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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.

Background Sepsis is a critical illness that requires early detection and intervention to prevent disability and/or death. Objective To analyze the association between various hospital-related factors and rates of sepsis after surgery in Massachusetts hospitals. Methods The sample consisted of 53 hospitals with intensive or critical care units and 25 hospitals with step-down units. Hospital characteristics, staffing levels, and health care–acquired conditions were examined using publicly available data. Analysis of variance and linear regression were performed to explore the relationship between nurse and physician staffing levels and sepsis rates. Results Sepsis rates were significantly lower when nurses cared for fewer patients (P < .001) and when intensivist hours were greater (P = .03). Linear regression for nurse staffing revealed that higher rates of catheter-associated urinary tract infection (P = .001) and higher numbers of step-down patients cared for by nurses (P = .001) were associated with a significantly higher rate of sepsis (P < .001). Linear regression for physician staffing revealed that higher rates of catheter-associated urinary tract infection (P < .001) and wound dehiscence after surgery (P < .001), greater hospitalist hours (P = .001), and greater physician hours (P = .05) were associated with a significantly higher sepsis rate, while greater intensivist hours were associated with a lower sepsis rate (P = .002). Conclusion In this study, greater nurse staffing and intensivist hours were associated with significantly lower rates of sepsis, whereas greater physician staffing and hospitalist hours were associated with significantly higher rates. Further research is needed to understand the roles of the various types of providers and the reasons for their differing effects on sepsis rates.

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.

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.

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.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.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.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.

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.]

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. [ J Nurs Educ. 2016;55(3):164–167.]

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.

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.

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. [ J Nurs Educ. 2013;52(4):185–190.]

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.

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.

A telephone survey of mothers of children with mitochondrial disease (n = 29) or phenylketonuria (PKU) (n = 29) revealed that mothers of children with mitochondrial disease report greater stress and worry, less satisfaction with social supports, greater difficulty meeting their child's extra care needs, and more impact on multiple aspects of their personal lives. They also reported more missed days of work and used a greater number of health care services and personal resources. Interventions must be developed that address the demands of biochemical genetic disorders, particularly those with the uncertain trajectory of mitochondrial disease.

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 andresponsibly integrate new genetic-genomic information into practice.

The genomic era in health care arrived in 2001 with the completion and publication of the Human Genome Project. This catalog of the 3 billion nucleotide bases that comprise human DNA and their organization into genes has been called both the book of life and a map to nowhere, because the power of the data is a challenge to harness (Read, 2001). Researchers and clinicians are struggling to understand the mechanisms by which sequences of nucleotides become activated to code for the proteins that regulate growth, direct metabolic processes, and cause or contribute to the development of disease. The genetic basis of most diseases and the external factors that influence the expression of disease-related genes are complex and poorly understood. If the relationships between DNA variants and specific disease phenotypes were known, preventive and treatment strategies for complex, multifactorial disorders could be developed. Epidemiologic methods allow for analysis of these relationships through genetic association studies (GAS). The purposes of this paper are to (a) define the types of GAS, (b) use the examples of age-related macular degeneration and type 2 diabetes mellitus to show the role of GAS in understanding the complex nature of common illnesses, (c) discuss the limitations of GAS, and (d) illustrate potential uses of GAS in general and advanced practice nursing and in clinical research.

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.

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.

An e-mail listserv was used to recruit participants, administer a survey, send electronic gift certificates, and disseminate the findings of a study of psychological responses to being a carrier of the gene for phenylketonuria, a rare genetic disease. The majority of responses to the call for participants were received within the first 24 hours, and most surveys (n = 83) were returned via e-mail within 5 days. The use of e-mail allowed more opportunities for researcher-participant interaction than Web-based surveys, but the return rate of 51% may reflect concerns about privacy when e-mail addresses are required.

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.

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.

A group of 28 patients with inherited metabolic disease (homocystinuria galactosaemia, maple syrup urine disease and biotinidase deficiency) diagnosed by screening were compared with a group of 17 similar patients identified clinically. The rate of hospitalization was similar for the two groups. The patients diagnosed clinically showed a higher incidence of mental retardation and their parents experienced greater stress and found greater difficulty in meeting their child's needs.

The Psychological Adaptation to Genetic Information Scale (PAGIS, Read et al.) has demonstrated that adaptation to genetic information is a multidimensional phenomenon comprised of five factors. The purpose of this web-based survey was to compare PAGIS scores of individuals with a genetic disease (n = 137, 49%) with scores of parents who have transmitted a genetic disease to their child (n = 143, 51%). Each of 26 items is rated on a 1–6 Likert scale, where a higher score represents more positive adaptation. The biological parents had higher scores (P = 0.004) on the total PAGIS and four of the five subscales (non-intrusiveness, support, self-worth, and certainty). There was no significant difference between the two groups on the self-efficacy subscale. Overall, parents who have transmitted a disease-related gene to their child demonstrate more positive adaptation than affected individuals to the knowledge that they possess a disease-related gene. This is not surprising, given the burden of having a genetic disease. However, parents do not score higher on the self-efficacy subscale, a measure that reflects the client’s general perception of control over consequences of having the gene. The findings reinforce the multidimensional nature of psychological adaptation to genetic information, and suggest that these dimensions will vary among subgroups.

The REVEAL (Risk Evaluation and Education for Alzheimer's Disease) study provides APOE genotype disclosure to first degree relatives of patients with Alzheimer's disease (AD). Individuals who test positive for the E4 allele of APOE are at increased risk of developing AD, but little is known about whether people would alter their health behaviors based on this information. The purpose of this study is to test the hypothesis that participants who are E4 positive will be more likely than those who are E4 negative to make medication, diet, and mental and physical exercise changes that they believe relevant to the prevention of AD. This information will guide the development of support and counseling interventions for persons with genetic risk for AD.

Healthy People 2000 has identified the importance of physical activity for healthy aging, but little is known about what motivates older individuals, older Latino adults, in particular, to be physically active. The purpose of this research was to examine the perceptions of older Latino adults toward physical fitness, physical activity, and exercise. This study used a qualitative focus group design. The sample of Latino adults age 60 and older resided in Northeast Massachusetts and was recruited from community settings which serve older Latino adults. Three focus groups, consisting of four to eight individuals in each group, were conducted and audiotaped. Data analysis used a combination of open, axial, and selective coding procedures. Focus group participants viewed physical fitness as being able to do anything; the mind and body working together; and feeling "light," being healthy. Support was viewed as a motivator of physical activity and exercise and included community resources, group support, cultural unity, and health provider assistance. Barriers of fear and a feeling of inappropriateness were identified by focus group participants. Although the study was exploratory and the sample size small, it provides useful cultural knowledge and information for community health and gerontological nurses. Knowledge about older Latino adults' perceptions of motivators and barriers to physical activity and exercise is a necessary first step for nurses to prescribe activities that will help improve functional independence and quality of life. Nurses can serve as links for older Latino adults in accessing community resources. Sociocultural factors that influence Latino adult perceptions must be assessed if health promotion program planning is to be tailored to meet individual and group needs.