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Background Interventions relevant to energy intake to prevent excessive gestational weight gain in pregnant overweight and obese women are important but scarce. This review synthesized healthy eating and physical activity strategies and their effects on excessive gestational weight gain prevention. Methods Twenty-three randomized controlled trials that included healthy eating and/or physical activity as an intervention in healthy pregnant overweight or obese adult women and gestational weight gain as a primary or secondary outcome were reviewed. Findings Heathy eating and/or physical activity (21 studies, n = 6,920 subjects) demonstrated 1.81 kg (95% CI: -3.47, -0.16) of gestational weight gain reduction favouring intervention. Healthy eating (-5.77 kg, 95% CI: -9.34, -2.21, p = 0.02) had a larger effect size than combined healthy eating/physical activity (-0.82 kg, 95% CI: -1.28, -0.36, p = 0.0005) in limiting gestational weight gain. Physical activity did not show a significant pooled effect. Healthy eating with prescribed daily calorie and macronutrient goals significantly limited gestational weight gain by 4.28 kg and 4.23 kg, respectively. Conclusion Healthy eating and/or physical activity are effective in gestational weight gain control. Healthy eating with calorie and macronutrient goals are especially effective in limiting excessive gestational weight gain among pregnant overweight and obese women.

Trauma and injuries represent a significant portion of presentations to the Paediatric Emergency Department, with a major subset comprising hand and fingertip injuries. These require input from specialist hand surgeons. In co-ordinating this care pathway, the aim is to provide effective and definitive treatment in a manner that is straightforward for parents and least stressful for the injured child. Frequently, these injuries are suitable for repair under local anaesthesia. In the presence of a well-stocked treatment room, repair of simple fingertip injuries can be facilitated, avoiding the need for full hospital admission and prolonged fasting for repair under general anaesthesia. Our study evaluated all fingertip and nailbed injuries presenting to our Emergency Department in an 8 month period from January to August 2018. Out of 964 presentations for Plastic Surgery review, 226 concerned hand or finger injuries. Of these, 140 represented fingertip or nailbed injuries. Almost 40% of these underwent repair in the Emergency Department under local anaesthesia with or without nitrous oxide sedation. 25% required repair in the operating theatre under general anaesthesia and 35% were managed conservatively. August was the busiest month for such injuries. Children undergoing nitrous sedation with local anaesthesia for these injuries ranged from 15months to 14 years, with a median of 4 years. In general, younger babies and more anxious or upset children were less suitable for sedation and local anaesthesia. All cases were followed up routinely in the Plastic Surgery clinic. Side effects of nitrous sedation were uncommon. There were almost no complications following these procedures. This audit provides a snapshot of the usefulness of nitrous sedation in combination with local anaesthesia as a safe and reproducible method of managing simple fingertip injuries in the paediatric setting. It highlights issues around provision for these services in the Emergency Department- staffing, equipment and training to name but some- but will surely assist in future resource planning.

In a coordinated national effort reported by the Agency for Healthcare Research and Quality, the use of 2% chlorhexidine gluconate (CHG) has reduced the central line-associated bloodstream infection (CLABSI) rate by 40%. Conversely, a recent randomized clinical trial determined that chlorhexidine bathing did not reduce the CLABSI rate. The objectives of this study were to conduct meta-analysis and clarify the effectiveness of 2% CHG bathing by nurses on CLABSIs in adult intensive care unit patients and to determine the contributing costs attributable to CLABSIs and 2% CHG bathing. Eligible studies that included the outcome of bloodstream infection rate for central lines were considered. A rigorous systematic review protocol and software tools available from the Joanna Briggs Institute via OvidSP were used. Agency for Healthcare Research and Quality tools assisted with identifiable CHG bathing costs. Four studies were included in the meta-analysis for the outcome of primary bloodstream infections, and 2 studies narratively supported the meta-analysis. A relative risk of 0.46 with 95% confidence interval (0.34-0.63) was determined. This significant effect is seen in an overall z-score of 4.84 (P < .0001). This meta-analysis supports that 2% CHG reduces CLABSIs. The estimated cost increase of 2% CHG-impregnated cloths is $4.10 versus nonmedicated bathing cloths. The cost associated with a single CLABSI is 10 times more than the cost of using 2% CHG-impregnated cloths. Nursing provides significant influence for the prevention of CLABSIs in critical care via evidence-based best practices.

Clinical track faculty often lack mentoring opportunities needed to develop their scholarship which may hinder their academic promotion. The Clinical Track Faculty Mentoring Initiative was designed to foster scholarship development and academic promotion of clinical assistant professors. Fifteen clinical assistant professors in two cohorts and their mentors participated in the Initiative. Each Cohort lasted two years with one overlapping year. Participating clinical assistant professors were required to attend five check-in meetings, a summer writing workshop, school and university promotion information sessions, and mentor-protege meetings. Program outcomes were assessed quarterly and they included knowledge of promotion processes, mentorship quality, scholarship productivity, and academic promotion. Scores on knowledge of promotion processes and perceived mentorship quality among participating clinical assistant professors were significantly increased. Participating clinical assistant professors published, on average, 3.33 papers and delivered 6.4 presentations in two years. The Initiative demonstrated an effective mentoring program that incorporated a multimethod approach with clear program goals, strong systems support, and high mentorship quality.

The purpose of this systematic review was to evaluate the effectiveness of mentoring strategies for nursing faculty progression and productivity in the nontenure track at institutions of higher education. Sixty articles were included in the review. Findings revealed that nontenure track nursing faculty require planned programs and mentoring strategies unique to their role and abilities. Schools of nursing can improve on faculty progression, scholarship, and career growth by providing structured mentoring activity.

The purpose of this article was to synthesize qualitative research data that examine parental coping strategies following infant death. This qualitative synthesis found that parents who effectively cope with the death of their infant would continue the bond with the deceased child, have differences in the way they manage their emotions about the loss, and have intergenerational support in the form of family being present, acknowledging the death, performing immediate tasks, and providing helpful information. Nurses should be vigilant to ensure parents receive "memories" of their infant after an in-hospital death. Knowledge of the coping process can assist nurses and clinicians to better care and support parents following an infant death and, in turn, facilitate the healing process.

Communication and collaboration skill mastery is as essential to nursing practice as expertise in clinical skills. Health profession graduates often lack the necessary communication skills to practice in a collaborative environment because they have been educated in silos with little or no interaction with other health profession students. Prelicensure interprofessional education has been suggested as a strategy for improving communication and collaboration among health profession students. Kolb's Experiential Learning Theory can be used to guide simulation-based interprofessional education, offering both a foundation and process for knowledge acquisition based on the needs of each individual learner.

For those individuals diagnosed with diabetes, the challenge is how to cope and manage the many aspects of their lives. The aim of this qualitative synthesis was to evaluate research studies for findings and then synthesize patients’ experiences within the context of diabetes self-care while facing daily barriers. A total of 95 findings from 21 studies were categorized via like themes. These themes were further analyzed and aggregated to represent an interpretive meta-synthesis via a rigorous methodological protocol as described by Pearson, Robertson-Malt, and Rittinmeyer and the Joanna Briggs Institute. Meta-synthesized findings suggest that patients “avoid and hinder self-management” as well as “desire self-care and living life.” Clinicians can improve interactions and potentiate understanding when the therapeutic approach is about the person living with diabetes as opposed to clinical control.

Objective Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. Method A consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. Results CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. Conclusions The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas., Highlights • Cognitive Therapy for PTSD can be effectively implemented in routine clinical care. • The intent-to-treat analysis showed very large treatment effects. • Patients found the treatment acceptable, and the majority showed clinically significant change. • Few patient characteristics moderated treatment outcome. • Inexperienced therapists had more dropouts.

Case illustrations from central Indiana provide the narrative for infant suffocations because of unsafe sleep environments. Accidental strangulation or suffocation in bed is caused by co-bedding, blankets and pillows in cribs, or wedging and entrapment. Knowledge of the evidence-based risks associated with case data may assist further in the prevention of unexpected infant sleep deaths and may better inform best practice for death scene investigation including forensic nurses.

Africa is faced with a myriad of challenges, such as HIV/AIDS, malaria, tuberculosis, and a variety of political and historical complications that have affected the educational system for advanced nursing practice. In Kenya, the current situation in the higher education sector does not give nurses an opportunity to pursue graduate education after they have acquired the basic diploma in nursing due to limited government support and the type of education system existing in the country today. Although distance education has been available in Kenya for professionals such as teachers, in public universities, this kind of opportunity is unreachable for nurses who are working and need to further their education. Nurses desire to have access to advanced practice education to equip them with the relevant knowledge to cope and address the complex health issues arising in the management and care of patients. A collaborative model is presented as a potential solution for this need. Four major constituents are identified including hospitals and agencies, communities of interest, Kenyan universities and international education partners. Each has a part to play including contributions to information, communication of opinion and expertise, money and support, infrastructure and in-kind resources. Distance education is cost-effective and will help in building capacity at various levels of nursing including leadership in clinical practice, teaching, administration and research.

Sudden unexplained infant death is responsible for 14% of Indiana’s infant mortality. The purpose of this qualitative research study was to describe mothers’ experiences when death of an infant occurred suddenly and unexpectedly. Field deputies or social workers interviewed mothers from central Indiana during the child-death team investigations. The Thematic Analysis Program from the Joanna Briggs Institute was used to analyze interview data. Sixteen de-identified interview cases were extracted, and a meta-aggregate method was conducted. The three synthesized themes were Extreme Emotional Shock, We Feel Like We’re to Blame, and Working Toward Moving On. Understanding these phenomena from mothers’ experience may assist in eliminating risks associated with infant deaths and inform nursing practice and policy.

Evidence-based practice (EBP) has become increasingly important in nursing. It has become a dominant philosophy in teaching research courses and it brings a new definition to the translation of science. As more has become known about EBP, it has continued to grow in its importance and significance. EBP is the foundation to many doctor of nursing practice (DNP) programs in both the advanced practice nursing and organizational foci. The purpose of this article is to define evidence-based practice competencies for advanced practice nurses, especially nurse practitioners. A corresponding teaching framework is presented. Additionally, competencies related to the DNP with aggregate systems and organizational foci are suggested. Practical experiences emanating from working within the NP competency development and framework are highlighted and described.

Purpose A Black infant dies every 13 hours in the state of Indiana. The overall infant mortality rate in 2013 was 7.2 deaths per 1000 live births, but for Black infants, the rate was 15.3 deaths per 1000 live births. For over 20 years, placing an infant to sleep on his back has decreased the death rate from sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS), but many Black families continue to advocate bed sharing, prone sleeping, and inappropriate bedding/sleep surfaces, predisposing an infant to a significantly higher risk for SUID/SIDS. Therefore, the purpose of this study is to understand why Black women are less likely than White women to follow safe sleep recommendations for their infants. Design A rigorous search of the literature was performed by searching the Web of Science, OVID, CINAHL, PsychINFO, and PubMed using the search terms: infant or child, death, loss, SIDS, SUID, qualitative, African American, Black, culture, safe sleep, experiences, and United States. A total of 217 articles were obtained. After review of inclusion and exclusion criteria and critical appraisal, only seven articles remained for the research study. Methods The meta-synthesis of these seven original qualitative studies was performed using the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute to assist with data management. Data were extracted and representative quotations were categorized. Categories were arranged into like themes. Themes were then synthesized with meta-aggregation. Results A total of 17 subthemes were identified and were formulated into three primary themes: convenience, safety, and culture. The final synthesized theme was that Black mothers are motivated by their beliefs. Practice Implications Black mothers tend to believe that SUIDS/SIDS is a random occurrence and is not preventable, so they see a little reason to make their infant sleep in a cold, hard crib, when they could sleep in a warm, comfortable bed with them. Nurses should work with Black mothers to understand their cultural beliefs while educating them about safe sleep practices.

Women's health care in the United States has been described as unsatisfactory and falling behind the Healthy People 2010 objectives. Inadequate health care due to a shortage of providers is especially problematic for women who are poor with lower socioeconomic status. Advanced practice nurses are well suited to address this need. In this article, preceptor and academic partnerships are discussed as strategies to make more qualified women's health and infant providers available.

Studies show that co-bedding is a common cause of death in babies. The purpose of this study is to identify teaching strategies that can be used to increase safe sleep practices.A rigorous systematic literature search identified articles that expressed ways in which to provide co-bedding teaching or provided recommended approaches to educating mothers and families about co-bedding risks. NOTARI software, from OVID Tools, was used to appraise articles, extract data, and thematically organize the findings, resulting in meta-aggregation.Two major findings were synthesized from four categories. First, co-bedding occurred despite knowing risks and having received teaching. Second, families should receive co-bedding messages tailored to their specific circumstances and risks.Findings showed that the lack of dialogue in co-bedding teaching often deters caregivers and families from seeking further education or consultation. Nurses need to ensure that safe sleep practices are taught and that the material provided pertains to the caregiver's specific cultural and familial situation.

Based on the results of the Surrogate Decision-Making Self Efficacy Scale (Lopez, 2009a), this study sought to determine whether nurses working in the field of intellectual disability (ID) experience increased confidence when they implemented the American Association of Neuroscience Nurses (AANN) Seizure Algorithm during telephone triage. The results of the study indicated using the AANN Seizure Algorithm increased self-confidence for many of the nurses in guiding care decisions during telephone triage. The treatment effect was statistically significant −3.169( p < 0.01) for a small sample of study participants. This increase in confidence is clinically essential for two reasons. Many individuals with ID and epilepsy reside within community-based settings. ID nurses provide seizure guidance to this population living in community-based settings via telephone triage. Evidenced-based training tools provide a valuable mechanism by guiding nurses via best practices. Nurses may need to be formally trained for seizure management due to high epilepsy rates in this population.

Persons utilizing long term oxygen therapy (LTOT) at home suffer from chronic obstructive pulmonary disease (COPD). Adherence to LTOT ranges from 45% to 70% and utilization of 15 hours per day is widely accepted as efficacious. Although studies have reviewed the level of patient adherence with LTOT, few have introduced or evaluated interventions. The paucity of information regarding patients following oxygen prescription is an enormous void that must be tackled to augment clinical effectiveness and cost containment for the long term. A research agenda for LTOT adherence is postulated to help connect treatment adherence variables and concepts with clinical outcomes and quality of life.

Nurse and physician clinicians often guide seizure care for individuals with intellectual and developmental disability (ID/DD) through telephone triage. This article evaluated the evidence for epilepsy management tools with a focus on the telephone triage tool. Studies were included in the systematic review, data was extracted, followed by meta-aggregated findings. A rigorous methodological protocol was used as described by The Cochrane Collaboration. All quantitative or descriptive studies that included epilepsy management tools or protocols for persons with ID/DD living in a community-based setting were considered. No tools specific to ID/DD seizure management via telephone triage were discovered. Study results reveal a possible gap in clinical care. Research findings did support the use of telephone triage tools and epilepsy protocols for clinicians. These findings may improve seizure management by focusing ID/DD clinicians on the advantages of using such tools. Findings may also illuminate the need for seizure management tools specific to the ID/DD population.

Background: Skill readiness remains a challenge for all health care professionals who are involved in direct patient care. Researchers suggest that skill retention may decrease within 6 months of an educational session. The purpose of this study was to explore competency retention for high-risk, low-frequency procedures, specifically, managing a difficult airway and placing a laryngeal mask airway, using a web-based content refresher. Method: The pilot study was conducted in two sessions. Session one established clinical skill competency. Six months later, the advanced practice RNs were randomized into two groups. Group 1 reviewed didactic content and participated in a complex airway management simulation. Group 2 participated only in a complex airway management simulation. Results: This study showed a positive trend in maintaining competency for a low-frequency procedure for which complex airway management was given, using web-based content review. It is feasible to maintain competency for low-frequency procedures using web-based content refreshers. Conclusion: This pilot study benefited advanced practice nurses by providing them with the potential to maintain competency in this high-risk, low-frequency procedure. Continuing education is an important consideration for health care organizations. J Contin Educ Nurs. 2015;46(7):322–325.

Background: Although enrollment in RN-to-BSN degree completion programs has grown profoundly, a dearth of literature exists regarding the impact of RN-to-BSN education and the adoption of evidence-based practice (EBP). This study examined the elements of RN-to-BSN education that improve the awareness and adoption for EBP. Method: A mixed methods meta-synthesis was conducted using qualitative, textual-narrative, and descriptive research studies. Data from six articles were analyzed, using standardized critical appraisal instruments. Results: Two findings were identified. First, EBP skills for RN-to-BSN students are influenced by exposure to educational partnerships, contextual teaching and learning, and practice experiences. Second, barriers to adoption exist for RN-to-BSN students, which limit advances in nursing practice. Conclusion: A variety of contextual teaching and learning strategies can provide empowerment for RN-to-BSN students to adopt EBP in their practice. Forming partnerships in creating EBP experiences may set the stage for RN-to-BSN leadership opportunities in today’s health care system. J Contin Educ Nurs. 2014;45(10):467–472.

This paper describes the work of a clinical case management core team (four nurses and an occupational therapist) during the course of a week. Information was gathered through non-participant observation of the team by two independent researchers. Transcripts produced from the data recorded were examined. From this, seven categories of activity were identified: planned client contact; unplanned client contact; family/carer contact; liaison; administration; team information sharing and supervision, training and personal development. These categories were felt to encompass the range of activities practised by the team. The amount of time that case managers spent engaged in these core functions was calculated. Detailed examples are presented. Results are discussed with reference to Kanter's components and principles of clinical case management.

There is increasing interest in the use of mobile technologies for nursing educational purposes in academic settings, but few evaluative studies exist. Understanding the best use of podcasting during distance learning is basic for instructional design. This pilot study compared online reading to a supplementary podcast to determine graduate nursing students' preferences and usage. Results indicated that students did not download the podcast to a mobile device but multitasked while listening. The podcast and the readings were equally supported as important by nursing students. Podcasting in distance-accessible courses may engage students by providing a human voice and thus a better virtual connection. Podcasting is only one method of knowledge acquisition; distance learning courses should consider providing multiple learner-centered delivery methods, given the variety of learning styles.

Although the number of women in management and administrative positions in all sectors of the economy is increasing over time, the majority of senior positions are still held by men. The lack of women role models in high management and administrative positions has been well documented, as has the lack of women faculty in many academic departments, and barriers to women's leadership due to male‐orientated organizational expectations. Research has shown that mentoring can significantly enhance income and promotion possibilities for individuals experiencing these relationships. In academe, mentoring awareness can reduce barriers to women's career advancement, tenure and pay. The objectives of this study were to explore mentoring functions senior women provided to their juniors and identify mentoring limitations women faced in academe. Senior women favored career mentoring and provided less psychosocial support. Subsequently, the classical mentoring experience is not realized. Research findings sugge...