clearance therapy (ACT) is a core component of daily treatment for cystic fibrosis (CF). However, surprisingly little is known about sustained or persistent use of ACT over time among adults with CF. This longitudinal study examined persistent adherence to ACT over 12 months and its modifiable predictors, drawing on aspects of Social Cognitive Theory and the Theory of Planned Behavior. METHODS: Subjects were drawn from a regional CF center in the southern United States. Predictor variables evaluated at baseline included self-efficacy for ACT (ie, self-confidence in overcoming barriers), outcome expectations (ie, perceived necessity of ACT and concerns about its disruptive effects), and subjective norms (ie, perceptions of being influenced by others). The Cystic Fibrosis Treatment Questionnaire (CFTQ) was used to assess self-reported adherence to ACT at baseline, at 6 months, and at 12 months. RESULTS: The mean age of subjects was 27.2 ± 9.1 y, and mean FEV1% predicted was 65.5 ± 24.8. Forty-six percent of subjects reported persistent use of ACT (classified as adherent at all assessment periods). In bivariate analyses, all social cognitive predictor variables assessed at baseline were significantly related to persistent adherence (all P < .03), except subjective norms. In logistic regression analyses that modeled the effects of these predictors simultaneously while controlling for FEV1%, fewer baseline concerns about ACT (odds ratio = 0.82, 95% CI 0.69-0.99) and greater self-efficacy (odds ratio = 1.09, 95% CI 1.01-1.18) remained significant independent predictors. CONCLUSIONS: This longitudinal study addresses an important gap in the literature regarding adherence to ACT over time (12 mo) in a routine clinical setting. Persistent adherence was problematic. As anticipated, social cognitive variables (self-confidence and perceived concerns) predicted self-reported persistence, and these may represent practical targets for intervention. [ABSTRACT FROM AUTHOR]

Background Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs). Purpose The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training. Methods Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature. Findings EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research. Discussion Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs. [ABSTRACT FROM AUTHOR]